Visual classification of emphysema heterogeneity compared with objective measurements: HRCT vs spiral CT in candidates for lung volume reduction surgery

International Nuclear Information System (INIS)

Cederlund, K.; Hoegberg, S.; Rasmussen, E.; Svane, B.; Bergstrand, L.; Tylen, U.; Aspelin, P.

2002-01-01

The aim of this study was to investigate whether spiral CT is superior to high-resolution computed tomography (HRCT) in evaluating the radiological morphology of emphysema, and whether the combination of both CT techniques improves the evaluation in patients undergoing lung volume reduction surgery (LVRS). The material consisted of HRCT (with 2-mm slice thickness) and spiral CT (with 10-mm slice thickness) of 94 candidates for LVRS. Selected image pairs from these examinations were evaluated. Each image pair consisted of one image from the cranial part of the lung and one image from the caudal part. The degree of emphysema in the two images was calculated by computer. The difference between the images determined the degree of heterogeneity. Five classes of heterogeneity were defined. The study was performed by visual classification of 95 image pairs (spiral CT) and 95 image pairs (HRCT) into one of five different classes of emphysema heterogeneity. This visual classification was compared with the computer-based classification. Spiral CT was superior to HRCT with 47% correct classifications of emphysema heterogeneity compared with 40% for HRCT-based classification (p<0.05). The combination of the techniques did not improve the evaluation (42%). Spiral CT is superior to HRCT in determining heterogeneity of emphysema visually, and should be included in the pre-operative CT evaluation of LVRS candidates. (orig.)

Visual classification of emphysema heterogeneity compared with objective measurements: HRCT vs spiral CT in candidates for lung volume reduction surgery

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Cederlund, K.; Hoegberg, S.; Rasmussen, E.; Svane, B. [Department of Thoracic Radiology, Karolinska Hospital, Stockholm (Sweden); Bergstrand, L. [Department of Radiology, Danderyds Hospital, Danderyd (Sweden); Tylen, U. [Deparment of Radiology, Sahlgrenska University Hospital, Gothenberg (Sweden); Aspelin, P. [Department of Radiology, Huddinge University Hospital, Huddinge (Sweden)

2002-05-01

The aim of this study was to investigate whether spiral CT is superior to high-resolution computed tomography (HRCT) in evaluating the radiological morphology of emphysema, and whether the combination of both CT techniques improves the evaluation in patients undergoing lung volume reduction surgery (LVRS). The material consisted of HRCT (with 2-mm slice thickness) and spiral CT (with 10-mm slice thickness) of 94 candidates for LVRS. Selected image pairs from these examinations were evaluated. Each image pair consisted of one image from the cranial part of the lung and one image from the caudal part. The degree of emphysema in the two images was calculated by computer. The difference between the images determined the degree of heterogeneity. Five classes of heterogeneity were defined. The study was performed by visual classification of 95 image pairs (spiral CT) and 95 image pairs (HRCT) into one of five different classes of emphysema heterogeneity. This visual classification was compared with the computer-based classification. Spiral CT was superior to HRCT with 47% correct classifications of emphysema heterogeneity compared with 40% for HRCT-based classification (p<0.05). The combination of the techniques did not improve the evaluation (42%). Spiral CT is superior to HRCT in determining heterogeneity of emphysema visually, and should be included in the pre-operative CT evaluation of LVRS candidates. (orig.)

Accurate heterogeneous dose calculation for lung cancer patients without high‐resolution CT densities

Science.gov (United States)

Li, Jonathan G.; Liu, Chihray; Olivier, Kenneth R.; Dempsey, James F.

2009-01-01

The aim of this study was to investigate the relative accuracy of megavoltage photon‐beam dose calculations employing either five bulk densities or independent voxel densities determined by calibration of the CT Houndsfield number. Full‐resolution CT and bulk density treatment plans were generated for 70 lung or esophageal cancer tumors (66 cases) using a commercial treatment planning system with an adaptive convolution dose calculation algorithm (Pinnacle3, Philips Medicals Systems). Bulk densities were applied to segmented regions. Individual and population average densities were compared to the full‐resolution plan for each case. Monitor units were kept constant and no normalizations were employed. Dose volume histograms (DVH) and dose difference distributions were examined for all cases. The average densities of the segmented air, lung, fat, soft tissue, and bone for the entire set were found to be 0.14, 0.26, 0.89, 1.02, and 1.12 g/cm3, respectively. In all cases, the normal tissue DVH agreed to better than 2% in dose. In 62 of 70 DVHs of the planning target volume (PTV), agreement to better than 3% in dose was observed. Six cases demonstrated emphysema, one with bullous formations and one with a hiatus hernia having a large volume of gas. These required the additional assignment of density to the emphysemic lung and inflammatory changes to the lung, the regions of collapsed lung, the bullous formations, and the hernia gas. Bulk tissue density dose calculation provides an accurate method of heterogeneous dose calculation. However, patients with advanced emphysema may require high‐resolution CT studies for accurate treatment planning. PACS number: 87.53.Tf

Large scale validation of the M5L lung CAD on heterogeneous CT datasets

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Lopez Torres, E., E-mail: Ernesto.Lopez.Torres@cern.ch, E-mail: cerello@to.infn.it [CEADEN, Havana 11300, Cuba and INFN, Sezione di Torino, Torino 10125 (Italy); Fiorina, E.; Pennazio, F.; Peroni, C. [Department of Physics, University of Torino, Torino 10125, Italy and INFN, Sezione di Torino, Torino 10125 (Italy); Saletta, M.; Cerello, P., E-mail: Ernesto.Lopez.Torres@cern.ch, E-mail: cerello@to.infn.it [INFN, Sezione di Torino, Torino 10125 (Italy); Camarlinghi, N.; Fantacci, M. E. [Department of Physics, University of Pisa, Pisa 56127, Italy and INFN, Sezione di Pisa, Pisa 56127 (Italy)

2015-04-15

Purpose: M5L, a fully automated computer-aided detection (CAD) system for the detection and segmentation of lung nodules in thoracic computed tomography (CT), is presented and validated on several image datasets. Methods: M5L is the combination of two independent subsystems, based on the Channeler Ant Model as a segmentation tool [lung channeler ant model (lungCAM)] and on the voxel-based neural approach. The lungCAM was upgraded with a scan equalization module and a new procedure to recover the nodules connected to other lung structures; its classification module, which makes use of a feed-forward neural network, is based of a small number of features (13), so as to minimize the risk of lacking generalization, which could be possible given the large difference between the size of the training and testing datasets, which contain 94 and 1019 CTs, respectively. The lungCAM (standalone) and M5L (combined) performance was extensively tested on 1043 CT scans from three independent datasets, including a detailed analysis of the full Lung Image Database Consortium/Image Database Resource Initiative database, which is not yet found in literature. Results: The lungCAM and M5L performance is consistent across the databases, with a sensitivity of about 70% and 80%, respectively, at eight false positive findings per scan, despite the variable annotation criteria and acquisition and reconstruction conditions. A reduced sensitivity is found for subtle nodules and ground glass opacities (GGO) structures. A comparison with other CAD systems is also presented. Conclusions: The M5L performance on a large and heterogeneous dataset is stable and satisfactory, although the development of a dedicated module for GGOs detection could further improve it, as well as an iterative optimization of the training procedure. The main aim of the present study was accomplished: M5L results do not deteriorate when increasing the dataset size, making it a candidate for supporting radiologists on large

Automated measurement of heterogeneity in CT images of healthy and diseased rat lungs using variogram analysis of an octree decomposition

International Nuclear Information System (INIS)

Jacob, Richard E; Carson, James P

2014-01-01

Assessing heterogeneity in lung images can be an important diagnosis tool. We present a novel and objective method for assessing lung damage in a rat model of emphysema. We combined a three-dimensional (3D) computer graphics method–octree decomposition–with a geostatistics-based approach for assessing spatial relationships–the variogram–to evaluate disease in 3D computed tomography (CT) image volumes. Male, Sprague-Dawley rats were dosed intratracheally with saline (control), or with elastase dissolved in saline to either the whole lung (for mild, global disease) or a single lobe (for severe, local disease). Gated 3D micro-CT images were acquired on the lungs of all rats at end expiration. Images were masked, and octree decomposition was performed on the images to reduce the lungs to homogeneous blocks of 2 × 2 × 2, 4 × 4 × 4, and 8 × 8 × 8 voxels. To focus on lung parenchyma, small blocks were ignored because they primarily defined boundaries and vascular features, and the spatial variance between all pairs of the 8 × 8 × 8 blocks was calculated as the square of the difference of signal intensity. Variograms–graphs of distance vs. variance–were constructed, and results of a least-squares-fit were compared. The robustness of the approach was tested on images prepared with various filtering protocols. Statistical assessment of the similarity of the three control rats was made with a Kruskal-Wallis rank sum test. A Mann-Whitney-Wilcoxon rank sum test was used to measure statistical distinction between individuals. For comparison with the variogram results, the coefficient of variation and the emphysema index were also calculated for all rats. Variogram analysis showed that the control rats were statistically indistinct (p = 0.12), but there were significant differences between control, mild global disease, and severe local disease groups (p < 0.0001). A heterogeneity index was calculated to describe the difference of an individual variogram from

Dosimetric evaluation of the impacts of different heterogeneity correction algorithms on target doses in stereotactic body radiation therapy for lung tumors

International Nuclear Information System (INIS)

Narabayashi, Masaru; Mizowaki, Takashi; Matsuo, Yukinori; Nakamura, Mitsuhiro; Takayama, Kenji; Norihisa, Yoshiki; Sakanaka, Katsuyuki; Hiraoka, Masahiro

2012-01-01

Heterogeneity correction algorithms can have a large impact on the dose distributions of stereotactic body radiation therapy (SBRT) for lung tumors. Treatment plans of 20 patients who underwent SBRT for lung tumors with the prescribed dose of 48 Gy in four fractions at the isocenter were reviewed retrospectively and recalculated with different heterogeneity correction algorithms: the pencil beam convolution algorithm with a Batho power-law correction (BPL) in Eclipse, the radiological path length algorithm (RPL), and the X-ray Voxel Monte Carlo algorithm (XVMC) in iPlan. The doses at the periphery (minimum dose and D95) of the planning target volume (PTV) were compared using the same monitor units among the three heterogeneity correction algorithms, and the monitor units were compared between two methods of dose prescription, that is, an isocenter dose prescription (IC prescription) and dose-volume based prescription (D95 prescription). Mean values of the dose at the periphery of the PTV were significantly lower with XVMC than with BPL using the same monitor units (P<0.001). In addition, under IC prescription using BPL, RPL and XVMC, the ratios of mean values of monitor units were 1, 0.959 and 0.986, respectively. Under D95 prescription, they were 1, 0.937 and 1.088, respectively. These observations indicated that the application of XVMC under D95 prescription results in an increase in the actually delivered dose by 8.8% on average compared with the application of BPL. The appropriateness of switching heterogeneity correction algorithms and dose prescription methods should be carefully validated from a clinical viewpoint. (author)

Assessment of interpatient heterogeneity in tumor radiosensitivity for nonsmall cell lung cancer using tumor-volume variation data

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Chvetsov, Alexei V., E-mail: chvetsov2@gmail.com; Schwartz, Jeffrey L.; Mayr, Nina [Department of Radiation Oncology, University of Washington, 1959 NE Pacific Street, Seattle, Washington 98195-6043 (United States); Yartsev, Slav [London Regional Cancer Program, London Health Sciences Centre, 790 Commissioners Road East, London, Ontario 46A 4L6 (Canada)

2014-06-15

Purpose: In our previous work, the authors showed that a distribution of cell surviving fractionsS{sub 2} in a heterogeneous group of patients could be derived from tumor-volume variation curves during radiotherapy for head and neck cancer. In this research study, the authors show that this algorithm can be applied to other tumors, specifically in nonsmall cell lung cancer. This new application includes larger patient volumes and includes comparison of data sets obtained at independent institutions. Methods: Our analysis was based on two data sets of tumor-volume variation curves for heterogeneous groups of 17 patients treated for nonsmall cell lung cancer with conventional dose fractionation. The data sets were obtained previously at two independent institutions by using megavoltage computed tomography. Statistical distributions of cell surviving fractionsS{sub 2} and clearance half-lives of lethally damaged cells T{sub 1/2} have been reconstructed in each patient group by using a version of the two-level cell population model of tumor response and a simulated annealing algorithm. The reconstructed statistical distributions of the cell surviving fractions have been compared to the distributions measured using predictive assays in vitro. Results: Nonsmall cell lung cancer presents certain difficulties for modeling surviving fractions using tumor-volume variation curves because of relatively large fractional hypoxic volume, low gradient of tumor-volume response, and possible uncertainties due to breathing motion. Despite these difficulties, cell surviving fractionsS{sub 2} for nonsmall cell lung cancer derived from tumor-volume variation measured at different institutions have similar probability density functions (PDFs) with mean values of 0.30 and 0.43 and standard deviations of 0.13 and 0.18, respectively. The PDFs for cell surviving fractions S{sub 2} reconstructed from tumor volume variation agree with the PDF measured in vitro. Conclusions: The data obtained

Comparison of dose calculation algorithms in phantoms with lung equivalent heterogeneities under conditions of lateral electronic disequilibrium

International Nuclear Information System (INIS)

Carrasco, P.; Jornet, N.; Duch, M.A.; Weber, L.; Ginjaume, M.; Eudaldo, T.; Jurado, D.; Ruiz, A.; Ribas, M.

2004-01-01

An extensive set of benchmark measurement of PDDs and beam profiles was performed in a heterogeneous layer phantom, including a lung equivalent heterogeneity, by means of several detectors and compared against the predicted dose values by different calculation algorithms in two treatment planning systems. PDDs were measured with TLDs, plane parallel and cylindrical ionization chambers and beam profiles with films. Additionally, Monte Carlo simulations by meansof the PENELOPE code were performed. Four different field sizes (10x10, 5x5, 2x2, and1x1 cm 2 ) and two lung equivalent materials (CIRS, ρ e w =0.195 and St. Bartholomew Hospital, London, ρ e w =0.244-0.322) were studied. The performance of four correction-based algorithms and one based on convolution-superposition was analyzed. The correction-based algorithms were the Batho, the Modified Batho, and the Equivalent TAR implemented in the Cadplan (Varian) treatment planning system and the TMS Pencil Beam from the Helax-TMS (Nucletron) treatment planning system. The convolution-superposition algorithm was the Collapsed Cone implemented in the Helax-TMS. The only studied calculation methods that correlated successfully with the measured values with a 2% average inside all media were the Collapsed Cone and the Monte Carlo simulation. The biggest difference between the predicted and the delivered dose in the beam axis was found for the EqTAR algorithm inside the CIRS lung equivalent material in a 2x2 cm 2 18 MV x-ray beam. In these conditions, average and maximum difference against the TLD measurements were 32% and 39%, respectively. In the water equivalent part of the phantom every algorithm correctly predicted the dose (within 2%) everywhere except very close to the interfaces where differences up to 24% were found for 2x2 cm 2 18 MV photon beams. Consistent values were found between the reference detector (ionization chamber in water and TLD in lung) and Monte Carlo simulations, yielding minimal differences (0

Application of Voxel Phantoms to Study the Influence of Heterogeneous Distribution of Actinides in Lungs on In Vivo Counting Calibration Factors Using Animal Experimentations

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Lamart, S.; Pierrat, N.; De Carlan, L.; Franck, D. [IRSN/DRPH/SDI/LEDI, BP 17, F-92 262 Fontenay-aux-Roses (France); Dudoignon, N. [IRSN/DRPH/SRBE/LRPAT, BP 17, F-92 262 Fontenay-aux-Roses (France); Rateau, S.; Van der Meeren, A.; Rouit, E. [CEA/DSV/DRR/SRCA/LRT BP no 12, F-91680 Bruyeres-le-Chatel (France); Bottlaender, M. [CEA/SHFJ, 4, place du General Leclerc F-91400 Orsay (France)

2006-07-01

Calibration of lung counting system dedicated to retention assessment of actinides in the lungs remains critical due to large uncertainties in calibration factors. Among them, the detector positioning, the chest wall thickness and composition (muscle/fat) assessment, and the distribution of the contamination are the main parameters influencing the detector response. In order to reduce these uncertainties, a numerical approach based on the application of voxel phantoms (numerical phantoms based on tomographic images, CT or MRI) associated to a Monte-Carlo code (namely M.C.N.P.) was developed. It led to the development of a dedicated tool, called O.E.D.I.P.E., that allows to easily handle realistic voxel phantoms for the simulation of in vivo measurement (or dose calculation, application that will not be presented in this paper). The goal of this paper is to present our study of the influence of the lung distribution on calibration factors using both animal experimentations and our numerical method. Indeed, physical anthropomorphic phantoms used for calibration always consider a uniform distribution of the source in the lungs, which is not true in many contamination conditions. The purpose of the study is to compare the response of the measurement detectors using a real distribution of actinide particles in the lungs, obtained from animal experimentations, with the homogeneous one considered as the reference. This comparison was performed using O.E.D.I.P.E. that can almost simulate any source distribution. A non human primate was contaminated heterogeneously by intra-tracheal administration of actinide oxide. After euthanasia, gamma spectrometry measurements were performed on the pulmonary lobes to obtain the distribution of the contamination in the lungs. This realistic distribution was used to simulate an heterogeneous contamination in the numerical phantom of the non human primate, which was compared with a simulation of an homogeneous contamination presenting the

Application of Voxel Phantoms to Study the Influence of Heterogeneous Distribution of Actinides in Lungs on In Vivo Counting Calibration Factors Using Animal Experimentations

International Nuclear Information System (INIS)

Lamart, S.; Pierrat, N.; De Carlan, L.; Franck, D.; Dudoignon, N.; Rateau, S.; Van der Meeren, A.; Rouit, E.; Bottlaender, M.

2006-01-01

Calibration of lung counting system dedicated to retention assessment of actinides in the lungs remains critical due to large uncertainties in calibration factors. Among them, the detector positioning, the chest wall thickness and composition (muscle/fat) assessment, and the distribution of the contamination are the main parameters influencing the detector response. In order to reduce these uncertainties, a numerical approach based on the application of voxel phantoms (numerical phantoms based on tomographic images, CT or MRI) associated to a Monte-Carlo code (namely M.C.N.P.) was developed. It led to the development of a dedicated tool, called O.E.D.I.P.E., that allows to easily handle realistic voxel phantoms for the simulation of in vivo measurement (or dose calculation, application that will not be presented in this paper). The goal of this paper is to present our study of the influence of the lung distribution on calibration factors using both animal experimentations and our numerical method. Indeed, physical anthropomorphic phantoms used for calibration always consider a uniform distribution of the source in the lungs, which is not true in many contamination conditions. The purpose of the study is to compare the response of the measurement detectors using a real distribution of actinide particles in the lungs, obtained from animal experimentations, with the homogeneous one considered as the reference. This comparison was performed using O.E.D.I.P.E. that can almost simulate any source distribution. A non human primate was contaminated heterogeneously by intra-tracheal administration of actinide oxide. After euthanasia, gamma spectrometry measurements were performed on the pulmonary lobes to obtain the distribution of the contamination in the lungs. This realistic distribution was used to simulate an heterogeneous contamination in the numerical phantom of the non human primate, which was compared with a simulation of an homogeneous contamination presenting the

Tumour heterogeneity in non-small cell lung carcinoma assessed by CT texture analysis: a potential marker of survival

International Nuclear Information System (INIS)

Ganeshan, Balaji; Miles, Ken; Panayiotou, Elleny; Burnand, Kate; Dizdarevic, Sabina

2012-01-01

To establish the potential for tumour heterogeneity in non-small cell lung cancer (NSCLC) as assessed by CT texture analysis (CTTA) to provide an independent marker of survival for patients with NSCLC. Tumour heterogeneity was assessed by CTTA of unenhanced images of primary pulmonary lesions from 54 patients undergoing 18 F-fluorodeoxyglucose (FDG) PET-CT for staging of NSCLC. CTTA comprised image filtration to extract fine, medium and coarse features with quantification of the distribution of pixel values (uniformity) within the filtered images. Receiver operating characteristics identified thresholds for PET and CTTA parameters that were related to patient survival using Kaplan-Meier analysis. The median (range) survival was 29.5 (1-38) months. 24, 10, 14 and 6 patients had tumour stages I, II, III and IV respectively. PET stage and tumour heterogeneity assessed by CTTA were significant independent predictors of survival (PET stage: Odds ratio 3.85, 95% confidence limits 0.9-8.09, P = 0.002; CTTA: Odds ratio 56.4, 95% confidence limits 4.79-666, p = 0.001). SUV was not a significantly associated with survival. Assessment of tumour heterogeneity by CTTA of non-contrast enhanced images has the potential for to provide a novel, independent predictor of survival for patients with NSCLC. (orig.)

Molecular Imaging and Precision Medicine in Lung Cancer.

Science.gov (United States)

Zukotynski, Katherine A; Gerbaudo, Victor H

2017-01-01

Precision medicine allows tailoring of preventive or therapeutic interventions to avoid the expense and toxicity of futile treatment given to those who will not respond. Lung cancer is a heterogeneous disease functionally and morphologically. PET is a sensitive molecular imaging technique with a major role in the precision medicine algorithm of patients with lung cancer. It contributes to the precision medicine of lung neoplasia by interrogating tumor heterogeneity throughout the body. It provides anatomofunctional insight during diagnosis, staging, and restaging of the disease. It is a biomarker of tumoral heterogeneity that helps direct selection of the most appropriate treatment, the prediction of early response to cytotoxic and cytostatic therapies, and is a prognostic biomarker in patients with lung cancer. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

Paradigm shift in LUNG SBRT dose calculation associated with Heterogeneity correction; Cambio de paradigma en SBRT pulmonar asociada al calculo de dosis con correccion de heterogeneidad

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Zucca Aparicio, D.; Perez Moreno, J. M.; Fernandez Leton, P.; Garcia Ruiz-Zorrilla, J.; Pinto Monedero, M.; Marti Asensjo, J.; Alonso Iracheta, L.

2015-07-01

Treatment of lung injury SBRT requires great dosimetric accuracy, the increasing clinical importance of dose calculation heterogeneities introducing algorithms that adequately model the transport of particles narrow beams in media of low density, as with Monte Carlo calculation. (Author)

The Impact of Optimal Respiratory Gating and Image Noise on Evaluation of Intratumor Heterogeneity on 18F-FDG PET Imaging of Lung Cancer.

Science.gov (United States)

Grootjans, Willem; Tixier, Florent; van der Vos, Charlotte S; Vriens, Dennis; Le Rest, Catherine C; Bussink, Johan; Oyen, Wim J G; de Geus-Oei, Lioe-Fee; Visvikis, Dimitris; Visser, Eric P

2016-11-01

Accurate measurement of intratumor heterogeneity using parameters of texture on PET images is essential for precise characterization of cancer lesions. In this study, we investigated the influence of respiratory motion and varying noise levels on quantification of textural parameters in patients with lung cancer. We used an optimal-respiratory-gating algorithm on the list-mode data of 60 lung cancer patients who underwent 18 F-FDG PET. The images were reconstructed using a duty cycle of 35% (percentage of the total acquired PET data). In addition, nongated images of varying statistical quality (using 35% and 100% of the PET data) were reconstructed to investigate the effects of image noise. Several global image-derived indices and textural parameters (entropy, high-intensity emphasis, zone percentage, and dissimilarity) that have been associated with patient outcome were calculated. The clinical impact of optimal respiratory gating and image noise on assessment of intratumor heterogeneity was evaluated using Cox regression models, with overall survival as the outcome measure. The threshold for statistical significance was adjusted for multiple comparisons using Bonferroni correction. In the lower lung lobes, respiratory motion significantly affected quantification of intratumor heterogeneity for all textural parameters (P 0.007). The mean increase in entropy, dissimilarity, zone percentage, and high-intensity emphasis was 1.3% ± 1.5% (P = 0.02), 11.6% ± 11.8% (P = 0.006), 2.3% ± 2.2% (P = 0.002), and 16.8% ± 17.2% (P = 0.006), respectively. No significant differences were observed for lesions in the upper lung lobes (P > 0.007). Differences in the statistical quality of the PET images affected the textural parameters less than respiratory motion, with no significant difference observed. The median follow-up time was 35 mo (range, 7-39 mo). In multivariate analysis for overall survival, total lesion glycolysis and high-intensity emphasis were the two most

SU-E-J-64: Evaluation of a Commercial EPID-Based in Vivo Dosimetric System in the Presence of Lung Tissue Heterogeneity

Energy Technology Data Exchange (ETDEWEB)

Gimeno-Olmos, J; Palomo-Llinares, R; Candela-Juan, C; Carmona Meseguer, V; Lliso-Valverde, F [Hospital Universitari i Politecnic La Fe, Valencia, Valencia (Spain); Garcia-Martinez, T [Hospital de la Ribera, Alzira, Valencia (Spain); Richart-Sancho, J [Clinica Benidorm, Benidorm, Alicante (Spain); Ballester, F [University of Valencia, Burjassot (Spain); Perez-Calatayud, J [Hospital Universitari i Politecnic La Fe, Valencia, Valencia (Spain); Clinica Benidorm, Benidorm, Alicante (Spain)

2014-06-01

Purpose: To study the performance of Dosimetry Check (DC), an EPID-based dosimetry software, which allows performing transit dosimetry, in low density medium, by comparing calculations in-phantom, and analysing results for 15 lung patients. Methods: DC software (v.3.8, pencil beam-based algorithm) has been tested, for plans (Eclipse v.10.0 TPS) delivered in two Varian Clinac iX equipped with aS1000 EPIDs.In the CIRS lung phantom, comparisons between DC and Eclipse (Acuros) were performed for several plans: (1) four field box; (2) square field delivered in arc mode; (3) RapidArc lung patient plan medially centred; (4) RapidArc lung patient plan centred in one lung. Reference points analysed: P1 (medial point, plans 1–3) and P2 (located inside one lung, plan 4).For fifteen lung patients treated with RapidArc, the isocentre and 9 additional points inside the PTV as well as the gamma passing rate (3%/3mm) for the PTV and at the main planes were studied. Results: In-phantom:P1: Per-field differences in plan 1: good agreement for AP-PA fields; discrepancy of 7% for the lateral fields. Global differences (plans 1–3): about 4%, showing a compensating effect of the individual differences.P2: Global difference (plan 4): 15 %. This represents the worst case situation as it is a point surrounded by lung tissue, where the DC pencil beam algorithm is expected to give the greater difference against Acuros.Lung patients: Mean point difference inside the PTV:(5.4±4.2) %. Gamma passing rate inside the PTV:(45±12) %. Conclusion: The performance of DC in heterogeneous lung medium was studied with a special phantom and the results for 15 patients were analysed. The found deviations show that even though DC is a highly promising in vivo dosimetry tool, there is a need of incorporating a more accurate algorithm mainly for plans with low density regions involved.

Imaging Tumor Response and Tumoral Heterogeneity in Non-Small Cell Lung Cancer Treated With Antiangiogenic Therapy: Comparison of the Prognostic Ability of RECIST 1.1, an Alternate Method (Crabb), and Image Heterogeneity Analysis.

Science.gov (United States)

Yip, Connie; Tacelli, Nunzia; Remy-Jardin, Martine; Scherpereel, Arnaud; Cortot, Alexis; Lafitte, Jean-Jacques; Wallyn, Frederic; Remy, Jacques; Bassett, Paul; Siddique, Musib; Cook, Gary J R; Landau, David B; Goh, Vicky

2015-09-01

We aimed to assess computed tomography (CT) intratumoral heterogeneity changes, and compared the prognostic ability of the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, an alternate response method (Crabb), and CT heterogeneity in non-small cell lung cancer treated with chemotherapy with and without bevacizumab. Forty patients treated with chemotherapy (group C) or chemotherapy and bevacizumab (group BC) underwent contrast-enhanced CT at baseline and after 1, 3, and 6 cycles of chemotherapy. Radiologic response was assessed using RECIST 1.1 and an alternate method. CT heterogeneity analysis generating global and locoregional parameters depicting tumor image spatial intensity characteristics was performed. Heterogeneity parameters between the 2 groups were compared using the Mann-Whitney U test. Associations between heterogeneity parameters and radiologic response with overall survival were assessed using Cox regression. Global and locoregional heterogeneity parameters changed with treatment, with increased tumor heterogeneity in group BC. Entropy [group C: median -0.2% (interquartile range -2.2, 1.7) vs. group BC: 0.7% (-0.7, 3.5), P=0.10] and busyness [-27.7% (-62.2, -5.0) vs. -11.5% (-29.1, 92.4), P=0.10] showed a greater reduction in group C, whereas uniformity [1.9% (-8.0, 9.8) vs. -5.0% (-13.9, 5.6), P=0.10] showed a relative increase after 1 cycle but did not reach statistical significance. Two (9%) and 1 (6%) additional responders were identified using the alternate method compared with RECIST in group C and group BC, respectively. Heterogeneity parameters were not significant prognostic factors. The alternate response method described by Crabb identified more responders compared with RECIST. However, both criteria and baseline imaging heterogeneity parameters were not prognostic of survival.

O n-butil cianoacrilato na lobectomia pulmonar parcial em felinos: estudo experimental The n-butyl cyanoacrilate in partial lung lobectomy in cats: experimental study

Directory of Open Access Journals (Sweden)

Marcos Makoto Ishizaki

2005-02-01

Full Text Available O presente estudo teve como objetivo verificar a viabilidade do n-butil cianoacrilato na pneumostasia e hemostasia em lobectomia pulmonar parcial. Foram utilizadas seis gatas hígidas, adultas, com peso médio de três quilogramas. O procedimento cirúrgico consistiu na realização de toracotomia intercostal com lobectomia pulmonar parcial em que se utilizou adesivo cirúrgico para fechamento do lobo pulmonar. Após 21 dias da cirurgia, os animais foram novamente submetidos à toracotomia para a coleta de fragmento da região onde o adesivo fora aplicado, para análise histopatológica. Foram realizadas radiografias de tórax das pacientes para o acompanhamento pré e pós lobectomia pulmonar parcial e, aos dois, sete, 14 e 21 dias subseqüentes. As alterações radiográficas e clínicas encontradas como pneumotórax residual, aumento na densidade pulmonar, enfisema subcutâneo e apatia foram corrigidas em tempo hábil, não comprometendo os resultados do estudo. A histopatologia evidenciou reação inflamatória com predomínio de células mononucleares, neovascularização, proliferação de tecido conjuntivo e pequenas áreas de enfisema e atelectasia, sem comprometimento clínico significativo. Concluiu-se que o cianoacrilato é capaz de produzir adequada pneumostasia e hemostasia, e poderá ser uma opção para a realização de lobectomia pulmonar parcial em felinos.The n-butyl cyanoacrilate tissue adhesive was used in this study aiming to verify the viability of its use for hemostasis and to avoid air leakage in partial lung lobectomy. Six healthy adult female domestic shorthair cats, weight range of three kg were submitted to an intercostal thoracotomy with partial lung lobectomy using n-butyl cyanoacrilate to close the lobe. After 21 days they were submitted to another thoracotomy to collect a fragment of the lung where the adhesive was applied to a histopathological study. Chest films were taken pre and post partial lung lobectomy

A comprehensive review of nongenetic prognostic and predictive factors influencing the heterogeneity of outcomes in advanced non-small-cell lung cancer

Directory of Open Access Journals (Sweden)

Cuyún Carter G

2014-10-01

Full Text Available Gebra Cuyún Carter,1 Amy M Barrett,2 James A Kaye,3 Astra M Liepa,1 Katherine B Winfree,1 William J John1 1Eli Lilly and Company, Indianapolis, IN, USA; 2RTI Health Solutions, Research Triangle Park, NC, USA; 3RTI Health Solutions, Waltham, MA, USA Abstract: While there have been advances in treatment options for those with advanced non-small-cell lung cancer, unmet medical needs remain, partly due to the heterogeneity of treatment effect observed among patients. The goals of this literature review were to provide updated information to complement past reviews and to identify a comprehensive set of nongenetic prognostic and predictive baseline factors that may account for heterogeneity of outcomes in advanced non-small-cell lung cancer. A review of the literature between 2000 and 2010 was performed using PubMed, Embase, and Cochrane Library. All relevant studies that met the inclusion criteria were selected and data elements were abstracted. A classification system was developed to evaluate the level of evidence for each study. A total of 54 studies were selected for inclusion. Patient-related factors (eg, performance status, sex, and age were the most extensively researched nongenetic prognostic factors, followed by disease stage and histology. Moderately researched prognostic factors were weight-related variables and number or site of metastases, and the least studied were comorbidities, previous therapy, smoking status, hemoglobin level, and health-related quality of life/symptom severity. The prognostic factors with the most consistently demonstrated associations with outcomes were performance status, number or site of metastases, previous therapy, smoking status, and health-related quality of life. Of the small number of studies that assessed predictive factors, those that were found to be significantly predictive of outcomes were performance status, age, disease stage, previous therapy, race, smoking status, sex, and histology. These

Interstitial lung disease: Diagnostic approach

OpenAIRE

Kaushik Saha

2014-01-01

Interstitial lung disease (ILD) is a final common pathway of a broad heterogeneous group of parenchymal lung disorders. It is characterized by progressive fibrosis of the lung leading to restriction and diminished oxygen transfer. Clinically, the presenting symptoms of ILD are non-specific (cough and progressive dyspnea on exertion) and are often attributed to other diseases, thus delaying diagnosis and timely therapy. Clues from the medical history along with the clinical context and radiolo...

Cellular Plasticity and Heterogeneity of EGFR Mutant Lung Cancer

Science.gov (United States)

2016-11-01

Department of the Army position, policy or decision unless so designated by other documentation. REPORT DOCUMENTATION PAGE Form Approved OMB No...Growth Factor Receptor (EGFR) is altered in 10-15% of lung adenocarcinomas, a subtype of lung cancer. Patients with tumors that have this alteration...presence of a viral infection in the colony of the donating lab. We were able to obtain these mice by purchasing and having them re- derived from Jackson

Exploring the uncertainties of early detection results: model-based interpretation of mayo lung project

Directory of Open Access Journals (Sweden)

Berman Barbara

2011-03-01

Full Text Available Abstract Background The Mayo Lung Project (MLP, a randomized controlled clinical trial of lung cancer screening conducted between 1971 and 1986 among male smokers aged 45 or above, demonstrated an increase in lung cancer survival since the time of diagnosis, but no reduction in lung cancer mortality. Whether this result necessarily indicates a lack of mortality benefit for screening remains controversial. A number of hypotheses have been proposed to explain the observed outcome, including over-diagnosis, screening sensitivity, and population heterogeneity (initial difference in lung cancer risks between the two trial arms. This study is intended to provide model-based testing for some of these important arguments. Method Using a micro-simulation model, the MISCAN-lung model, we explore the possible influence of screening sensitivity, systematic error, over-diagnosis and population heterogeneity. Results Calibrating screening sensitivity, systematic error, or over-diagnosis does not noticeably improve the fit of the model, whereas calibrating population heterogeneity helps the model predict lung cancer incidence better. Conclusions Our conclusion is that the hypothesized imperfection in screening sensitivity, systematic error, and over-diagnosis do not in themselves explain the observed trial results. Model fit improvement achieved by accounting for population heterogeneity suggests a higher risk of cancer incidence in the intervention group as compared with the control group.

Prognostic value of the neutrophil to lymphocyte ratio in lung cancer: A meta-analysis.

Science.gov (United States)

Yin, Yongmei; Wang, Jun; Wang, Xuedong; Gu, Lan; Pei, Hao; Kuai, Shougang; Zhang, Yingying; Shang, Zhongbo

2015-07-01

Recently, a series of studies explored the correlation between the neutrophil to lymphocyte ratio and the prognosis of lung cancer. However, the current opinion regarding the prognostic role of the neutrophil to lymphocyte ratio in lung cancer is inconsistent. We performed a meta-analysis of published articles to investigate the prognostic value of the neutrophil to lymphocyte ratio in lung cancer. The hazard ratio (HR) and its 95% confidence interval (CI) were calculated. An elevated neutrophil to lymphocyte ratio predicted worse overall survival, with a pooled HR of 1.243 (95%CI: 1.106-1.397; P(heterogeneity)=0.001) from multivariate studies and 1.867 (95%CI: 1.487-2.344; P(heterogeneity)=0.047) from univariate studies. Subgroup analysis showed that a high neutrophil to lymphocyte ratio yielded worse overall survival in non-small cell lung cancer (NSCLC) (HR=1.192, 95%CI: 1.061-1.399; P(heterogeneity)=0.003) as well as small cell lung cancer (SCLC) (HR=1.550, 95% CI: 1.156-2.077; P(heterogeneity)=0.625) in multivariate studies. The synthesized evidence from this meta-analysis of published articles demonstrated that an elevated neutrophil to lymphocyte ratio was a predictor of poor overall survival in patients with lung cancer.

Imaging of macrophage-related lung diseases

International Nuclear Information System (INIS)

Marten, Katharina; Hansell, David M.

2005-01-01

Macrophage-related pulmonary diseases are a heterogeneous group of disorders characterized by macrophage accumulation, activation or dysfunction. These conditions include smoking-related interstitial lung diseases, metabolic disorders such as Niemann-Pick or Gaucher disease, and rare primary lung tumors. High-resolution computed tomography abnormalities include pulmonary ground-glass opacification secondary to infiltration by macrophages, centrilobular nodules or interlobular septal thickening reflecting peribronchiolar or septal macrophage accumulation, respectively, emphysema caused by macrophage dysfunction, and honeycombing following macrophage-related lung matrix remodeling. (orig.)

Transfer factor, lung volumes, resistance and ventilation distribution in healthy adults.

Science.gov (United States)

Verbanck, Sylvia; Van Muylem, Alain; Schuermans, Daniel; Bautmans, Ivan; Thompson, Bruce; Vincken, Walter

2016-01-01

Monitoring of chronic lung disease requires reference values of lung function indices, including putative markers of small airway function, spanning a wide age range.We measured spirometry, transfer factor of the lung for carbon monoxide (TLCO), static lung volume, resistance and ventilation distribution in a healthy population, studying at least 20 subjects per sex and per decade between the ages of 20 and 80 years.With respect to the Global Lung Function Initiative reference data, our subjects had average z-scores for forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC of -0.12, 0.04 and -0.32, respectively. Reference equations were obtained which could account for a potential dependence of index variability on age and height. This was done for (but not limited to) indices that are pertinent to asthma and chronic obstructive pulmonary disease studies: forced expired volume in 6 s, forced expiratory flow, TLCO, specific airway conductance, residual volume (RV)/total lung capacity (TLC), and ventilation heterogeneity in acinar and conductive lung zones.Deterioration in acinar ventilation heterogeneity and lung clearance index with age were more marked beyond 60 years, and conductive ventilation heterogeneity showed the greatest increase in variability with age. The most clinically relevant deviation from published reference values concerned RV/TLC values, which were considerably smaller than American Thoracic Society/European Respiratory Society-endorsed reference values. Copyright ©ERS 2016.

Estudo morfométrico de pulmões remanescentes de ratos após lobectomia ou bilobectomia Morphometric study of the remaining lungs of rats submitted to lobectomy or bilobectomy

Directory of Open Access Journals (Sweden)

Amélia C. Seidel

1997-12-01

Full Text Available Este estudo foi realizado para analizar a morfometria de pulmões remanescentes de ratos tendo-se como parâmetros o peso e o volume médio pulmonares. Foram utilizados 45 Rattus novergicus albinus, Wistar, fêmeas, adultos. Os animais foram divididos em 3 grupos. Grupo I, submetido a lobectomia média do pulmão direito; grupo II, a bilobectomia cranial e média do pulmão direito e o grupo controle não sofreu intervenção cirúrgica. Os 3 grupos foram submetidos para avaliação do pós-operatório aos 30 e 60 dias. A comparação entre os grupos operados e destes com o grupo controle não apresentou diferenças significantes quanto aos parâmetros estudados.The present study has been carried out in order to analyse the morphometry of remaining lungs of rats bearing in mind the average weight and volume of these lungs. Forty-five female adults Rattus novergicus albinus, Wistar were utilized. The animals were divided into three groups. Group I was submitted to middle lobectony of the right lung. Group II was submitted to upper and middle bilobectomy of the right lung and the control group did not undergo operation. The groups were subdivided into subgroups for post operatory evaluation at 30 and 60 days. The comparison between the groups operated on and the comparison between these two groups with the control group did not show major differences regarding average weight and volume of the lungs.

18F-FDG PET/CT heterogeneity quantification through textural features in the era of harmonisation programs: a focus on lung cancer.

Science.gov (United States)

Lasnon, Charline; Majdoub, Mohamed; Lavigne, Brice; Do, Pascal; Madelaine, Jeannick; Visvikis, Dimitris; Hatt, Mathieu; Aide, Nicolas

2016-12-01

Quantification of tumour heterogeneity in PET images has recently gained interest, but has been shown to be dependent on image reconstruction. This study aimed to evaluate the impact of the EANM/EARL accreditation program on selected 18 F-FDG heterogeneity metrics. To carry out our study, we prospectively analysed 71 tumours in 60 biopsy-proven lung cancer patient acquisitions reconstructed with unfiltered point spread function (PSF) positron emission tomography (PET) images (optimised for diagnostic purposes), PSF-reconstructed images with a 7-mm Gaussian filter (PSF 7 ) chosen to meet European Association of Nuclear Medicine (EANM) 1.0 harmonising standards, and EANM Research Ltd. (EARL)-compliant ordered subset expectation maximisation (OSEM) images. Delineation was performed with fuzzy locally adaptive Bayesian (FLAB) algorithm on PSF images and reported on PSF 7 and OSEM ones, and with a 50 % standardised uptake values (SUV) max threshold (SUV max50% ) applied independently to each image. Robust and repeatable heterogeneity metrics including 1st-order [area under the curve of the cumulative histogram (CH AUC )], 2nd-order (entropy, correlation, and dissimilarity), and 3rd-order [high-intensity larger area emphasis (HILAE) and zone percentage (ZP)] textural features (TF) were statistically compared. Volumes obtained with SUV max50% were significantly smaller than FLAB-derived ones, and were significantly smaller in PSF images compared to OSEM and PSF 7 images. PSF-reconstructed images showed significantly higher SUVmax and SUVmean values, as well as heterogeneity for CH AUC , dissimilarity, correlation, and HILAE, and a wider range of heterogeneity values than OSEM images for most of the metrics considered, especially when analysing larger tumours. Histological subtypes had no impact on TF distribution. No significant difference was observed between any of the considered metrics (SUV or heterogeneity features) that we extracted from OSEM and PSF 7

Bronchoscopic Lung Volume Reduction Coil Treatment of Patients With Severe Heterogeneous Emphysema

NARCIS (Netherlands)

Slebos, Dirk-Jan; Klooster, Karin; Ernst, Armin; Herth, Felix J. F.; Kerstjens, Huib A. M.

Background: The lung volume reduction coil (LVR-coil), a new experimental device to achieve lung volume reduction by bronchoscopy in patients with severe emphysema, works in a manner unaffected by collateral airflow. We investigated the safety and efficacy of LVR-coil treatment in patients with

Characterization of tumor heterogeneity using dynamic contrast enhanced CT and FDG-PET in non-small cell lung cancer

International Nuclear Information System (INIS)

Elmpt, Wouter van; Das, Marco; Hüllner, Martin; Sharifi, Hoda; Zegers, Catharina M.L.; Reymen, Bart; Lambin, Philippe; Wildberger, Joachim E.; Troost, Esther G.C.; Veit-Haibach, Patrick; De Ruysscher, Dirk

2013-01-01

Purpose: Dynamic contrast-enhanced CT (DCE-CT) quantifies vasculature properties of tumors, whereas static FDG-PET/CT defines metabolic activity. Both imaging modalities are capable of showing intra-tumor heterogeneity. We investigated differences in vasculature properties within primary non-small cell lung cancer (NSCLC) tumors measured by DCE-CT and metabolic activity from FDG-PET/CT. Methods: Thirty three NSCLC patients were analyzed prior to treatment. FDG-PET/CT and DCE-CT were co-registered. The tumor was delineated and metabolic activity was segmented on the FDG-PET/CT in two regions: low (<50% maximum SUV) and high (⩾50% maximum SUV) metabolic uptake. Blood flow, blood volume and permeability were calculated using a maximum slope, deconvolution algorithm and a Patlak model. Correlations were assessed between perfusion parameters for the regions of interest. Results: DCE-CT provided additional information on vasculature and tumor heterogeneity that was not correlated to metabolic tumor activity. There was no significant difference between low and high metabolic active regions for any of the DCE-CT parameters. Furthermore, only moderate correlations between maximum SUV and DCE-CT parameters were observed. Conclusions: No direct correlation was observed between FDG-uptake and parameters extracted from DCE-CT. DCE-CT may provide complementary information to the characterization of primary NSCLC tumors over FDG-PET/CT imaging

{sup 18}F-FDG PET/CT heterogeneity quantification through textural features in the era of harmonisation programs: a focus on lung cancer

Energy Technology Data Exchange (ETDEWEB)

Lasnon, Charline [University Hospital, Nuclear Medicine Department, Caen (France); Biologie et Therapies Innovantes des Cancers Localement Agressifs, Universite de Caen Normandie, INSERM, Caen (France); Normandie University, Caen (France); Majdoub, Mohamed; Lavigne, Brice; Visvikis, Dimitris [LaTIM, INSERM UMR 1101, Brest (France); Do, Pascal [Thoracic Oncology, Francois Baclesse Cancer Centre, Caen (France); Madelaine, Jeannick [Caen University Hospital, Pulmonology Department, Caen (France); Hatt, Mathieu [LaTIM, INSERM UMR 1101, Brest (France); CHRU Morvan, INSERM UMR 1101, Laboratoire de Traitement de l' Information Medicale (LaTIM), Groupe ' Imagerie multi-modalite quantitative pour le diagnostic et la therapie' , Brest (France); Aide, Nicolas [University Hospital, Nuclear Medicine Department, Caen (France); Biologie et Therapies Innovantes des Cancers Localement Agressifs, Universite de Caen Normandie, INSERM, Caen (France); Normandie University, Caen (France); Caen University Hospital, Nuclear Medicine Department, Caen (France)

2016-12-15

Quantification of tumour heterogeneity in PET images has recently gained interest, but has been shown to be dependent on image reconstruction. This study aimed to evaluate the impact of the EANM/EARL accreditation program on selected {sup 18}F-FDG heterogeneity metrics. To carry out our study, we prospectively analysed 71 tumours in 60 biopsy-proven lung cancer patient acquisitions reconstructed with unfiltered point spread function (PSF) positron emission tomography (PET) images (optimised for diagnostic purposes), PSF-reconstructed images with a 7-mm Gaussian filter (PSF{sub 7}) chosen to meet European Association of Nuclear Medicine (EANM) 1.0 harmonising standards, and EANM Research Ltd. (EARL)-compliant ordered subset expectation maximisation (OSEM) images. Delineation was performed with fuzzy locally adaptive Bayesian (FLAB) algorithm on PSF images and reported on PSF{sub 7} and OSEM ones, and with a 50 % standardised uptake values (SUV){sub max} threshold (SUV{sub max50%}) applied independently to each image. Robust and repeatable heterogeneity metrics including 1st-order [area under the curve of the cumulative histogram (CH{sub AUC})], 2nd-order (entropy, correlation, and dissimilarity), and 3rd-order [high-intensity larger area emphasis (HILAE) and zone percentage (ZP)] textural features (TF) were statistically compared. Volumes obtained with SUV{sub max50%} were significantly smaller than FLAB-derived ones, and were significantly smaller in PSF images compared to OSEM and PSF{sub 7} images. PSF-reconstructed images showed significantly higher SUVmax and SUVmean values, as well as heterogeneity for CH{sub AUC}, dissimilarity, correlation, and HILAE, and a wider range of heterogeneity values than OSEM images for most of the metrics considered, especially when analysing larger tumours. Histological subtypes had no impact on TF distribution. No significant difference was observed between any of the considered metrics (SUV or heterogeneity features) that we

"1"8F-FDG PET/CT heterogeneity quantification through textural features in the era of harmonisation programs: a focus on lung cancer

International Nuclear Information System (INIS)

Lasnon, Charline; Majdoub, Mohamed; Lavigne, Brice; Visvikis, Dimitris; Do, Pascal; Madelaine, Jeannick; Hatt, Mathieu; Aide, Nicolas

2016-01-01

Quantification of tumour heterogeneity in PET images has recently gained interest, but has been shown to be dependent on image reconstruction. This study aimed to evaluate the impact of the EANM/EARL accreditation program on selected "1"8F-FDG heterogeneity metrics. To carry out our study, we prospectively analysed 71 tumours in 60 biopsy-proven lung cancer patient acquisitions reconstructed with unfiltered point spread function (PSF) positron emission tomography (PET) images (optimised for diagnostic purposes), PSF-reconstructed images with a 7-mm Gaussian filter (PSF_7) chosen to meet European Association of Nuclear Medicine (EANM) 1.0 harmonising standards, and EANM Research Ltd. (EARL)-compliant ordered subset expectation maximisation (OSEM) images. Delineation was performed with fuzzy locally adaptive Bayesian (FLAB) algorithm on PSF images and reported on PSF_7 and OSEM ones, and with a 50 % standardised uptake values (SUV)_m_a_x threshold (SUV_m_a_x_5_0_%) applied independently to each image. Robust and repeatable heterogeneity metrics including 1st-order [area under the curve of the cumulative histogram (CH_A_U_C)], 2nd-order (entropy, correlation, and dissimilarity), and 3rd-order [high-intensity larger area emphasis (HILAE) and zone percentage (ZP)] textural features (TF) were statistically compared. Volumes obtained with SUV_m_a_x_5_0_% were significantly smaller than FLAB-derived ones, and were significantly smaller in PSF images compared to OSEM and PSF_7 images. PSF-reconstructed images showed significantly higher SUVmax and SUVmean values, as well as heterogeneity for CH_A_U_C, dissimilarity, correlation, and HILAE, and a wider range of heterogeneity values than OSEM images for most of the metrics considered, especially when analysing larger tumours. Histological subtypes had no impact on TF distribution. No significant difference was observed between any of the considered metrics (SUV or heterogeneity features) that we extracted from OSEM and PSF_7

SU-E-T-131: Dosimetric Impact and Evaluation of Different Heterogenity Algorithm in Volumetric Modulated Arc Therapy Plan for Stereotactic Ablative Radiotherapy Lung Treatment with the Flattening Filter Free Beam

Energy Technology Data Exchange (ETDEWEB)

Chung, J; Kim, J [Seoul National University Bundang Hospital, Seongnam, Kyeonggi-do (Korea, Republic of); Lee, J [Konkuk University Medical Center, Seoul, Seoul (Korea, Republic of); Kim, Y [Choonhae College of Health Sciences, Ulsan (Korea, Republic of)

2014-06-01

Purpose: The present study aimed to investigate the dosimetric impacts of the anisotropic analytic algorithm (AAA) and the Acuros XB (AXB) plan for lung stereotactic ablative radiation therapy using flattening filter-free (FFF) beam. We retrospectively analyzed 10 patients. Methods: We retrospectively analyzed 10 patients. The dosimetric parameters for the target and organs at risk (OARs) from the treatment plans calculated with these dose calculation algorithms were compared. The technical parameters, such as the computation times and the total monitor units (MUs), were also evaluated. Results: A comparison of DVHs from AXB and AAA showed that the AXB plan produced a high maximum PTV dose by average 4.40% with a statistical significance but slightly lower mean PTV dose by average 5.20% compared to the AAA plans. The maximum dose to the lung was slightly higher in the AXB compared to the AAA. For both algorithms, the values of V5, V10 and V20 for ipsilateral lung were higher in the AXB plan more than those of AAA. However, these parameters for contralateral lung were comparable. The differences of maximum dose for the spinal cord and heart were also small. The computation time of AXB was found fast with the relative difference of 13.7% than those of AAA. The average of monitor units (MUs) for all patients was higher in AXB plans than in the AAA plans. These results indicated that the difference between AXB and AAA are large in heterogeneous region with low density. Conclusion: The AXB provided the advantages such as the accuracy of calculations and the reduction of the computation time in lung stereotactic ablative radiotherapy (SABR) with using FFF beam, especially for VMAT planning. In dose calculation with the media of different density, therefore, the careful attention should be taken regarding the impacts of different heterogeneity correction algorithms. The authors report no conflicts of interest.

SU-E-T-131: Dosimetric Impact and Evaluation of Different Heterogenity Algorithm in Volumetric Modulated Arc Therapy Plan for Stereotactic Ablative Radiotherapy Lung Treatment with the Flattening Filter Free Beam

International Nuclear Information System (INIS)

Chung, J; Kim, J; Lee, J; Kim, Y

2014-01-01

Purpose: The present study aimed to investigate the dosimetric impacts of the anisotropic analytic algorithm (AAA) and the Acuros XB (AXB) plan for lung stereotactic ablative radiation therapy using flattening filter-free (FFF) beam. We retrospectively analyzed 10 patients. Methods: We retrospectively analyzed 10 patients. The dosimetric parameters for the target and organs at risk (OARs) from the treatment plans calculated with these dose calculation algorithms were compared. The technical parameters, such as the computation times and the total monitor units (MUs), were also evaluated. Results: A comparison of DVHs from AXB and AAA showed that the AXB plan produced a high maximum PTV dose by average 4.40% with a statistical significance but slightly lower mean PTV dose by average 5.20% compared to the AAA plans. The maximum dose to the lung was slightly higher in the AXB compared to the AAA. For both algorithms, the values of V5, V10 and V20 for ipsilateral lung were higher in the AXB plan more than those of AAA. However, these parameters for contralateral lung were comparable. The differences of maximum dose for the spinal cord and heart were also small. The computation time of AXB was found fast with the relative difference of 13.7% than those of AAA. The average of monitor units (MUs) for all patients was higher in AXB plans than in the AAA plans. These results indicated that the difference between AXB and AAA are large in heterogeneous region with low density. Conclusion: The AXB provided the advantages such as the accuracy of calculations and the reduction of the computation time in lung stereotactic ablative radiotherapy (SABR) with using FFF beam, especially for VMAT planning. In dose calculation with the media of different density, therefore, the careful attention should be taken regarding the impacts of different heterogeneity correction algorithms. The authors report no conflicts of interest

Clinical heterogeneity in Fabry disease

Directory of Open Access Journals (Sweden)

G. N. Salogub

2015-01-01

Full Text Available Fabry disease is an X-linked, lysosomal storage disease (OMIM: 301500, caused by α-galactosidase A deficiency, resulting in accumulation of its substrates, glycosphingolipids, primarily – globotriaosylceramide, in the lysosomes of multiple cell types with multi-system clinical manifestations, even within the same family, including abnormalities of the central and peripheral nervous system, kidneys, heart, gastrointestinal tract, lungs, organ of vision. Clinical heterogeneity is often the reason of the delayed diagnosis. Nowadays enzyme replacement therapy has proved its efficiency in the treatment of Fabry disease. Including Fabry disease in the differential diagnosis of a large range of disorders is important because of its wide clinical heterogeneity and the possibility of an earlier intervention with a beneficial treatment.

Tracking the Evolution of Non-Small-Cell Lung Cancer

DEFF Research Database (Denmark)

Jamal-Hanjani, Mariam; Wilson, Gareth A.; McGranahan, Nicholas

2017-01-01

Background Among patients with non-small-cell lung cancer (NSCLC), data on intratumor heterogeneity and cancer genome evolution have been limited to small retrospective cohorts. We wanted to prospectively investigate intratumor heterogeneity in relation to clinical outcome and to determine...... as a prognostic predictor. (Funded by Cancer Research UK and others; TRACERx ClinicalTrials.gov number, NCT01888601 .)....

Molecular pathways and therapeutic targets in lung cancer

Science.gov (United States)

Shtivelman, Emma; Hensing, Thomas; Simon, George R.; Dennis, Phillip A.; Otterson, Gregory A.; Bueno, Raphael; Salgia, Ravi

2014-01-01

Lung cancer is still the leading cause of cancer death worldwide. Both histologically and molecularly lung cancer is heterogeneous. This review summarizes the current knowledge of the pathways involved in the various types of lung cancer with an emphasis on the clinical implications of the increasing number of actionable molecular targets. It describes the major pathways and molecular alterations implicated in the development and progression of non-small cell lung cancer (adenocarcinoma and squamous cancer), and of small cell carcinoma, emphasizing the molecular alterations comprising the specific blueprints in each group. The approved and investigational targeted therapies as well as the immune therapies, and clinical trials exploring the variety of targeted approaches to treatment of lung cancer are the main focus of this review. PMID:24722523

Smoking-related interstitial lung diseases: radiologic-pathologic correlation

International Nuclear Information System (INIS)

Hidalgo, Alberto; Franquet, Tomas; Gimenez, Ana; Pineda, Rosa; Madrid, Marta; Bordes, Ramon

2006-01-01

Smoking-related interstitial lung diseases (SRILD) are a heterogeneous group of entities of unknown cause. These diseases include desquamative interstitial pneumonia (DIP), respiratory-bronchiolitis-related interstitial lung disease (RB-ILD), pulmonary Langerhans' cell histiocytosis (LCH) and idiopathic pulmonary fibrosis (IPF). High-resolution CT is highly sensitive in the detection of abnormalities in the lung parenchyma and airways. Ground-glass attenuation can occur in DIP and RB-ILD. Whereas DIP is histologically characterized by intra-alveolar pigmented macrophages, RB-ILD shows alveolar macrophages in a patchy peribronchiolar distribution. LCH shows nodular infiltrates on histopathological examination containing varying amounts of characteristic Langerhans' histiocytes. The HRCT findings are characteristically bilateral, symmetrical and diffuse, involving the upper lobe zones with sparing of the costophrenic angles. The most prominent CT features are nodules (sometimes cavitary) measuring 1 to 10 mm in diameter, cysts and areas of ground-glass attenuation. Pathologically, IPF is characterized by its heterogeneity with areas of normal clung, alveolitis and end-stage fibrosis shown in the same biopsy specimen. High-resolution CT findings consist of honeycombing, traction bronchiectasis and intralobular interstitial thickening with subpleural and lower lung predominance. Since coexisting lesions in the same cases have been observed, a better understanding of the different smoking-related interstitial lung diseases (SRILD) allows a more confident and specific diagnosis. (orig.)

Smoking-related interstitial lung diseases: radiologic-pathologic correlation

Energy Technology Data Exchange (ETDEWEB)

Hidalgo, Alberto [Universidad Autonoma de Barcelona, Department of Radiology, Hospital de Sant Pau, Barcelona (Spain); Hospital de la Santa Creu i Sant Pau, Thoracic Radiology, Department of Radiology, Barcelona (Spain); Franquet, Tomas; Gimenez, Ana; Pineda, Rosa; Madrid, Marta [Universidad Autonoma de Barcelona, Department of Radiology, Hospital de Sant Pau, Barcelona (Spain); Bordes, Ramon [Universidad Autonoma de Barcelona, Department of Pathology, Hospital de Sant Pau, Barcelona (Spain)

2006-11-15

Smoking-related interstitial lung diseases (SRILD) are a heterogeneous group of entities of unknown cause. These diseases include desquamative interstitial pneumonia (DIP), respiratory-bronchiolitis-related interstitial lung disease (RB-ILD), pulmonary Langerhans' cell histiocytosis (LCH) and idiopathic pulmonary fibrosis (IPF). High-resolution CT is highly sensitive in the detection of abnormalities in the lung parenchyma and airways. Ground-glass attenuation can occur in DIP and RB-ILD. Whereas DIP is histologically characterized by intra-alveolar pigmented macrophages, RB-ILD shows alveolar macrophages in a patchy peribronchiolar distribution. LCH shows nodular infiltrates on histopathological examination containing varying amounts of characteristic Langerhans' histiocytes. The HRCT findings are characteristically bilateral, symmetrical and diffuse, involving the upper lobe zones with sparing of the costophrenic angles. The most prominent CT features are nodules (sometimes cavitary) measuring 1 to 10 mm in diameter, cysts and areas of ground-glass attenuation. Pathologically, IPF is characterized by its heterogeneity with areas of normal clung, alveolitis and end-stage fibrosis shown in the same biopsy specimen. High-resolution CT findings consist of honeycombing, traction bronchiectasis and intralobular interstitial thickening with subpleural and lower lung predominance. Since coexisting lesions in the same cases have been observed, a better understanding of the different smoking-related interstitial lung diseases (SRILD) allows a more confident and specific diagnosis. (orig.)

Uncertainties in planned dose due to the limited voxel size of the planning CT when treating lung tumors with proton therapy

International Nuclear Information System (INIS)

Espana, Samuel; Paganetti, Harald

2011-01-01

Dose calculation for lung tumors can be challenging due to the low density and the fine structure of the geometry. The latter is not fully considered in the CT image resolution used in treatment planning causing the prediction of a more homogeneous tissue distribution. In proton therapy, this could result in predicting an unrealistically sharp distal dose falloff, i.e. an underestimation of the distal dose falloff degradation. The goal of this work was the quantification of such effects. Two computational phantoms resembling a two-dimensional heterogeneous random lung geometry and a swine lung were considered applying a variety of voxel sizes for dose calculation. Monte Carlo simulations were used to compare the dose distributions predicted with the voxel size typically used for the treatment planning procedure with those expected to be delivered using the finest resolution. The results show, for example, distal falloff position differences of up to 4 mm between planned and expected dose at the 90% level for the heterogeneous random lung (assuming treatment plan on a 2 x 2 x 2.5 mm 3 grid). For the swine lung, differences of up to 38 mm were seen when airways are present in the beam path when the treatment plan was done on a 0.8 x 0.8 x 2.4 mm 3 grid. The two-dimensional heterogeneous random lung phantom apparently does not describe the impact of the geometry adequately because of the lack of heterogeneities in the axial direction. The differences observed in the swine lung between planned and expected dose are presumably due to the poor axial resolution of the CT images used in clinical routine. In conclusion, when assigning margins for treatment planning for lung cancer, proton range uncertainties due to the heterogeneous lung geometry and CT image resolution need to be considered.

Telomere-related lung fibrosis is diagnostically heterogeneous but uniformly progressive.

Science.gov (United States)

Newton, Chad A; Batra, Kiran; Torrealba, Jose; Kozlitina, Julia; Glazer, Craig S; Aravena, Carlos; Meyer, Keith; Raghu, Ganesh; Collard, Harold R; Garcia, Christine Kim

2016-12-01

Heterozygous mutations in four telomere-related genes have been linked to pulmonary fibrosis, but little is known about similarities or differences of affected individuals.115 patients with mutations in telomerase reverse transcriptase (TERT) (n=75), telomerase RNA component (TERC) (n=7), regulator of telomere elongation helicase 1 (RTEL1) (n=14) and poly(A)-specific ribonuclease (PARN) (n=19) were identified and clinical data were analysed.Approximately one-half (46%) had a multidisciplinary diagnosis of idiopathic pulmonary fibrosis (IPF); others had unclassifiable lung fibrosis (20%), chronic hypersensitivity pneumonitis (12%), pleuroparenchymal fibroelastosis (10%), interstitial pneumonia with autoimmune features (7%), an idiopathic interstitial pneumonia (4%) and connective tissue disease-related interstitial fibrosis (3%). Discordant interstitial lung disease diagnoses were found in affected individuals from 80% of families. Patients with TERC mutations were diagnosed at an earlier age than those with PARN mutations (51±11 years versus 64±8 years; p=0.03) and had a higher incidence of haematological comorbidities. The mean rate of forced vital capacity decline was 300 mL·year -1 and the median time to death or transplant was 2.87 years. There was no significant difference in time to death or transplant for patients across gene mutation groups or for patients with a diagnosis of IPF versus a non-IPF diagnosis.Genetic mutations in telomere related genes lead to a variety of interstitial lung disease (ILD) diagnoses that are universally progressive. Copyright ©ERS 2016.

SU-E-T-101: Determination and Comparison of Correction Factors Obtained for TLDs in Small Field Lung Heterogenous Phantom Using Acuros XB and EGSnrc

International Nuclear Information System (INIS)

Soh, R; Lee, J; Harianto, F

2014-01-01

Purpose: To determine and compare the correction factors obtained for TLDs in 2 × 2cm 2 small field in lung heterogenous phantom using Acuros XB (AXB) and EGSnrc. Methods: This study will simulate the correction factors due to the perturbation of TLD-100 chips (Harshaw/Thermoscientific, 3 × 3 × 0.9mm 3 , 2.64g/cm 3 ) in small field lung medium for Stereotactic Body Radiation Therapy (SBRT). A physical lung phantom was simulated by a 14cm thick composite cork phantom (0.27g/cm 3 , HU:-743 ± 11) sandwiched between 4cm thick Plastic Water (CIRS,Norfolk). Composite cork has been shown to be a good lung substitute material for dosimetric studies. 6MV photon beam from Varian Clinac iX (Varian Medical Systems, Palo Alto, CA) with field size 2 × 2cm 2 was simulated. Depth dose profiles were obtained from the Eclipse treatment planning system Acuros XB (AXB) and independently from DOSxyznrc, EGSnrc. Correction factors was calculated by the ratio of unperturbed to perturbed dose. Since AXB has limitations in simulating actual material compositions, EGSnrc will also simulate the AXB-based material composition for comparison to the actual lung phantom. Results: TLD-100, with its finite size and relatively high density, causes significant perturbation in 2 × 2cm 2 small field in a low lung density phantom. Correction factors calculated by both EGSnrc and AXB was found to be as low as 0.9. It is expected that the correction factor obtained by EGSnrc wlll be more accurate as it is able to simulate the actual phantom material compositions. AXB have a limited material library, therefore it only approximates the composition of TLD, Composite cork and Plastic water, contributing to uncertainties in TLD correction factors. Conclusion: It is expected that the correction factors obtained by EGSnrc will be more accurate. Studies will be done to investigate the correction factors for higher energies where perturbation may be more pronounced

Table incremental slow injection CE-CT in lung cancer

International Nuclear Information System (INIS)

Yoshida, Shoji; Maeda, Tomoho; Morita, Masaru

1988-01-01

The purpose of this study is to evaluate tumor enhancement in lung cancer under the table incremental study with slow injection of contrast media. The early serial 8 sliced images during the slow injection (1.5 ml/sec) of contrant media were obtained. Following the early images, delayed 8 same sliced images were taken in 2 minutes later. Chacteristic enhanced patterns of the primary cancer and metastatic mediastinal lymphnode were recognized in this study. Enhancement of the primary lesion was classified in 4 patterns, irregular geographic pattern, heterogeneous pattern, homogeneous pattern and rim-enhanced pattern. In mediastinal metastatic lymphadenopathy, three enhanced patterns were obtained, heterogeneous, homogeneous and ring enhanced pattern. Some characteristic enhancement patterns according to the histopathological finding of the lung cancer were obtained. With using this incremental slow injection CE-CT, precise information about the relationship between lung cancer and adjacent mediastinal structure, and obvious staining patterns of the tumor and mediastinal lymphnode were recognized. (author)

Heterogeneity and compartmentalization of Pneumocystis carinii f. sp. hominis genotypes in autopsy lungs

DEFF Research Database (Denmark)

Helweg-Larsen, J; Lundgren, Bettina; Lundgren, Jens Dilling

2001-01-01

. Not all genotypes present in the lungs at autopsy were detected in the diagnostic respiratory samples. Compartmentalization of specific ITS and mtLSU rRNA sequence types was observed in different lung segments. In conclusion, the interpretation of genotype data and in particular ITS sequence types...

Idiopathic inflammatory myopathies and the lung

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Jean-Christophe Lega

2015-06-01

Full Text Available Idiopathic inflammatory myositis (IIM is a group of rare connective tissue diseases (CTDs characterised by muscular and extramuscular signs, in which lung involvement is a challenging issue. Interstitial lung disease (ILD is the hallmark of pulmonary involvement in IIM, and causes morbidity and mortality, resulting in an estimated excess mortality of 50% in some series. Except for inclusion body myositis, these extrapulmonary disorders are associated with the general and visceral involvement frequently found in other CTDs including fever, Raynaud's phenomenon, arthralgia, nonspecific cutaneous modifications and ILD, for which the prevalence is estimated to be up to 65%. Substantial heterogeneity exists within the spectrum of IIMs, and each condition is associated with various frequencies and subtypes of pulmonary involvement. This heterogeneity is partly related to the presence of various autoantibodies encompassing anti-synthetase, anti-MDA5 and anti-PM/Scl. ILD is present in all subsets of IIM including juvenile myositis, but is more frequent in dermatomyositis and overlap myositis. IIM can also be associated with other presentations of respiratory involvement, namely pulmonary arterial hypertension, pleural disease, infections, drug-induced toxicity, malignancy and respiratory muscle weakness. Here, we critically review the current knowledge about adult and juvenile myositis-associated lung disease with a detailed description of therapeutics for chronic and rapidly progressive ILD.

Lung volume reduction surgery: an overview Cirurgia redutora de volume pulmonar: uma revisão

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Rodrigo Afonso da Silva Sardenberg

2010-01-01

Full Text Available This study intends to review the literature on the efficacy, safety and feasibility of lung volume reduction surgery (LVRS in patients with advanced emphysema. Studies on LVRS from January 1995 to December 2009 were included by using Pubmed (MEDLINE and Cochrane Library literature in English. Search words such as lung volume reduction surgery or lung reduction surgery, pneumoplasty or reduction pneumoplasty, COPD or chronic obstructive pulmonary disease and surgery, were used. We also compared medical therapy and surgical technique. Studies consisting of randomized controlled trials, controlled clinical trials (randomized and nonrandomized, reviews and case series were analyzed. Questions regarding validity of the early clinical reports, incomplete follow-up bias, selection criteria and survival, confounded the interpretation of clinical data on LVRS. Patients with upper, lower and diffuse distribution of emphysema were included; we also analyzed as key points perioperative morbidity and mortality and lung function measurement as FEV1. Bullous emphysema was excluded from this review. Surgical approach included median sternotomy, unilateral or bilateral thoracotomy, and videothoracoscopy with stapled or laser ablation. Results of prospective randomized trials between medical management and LVRS are essential before final assessment can be established.O objetivo deste estudo é revisar a literatura acerca da eficácia, segurança e viabilidade da cirurgia redutora de volume pulmonar (CRVP em pacientes com enfisema pulmonar avançado. Estudos de CRVP de janeiro de 1995 a dezembro de 2009 foram incluídos através de pesquisa na Pubmed (MEDLINE e Cochrane Library, na literatura inglesa. Palavras de busca tais como lung volume reduction surgery ou lung reduction surgery, pneumoplasty ou reduction pneumoplasty, COPD ou chronic obstructive pulmonary disease e surgery foram utilizadas. Também realizamos comparação entre terapia médica e cir

SU-F-T-600: Influence of Acuros XB and AAA Dose Calculation Algorithms On Plan Quality Metrics and Normal Lung Doses in Lung SBRT

International Nuclear Information System (INIS)

Yaparpalvi, R; Mynampati, D; Kuo, H; Garg, M; Tome, W; Kalnicki, S

2016-01-01

Purpose: To study the influence of superposition-beam model (AAA) and determinant-photon transport-solver (Acuros XB) dose calculation algorithms on the treatment plan quality metrics and on normal lung dose in Lung SBRT. Methods: Treatment plans of 10 Lung SBRT patients were randomly selected. Patients were prescribed to a total dose of 50-54Gy in 3–5 fractions (10?5 or 18?3). Doses were optimized accomplished with 6-MV using 2-arcs (VMAT). Doses were calculated using AAA algorithm with heterogeneity correction. For each plan, plan quality metrics in the categories- coverage, homogeneity, conformity and gradient were quantified. Repeat dosimetry for these AAA treatment plans was performed using AXB algorithm with heterogeneity correction for same beam and MU parameters. Plan quality metrics were again evaluated and compared with AAA plan metrics. For normal lung dose, V_2_0 and V_5 to (Total lung- GTV) were evaluated. Results: The results are summarized in Supplemental Table 1. PTV volume was mean 11.4 (±3.3) cm"3. Comparing RTOG 0813 protocol criteria for conformality, AXB plans yielded on average, similar PITV ratio (individual PITV ratio differences varied from −9 to +15%), reduced target coverage (−1.6%) and increased R50% (+2.6%). Comparing normal lung doses, the lung V_2_0 (+3.1%) and V_5 (+1.5%) were slightly higher for AXB plans compared to AAA plans. High-dose spillage ((V105%PD - PTV)/ PTV) was slightly lower for AXB plans but the % low dose spillage (D2cm) was similar between the two calculation algorithms. Conclusion: AAA algorithm overestimates lung target dose. Routinely adapting to AXB for dose calculations in Lung SBRT planning may improve dose calculation accuracy, as AXB based calculations have been shown to be closer to Monte Carlo based dose predictions in accuracy and with relatively faster computational time. For clinical practice, revisiting dose-fractionation in Lung SBRT to correct for dose overestimates attributable to algorithm

SU-F-T-600: Influence of Acuros XB and AAA Dose Calculation Algorithms On Plan Quality Metrics and Normal Lung Doses in Lung SBRT

Energy Technology Data Exchange (ETDEWEB)

Yaparpalvi, R; Mynampati, D; Kuo, H; Garg, M; Tome, W; Kalnicki, S [Montefiore Medical Center, Bronx, NY (United States)

2016-06-15

Purpose: To study the influence of superposition-beam model (AAA) and determinant-photon transport-solver (Acuros XB) dose calculation algorithms on the treatment plan quality metrics and on normal lung dose in Lung SBRT. Methods: Treatment plans of 10 Lung SBRT patients were randomly selected. Patients were prescribed to a total dose of 50-54Gy in 3–5 fractions (10?5 or 18?3). Doses were optimized accomplished with 6-MV using 2-arcs (VMAT). Doses were calculated using AAA algorithm with heterogeneity correction. For each plan, plan quality metrics in the categories- coverage, homogeneity, conformity and gradient were quantified. Repeat dosimetry for these AAA treatment plans was performed using AXB algorithm with heterogeneity correction for same beam and MU parameters. Plan quality metrics were again evaluated and compared with AAA plan metrics. For normal lung dose, V{sub 20} and V{sub 5} to (Total lung- GTV) were evaluated. Results: The results are summarized in Supplemental Table 1. PTV volume was mean 11.4 (±3.3) cm{sup 3}. Comparing RTOG 0813 protocol criteria for conformality, AXB plans yielded on average, similar PITV ratio (individual PITV ratio differences varied from −9 to +15%), reduced target coverage (−1.6%) and increased R50% (+2.6%). Comparing normal lung doses, the lung V{sub 20} (+3.1%) and V{sub 5} (+1.5%) were slightly higher for AXB plans compared to AAA plans. High-dose spillage ((V105%PD - PTV)/ PTV) was slightly lower for AXB plans but the % low dose spillage (D2cm) was similar between the two calculation algorithms. Conclusion: AAA algorithm overestimates lung target dose. Routinely adapting to AXB for dose calculations in Lung SBRT planning may improve dose calculation accuracy, as AXB based calculations have been shown to be closer to Monte Carlo based dose predictions in accuracy and with relatively faster computational time. For clinical practice, revisiting dose-fractionation in Lung SBRT to correct for dose overestimates

Quantitative CT scans of lung parenchymal pathology in premature infants ages 0-6 years.

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Spielberg, David R; Walkup, Laura L; Stein, Jill M; Crotty, Eric J; Rattan, Mantosh S; Hossain, Md Monir; Brody, Alan S; Woods, Jason C

2018-03-01

Bronchopulmonary dysplasia (BPD) is a common, heterogeneous disease in premature infants. We hypothesized that quantitative CT techniques could assess lung parenchymal heterogeneity in BPD patients across a broad age range and demonstrate how pathologies change over time. A cross-sectional, retrospective study of children age 0-6 years with non-contrast chest CT scans was conducted. BPD subjects met NICHD/NHLBI diagnostic criteria for BPD and were excluded for congenital lung/airway abnormalities or other known/suspected pulmonary diagnoses; control subjects were not premature and had normal CT scan findings. Radiologic opacities, lucencies, and spatial heterogeneity were quantified via: 1) thresholding using CT-attenuation (HU); 2) manual segmentation; and 3) Ochiai reader-scoring system. Clinical outcomes included BPD severity by NICHD/NHLBI criteria, respiratory support at NICU discharge, wheezing, and respiratory exacerbations. Heterogeneity (standard deviation) of lung attenuation in BPD was significantly greater than in controls (difference 36.4 HU [26.1-46.7 HU], P < 0.001); the difference between the groups decreased 0.58 HU per month of age (0.08-1.07 HU per month, P = 0.02). BPD patients had greater amounts of opacities and lucencies than controls except with automated quantification of lucencies. Cross-sectionally, lucencies per Ochiai score and opacities per manual segmentation decreased with time. No approach measured a statistically significant relationship to BPD clinical severity. Opacities, lucencies, and overall heterogeneity of lungs via quantitative CT can distinguish BPD patients from healthy controls, and these abnormalities decrease with age across BPD patients. Defining BPD severity by clinical outcomes such as respiratory support at several time points (vs a single time point, per current guidelines) may be meaningful. © 2017 Wiley Periodicals, Inc.

Differential diagnosis of granulomatous lung disease: clues and pitfalls

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Shinichiro Ohshimo

2017-09-01

Full Text Available Granulomatous lung diseases are a heterogeneous group of disorders that have a wide spectrum of pathologies with variable clinical manifestations and outcomes. Precise clinical evaluation, laboratory testing, pulmonary function testing, radiological imaging including high-resolution computed tomography and often histopathological assessment contribute to make a confident diagnosis of granulomatous lung diseases. Differential diagnosis is challenging, and includes both infectious (mycobacteria and fungi and noninfectious lung diseases (sarcoidosis, necrotising sarcoid granulomatosis, hypersensitivity pneumonitis, hot tub lung, berylliosis, granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, rheumatoid nodules, talc granulomatosis, Langerhans cell histiocytosis and bronchocentric granulomatosis. Bronchoalveolar lavage, endobronchial ultrasound-guided transbronchial needle aspiration, transbronchial cryobiopsy, positron emission tomography and genetic evaluation are potential candidates to improve the diagnostic accuracy for granulomatous lung diseases. As granuloma alone is a nonspecific histopathological finding, the multidisciplinary approach is important for a confident diagnosis.

Factors influencing the development of lung fibrosis after chemoradiation for small cell carcinoma of the lung: Evidence for inherent interindividual variation

International Nuclear Information System (INIS)

Geara, Fady B.; Komaki, Ritsuko; Tucker, Susan L.; Travis, Elizabeth L.; Cox, James D.

1998-01-01

score residuals were calculated for each patient. The residual for each score is defined as the difference between the observed and expected score based on the dose and treatment schedule received. Average residuals varied significantly among patients (p = 0.005, Kruskal-Willis test). Using a modified version of the PO model, the coefficient of variation in patient heterogeneity was estimated to be 10.1% (95% confidence interval: 6.2-14.9%). Inclusion of the heterogeneity factor, in addition to total dose and fractionation schedule, improved the fit of the PO model to an extremely high level of significance (p -7 ). Conclusions: Our data indicate that the risk and severity of lung fibrosis analyzed radiographically on CT images increases with total dose and with the use of an accelerated radiation schedule, for patients treated with chemoradiation for small-cell lung cancer. There was also demonstrable patient-to-patient heterogeneity, suggesting that the risk of lung fibrosis is strongly affected by inherent factors that vary among individuals

Intercomparison of JAERI Torso Phantom lung sets

International Nuclear Information System (INIS)

Kramer, Gary H.; Hauck, Barry M.

2000-01-01

During the course of an IAEA sponsored In Vivo intercomparison using the JAERI phantom the Human Monitoring Laboratory was able to intercompare thirteen lung sets made by three suppliers. One set consisted of sliced lungs with planar inserts containing different radionuclides. The others consisted of whole lung sets with the activity homogeneously distributed throughout the tissue substitute material. Radionuclides in the study were: natural uranium, 3% enriched uranium, 241 Am, 238 Pu, 239 Pu, 152 Eu, and 232 Th Except for the 241 Am (59.5 keV) and occasionally one of the 232 Th (209 keV) photopeaks, the lung sets that had radioactivity homogeneously distributed throughout the tissue equivalent lung tissue material showed good agreement. The 241 Am lung set gave a counting efficiency that appeared 25% too high for all overlay plate configurations. This was observed by other participants. It exemplifies that the manufacture of tissue substitute lung sets is still something of a black art. Despite all precautions, this lung set is either inhomogeneous or has had the wrong activity added. Heterogeneity can lead to an error in the activity estimate of a factor of three if the activity was severely localised due to improper mixing. A factor of 1.25, which appears to be the discrepancy, could easily be explained in this way. It will not be known for some time, however, what the true reason is as the participants are still waiting for the destructive analysis of this lung set to determine the 'true' activity. The sliced lungs ( 241 Am, 152 Eu, and U-nat) manufactured by the Human Monitoring Laboratory are in excellent agreement with the other lung sets. The advantages of sliced lung sets and planar sources are manifold. Activity can be distributed in a known and reproducible manner to mimic either a homogeneous or heterogeneous distribution in the lung. Short lived radionuclides can be used. Cost is much less than purchasing or manufacturing lung sets that have the

Outcomes of Adolescent and Adult Patients with Lung Metastatic Osteosarcoma and Comparison of Synchronous and Metachronous Lung Metastatic Groups.

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Ayse Gok Durnali

Full Text Available Osteosarcomas with lung metastases are rather heterogenous group. We aimed to evaluate the clinicopathological characteristics and outcomes of osteosarcoma patients with lung metastases and to compare the synchronous and metachronous lung metastatic groups. A total of 93 adolescent and adult patients with lung metastatic osteosarcoma, from March 1995 to July 2011, in a single center, were included. Sixty-five patients (69.9% were male. The median age was 19 years (range, 14-74. Thirty-nine patients (41.9% had synchronous lung metastases (Group A and 54 patients (58.1% had metachronous lung metastases (Group B. The 5-year and 10-year post-lung metastases overall survival (PLM-OS was 17% and 15%, respectively. In multivariate analysis for PLM-OS, time to lung metastases (p = 0.010, number of metastatic pulmonary nodules (p = 0.020, presence of pulmonary metastasectomy (p = 0.007 and presence of chemotherapy for lung metastases (p< 0.001 were found to be independent prognostic factors. The median PLM-OS of Group A and Group B was 16 months and 9 months, respectively. In Group B, the median PLM-OS of the patients who developed lung metastases within 12 months was 6 months, whereas that of the patients who developed lung metastases later was 16 months. Time to lung metastases, number and laterality of metastatic pulmonary nodules, chemotherapy for lung metastatic disease and pulmonary metastasectomy were independent prognostic factors for patients with lung metastatic osteosarcoma. The best PLM-OS was in the subgroup of patients treated both surgery and chemotherapy. The prognosis of the patients who developed lung metastases within 12 months after diagnosis was worst.

Analytic Intermodel Consistent Modeling of Volumetric Human Lung Dynamics.

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Ilegbusi, Olusegun; Seyfi, Behnaz; Neylon, John; Santhanam, Anand P

2015-10-01

Human lung undergoes breathing-induced deformation in the form of inhalation and exhalation. Modeling the dynamics is numerically complicated by the lack of information on lung elastic behavior and fluid-structure interactions between air and the tissue. A mathematical method is developed to integrate deformation results from a deformable image registration (DIR) and physics-based modeling approaches in order to represent consistent volumetric lung dynamics. The computational fluid dynamics (CFD) simulation assumes the lung is a poro-elastic medium with spatially distributed elastic property. Simulation is performed on a 3D lung geometry reconstructed from four-dimensional computed tomography (4DCT) dataset of a human subject. The heterogeneous Young's modulus (YM) is estimated from a linear elastic deformation model with the same lung geometry and 4D lung DIR. The deformation obtained from the CFD is then coupled with the displacement obtained from the 4D lung DIR by means of the Tikhonov regularization (TR) algorithm. The numerical results include 4DCT registration, CFD, and optimal displacement data which collectively provide consistent estimate of the volumetric lung dynamics. The fusion method is validated by comparing the optimal displacement with the results obtained from the 4DCT registration.

Lung volumes and airway resistance in patients with a possible restrictive pattern on spirometry.

Science.gov (United States)

Schultz, Kenia; D'Aquino, Luiz Carlos; Soares, Maria Raquel; Gimenez, Andrea; Pereira, Carlos Alberto de Castro

2016-01-01

Many patients with proportional reductions in FVC and FEV1 on spirometry show no reduction in TLC. The aim of this study was to evaluate the role that measuring lung volumes and airway resistance plays in the correct classification of patients with a possible restrictive pattern on spirometry. This was a prospective study involving adults with reduced FVC and FEV1, as well as an FEV1/FV(C) ratio within the predicted range. Restrictive lung disease (RLD) was characterized by TLC below the 5th percentile, as determined by plethysmography. Obstructive lung disease (OLD) was characterized by high specific airway resistance, significant changes in post-bronchodilator FEV1, or an FEF25-75% espirometria não têm CPT reduzida. O objetivo deste estudo foi avaliar o papel da medida dos volumes pulmonares e da resistência das vias aéreas para a classificação correta de pacientes com possível restrição à espirometria. Estudo prospectivo de adultos com CVF e VEF1 reduzidos e relação VEF1/CV(F) na faixa prevista. Distúrbio ventilatório restritivo (DVR) foi definido por CPT espirometria. A obstrução ao fluxo aéreo é comum nesses casos.

Accelerated deflation promotes homogeneous airspace liquid distribution in the edematous lung.

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Wu, You; Nguyen, Tam L; Perlman, Carrie E

2017-04-01

Edematous lungs contain regions with heterogeneous alveolar flooding. Liquid is trapped in flooded alveoli by a pressure barrier-higher liquid pressure at the border than in the center of flooded alveoli-that is proportional to surface tension, T Stress is concentrated between aerated and flooded alveoli, to a degree proportional to T Mechanical ventilation, by cyclically increasing T , injuriously exacerbates stress concentrations. Overcoming the pressure barrier to redistribute liquid more homogeneously between alveoli should reduce stress concentration prevalence and ventilation injury. In isolated rat lungs, we test whether accelerated deflation can overcome the pressure barrier and catapult liquid out of flooded alveoli. We generate a local edema model with normal T by microinfusing liquid into surface alveoli. We generate a global edema model with high T by establishing hydrostatic edema, which does not alter T , and then gently ventilating the edematous lungs, which increases T at 15 cmH 2 O transpulmonary pressure by 52%. Thus ventilation of globally edematous lungs increases T , which should increase stress concentrations and, with positive feedback, cause escalating ventilation injury. In the local model, when the pressure barrier is moderate, accelerated deflation causes liquid to escape from flooded alveoli and redistribute more equitably. Flooding heterogeneity tends to decrease. In the global model, accelerated deflation causes liquid escape, but-because of elevated T -the liquid jumps to nearby, aerated alveoli. Flooding heterogeneity is unaltered. In pulmonary edema with normal T , early ventilation with accelerated deflation might reduce the positive feedback mechanism through which ventilation injury increases over time. NEW & NOTEWORTHY We introduce, in the isolated rat lung, a new model of pulmonary edema with elevated surface tension. We first generate hydrostatic edema and then ventilate gently to increase surface tension. We investigate the

Tracking Genomic Cancer Evolution for Precision Medicine: The Lung TRACERx Study

DEFF Research Database (Denmark)

Jamal-Hanjani, Mariam; Hackshaw, Alan; Ngai, Yenting

2014-01-01

. TRACERx (TRAcking non-small cell lung Cancer Evolution through therapy [Rx]), a prospective study of patients with primary non-small cell lung cancer (NSCLC), aims to define the evolutionary trajectories of lung cancer in both space and time through multiregion and longitudinal tumour sampling and genetic...... analysis. By following cancers from diagnosis to relapse, tracking the evolutionary trajectories of tumours in relation to therapeutic interventions, and determining the impact of clonal heterogeneity on clinical outcomes, TRACERx may help to identify novel therapeutic targets for NSCLC and may also serve...

Incidental lung volume reduction following fulminant pulmonary hemorrhage in a patient with severe emphysema.

Science.gov (United States)

Hetzel, Juergen; Spengler, Werner; Horger, Marius; Boeckeler, Michael

2015-06-01

Endoscopic lung volume reduction is an emerging technique meant to improve lung function parameters, quality of life, and exercise tolerance in patients with severe lung emphysema. This is the first report of lung volume reduction by autologous blood in a patient with non-bullous lung emphysema. A 74-year-old woman with heterogeneous lung emphysema developed accidentally diffuse lobar bleeding immediately after valve placement. Due to persistent hemorrhage, the valves had to be removed shortly thereafter. Despite extraction of the valves, respiratory function of the patient improved rapidly indicated also by a drop in the COPD assessment test questionnaire, 3 months later. This was consistent with both improvement of lung function tests and six-minute walking test.

Spatial distribution of sequential ventilation during mechanical ventilation of the uninjured lung: an argument for cyclical airway collapse and expansion

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Altemeier William A

2010-05-01

Full Text Available Abstract Background Ventilator-induced lung injury (VILI is a recognized complication of mechanical ventilation. Although the specific mechanism by which mechanical ventilation causes lung injury remains an active area of study, the application of positive end expiratory pressure (PEEP reduces its severity. We have previously reported that VILI is spatially heterogeneous with the most severe injury in the dorsal-caudal lung. This regional injury heterogeneity was abolished by the application of PEEP = 8 cm H2O. We hypothesized that the spatial distribution of lung injury correlates with areas in which cyclical airway collapse and recruitment occurs. Methods To test this hypothesis, rabbits were mechanically ventilated in the supine posture, and regional ventilation distribution was measured under four conditions: tidal volumes (VT of 6 and 12 ml/kg with PEEP levels of 0 and 8 cm H2O. Results We found that relative ventilation was sequentially redistributed towards dorsal-caudal lung with increasing tidal volume. This sequential ventilation redistribution was abolished with the addition of PEEP. Conclusions These results suggest that cyclical airway collapse and recruitment is regionally heterogeneous and spatially correlated with areas most susceptible to VILI.

Characterizing functional lung heterogeneity in COPD using reference equations for CT scan-measured lobar volumes.

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Come, Carolyn E; Diaz, Alejandro A; Curran-Everett, Douglas; Muralidhar, Nivedita; Hersh, Craig P; Zach, Jordan A; Schroeder, Joyce; Lynch, David A; Celli, Bartolome; Washko, George R

2013-06-01

CT scanning is increasingly used to characterize COPD. Although it is possible to obtain CT scan-measured lung lobe volumes, normal ranges remain unknown. Using COPDGene data, we developed reference equations for lobar volumes at maximal inflation (total lung capacity [TLC]) and relaxed exhalation (approximating functional residual capacity [FRC]). Linear regression was used to develop race-specific (non-Hispanic white [NHW], African American) reference equations for lobar volumes. Covariates included height and sex. Models were developed in a derivation cohort of 469 subjects with normal pulmonary function and validated in 546 similar subjects. These cohorts were combined to produce final prediction equations, which were applied to 2,191 subjects with old GOLD (Global Initiative for Chronic Obstructive Lung Disease) stage II to IV COPD. In the derivation cohort, women had smaller lobar volumes than men. Height positively correlated with lobar volumes. Adjusting for height, NHWs had larger total lung and lobar volumes at TLC than African Americans; at FRC, NHWs only had larger lower lobes. Age and weight had no effect on lobar volumes at TLC but had small effects at FRC. In subjects with COPD at TLC, upper lobes exceeded 100% of predicted values in GOLD II disease; lower lobes were only inflated to this degree in subjects with GOLD IV disease. At FRC, gas trapping was severe irrespective of disease severity and appeared uniform across the lobes. Reference equations for lobar volumes may be useful in assessing regional lung dysfunction and how it changes in response to pharmacologic therapies and surgical or endoscopic lung volume reduction.

Intravenous Immunoglobulin Monotherapy for Granulomatous Lymphocytic Interstitial Lung Disease in Common Variable Immunodeficiency.

Science.gov (United States)

Hasegawa, Mizue; Sakai, Fumikazu; Okabayashi, Asako; Sato, Akitoshi; Yokohori, Naoko; Katsura, Hideki; Asano, Chihiro; Kamata, Toshiko; Koh, Eitetsu; Sekine, Yasuo; Hiroshima, Kenzo; Ogura, Takashi; Takemura, Tamiko

2017-11-01

Common variable immunodeficiency (CVID) is a heterogeneous subset of immunodeficiency disorders. Recurrent bacterial infection is the main feature of CVID, but various non-infectious complications can occur. A 42-year-old woman presented with cough and abnormal chest X-ray shadows. Laboratory tests showed remarkable hypogammaglobulinemia. Computed tomography revealed multiple consolidation and nodules on the bilateral lung fields, systemic lymphadenopathy, and splenomegaly. A surgical lung biopsy specimen provided the final diagnosis of lymphoproliferative disease in CVID, which was grouped under the term granulomatous lymphocytic interstitial lung disease. Interestingly, the lung lesions of this case resolved immediately after the initiation of intravenous immunoglobulin monotherapy.

Degradation of proton depth dose distributions attributable to microstructures in lung-equivalent material

Energy Technology Data Exchange (ETDEWEB)

Titt, Uwe, E-mail: utitt@mdanderson.org; Mirkovic, Dragan; Mohan, Radhe [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030 (United States); Sell, Martin [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030 and Department of Medical Physics, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg 69120 (Germany); Unkelbach, Jan [Department of Radiation Oncology, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02114 (United States); Bangert, Mark [Department of Medical Physics, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg 69120 (Germany); Oelfke, Uwe [Department of Medical Physics, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg 69120, Germany and Department of Physics, The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP (United Kingdom)

2015-11-15

Purpose: The purpose of the work reported here was to investigate the influence of sub-millimeter size heterogeneities on the degradation of the distal edges of proton beams and to validate Monte Carlo (MC) methods’ ability to correctly predict such degradation. Methods: A custom-designed high-resolution plastic phantom approximating highly heterogeneous, lung-like structures was employed in measurements and in Monte Carlo simulations to evaluate the degradation of proton Bragg curves penetrating heterogeneous media. Results: Significant differences in distal falloff widths and in peak dose values were observed in the measured and the Monte Carlo simulated curves compared to pristine proton Bragg curves. Furthermore, differences between simulations of beams penetrating CT images of the phantom did not agree well with the corresponding experimental differences. The distal falloff widths in CT image-based geometries were underestimated by up to 0.2 cm in water (corresponding to 0.8–1.4 cm in lung tissue), and the peak dose values of pristine proton beams were overestimated by as much as ~35% compared to measured curves or depth-dose curves simulated on the basis of true geometry. The authors demonstrate that these discrepancies were caused by the limited spatial resolution of CT images that served as a basis for dose calculations and lead to underestimation of the impact of the fine structure of tissue heterogeneities. A convolution model was successfully applied to mitigate the underestimation. Conclusions: The results of this study justify further development of models to better represent heterogeneity effects in soft-tissue geometries, such as lung, and to correct systematic underestimation of the degradation of the distal edge of proton doses.

Degradation of proton depth dose distributions attributable to microstructures in lung-equivalent material

International Nuclear Information System (INIS)

Titt, Uwe; Mirkovic, Dragan; Mohan, Radhe; Sell, Martin; Unkelbach, Jan; Bangert, Mark; Oelfke, Uwe

2015-01-01

Purpose: The purpose of the work reported here was to investigate the influence of sub-millimeter size heterogeneities on the degradation of the distal edges of proton beams and to validate Monte Carlo (MC) methods’ ability to correctly predict such degradation. Methods: A custom-designed high-resolution plastic phantom approximating highly heterogeneous, lung-like structures was employed in measurements and in Monte Carlo simulations to evaluate the degradation of proton Bragg curves penetrating heterogeneous media. Results: Significant differences in distal falloff widths and in peak dose values were observed in the measured and the Monte Carlo simulated curves compared to pristine proton Bragg curves. Furthermore, differences between simulations of beams penetrating CT images of the phantom did not agree well with the corresponding experimental differences. The distal falloff widths in CT image-based geometries were underestimated by up to 0.2 cm in water (corresponding to 0.8–1.4 cm in lung tissue), and the peak dose values of pristine proton beams were overestimated by as much as ~35% compared to measured curves or depth-dose curves simulated on the basis of true geometry. The authors demonstrate that these discrepancies were caused by the limited spatial resolution of CT images that served as a basis for dose calculations and lead to underestimation of the impact of the fine structure of tissue heterogeneities. A convolution model was successfully applied to mitigate the underestimation. Conclusions: The results of this study justify further development of models to better represent heterogeneity effects in soft-tissue geometries, such as lung, and to correct systematic underestimation of the degradation of the distal edge of proton doses

WE-E-17A-05: Complementary Prognostic Value of CT and 18F-FDG PET Non-Small Cell Lung Cancer Tumor Heterogeneity Features Quantified Through Texture Analysis

Energy Technology Data Exchange (ETDEWEB)

Desseroit, M; Cheze Le Rest, C; Tixier, F [CHU Poitiers Poitiers (France); INSERM LaTIM UMR 1101, Brest (France); Majdoub, M; Visvikis, D; Hatt, M [INSERM LaTIM UMR 1101, Brest (France); Guillevin, R; Perdrisot, R [CHU Poitiers Poitiers (France)

2014-06-15

Purpose: Previous studies have shown that CT or 18F-FDG PET intratumor heterogeneity features computed using texture analysis may have prognostic value in Non-Small Cell Lung Cancer (NSCLC), but have been mostly investigated separately. The purpose of this study was to evaluate the potential added value with respect to prognosis regarding the combination of non-enhanced CT and 18F-FDG PET heterogeneity textural features on primary NSCLC tumors. Methods: One hundred patients with non-metastatic NSCLC (stage I–III), treated with surgery and/or (chemo)radiotherapy, that underwent staging 18F-FDG PET/CT images, were retrospectively included. Morphological tumor volumes were semi-automatically delineated on non-enhanced CT using 3D SlicerTM. Metabolically active tumor volumes (MATV) were automatically delineated on PET using the Fuzzy Locally Adaptive Bayesian (FLAB) method. Intratumoral tissue density and FDG uptake heterogeneities were quantified using texture parameters calculated from co-occurrence, difference, and run-length matrices. In addition to these textural features, first order histogram-derived metrics were computed on the whole morphological CT tumor volume, as well as on sub-volumes corresponding to fine, medium or coarse textures determined through various levels of LoG-filtering. Association with survival regarding all extracted features was assessed using Cox regression for both univariate and multivariate analysis. Results: Several PET and CT heterogeneity features were prognostic factors of overall survival in the univariate analysis. CT histogram-derived kurtosis and uniformity, as well as Low Grey-level High Run Emphasis (LGHRE), and PET local entropy were independent prognostic factors. Combined with stage and MATV, they led to a powerful prognostic model (p<0.0001), with median survival of 49 vs. 12.6 months and a hazard ratio of 3.5. Conclusion: Intratumoral heterogeneity quantified through textural features extracted from both CT and FDG PET

Monte Carlo calculations of the response of an external detector to a source of photons in the lungs of a heterogeneous phantom

International Nuclear Information System (INIS)

Bhati, S.; Sharma, R.C.; Somasundaram, S.

1979-01-01

A computer program to calculate the response of a 20 cm dia phoswich (3mm thick NaI(Tl) primary detector) to a source of low-energy photons distributed in the lungs of a heterogeneous (MIRD) phantom, approximating ICRP Reference Man, has been developed. Monte Carlo techniques are employed to generate photons and trace their fates in the thorax of MIRD phantom. The acceptable points of photon interactions in skeletal, lung and ordinary tissue are determined by Coleman technique. The photon interactions considered are photoelectric and Compton. The calculations yield the exit photon energy spectrum which is smeared with experimentally determined Gaussian resolution function to convert into pulse-height spectrum observable with the detector. The computer program has provisions for incorporating the effects of iodine K x-ray escape as well as variable intrinsic efficiency of the detector. Computed calibration factors (cpm/μCi integrated over the full spectrum) are given for the phoswich located centrally over and in contact with the chest for several low-energy photon sources distributed uniformly or as points in the lungs of the phantom. The radionuclides considered are 238 Pu, 239 Pu, 241 Am, 244 Cm, 246 Cm, 250 Cf and 103 Pd. Examples of generated exit photon and the corresponding pulse-height spectra are included. The spectral changes observed in these generated spectra, which are also discerned in experimental pulse-height spectra, are discussed in detail. Thus, photopeak energies of 18.4 and 55.5 KeV for Usub(L) x-rays and 241 Am gamma-rays respectively have been observed. It is shown that consideration of the total (i.e. both uncollided and those escaping after collision instead of the uncollided alone) flux of escaping photons improves the calibration factors by about 50% for 239 Pu, 70% for 103 Pd and as much as 340% for 241 Am gamma-rays. In addition, calibration factors are calculated for point 239 Pu sources located at different sites in the phantom lungs

Whole body irradiation in paediatrics: in vivo dose heterogeneity and relationship with survival and the complications rate

International Nuclear Information System (INIS)

Paoli, J.B.; Pignon, T.; Porcheron, D.; Juin, P.; Coze, C.; Bernard, J.L.

2000-01-01

No relationship has been found between the in vivo measured dose and the survival, neither relationship between the measured dose and the toxicity. The only organ for which an inter patients heterogeneity has been found was the lung. The reduction of the lung radiation dose allows to avoid any interstitial pneumopathy, but is significantly associated to a shortening of the survival. (N.C.)

Heterogeneity of Prognostic Profiles in Non-small Cell Lung Cancer: Too Many Variables but a Few Relevant

International Nuclear Information System (INIS)

Camara, Agustin Gomez de la; Lopez-Encuentra, Angel; Ferrando, Paloma

2005-01-01

Objective: Many prognostic factors, exceeding 150, for non-small cell lung cancer (NSCLC) are mentioned in the literature. The different statistical weight of the some variables at issue, their heterogeneity and their clinical uselessness is reviewed. Study design and setting: Survival analysis of a cohort of NSCLC operated (n = 1730, 1993-1997) was carried out utilizing different statistical approaches: Cox proportional hazard analysis (CPHA), logistic regression (LRA), and recursive partitioning (CART). Results: CPHA identified 13 prognostic variables and 11 LRA. Of the 17 possible variables, 10 are coincident. CART provided five different diagnostic groups but only three differentiated survival levels. Parsimonious models were constructed including only T and N cancer staging variables. Areas under the ROC curve of 0.68 and 0.68 were found for CPHA and LGA parsimonious models respectively, and 0.72 and 0.71 for complete models. Conclusion: Variables with a minimal impact on the respective models and thus with little or scarce predictive clinical repercussion were identified. Differences in the prognostic profile of survival can be caused by the different methodological approaches used. No relevant differences were found between the parsimonious and complete models. Although the amount of information managed is considerable, there continues to be a large predictive gap yet to be explained

Lung cancer risk in painters: a meta-analysis Risco de câncer de pulmão em pintores: uma meta-análise

Directory of Open Access Journals (Sweden)

Neela Guha

2011-08-01

Full Text Available We conducted a meta-analysis to quantitatively compare the association between occupation as a painter and the incidence or mortality from lung cancer. PubMed and the reference lists of pertinent publications were searched and reviewed. For the meta-analysis, we used data from 47 independent cohort, record linkage, and case-control studies (from a total of 74 reports, including > 11,000 incident cases or deaths from lung cancer among painters. Three authors independently abstracted data and assessed study quality. The summary relative risk (meta-RR, random effects for lung cancer in paint-ers was 1.35 [95% confidence interval (CI, 1.29-1.41; 47 studies] and 1.35 (95% CI, 1.21-1.51; 27 studies after controlling for smoking. The relative risk was higher in never-smokers (meta-RR = 2.00; 95% CI, 1.09-3.67; 3studies and persisted when restricted to studies that adjusted for other occupational exposures (meta-RR = 1.57; 95% CI, 1.21-2.04; 5 studies. These results support the conclusion that occupational exposures in painters are causally associated with the risk of lung cancer.Conduziu-se uma meta-análise para comparar quatitativamente a associação entre o trabalho de pintor e a incidência ou mortalidade por câncer de pulmão. PubMed e listas de referência de publicações pertinentes foram pesquisadas e revisadas. Para a análise, foram usados dados de 47 estudos de caso, coorte independente e ligação de dados (de um total de 74 relatórios, incluindo > 11 mil casos de incidentes ou morte por câncer de pulmão entre pintores. Três autores coletaram dados e avaliaram a qualidade de estudo. O risco relativo (meta-RR, efeitos aleatórios de câncer de pulmão em pintores foi de 1,35 [95% intervalo de confiança (IC, 1,29-1,41; 47 estudos] e 1,35 (95% IC, 1,21-1,51; 27 estudos depois de se destacar os fumantes. O risco relativo foi maior naqueles que nunca fumaram (meta-RR = 2.00; 95% CI, 1,09-3,67; 3 estudos e persistiu quanto restringido a

Effect of cadmium on lung lysosomal enzymes in vitro

International Nuclear Information System (INIS)

Giri, S.N.; Hollinger, M.A.

1995-01-01

Labilization of lysosomal enzymes is often associated with the general process of inflammation. The present study investigated the effect of the pneumotoxin cadmium on the release and activity of two lung lysosomal enzymes. Incubation of rat lung lysosomes with cadmium resulted in the release of β-glucuronidase but not acid phosphatase. The failure to ''release'' acid phosphatase appears to be the result of a direct inhibitory effect of cadmium on this enzyme. The K I for cadmium was determined to be 26.3 μM. The differential effect of cadmium on these two lysosomal enzymes suggests that caution should be exercised in selecting the appropriate enzyme marker for assessing lysosomal fragility in the presence of this toxicant. Furthermore, the differential basal release rate of the two enzymes from lung lysosomes may reflect the cellular heterogeneity of the lung. (orig.)

Injurious mechanical ventilation in the normal lung causes a progressive pathologic change in dynamic alveolar mechanics

OpenAIRE

Pavone, Lucio A; Albert, Scott; Carney, David; Gatto, Louis A; Halter, Jeffrey M; Nieman, Gary F

2007-01-01

Introduction Acute respiratory distress syndrome causes a heterogeneous lung injury, and without protective mechanical ventilation a secondary ventilator-induced lung injury can occur. To ventilate noncompliant lung regions, high inflation pressures are required to 'pop open' the injured alveoli. The temporal impact, however, of these elevated pressures on normal alveolar mechanics (that is, the dynamic change in alveolar size and shape during ventilation) is unknown. In the present study we ...

[Modern Views on Children's Interstitial Lung Disease].

Science.gov (United States)

Boĭtsova, E V; Beliashova, M A; Ovsiannikov, D Iu

2015-01-01

Interstitial lung diseases (ILD, diffuse lung diseases) are a heterogeneous group of diseases in which a pathological process primarily involved alveoli and perialveolar interstitium, resulting in impaired gas exchange, restrictive changes of lung ventilation function and diffuse interstitial changes detectable by X-ray. Children's interstitial lung diseases is an topical problem ofpediatricpulmonoogy. The article presents current information about classification, epidemiology, clinical presentation, diagnostics, treatment and prognosis of these rare diseases. The article describes the differences in the structure, pathogenesis, detection of various histological changes in children's ILD compared with adult patients with ILD. Authors cite an instance of registers pediatric patients with ILD. The clinical semiotics of ILD, the possible results of objective research, the frequency of symptoms, the features of medical history, the changes detected on chest X-rays, CT semiotics described in detail. Particular attention was paid to interstitial lung diseases, occurring mainly in newborns and children during the first two years of life, such as congenital deficiencies of surfactant proteins, neuroendocrine cell hyperplasia of infancy, pulmonary interstitial glycogenosis. The diagnostic program for children's ILD, therapy options are presented in this article.

Dosimetric implications associated to heterogeneity dose correction in stereotactic body radiation therapy (SBRT) of lung cancer; Implicaciones dosimetricas asociadas al calculo de dosis con correccion de heterogeneidad en radioterapia estereotaxica extracraneal (SBRT) de pulmon

Energy Technology Data Exchange (ETDEWEB)

Zucca Aparicio, D.; Perez Moreno, J. M.; Fernandez Leton, P.; Garcia Ruiz-Zorrila

2016-10-01

Treatment of lung lesions using stereotactic body radiation therapy (SBRT) requires algorithms with corrections that adequately model the behavior of narrow beams in the presence of tissue heterogeneities, although protocols such as RTOG 0236 excluded these kind of corrections. 100 cases were evaluated retrospectively following the RTOG 0813 and RTOG 0915 guidelines, by obtaining the deviations of the relevant dosimetric indicators from Monte Carlo (MC) and Pencil Beam (PB), maintaining the same configuration and monitor units (MU). Deviations between MC and PB have been classified according to the volume and density of the lesion. The greatest variations (up to 45% difference in D50%) are found for cases with lower volume and density, where the lesion is almost equivalent to lung tissue, given the higher proportion of air surrounding the periphery of the tumor, and the reduction of the radiation fields, resulting in a lack of electronic equilibrium that must be properly considered in the treatment planning system. These deviations involve dosimetric implications which are observable in clinical outcomes, determining how to proceed in treatment planning, to ensure that the actual dose delivered is performed accordingly to the prescription dose, while requiring the use of algorithms with a proper heterogeneity correction. (Author)

Diffusion-weighted MR imaging of the normal fetal lung

International Nuclear Information System (INIS)

Balassy, Csilla; Kasprian, Gregor; Weber, Michael; Hoermann, Marcus; Bankier, Alexander; Herold, Christian J.; Prayer, Daniela; Brugger, Peter C.; Csapo, Bence; Bammer, Roland

2008-01-01

To quantify apparent diffusion coefficient (ADC) changes in fetuses with normal lungs and to determine whether ADC can be used in the assessment of fetal lung development. In 53 pregnancies (20-37th weeks of gestation), we measured ADC on diffusion-weighted imaging (DWI) in the apical, middle, and basal thirds of the right lung. ADCs were correlated with gestational age. Differences between the ADCs were assessed. Fetal lung volumes were measured on T2-weighted sequences and correlated with ADCs and with age. ADCs were 2.13 ± 0.44 μm 2 /ms (mean ± SD) in the apex, 1.99 ± 0.42 μm 2 /ms (mean ± SD) in the middle third, and 1.91 ± 0.41 μm 2 /ms (mean ± SD) in the lung base. Neither the individual ADC values nor average ADC values showed a significant correlation with gestational age or with lung volumes. Average ADCs decreased significantly from the lung apex toward the base. Individual ADCs showed little absolute change and heterogeneity. Lung volumes increased significantly during gestation. We have not been able to identify a pattern of changes in the ADC values that correlate with lung maturation. Furthermore, the individual, gravity-related ADC changes are subject to substantial variability and show nonuniform behavior. ADC can therefore not be used as an indicator of lung maturity. (orig.)

Diffusion-weighted MR imaging of the normal fetal lung

Energy Technology Data Exchange (ETDEWEB)

Balassy, Csilla; Kasprian, Gregor; Weber, Michael; Hoermann, Marcus; Bankier, Alexander; Herold, Christian J.; Prayer, Daniela [Medical University of Vienna, Department of Radiology, Vienna (Austria); Brugger, Peter C. [Medical University of Vienna, Center of Anatomy and Cell Biology, Vienna (Austria); Csapo, Bence [Medical University of Vienna, Department of Obstetrics and Gyneocology, Vienna (Austria); Bammer, Roland [University of Stanford, Department of Radiology, Stanford, CA (United States)

2008-04-15

To quantify apparent diffusion coefficient (ADC) changes in fetuses with normal lungs and to determine whether ADC can be used in the assessment of fetal lung development. In 53 pregnancies (20-37th weeks of gestation), we measured ADC on diffusion-weighted imaging (DWI) in the apical, middle, and basal thirds of the right lung. ADCs were correlated with gestational age. Differences between the ADCs were assessed. Fetal lung volumes were measured on T2-weighted sequences and correlated with ADCs and with age. ADCs were 2.13 {+-} 0.44 {mu}m{sup 2}/ms (mean {+-} SD) in the apex, 1.99 {+-} 0.42 {mu}m{sup 2}/ms (mean {+-} SD) in the middle third, and 1.91 {+-} 0.41 {mu}m{sup 2}/ms (mean {+-} SD) in the lung base. Neither the individual ADC values nor average ADC values showed a significant correlation with gestational age or with lung volumes. Average ADCs decreased significantly from the lung apex toward the base. Individual ADCs showed little absolute change and heterogeneity. Lung volumes increased significantly during gestation. We have not been able to identify a pattern of changes in the ADC values that correlate with lung maturation. Furthermore, the individual, gravity-related ADC changes are subject to substantial variability and show nonuniform behavior. ADC can therefore not be used as an indicator of lung maturity. (orig.)

A Method for Correcting IMRT Optimizer Heterogeneity Dose Calculations

International Nuclear Information System (INIS)

Zacarias, Albert S.; Brown, Mellonie F.; Mills, Michael D.

2010-01-01

Radiation therapy treatment planning for volumes close to the patient's surface, in lung tissue and in the head and neck region, can be challenging for the planning system optimizer because of the complexity of the treatment and protected volumes, as well as striking heterogeneity corrections. Because it is often the goal of the planner to produce an isodose plan with uniform dose throughout the planning target volume (PTV), there is a need for improved planning optimization procedures for PTVs located in these anatomical regions. To illustrate such an improved procedure, we present a treatment planning case of a patient with a lung lesion located in the posterior right lung. The intensity-modulated radiation therapy (IMRT) plan generated using standard optimization procedures produced substantial dose nonuniformity across the tumor caused by the effect of lung tissue surrounding the tumor. We demonstrate a novel iterative method of dose correction performed on the initial IMRT plan to produce a more uniform dose distribution within the PTV. This optimization method corrected for the dose missing on the periphery of the PTV and reduced the maximum dose on the PTV to 106% from 120% on the representative IMRT plan.

The fetal MR appearance of 'nutmeg lung': findings in 8 cases linked to pulmonary lymphangiectasia

Energy Technology Data Exchange (ETDEWEB)

Victoria, Teresa [The Children' s Hospital of Philadelphia, Radiology Department, Center for Fetal Diagnosis and Treatment, Philadelphia, PA (United States); Andronikou, Savvas [University of the Witwatersrand, Department of Radiology, Faculty of Health Sciences, Cape Town (South Africa)

2014-10-15

A pattern of abnormal signal at fetal MRI may be seen in the setting of primary or secondary congenital lymphangiectasia, manifested as a heterogeneous appearance of the lung parenchyma and the presence of subtle T2-hyperintense branching tubular structures that emanate from the hila. We have named this pattern the nutmeg lung. We describe the nutmeg lung appearance seen in fetal MRI scans, with discussion of possible etiologies and outcomes in a series of eight fetuses. We retrospectively reviewed imaging from a database of patients demonstrating features of nutmeg lung on fetal MRI. Medical records were used to determine the postnatal diagnosis, clinical course and outcome. Among the eight fetal cases of nutmeg lung, two had postnatal confirmation of primary lymphangiectasia and the remaining six had secondary lymphangiectasia, presumably secondary to congenital cardiac anomalies. There were various-size pleural effusions in all cases. Only one of the cases demonstrated hydrops fetalis. We present the description of the nutmeg lung sign on fetal MRI as T2-hyperintense heterogeneous lungs with fluid-filled, serpiginous branching structures that extend from the pulmonary hila to the periphery of the lung, often accompanied by pleural effusions. The sign denotes findings of primary or secondary lymphangiectasia. Findings of secondary lymphangiectasia in our series were a result of cardiac insufficiency. Recognizing this sign might be helpful in the diagnostic algorithm of the fetus with abnormal lung parenchyma. (orig.)

A dominated and resistant subpopulation causes regrowth after response to 1,3-bis(2-chloroethyl)-1-nitrosourea treatment of a heterogeneous small cell lung cancer xenograft in nude mice

DEFF Research Database (Denmark)

Aabo, K; Roed, H; Vindeløv, L L

1994-01-01

In order to address the question of the influence of a primarily chemoresistant tumor cell subpopulation on the progression of a heterogeneous tumor after cytotoxic therapy, in vitro established human small cell lung cancer cell lines of a 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU)-sensitive (592...... was demonstrated in the 9:1 mixed tumors in which only 592 cells were detectable at the start of the treatment. The response was short and less pronounced compared with tumors containing only 592. In the regrowing tumors after treatment, only NYH was detected. In untreated 9:1 mixed control tumors, only 592 cells...

Differences in the dose-volume metrics with heterogeneity correction status and its influence on local control in stereotactic body radiation therapy for lung cancer

International Nuclear Information System (INIS)

Ueki, Nami; Matsuo, Yukinori; Nakamura, Mitsuhiro; Narabayashi, Masaru; Sakanaka, Katsuyuki; Norihisa, Yoshiki; Mizowaki, Takashi; Hiraoka, Masahiro; Shibuya, Keiko

2013-01-01

The purpose of this study is to evaluate the dose-volume metrics under different heterogeneity corrections and the factors associated with local recurrence (LR) after stereotactic body radiation therapy (SBRT) for non-small-cell lung cancer (NSCLC). Eighty-three patients who underwent SBRT for pathologically proven stage I NSCLC were reviewed retrospectively. The prescribed dose was 48 Gy in four fractions at the isocenter (IC) under heterogeneity correction with the Batho power law (BPL). The clinical plans were recalculated with Eclipse (Varian) for the same monitor units under the BPL and anisotropic analytical algorithm (AAA) and with no heterogeneity correction (NC). The dose at the IC, dose that covers 95% of the volume (D95), minimum dose (Min), and mean dose (Mean) of the planning target volume (PTV) were compared under each algorithm and between patients with local lesion control (LC) and LR. The IC doses under NC were significantly lower than those under the BPL and AAA. Under the BPL, the mean PTV D95, Min and Mean were 8.0, 9.4 and 7.4% higher than those under the AAA, and 9.6, 9.2 and 4.6% higher than those under NC, respectively. Under the AAA, all dose-volumetric parameters were significantly lower in T1a patients than in those with T1b and T2a. With a median follow-up of 35.9 months, LR occurred in 18 patients. Between the LC and LR groups, no significant differences were observed for any of the metrics. Even after stratification according to T-stage, no significant difference was observed between LC and LR. (author)

Air pollution from traffic and risk for lung cancer in three Danish cohorts

DEFF Research Database (Denmark)

Raaschou-Nielsen, Ole; Bak, Helle; Sørensen, Mette

2010-01-01

BACKGROUND: Air pollution is suspected to cause lung cancer. The purpose was to investigate whether the concentration of nitrogen oxides (NOx) at the residence, used as an indicator of air pollution from traffic, is associated with risk for lung cancer. METHODS: We identified 679 lung cancer cases...... ratio per 100 microg/m3 NOx. The results showed no significant heterogeneity in the incidence rate ratio for lung cancer between cohorts or between strata defined by gender, educational level, or smoking status. CONCLUSION: The study showed a modest association between air pollution from traffic...... and the risk for lung cancer. IMPACT: This study points at traffic as a source of carcinogenic air pollution and stresses the importance of strategies for reduction of population exposure to traffic-related air pollution....

Airway remodeling and long-term decline in lung function in asthma

NARCIS (Netherlands)

Ten Hacken, NHT; Postma, DS; Timens, W

Asthma is a heterogeneous disease that frequently shows progression of airway obstruction. There are indications that ongoing airway inflammation is responsible for the more severe hyperresponsiveness, lower lung function, and accelerated loss of forced expiratory volume in 1 second. At this moment,

Functions and mechanisms of long noncoding RNAs in lung cancer

Directory of Open Access Journals (Sweden)

Peng ZZ

2016-07-01

Full Text Available Zhenzi Peng, Chunfang Zhang, Chaojun Duan Institute of Medical Sciences, Key Laboratory of Cancer Proteomics of Chinese Ministry of Health, Xiangya Hospital, Central South University, Changsha, People’s Republic of China Abstract: Lung cancer is a heterogeneous disease, and there is a lack of adequate biomarkers for diagnosis. Long noncoding RNAs (lncRNAs are emerging as an important set of molecules because of their roles in various key pathophysiological pathways, including cell growth, apoptosis, and metastasis. We review the current knowledge of the lncRNAs in lung cancer. In-depth analyses of lncRNAs in lung cancer have increased the number of potential effective biomarkers, thus providing options to increase the therapeutic benefit. In this review, we summarize the functions, mechanisms, and regulatory networks of lncRNAs in lung cancer, providing a basis for further research in this field. Keywords: ncRNA, tumorigenesis, biomarker, network, proliferation, apoptosis 

Early Change in Metabolic Tumor Heterogeneity during Chemoradiotherapy and Its Prognostic Value for Patients with Locally Advanced Non-Small Cell Lung Cancer.

Directory of Open Access Journals (Sweden)

Xinzhe Dong

Full Text Available To observe the early change of metabolic tumor heterogeneity during chemoradiotherapy and to determine its prognostic value for patients with locally advanced non-small cell lung cancer (NSCLC.From January 2007 to March 2010, 58 patients with NSCLC were included who were received 18F-fluorodeoxyglucose (18F-FDG PET/CT before and following 40 Gy radiotherapy with the concurrent cisplatin-based chemotherapy (CCRT. Primary tumor FDG uptake heterogeneity was determined using global and local scale textural features extracted from standardized uptake value (SUV histogram analysis (coefficient of variation [COV], skewness, kurtosis, area under the curve of the cumulative SUV histogram [AUC-CSH] and normalized gray-level co-occurrence matrix (contrast, dissimilarity, entropy, homogeneity. SUVmax and metabolic tumor volume (MTV were also evaluated. Correlations were analyzed between parameters on baseline or during treatments with tumor response, progression-free survival (PFS, and overall survival (OS.Compared with non-responders, responders showed significantly greater pre-treatment COV, contrast and MTV (AUC = 0.781, 0.804, 0.686, respectively. Receiver-operating-characteristic curve analysis showed that early change of tumor textural analysis serves as a response predictor with higher sensitivity (73.2%~92.1% and specificity (80.0%~83.6% than baseline parameters. Change in AUC-CSH and dissimilarity during CCRT could also predict response with optimal cut-off values (33.0% and 28.7%, respectively. The patients with greater changes in contrast and AUC-CSH had significantly higher 5-year OS (P = 0.008, P = 0.034 and PFS (P = 0.007, P = 0.039. In multivariate analysis, only change in contrast was found as the independent prognostic factor of PFS (HR 0.476, P = 0.021 and OS (HR 0.519, P = 0.015.The metabolic tumor heterogeneity change during CCRT characterized by global and local scale textural features may be valuable for predicting treatment response

Effects of ionization chamber construction on dose measurements in a heterogeneity

International Nuclear Information System (INIS)

Mauceri, T.; Kase, K.

1987-01-01

Traditionally, measurements have been made in heterogeneous phantoms to determine the factors which should be applied to dose calculations, when calculating a dose to a heterogeneous medium. Almost all measurements have relied on relatively thin-walled ion chambers, with no attempt to match ion chamber wall material to the measuring medium. The recent AAPM dosimetry protocol has established that a mismatch between ion chamber wall and phantom material can have an effect on dose measurement. To investigate the affect of this mismatch of ion chamber wall material to phantom material, two parallel-plate ion chambers were constructed. One ion chamber from solid water, for measurements in a solid water phantom and the other from plastic lung material, for measurements in a plastic lung material phantom. Correction factors measured by matching ion chamber to media were compared to correction factors measured by using a thin-walled cavity ion chamber with no regard for matching wall and media for cobalt-60, 6-, 10- and 20-MV photon beams. The results demonstrated that the matching of ion chamber to measuring media can be ignored, provided that a small, approximately tissue-equivalent, thin-walled ion chamber is used for measuring the correction factors

miR-638 regulates gene expression networks associated with emphysematous lung destruction

NARCIS (Netherlands)

Christenson, Stephanie A.; Brandsma, Corry-Anke; Campbell, Joshua D.; Knight, Darryl A.; Pechkovsky, Dmitri V.; Hogg, James C.; Timens, Wim; Postma, Dirkje S.; Lenburg, Marc; Spira, Avrum

2013-01-01

Background: Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease characterized by varying degrees of emphysematous lung destruction and small airway disease, each with distinct effects on clinical outcomes. There is little known about how microRNAs contribute specifically to the

Compensatory lung growth in autologus lobar implant after pneumonectomy in dogs Crescimento pulmonar compensatório em implante lobar autólogo pós-pneumonectomia em cães

Directory of Open Access Journals (Sweden)

Antônio José Maria Cataneo

2005-10-01

Full Text Available PURPOSE: Evaluate compensatory lung growth (CLG in lobar transplant and see if it is similar to CLG after lobectomy. METHODS: We used 48 dogs in three groups (G1=control, G2=left cranial lobectomy, and G3=pneumonectomy with reimplantation of left caudal lobe. Five months after surgery animals underwent lung scintigraphy and were then sacrificed for lung morphometric study. RESULTS: There was no correlation between scintigraphy and lung mass or lung volume. There was both mass and residual volume CLG in the operated groups, both contralateral and epsilateral to surgery; there was no compensation for total lung capacity or compliance in the remaining caudal lobe (G2 or the reimplanted caudal lobe (G3 5 months after surgery, there was more damage in the reimplanted lobe. As previous studies have show that CLG starts with increased mass and residual volume and that compliance is later compensated, this study seems to have documented the beginning of CLG, with lung compliance being the limiting factor of CLG after 5 months of study. CONCLUSION: There is CLG in both reimplanted lobe and contralateral lung but compliance is still reduced. CLG was similar in both groups but implanted lobe compliance was more prejudiced.OBJETIVO: Avaliar se existe crescimento compensatório pulmonar em transplante lobar e verificar se este crescimento é semelhante ao que ocorre após lobectomia. MÉTODOS: Foram utilizados 48 cães, distribuídos em 3 grupos (G1=controle, G2=lobectomia cranial esquerda e G3=pneumonectomia com reimplante do lobo caudal esquerdo. Após 5 meses da cirurgia, os animais foram submetidos à cintilografia pulmonar e a seguir sacrificados para estudo morfométrico pulmonar. RESULTADOS: Os resultados mostraram que não existe correlação da cintilografia nem com a massa nem com o volume do pulmão. Houve crescimento compensatório em massa e volume residual nos dois grupos operados, tanto no pulmão contralateral como no ipsilateral à cirurgia

Systems medicine advances in interstitial lung disease.

Science.gov (United States)

Greiffo, Flavia R; Eickelberg, Oliver; Fernandez, Isis E

2017-09-30

Fibrotic lung diseases involve subject-environment interactions, together with dysregulated homeostatic processes, impaired DNA repair and distorted immune functions. Systems medicine-based approaches are used to analyse diseases in a holistic manner, by integrating systems biology platforms along with clinical parameters, for the purpose of understanding disease origin, progression, exacerbation and remission.Interstitial lung diseases (ILDs) refer to a heterogeneous group of complex fibrotic diseases. The increase of systems medicine-based approaches in the understanding of ILDs provides exceptional advantages by improving diagnostics, unravelling phenotypical differences, and stratifying patient populations by predictable outcomes and personalised treatments. This review discusses the state-of-the-art contributions of systems medicine-based approaches in ILDs over the past 5 years. Copyright ©ERS 2017.

Abcesso Pulmonar – Estudo Retrospectivo

Directory of Open Access Journals (Sweden)

M. José Augusto

1995-11-01

Full Text Available RESUMO: O abcesso pulmonar é definido como uma supuração colectada numa cavidade neoformada no pulmão, por uma inflamação aguda não tuberculosa. Por esta definição, estão excluídas as supuraçãoes desenvolvidas em cavidades pré existentes (quistos aereos, carcinoma escavado, bronquiectasias e as resultantes de processos bacilares (1,2,4.Os autores apresentam os resultados de uma revisão clínica de 24 casos correspondentes aos doentes internados com aquele diagnóstico desde 1 de Janeiro de 1990 a 31 de Dezembro de 1994 no Serviço de Medicina Interna do Hospital Distrital de Aveiro.O estudo incidiu na análise dos processos clínicos e radiológicos avaliando a distribuição por sexo, faixa etária, factores predisponentes, tempo de internamento, expressão clínica, radiológica, bacteriológica e finalizando com a terapêutica e evolução. SUMMARY: Lung abcess is defined as a collected suppuration in a neoformed cavity in the lung, caused by a non tuberculous inflammation. From this definition, supurations developed in pre-existant cavities (aerial cysts, escavated carcinoma, bronchiectasis and those resulting from bacillary process, are excluded.The authors submit the results of a clinical revision of 24 cases corresponding to resident patients with that diagnosis from 1st. January 1990 to 31st December 1994 in the Internal Medicine at R.D. Aveiro.The study rests on the analysis of the radiologic and clinical processes taking into account distribution by age and sex, predisposing factors, lenght of internment, radiological and clinical expression, bacteriological profile, therapy and evolution. Palavras-chave: Abcesso Pulmonar, terapêutica, radiologia, Key-Words: Lung abcess, therapy, radiology

Obesity Paradox in Lung Cancer Prognosis: Evolving Biological Insights and Clinical Implications.

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Zhang, Xueli; Liu, Yamin; Shao, Hua; Zheng, Xiao

2017-10-01

The survival rate of lung cancer remains low despite the progress of surgery and chemotherapy. With the increasing comorbidity of obesity in patients with lung cancer, new challenges are emerging in the management of this patient population. A key issue of interest is the prognostic effect of obesity on surgical and chemotherapeutic outcomes in patients with lung cancer, which is fueled by the growing observation of survival benefits in overweight or obese patients. This unexpected inverse relationship between obesity and lung cancer mortality, called the obesity paradox, remains poorly understood. The evolving insights into the heterogeneity of obesity phenotypes and associated biological connections with lung cancer progression in recent years may help explain some of the seemingly paradoxical relationship, and well-designed clinical studies looking at the causal role of obesity-associated molecules are expected. Here, we examine potential biological mechanisms behind the protective effects of obesity in lung cancer. We highlight the need to clarify the clinical implications of this relationship toward an updated intervention strategy in the clinical care of patients with lung cancer and obesity. Copyright © 2017 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.

Significance of lung anomalies in fetuses affected by tetralogy of Fallot with absent pulmonary valve syndrome.

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Tenisch, Estelle; Raboisson, Marie-Josée; Rypens, Françoise; Déry, Julie; Grignon, Andrée; Lapierre, Chantale

2017-11-01

Tetralogy of Fallot with absent pulmonary valve syndrome is a rare form of tetralogy of Fallot with dilatation of large pulmonary arteries. Prognosis is related to the severity of the cardiac malformation and to bronchial tree compression by dilated pulmonary arteries. This study analyses the prenatal echographic lung appearance in fetuses with tetralogy of Fallot with absent pulmonary valve and discusses its significance. We carried out a retrospective review of fetal and postnatal files of nine fetuses diagnosed with tetralogy of Fallot with absent pulmonary valve syndrome in our institution. Correlations of prenatal ultrasound and cardiac imaging findings were obtained with outcome. Abnormal heterogeneous fetal lung echogenicity was detected in eight cases out of nine, always associated with significant lobar arterial dilatation. This aspect was well correlated with postnatal imaging and outcome in the four neonatal cases. The only fetus with normal lung echogenicity also had lower degree of pulmonary artery dilatation in the series. This study demonstrates that a heterogeneous ultrasound appearance of the fetal lungs can be detected in utero in the most severe cases. This aspect suggests an already significant compression of the fetal bronchial tree by the dilated arteries that may have prognostic implications.

Characterisation of COPD heterogeneity in the ECLIPSE cohort

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Agusti Alvar

2010-09-01

Full Text Available Abstract Background Chronic obstructive pulmonary disease (COPD is a complex condition with pulmonary and extra-pulmonary manifestations. This study describes the heterogeneity of COPD in a large and well characterised and controlled COPD cohort (ECLIPSE. Methods We studied 2164 clinically stable COPD patients, 337 smokers with normal lung function and 245 never smokers. In these individuals, we measured clinical parameters, nutritional status, spirometry, exercise tolerance, and amount of emphysema by computed tomography. Results COPD patients were slightly older than controls and had more pack years of smoking than smokers with normal lung function. Co-morbidities were more prevalent in COPD patients than in controls, and occurred to the same extent irrespective of the GOLD stage. The severity of airflow limitation in COPD patients was poorly related to the degree of breathlessness, health status, presence of co-morbidity, exercise capacity and number of exacerbations reported in the year before the study. The distribution of these variables within each GOLD stage was wide. Even in subjects with severe airflow obstruction, a substantial proportion did not report symptoms, exacerbations or exercise limitation. The amount of emphysema increased with GOLD severity. The prevalence of bronchiectasis was low (4% but also increased with GOLD stage. Some gender differences were also identified. Conclusions The clinical manifestations of COPD are highly variable and the degree of airflow limitation does not capture the heterogeneity of the disease.

Can dogs smell lung cancer? First study using exhaled breath and urine screening in unselected patients with suspected lung cancer.

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Amundsen, Tore; Sundstrøm, Stein; Buvik, Turid; Gederaas, Odrun Arna; Haaverstad, Rune

2014-03-01

On the basis of our own experience and literature search, we hypothesised that a canine olfactory test may be useful for detecting lung cancer in an unselected population of patients suspected to have lung cancer. We conducted a prospective study of 93 patients consecutively admitted to hospital with suspected lung cancer. Exhaled breath and urine were sampled before the patients underwent bronchoscopy. The canine olfactory test was performed in a double-blinded manner. Sensitivity and specificity were outcome measures. With 99% sensitivity, the olfactory test demonstrated that dogs have the ability to distinguish cancer patients from healthy individuals. With an intensified training procedure, the exhaled breath and urine tests showed sensitivity rates of 56-76% and specificity rates of 8.3-33.3%, respectively, in our heterogeneous study population. Although the olfactory test appears to be a promising tool for the detection of cancer, the main challenge is to determine whether the test can sufficiently discriminate between patients at risk, patients with benign disease, and patients with malignant disease. We need to gain a deeper understanding of this test and further refine it before applying it as a screening tool for lung cancer in clinical settings.

Large-scale association analysis identifies new lung cancer susceptibility loci and heterogeneity in genetic susceptibility across histological subtypes

DEFF Research Database (Denmark)

McKay, James D; Hung, Rayjean J; Han, Younghun

2017-01-01

Although several lung cancer susceptibility loci have been identified, much of the heritability for lung cancer remains unexplained. Here 14,803 cases and 12,262 controls of European descent were genotyped on the OncoArray and combined with existing data for an aggregated genome-wide association ...... receptor, CHRNA2, and the telomere-related genes OFBC1 and RTEL1. Further exploration of the target genes will continue to provide new insights into the etiology of lung cancer....

Combining Cell Type-Restricted Adenoviral Targeting with Immunostaining and Flow Cytometry to Identify Cells-of-Origin of Lung Cancer.

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Best, Sarah A; Kersbergen, Ariena; Asselin-Labat, Marie-Liesse; Sutherland, Kate D

2018-01-01

Lung cancers display considerable intertumoral heterogeneity, leading to the classification of distinct tumor subtypes. Our understanding of the genetic aberrations that underlie tumor subtypes has been greatly enhanced by recent genomic sequencing studies and state-of-the-art gene targeting technologies, highlighting evidence that distinct lung cancer subtypes may be derived from different "cells-of-origin". Here, we describe the intra-tracheal delivery of cell type-restricted Ad5-Cre viruses into the lungs of adult mice, combined with immunohistochemical and flow cytometry strategies for the detection of lung cancer-initiating cells in vivo.

Tumor cell heterogeneity in Small Cell Lung Cancer (SCLC: phenotypical and functional differences associated with Epithelial-Mesenchymal Transition (EMT and DNA methylation changes.

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Alexander Krohn

Full Text Available Small Cell Lung Cancer (SCLC is a specific subtype of lung cancer presenting as highly metastatic disease with extremely poor prognosis. Despite responding initially well to chemo- or radiotherapy, SCLC almost invariably relapses and develops resistance to chemotherapy. This is suspected to be related to tumor cell subpopulations with different characteristics resembling stem cells. Epithelial-Mesenchymal Transition (EMT is known to play a key role in metastatic processes and in developing drug resistance. This is also true for NSCLC, but there is very little information on EMT processes in SCLC so far. SCLC, in contrast to NSCLC cell lines, grow mainly in floating cell clusters and a minor part as adherent cells. We compared these morphologically different subpopulations of SCLC cell lines for EMT and epigenetic features, detecting significant differences in the adherent subpopulations with high levels of mesenchymal markers such as Vimentin and Fibronectin and very low levels of epithelial markers like E-cadherin and Zona Occludens 1. In addition, expression of EMT-related transcription factors such as Snail/Snai1, Slug/Snai2, and Zeb1, DNA methylation patterns of the EMT hallmark genes, functional responses like migration, invasion, matrix metalloproteases secretion, and resistance to chemotherapeutic drug treatment all differed significantly between the sublines. This phenotypic variability might reflect tumor cell heterogeneity and EMT during metastasis in vivo, accompanied by the development of refractory disease in relapse. We propose that epigenetic regulation plays a key role during phenotypical and functional changes in tumor cells and might therefore provide new treatment options for SCLC patients.

Cancro do pulmão no norte de Portugal: um estudo de base hospitalar

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V. Hespanhol

2013-11-01

Full Text Available Resumo: Introdução: O cancro do pulmão é o cancro que mais mortalidade determina em todo mundo. Em Portugal a doença mantém-se a principal causa de morte por cancro no sexo masculino. Objetivo: Neste estudo pretendeu-se avaliar as características demográficas e clínicas dos doentes com cancro do pulmão diagnosticados e tratados nos hospitais do norte de Portugal entre os anos 2000-2010. Doentes e métodos: Doze hospitais contribuíram para este estudo. Foram analisadas as características demográficas e clínicas dos doentes com cancro do pulmão registados em cada hospital, entre os anos 2000-2010, nos hospitais do norte de Portugal, bem como os padrões de ocorrência da doença. Resultados: Ao longo de um período de 11 anos (2000-2010, 9.767 doentes com cancro do pulmão foram registados nos hospitais participantes. Identificamos um importante aumento no número de doentes registados em relação aos registados em 2000. No sexo feminino observou-se uma elevação da ocorrência atingindo os 30%, o que é significativo, apesar do cancro do pulmão nas mulheres, em Portugal, ser muito menos frequente que nos homens e nesta série representar apenas 20% dos casos. Um número elevado de doentes, 3.117 (48,6%, tinha mau estado geral na altura que recorreram aos cuidados de saúde. O adenocarcinoma foi-se tornando a histologia mais preponderante ao longo do período de estudo. A maior parte dos doentes, 7.206 (77,8%, foi diagnosticada em estádios avançados (IIIB, IV da doença. A quimioterapia foi o tratamento escolhido para 3.529 (40,4% dos doentes, por outro lado, a cirurgia foi possível em 1.301 (14,9% dos casos. Conclusão: Um elevado número de doentes com cancro do pulmão é diagnosticado e tratado nos hospitais do norte de Portugal. A incidência no sexo feminino tem vindo a aumentar. A esmagadora maioria dos tumores foi diagnosticada em estádio avançado, tendo sido possível, apesar disso, tratar cirurgicamente 14,9% dos

SU-E-J-55: Dosimetric Evaluation of Centrally Located Lung Tumors: A Monte Carlo (MC) Study of Lung SBRT Planning

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Pokhrel, D; Badkul, R; Jiang, H; Saleh, H; Estes, C; Park, J; Kumar, P; Wang, F [University Kansas Medical Center, Kansas City, KS (United States)

2014-06-01

Purpose: To compare dose distributions calculated using the iPlan XVMC algorithm and heterogeneities corrected/uncorrected Pencil Beam (PB-hete/PB-homo) algorithms for SBRT treatments of lung tumors. Methods: Ten patients with centrally located solitary lung tumors were treated using MC-based SBRT to 60Gy in 5 fractions for PTVV100%=95%. ITV was delineated on MIP-images based on 4D-CT scans. PTVs(ITV+5mm margins) ranged from 10.1–106.5cc(mean=48.6cc). MC-SBRT plans were generated with a combination of non-coplanar conformal arcs/beams using iPlan-XVMC-algorithm (BrainLABiPlan ver.4.1.2) for Novalis-TX consisting of HD-MLCs and 6MV-SRS(1000MU/min) mode, following RTOG 0813 dosimetric criteria. For comparison, PB-hete/PB-homo algorithms were used to re-calculate dose distributions using same beam configurations, MLCs/monitor units. Plans were evaluated with isocenter/maximal/mean doses to PTV. Normal lung doses were evaluated with V5/V10/V20 and mean-lung-dose(MLD), excluding PTV. Other OAR doses such as maximal spinal cord/2cc-esophagus/max bronchial tree (BT/maximal heart doses were tabulated. Results: Maximal/mean/isocenter doses to PTV calculated by PB-hete were uniformly larger than MC plans by a factors of 1.09/1.13/1.07, on average, whereas they were consistently lower by PB-homo by a factors of 0.9/0.84/0.9, respectively. The volume covered by 5Gy/10Gy/20Gy isodose-lines of the lung were comparable (average within±3%) when calculated by PB-hete compared to XVMC, but, consistently lower by PB-homo by a factors of 0.90/0.88/0.85, respectively. MLD was higher with PB-hete by 1.05, but, lower by PB-homo by 0.9, on average, compared to XVMC. XVMC max-cord/max-BT/max-heart and 2cc of esophagus doses were comparable to PB-hete; however, PB-homo underestimates by a factors of 0.82/0.89/0.88/0.86, on average, respectively. Conclusion: PB-hete significantly overestimates dose to PTV relative to XVMC -hence underdosing the target. MC is more complex and accurate with

Studies on mRNA expression of the somatostatin receptor family in lung cancer

International Nuclear Information System (INIS)

Wang Jing; Deng Jinglan; Wu Shengxi; Qiao Hongqing

2000-01-01

Objective: To investigate the characteristics of expression and distribution of 5 subtypes of somatostatin receptors (SSTR1∼5) in lung cancer. Methods: With [α- 35 S]dATP labelled oligonucleotides of the 5 SSTR subtypes as probes, using in situ hybridization, patterns of mRNA expression were detected in lung cancer tissue sections of 21 cases which fell in varied pathologic types. Additionally, Leica Q-500 image analyzing device was employed to semi-quantitatively analyze density of the expression. Results: Patterns of SSTR1∼5 expression in lung cancer were as follows: SSTR2 expression was dominant in small cell lung cancer (SCLC) while in non-small cell lung cancer (NSCLC) such as adenous and squamous, SSTR1 expression was stronger than that of the other 4 subtypes, In density of SSTR1∼5 expression in lung cancer, NSCLC was higher than SCLC (P<0.01). Conclusions: even though patterns and density of expression of SSTR subtypes in the lung cancer showed heterogeneity in different histopathologic types, as in SCLC and in NSCLC. Therefore, it has positive prospects for somatostatin analog-oriented agents to be used in treatment of both types of the lung cancers

Expression of the somatostatin receptor family mRNAs in lung cancer

International Nuclear Information System (INIS)

Wang Jing; Wang Liangang; Deng Jinglan; Wu Shengxi

2000-01-01

To investigate the characteristics of expression and distribution of 5 subtypes of somatostatin receptors (SSTR1-5) in lung cancer, in situ hybridization was used to examine the expression patterns of SSTR mRNAs in 21 cases of different pathologic types of lung cancer tissues with [α- 35 S]dATP labelled oligonucleotides of the 5 SSTR subtypes as probes. Additionally, Leica Q-500 image analysis processing system was employed for the semi-quantitatively analysis of the hybridization signals. Patterns of SSTR1-5 expression in lung cancer tissues were found as follows. SSTR2 was prominent in small cell lung cancer (SCLC), whereas in non-small cell lung cancer (NSCLC) including the adenous cancer (Ad) and the squamous cancer (Sq), the expression of SSTR1 mRNA was stronger than that of the other 4 types. the expression density of SSTR1-5 in the NSCLC was higher that the SCLC (p < 0.01). The expression patterns and densities of the SSTR subtypes showed heterogeneity in different pathologic types of lung cancer. The expressions of the SSTR mRNAs in both SCLC and NSCLC indicated the positive prospects for somatostatin analog (SSA)-oriented agents in the treatment of both types of the lung cancer

Intra-Tumour Signalling Entropy Determines Clinical Outcome in Breast and Lung Cancer

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Banerji, Christopher R. S.; Severini, Simone; Caldas, Carlos; Teschendorff, Andrew E.

2015-01-01

The cancer stem cell hypothesis, that a small population of tumour cells are responsible for tumorigenesis and cancer progression, is becoming widely accepted and recent evidence has suggested a prognostic and predictive role for such cells. Intra-tumour heterogeneity, the diversity of the cancer cell population within the tumour of an individual patient, is related to cancer stem cells and is also considered a potential prognostic indicator in oncology. The measurement of cancer stem cell abundance and intra-tumour heterogeneity in a clinically relevant manner however, currently presents a challenge. Here we propose signalling entropy, a measure of signalling pathway promiscuity derived from a sample’s genome-wide gene expression profile, as an estimate of the stemness of a tumour sample. By considering over 500 mixtures of diverse cellular expression profiles, we reveal that signalling entropy also associates with intra-tumour heterogeneity. By analysing 3668 breast cancer and 1692 lung adenocarcinoma samples, we further demonstrate that signalling entropy correlates negatively with survival, outperforming leading clinical gene expression based prognostic tools. Signalling entropy is found to be a general prognostic measure, valid in different breast cancer clinical subgroups, as well as within stage I lung adenocarcinoma. We find that its prognostic power is driven by genes involved in cancer stem cells and treatment resistance. In summary, by approximating both stemness and intra-tumour heterogeneity, signalling entropy provides a powerful prognostic measure across different epithelial cancers. PMID:25793737

Intra-tumour signalling entropy determines clinical outcome in breast and lung cancer.

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Christopher R S Banerji

2015-03-01

Full Text Available The cancer stem cell hypothesis, that a small population of tumour cells are responsible for tumorigenesis and cancer progression, is becoming widely accepted and recent evidence has suggested a prognostic and predictive role for such cells. Intra-tumour heterogeneity, the diversity of the cancer cell population within the tumour of an individual patient, is related to cancer stem cells and is also considered a potential prognostic indicator in oncology. The measurement of cancer stem cell abundance and intra-tumour heterogeneity in a clinically relevant manner however, currently presents a challenge. Here we propose signalling entropy, a measure of signalling pathway promiscuity derived from a sample's genome-wide gene expression profile, as an estimate of the stemness of a tumour sample. By considering over 500 mixtures of diverse cellular expression profiles, we reveal that signalling entropy also associates with intra-tumour heterogeneity. By analysing 3668 breast cancer and 1692 lung adenocarcinoma samples, we further demonstrate that signalling entropy correlates negatively with survival, outperforming leading clinical gene expression based prognostic tools. Signalling entropy is found to be a general prognostic measure, valid in different breast cancer clinical subgroups, as well as within stage I lung adenocarcinoma. We find that its prognostic power is driven by genes involved in cancer stem cells and treatment resistance. In summary, by approximating both stemness and intra-tumour heterogeneity, signalling entropy provides a powerful prognostic measure across different epithelial cancers.

Percentage depth dose evaluation in heterogeneous media using thermoluminescent dosimetry

Science.gov (United States)

da Rosa, L.A.R.; Campos, L.T.; Alves, V.G.L.; Batista, D.V.S.; Facure, A.

2010-01-01

The purpose of this study is to investigate the influence of lung heterogeneity inside a soft tissue phantom on percentage depth dose (PDD). PDD curves were obtained experimentally using LiF:Mg,Ti (TLD‐100) thermoluminescent detectors and applying Eclipse treatment planning system algorithms Batho, modified Batho (M‐Batho or BMod), equivalent TAR (E‐TAR or EQTAR), and anisotropic analytical algorithm (AAA) for a 15 MV photon beam and field sizes of 1×1,2×2,5×5, and 10×10cm2. Monte Carlo simulations were performed using the DOSRZnrc user code of EGSnrc. The experimental results agree with Monte Carlo simulations for all irradiation field sizes. Comparisons with Monte Carlo calculations show that the AAA algorithm provides the best simulations of PDD curves for all field sizes investigated. However, even this algorithm cannot accurately predict PDD values in the lung for field sizes of 1×1 and 2×2cm2. An overdosage in the lung of about 40% and 20% is calculated by the AAA algorithm close to the interface soft tissue/lung for 1×1 and 2×2cm2 field sizes, respectively. It was demonstrated that differences of 100% between Monte Carlo results and the algorithms Batho, modified Batho, and equivalent TAR responses may exist inside the lung region for the 1×1cm2 field. PACS number: 87.55.kd

Improved radiotherapy for locally advanced Non-Small Cell Lung Carcinoma (NSCLC) patients

DEFF Research Database (Denmark)

Ottosson, Wiviann

to comply with the DIBH technique. For DIBH, the patients are guided to hold their breath almost at their maximum inspiration level during imaging and treatment. This leads to reduction of the breathing motion which decreases the movement of the tumor and OARs. It also expands the lung tissue which...... be reduced by the DIBH method for the lung cancer patients. The overall aim of the clinical part of this thesis was to clarify the potential benefit of offering DIBH gating, compared to free-breathing (FB), for lung cancer patients. Particularly, the benefits for locally advanced non-small cell lung cancer...... (NSCLC) patients were explored. For the dosimetric part of the thesis, the dosimetric aspects of correct dose calculations in heterogeneous patient-like geometries were studied. The clinical aspects of DIBH were evaluated in three different studies, where planning and setup verification images acquired...

The associations between two vital GSTs genetic polymorphisms and lung cancer risk in the Chinese population: evidence from 71 studies.

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Kui Liu

Full Text Available BACKGROUND: The genetic polymorphisms of glutathione S-transferase (GSTs have been suspected to be related to the development of lung cancer while the current results are conflicting, especially in the Chinese population. METHODS: Data on genetic polymorphisms of glutathione S-transferase Mu 1 (GSTM1 from 68 studies, glutathione S-transferase theta 1 (GSTT1 from 17 studies and GSTM1-GSTT1 from 8 studies in the Chinese population were reanalyzed on their association with lung cancer risk. Odds ratios (OR were pooled using forest plots. 9 subgroups were all or partly performed in the subgroup analyses. The Galbraith plot was used to identify the heterogeneous records. Potential publication biases were detected by Begg's and Egger's tests. RESULTS: 71 eligible studies were identified after screening of 1608 articles. The increased association between two vital GSTs genetic polymorphisms and lung cancer risk was detected by random-effects model based on a comparable heterogeneity. Subgroup analysis showed a significant relationship between squamous carcinoma (SC, adenocarcinoma (AC or small cell lung carcinoma (SCLC and GSTM1 null genotype, as well as SC or AC and GSTT1 null genotype. Additionally, smokers with GSTM1 null genotype had a higher lung cancer risk than non-smokers. Our cumulative meta-analysis demonstrated a stable and reliable result of the relationship between GSTM1 null genotype and lung cancer risk. After the possible heterogeneous articles were omitted, the adjusted risk of GSTs and lung cancer susceptibility increased (fixed-effects model: ORGSTM1 = 1.23, 95% CI: 1.19 to 1.27, P<0.001; ORGSTT1 = 1.18, 95% CI: 1.10 to 1.26, P<0.001; ORGSTM1-GSTT1 = 1.33, 95% CI: 1.10 to 1.61, P = 0.004. CONCLUSIONS: An increased risk of lung cancer with GSTM1 and GSTT1 null genotype, especially with dual null genotype, was found in the Chinese population. In addition, special histopathological classification of lung cancers and a

Large-scale association analysis identifies new lung cancer susceptibility loci and heterogeneity in genetic susceptibility across histological subtypes

NARCIS (Netherlands)

Mckay, James D.; Hung, Rayjean J; Han, Younghun; Zong, Xuchen; Carreras-Torres, Robert; Christiani, David C.; Caporaso, Neil E.; Johansson, Mattias; Xiao, Xiangjun; Li, Yafang; Byun, Jinyoung; Dunning, Alison; Pooley, Karen A.; Qian, David C.; Ji, Xuemei; Liu, Geoffrey; Timofeeva, Maria N.; Bojesen, Stig E.; Wu, Xifeng; Le Marchand, Loic; Albanes, Demetrios; Bickeboeller, Heike; Aldrich, Melinda C.; Bush, William S.; Tardon, Adonina; Rennert, Gad; Teare, M. Dawn; Field, John K.; Kiemeney, Lambertus A.; Lazarus, Philip; Haugen, Aage; Lam, Stephen; Schabath, Matthew B.; Andrew, Angeline S.; Shen, Hongbing; Hong, Yun-Chul; Yuan, Jian-Min; Bertazzi, Pier Alberto; Pesatori, Angela C.; Ye, Yuanqing; Diao, Nancy; Su, Li; Zhang, Ruyang; Brhane, Yonathan; Leighl, Natasha; Johansen, Jakob S.; Mellemgaard, Anders; Saliba, Walid; Marcus, Michael W.; Timens, Wim

Although several lung cancer susceptibility loci have been identified, much of the heritability for lung cancer remains unexplained. Here 14,803 cases and 12,262 controls of European descent were genotyped on the OncoArray and combined with existing data for an aggregated genomewide association

Mucoepidermoid carcinoma of lung masquerading as urothelial carcinoma of bladder

Science.gov (United States)

Graham, Donna M.; O’Connor, Kate M.; Hinchion, John; Coate, Linda E.; Burke, Louise; Power, Derek G.

2013-01-01

Background Mucoepidermoid carcinoma (MEC) of the lung is a rare subtype of non-small cell lung cancer. There is no consensus regarding optimal management for this disease. Case report We present a case of MEC of the lung in a 75 year-old female with a history of superficial urothelial carcinoma of the bladder. The patient was found to have an asymptomatic lung mass. Initial biopsy suggested metastatic recurrence of urothelial carcinoma and therefore, cisplatin and gemcitabine chemotherapy was administered prior to surgical resection. Pathological analysis of the resected specimen confirmed a diagnosis of stage IIIA MEC with focal high-grade features including transitional cell-like areas. Adjuvant radiotherapy was administered due to a positive microscopic resection margin. No chemotherapy was given due to lack of supporting data. The patient developed widespread metastatic disease 3 months following completion of radiotherapy and died 1 month later. Conclusion This case demonstrates the possibility of dual pathology in cases where metastatic disease is suspected. The use of small tissue samples may complicate diagnosis due to the heterogeneity of malignant tumours. PMID:24936321

Uniform background assumption produces misleading lung EIT images.

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Grychtol, Bartłomiej; Adler, Andy

2013-06-01

Electrical impedance tomography (EIT) estimates an image of conductivity change within a body from stimulation and measurement at body surface electrodes. There is significant interest in EIT for imaging the thorax, as a monitoring tool for lung ventilation. To be useful in this application, we require an understanding of if and when EIT images can produce inaccurate images. In this paper, we study the consequences of the homogeneous background assumption, frequently made in linear image reconstruction, which introduces a mismatch between the reference measurement and the linearization point. We show in simulation and experimental data that the resulting images may contain large and clinically significant errors. A 3D finite element model of thorax conductivity is used to simulate EIT measurements for different heart and lung conductivity, size and position, as well as different amounts of gravitational collapse and ventilation-associated conductivity change. Three common linear EIT reconstruction algorithms are studied. We find that the asymmetric position of the heart can cause EIT images of ventilation to show up to 60% undue bias towards the left lung and that the effect is particularly strong for a ventilation distribution typical of mechanically ventilated patients. The conductivity gradient associated with gravitational lung collapse causes conductivity changes in non-dependent lung to be overestimated by up to 100% with respect to the dependent lung. Eliminating the mismatch by using a realistic conductivity distribution in the forward model of the reconstruction algorithm strongly reduces these undesirable effects. We conclude that subject-specific anatomically accurate forward models should be used in lung EIT and extra care is required when analysing EIT images of subjects whose background conductivity distribution in the lungs is known to be heterogeneous or exhibiting large changes.

Uniform background assumption produces misleading lung EIT images

International Nuclear Information System (INIS)

Grychtol, Bartłomiej; Adler, Andy

2013-01-01

Electrical impedance tomography (EIT) estimates an image of conductivity change within a body from stimulation and measurement at body surface electrodes. There is significant interest in EIT for imaging the thorax, as a monitoring tool for lung ventilation. To be useful in this application, we require an understanding of if and when EIT images can produce inaccurate images. In this paper, we study the consequences of the homogeneous background assumption, frequently made in linear image reconstruction, which introduces a mismatch between the reference measurement and the linearization point. We show in simulation and experimental data that the resulting images may contain large and clinically significant errors. A 3D finite element model of thorax conductivity is used to simulate EIT measurements for different heart and lung conductivity, size and position, as well as different amounts of gravitational collapse and ventilation-associated conductivity change. Three common linear EIT reconstruction algorithms are studied. We find that the asymmetric position of the heart can cause EIT images of ventilation to show up to 60% undue bias towards the left lung and that the effect is particularly strong for a ventilation distribution typical of mechanically ventilated patients. The conductivity gradient associated with gravitational lung collapse causes conductivity changes in non-dependent lung to be overestimated by up to 100% with respect to the dependent lung. Eliminating the mismatch by using a realistic conductivity distribution in the forward model of the reconstruction algorithm strongly reduces these undesirable effects. We conclude that subject-specific anatomically accurate forward models should be used in lung EIT and extra care is required when analysing EIT images of subjects whose background conductivity distribution in the lungs is known to be heterogeneous or exhibiting large changes. (paper)

Dose verification of radiotherapy for lung cancer by using plastic scintillator dosimetry and a heterogeneous phantom

DEFF Research Database (Denmark)

Ottosson, Wiviann; Behrens, C. F.; Andersen, Claus E.

2015-01-01

Bone, air passages, cavities, and lung are elements present in patients, but challenging to properly correct for in treatment planning dose calculations. Plastic scintillator detectors (PSDs) have proven to be well suited for dosimetry in non-reference conditions such as small fields. The objective...... of this study was to investigate the performance of a commercial treatment planning system (TPS) using a PSD and a specially designed thorax phantom with lung tumor inserts. 10 treatment plans of different complexity and phantom configurations were evaluated. Although the TPS agreed well with the measurements...

A unified approach for EIT imaging of regional overdistension and atelectasis in acute lung injury.

Science.gov (United States)

Gómez-Laberge, Camille; Arnold, John H; Wolf, Gerhard K

2012-03-01

Patients with acute lung injury or acute respiratory distress syndrome (ALI/ARDS) are vulnerable to ventilator-induced lung injury. Although this syndrome affects the lung heterogeneously, mechanical ventilation is not guided by regional indicators of potential lung injury. We used electrical impedance tomography (EIT) to estimate the extent of regional lung overdistension and atelectasis during mechanical ventilation. Techniques for tidal breath detection, lung identification, and regional compliance estimation were combined with the Graz consensus on EIT lung imaging (GREIT) algorithm. Nine ALI/ARDS patients were monitored during stepwise increases and decreases in airway pressure. Our method detected individual breaths with 96.0% sensitivity and 97.6% specificity. The duration and volume of tidal breaths erred on average by 0.2 s and 5%, respectively. Respiratory system compliance from EIT and ventilator measurements had a correlation coefficient of 0.80. Stepwise increases in pressure could reverse atelectasis in 17% of the lung. At the highest pressures, 73% of the lung became overdistended. During stepwise decreases in pressure, previously-atelectatic regions remained open at sub-baseline pressures. We recommend that the proposed approach be used in collaborative research of EIT-guided ventilation strategies for ALI/ARDS.

Transcriptional blood signatures distinguish pulmonary tuberculosis, pulmonary sarcoidosis, pneumonias and lung cancers.

Science.gov (United States)

Bloom, Chloe I; Graham, Christine M; Berry, Matthew P R; Rozakeas, Fotini; Redford, Paul S; Wang, Yuanyuan; Xu, Zhaohui; Wilkinson, Katalin A; Wilkinson, Robert J; Kendrick, Yvonne; Devouassoux, Gilles; Ferry, Tristan; Miyara, Makoto; Bouvry, Diane; Valeyre, Dominique; Dominique, Valeyre; Gorochov, Guy; Blankenship, Derek; Saadatian, Mitra; Vanhems, Phillip; Beynon, Huw; Vancheeswaran, Rama; Wickremasinghe, Melissa; Chaussabel, Damien; Banchereau, Jacques; Pascual, Virginia; Ho, Ling-Pei; Lipman, Marc; O'Garra, Anne

2013-01-01

New approaches to define factors underlying the immunopathogenesis of pulmonary diseases including sarcoidosis and tuberculosis are needed to develop new treatments and biomarkers. Comparing the blood transcriptional response of tuberculosis to other similar pulmonary diseases will advance knowledge of disease pathways and help distinguish diseases with similar clinical presentations. To determine the factors underlying the immunopathogenesis of the granulomatous diseases, sarcoidosis and tuberculosis, by comparing the blood transcriptional responses in these and other pulmonary diseases. We compared whole blood genome-wide transcriptional profiles in pulmonary sarcoidosis, pulmonary tuberculosis, to community acquired pneumonia and primary lung cancer and healthy controls, before and after treatment, and in purified leucocyte populations. An Interferon-inducible neutrophil-driven blood transcriptional signature was present in both sarcoidosis and tuberculosis, with a higher abundance and expression in tuberculosis. Heterogeneity of the sarcoidosis signature correlated significantly with disease activity. Transcriptional profiles in pneumonia and lung cancer revealed an over-abundance of inflammatory transcripts. After successful treatment the transcriptional activity in tuberculosis and pneumonia patients was significantly reduced. However the glucocorticoid-responsive sarcoidosis patients showed a significant increase in transcriptional activity. 144-blood transcripts were able to distinguish tuberculosis from other lung diseases and controls. Tuberculosis and sarcoidosis revealed similar blood transcriptional profiles, dominated by interferon-inducible transcripts, while pneumonia and lung cancer showed distinct signatures, dominated by inflammatory genes. There were also significant differences between tuberculosis and sarcoidosis in the degree of their transcriptional activity, the heterogeneity of their profiles and their transcriptional response to treatment.

Changes in epidermal growth factor receptor expression during chemotherapy in non-small cell lung cancer

DEFF Research Database (Denmark)

Jakobsen, Jan Nyrop; Santoni-Rugiu, Eric; Sørensen, Jens Benn

2014-01-01

BACKGROUND: Antibodies targeting epidermal growth factor receptor (EGFR), such as cetuximab, may potentially improve outcome in non-small cell lung cancer (NSCLC) patients with high EGFR expression. The EGFR expression may be heterogeneously distributed within tumors, and small biopsies may thus...

A Healthy Dietary Pattern Reduces Lung Cancer Risk: A Systematic Review and Meta-Analysis.

Science.gov (United States)

Sun, Yanlai; Li, Zhenxiang; Li, Jianning; Li, Zengjun; Han, Jianjun

2016-03-04

Diet and nutrients play an important role in cancer development and progress; a healthy dietary pattern has been found to be associated with several types of cancer. However, the association between a healthy eating pattern and lung cancer risk is still unclear. Therefore, we conducted a systematic review with meta-analysis to evaluate whether a healthy eating pattern might reduce lung cancer risk. We identified relevant studies from the PubMed and Embase databases up to October 2015, and the relative risks were extracted and combined by the fixed-effects model when no substantial heterogeneity was observed; otherwise, the random-effects model was employed. Subgroup and publication bias analyses were also performed. Finally, eight observational studies were included in the meta-analysis. The pooled relative risk of lung cancer for the highest vs. lowest category of healthy dietary pattern was 0.81 (95% confidence interval, CI: 0.75-0.86), and no significant heterogeneity was detected. The relative risks (RRs) for non-smokers, former smokers and current smokers were 0.89 (95% CI: 0.63-1.27), 0.74 (95% CI: 0.62-0.89) and 0.86 (95% CI: 0.79-0.93), respectively. The results remained stable in subgroup analyses by other confounders and sensitivity analysis. The results of our meta-analysis suggest that a healthy dietary pattern is associated with a lower lung cancer risk, and they provide more beneficial evidence for changing the diet pattern in the general population.

Bioinformatics Methods for Learning Radiation-Induced Lung Inflammation from Heterogeneous Retrospective and Prospective Data

Science.gov (United States)

Spencer, Sarah J.; Almiron Bonnin, Damian; Deasy, Joseph O.; Bradley, Jeffrey D.; El Naqa, Issam

2009-01-01

Radiotherapy outcomes are determined by complex interactions between physical and biological factors, reflecting both treatment conditions and underlying genetics. Recent advances in radiotherapy and biotechnology provide new opportunities and challenges for predicting radiation-induced toxicities, particularly radiation pneumonitis (RP), in lung cancer patients. In this work, we utilize datamining methods based on machine learning to build a predictive model of lung injury by retrospective analysis of treatment planning archives. In addition, biomarkers for this model are extracted from a prospective clinical trial that collects blood serum samples at multiple time points. We utilize a 3-way proteomics methodology to screen for differentially expressed proteins that are related to RP. Our preliminary results demonstrate that kernel methods can capture nonlinear dose-volume interactions, but fail to address missing biological factors. Our proteomics strategy yielded promising protein candidates, but their role in RP as well as their interactions with dose-volume metrics remain to be determined. PMID:19704920

Predicting Structure-Function Relations and Survival following Surgical and Bronchoscopic Lung Volume Reduction Treatment of Emphysema.

Science.gov (United States)

Mondoñedo, Jarred R; Suki, Béla

2017-02-01

Lung volume reduction surgery (LVRS) and bronchoscopic lung volume reduction (bLVR) are palliative treatments aimed at reducing hyperinflation in advanced emphysema. Previous work has evaluated functional improvements and survival advantage for these techniques, although their effects on the micromechanical environment in the lung have yet to be determined. Here, we introduce a computational model to simulate a force-based destruction of elastic networks representing emphysema progression, which we use to track the response to lung volume reduction via LVRS and bLVR. We find that (1) LVRS efficacy can be predicted based on pre-surgical network structure; (2) macroscopic functional improvements following bLVR are related to microscopic changes in mechanical force heterogeneity; and (3) both techniques improve aspects of survival and quality of life influenced by lung compliance, albeit while accelerating disease progression. Our model predictions yield unique insights into the microscopic origins underlying emphysema progression before and after lung volume reduction.

Update on Nonsurgical Lung Volume Reduction Procedures

Directory of Open Access Journals (Sweden)

J. Alberto Neder

2016-01-01

Full Text Available There has been a surge of interest in endoscopic lung volume reduction (ELVR strategies for advanced COPD. Valve implants, coil implants, biological LVR (BioLVR, bronchial thermal vapour ablation, and airway stents are used to induce lung deflation with the ultimate goal of improving respiratory mechanics and chronic dyspnea. Patients presenting with severe air trapping (e.g., inspiratory capacity/total lung capacity (TLC 225% predicted and thoracic hyperinflation (TLC > 150% predicted have the greatest potential to derive benefit from ELVR procedures. Pre-LVRS or ELVR assessment should ideally include cardiological evaluation, high resolution CT scan, ventilation and perfusion scintigraphy, full pulmonary function tests, and cardiopulmonary exercise testing. ELVR procedures are currently available in selected Canadian research centers as part of ethically approved clinical trials. If a decision is made to offer an ELVR procedure, one-way valves are the first option in the presence of complete lobar exclusion and no significant collateral ventilation. When the fissure is not complete, when collateral ventilation is evident in heterogeneous emphysema or when emphysema is homogeneous, coil implants or BioLVR (in that order are the next logical alternatives.

Emphysema. Imaging for endoscopic lung volume reduction

International Nuclear Information System (INIS)

Storbeck, B.; Oldigs, M.; Rabe, K.F.; Weber, C.; University Medical Center Hamburg-Eppendorf

2015-01-01

Chronic obstructive pulmonary disease (COPD) is characterized by two entities, the more airway-predominant type (''bronchitis'') on the one hand, and emphysema-predominant type on the other. Imaging via high-resolution computed tomography plays an important role in phenotyping COPD. For patients with advanced lung emphysema, new endoscopic lung volume reduction therapies (ELVR) have been developed. Proper selection of suitable patients requires thin-section reconstruction of volumetric CT image data sets also in coronal and sagittal orientation are required. In the current manuscript we will describe emphysema subtypes (centrilobular, paraseptal, panlobular), options for quantifying emphysema and this importance of regional distribution (homogeneous or heterogeneous, target area) as this is crucial for patient selection. Analysis of the interlobular fissures is obligatory despite the lack of standardization, as incomplete fissures indicate collateral ventilation (CV) via parenchymal bridges, which is an important criterion in choosing endoscopic methods of LVR. Every radiologist should be familiar with modern LVR therapies such as valves and coils, and furthermore should know what a lung doctor expects from radiologic evaluation (before and after ELVR). Finally we present a checklist as a quick reference for all steps concerning imaging for ELVR.

Brachytherapy dose measurements in heterogeneous tissues

International Nuclear Information System (INIS)

Paiva F, G.; Luvizotto, J.; Salles C, T.; Guimaraes A, P. C.; Dalledone S, P. de T.; Yoriyaz, H.; Rubo, R.

2014-08-01

Recently, Beau lieu et al. published an article providing guidance for Model-Based Dose Calculation Algorithms (MBDCAs), where tissue heterogeneity considerations are addressed. It is well-known that T G-43 formalism which considers only water medium is limited and significant dose differences have been found comparing both methodologies. The aim of the present work is to experimentally quantify dose values in heterogeneous medium using different dose measurement methods and techniques and compare them with those obtained with Monte Carlo simulations. Experiments have been performed using a Nucletron micro Selectron-Hdr Ir-192 brachytherapy source and a heterogeneous phantom composed by PMMA and different tissue equivalent cylinders like bone, lungs and muscle. Several dose measurements were obtained using tissue equivalent materials with height 1.8 cm and 4.3 cm positioned between the radiation source and the detectors. Radiochromic films, TLDs and MOSFET S have been used for the dose measurements. Film dosimetry has been performed using two methodologies: a) linearization for dose-response curve based on calibration curves to create a functional form that linearize s the dose response and b) 177 multichannel analysis dosimetry where the multiple color channels are analyzed allowing to address not only disturbances in the measurements caused by thickness variation in the film layer, but also, separate other external influences in the film response. All experiments have been simulated using the MCNP5 Monte Carlo radiation transport code. Comparison of experimental results are in good agreement with calculated dose values with differences less than 6% for almost all cases. (Author)

Brachytherapy dose measurements in heterogeneous tissues

Energy Technology Data Exchange (ETDEWEB)

Paiva F, G.; Luvizotto, J.; Salles C, T.; Guimaraes A, P. C.; Dalledone S, P. de T.; Yoriyaz, H. [Instituto de Pesquisas Energeticas e Nucleares / CNEN, Av. Lineu Prestes 2242, Cidade Universitaria, 05508-000 Sao Paulo (Brazil); Rubo, R., E-mail: gabrielpaivafonseca@gmail.com [Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, 05403-900 Sao Paulo (Brazil)

2014-08-15

Recently, Beau lieu et al. published an article providing guidance for Model-Based Dose Calculation Algorithms (MBDCAs), where tissue heterogeneity considerations are addressed. It is well-known that T G-43 formalism which considers only water medium is limited and significant dose differences have been found comparing both methodologies. The aim of the present work is to experimentally quantify dose values in heterogeneous medium using different dose measurement methods and techniques and compare them with those obtained with Monte Carlo simulations. Experiments have been performed using a Nucletron micro Selectron-Hdr Ir-192 brachytherapy source and a heterogeneous phantom composed by PMMA and different tissue equivalent cylinders like bone, lungs and muscle. Several dose measurements were obtained using tissue equivalent materials with height 1.8 cm and 4.3 cm positioned between the radiation source and the detectors. Radiochromic films, TLDs and MOSFET S have been used for the dose measurements. Film dosimetry has been performed using two methodologies: a) linearization for dose-response curve based on calibration curves to create a functional form that linearize s the dose response and b) 177 multichannel analysis dosimetry where the multiple color channels are analyzed allowing to address not only disturbances in the measurements caused by thickness variation in the film layer, but also, separate other external influences in the film response. All experiments have been simulated using the MCNP5 Monte Carlo radiation transport code. Comparison of experimental results are in good agreement with calculated dose values with differences less than 6% for almost all cases. (Author)

[Prediction of the efficiency of endoscopic lung volume reduction by valves in severe emphysema].

Science.gov (United States)

Bocquillon, V; Briault, A; Reymond, E; Arbib, F; Jankowski, A; Ferretti, G; Pison, C

2016-11-01

In severe emphysema, endoscopic lung volume reduction with valves is an alternative to surgery with less morbidity and mortality. In 2015, selection of patients who will respond to this technique is based on emphysema heterogeneity, a complete fissure visible on the CT-scan and absence of collateral ventilation between lobes. Our case report highlights that individualized prediction is possible. A 58-year-old woman had severe, disabling pulmonary emphysema. A high resolution thoracic computed tomography scan showed that the emphysema was heterogeneous, predominantly in the upper lobes, integrity of the left greater fissure and no collateral ventilation with the left lower lobe. A valve was inserted in the left upper lobe bronchus. At one year, clinical and functional benefits were significant with complete atelectasis of the treated lobe. The success of endoscopic lung volume reduction with a valve can be predicted, an example of personalized medicine. Copyright © 2016 SPLF. Published by Elsevier Masson SAS. All rights reserved.

Intersections of lung progenitor cells, lung disease and lung cancer.

Science.gov (United States)

Kim, Carla F

2017-06-30

The use of stem cell biology approaches to study adult lung progenitor cells and lung cancer has brought a variety of new techniques to the field of lung biology and has elucidated new pathways that may be therapeutic targets in lung cancer. Recent results have begun to identify the ways in which different cell populations interact to regulate progenitor activity, and this has implications for the interventions that are possible in cancer and in a variety of lung diseases. Today's better understanding of the mechanisms that regulate lung progenitor cell self-renewal and differentiation, including understanding how multiple epigenetic factors affect lung injury repair, holds the promise for future better treatments for lung cancer and for optimising the response to therapy in lung cancer. Working between platforms in sophisticated organoid culture techniques, genetically engineered mouse models of injury and cancer, and human cell lines and specimens, lung progenitor cell studies can begin with basic biology, progress to translational research and finally lead to the beginnings of clinical trials. Copyright ©ERS 2017.

Intersections of lung progenitor cells, lung disease and lung cancer

Directory of Open Access Journals (Sweden)

Carla F. Kim

2017-06-01

Full Text Available The use of stem cell biology approaches to study adult lung progenitor cells and lung cancer has brought a variety of new techniques to the field of lung biology and has elucidated new pathways that may be therapeutic targets in lung cancer. Recent results have begun to identify the ways in which different cell populations interact to regulate progenitor activity, and this has implications for the interventions that are possible in cancer and in a variety of lung diseases. Today's better understanding of the mechanisms that regulate lung progenitor cell self-renewal and differentiation, including understanding how multiple epigenetic factors affect lung injury repair, holds the promise for future better treatments for lung cancer and for optimising the response to therapy in lung cancer. Working between platforms in sophisticated organoid culture techniques, genetically engineered mouse models of injury and cancer, and human cell lines and specimens, lung progenitor cell studies can begin with basic biology, progress to translational research and finally lead to the beginnings of clinical trials.

Identifying and Assessing Interesting Subgroups in a Heterogeneous Population.

Science.gov (United States)

Lee, Woojoo; Alexeyenko, Andrey; Pernemalm, Maria; Guegan, Justine; Dessen, Philippe; Lazar, Vladimir; Lehtiö, Janne; Pawitan, Yudi

2015-01-01

Biological heterogeneity is common in many diseases and it is often the reason for therapeutic failures. Thus, there is great interest in classifying a disease into subtypes that have clinical significance in terms of prognosis or therapy response. One of the most popular methods to uncover unrecognized subtypes is cluster analysis. However, classical clustering methods such as k-means clustering or hierarchical clustering are not guaranteed to produce clinically interesting subtypes. This could be because the main statistical variability--the basis of cluster generation--is dominated by genes not associated with the clinical phenotype of interest. Furthermore, a strong prognostic factor might be relevant for a certain subgroup but not for the whole population; thus an analysis of the whole sample may not reveal this prognostic factor. To address these problems we investigate methods to identify and assess clinically interesting subgroups in a heterogeneous population. The identification step uses a clustering algorithm and to assess significance we use a false discovery rate- (FDR-) based measure. Under the heterogeneity condition the standard FDR estimate is shown to overestimate the true FDR value, but this is remedied by an improved FDR estimation procedure. As illustrations, two real data examples from gene expression studies of lung cancer are provided.

I-125 seed dose estimates in heterogeneous phantom

International Nuclear Information System (INIS)

Branco, Isabela S.L.; Antunes, Paula C.G.; Cavalieri, Tassio A.; Moura, Eduardo S.; Zeituni, Carlos A.; Yoriyaz, Helio

2015-01-01

Brachytherapy plays an important role in the healing process involving tumors in a variety of diseases. Several studies are currently conducted to examine the heterogeneity effects of different tissues and organs in brachytherapy clinical situations and a great effort has been made to incorporate new methodologies to estimate doses with greater accuracy. The objective of this study is to contribute to the assessment of heterogeneous effects on dose due to I-125 brachytherapy source in the presence of different materials with different densities and chemical compositions. The study was performed in heterogeneous phantoms using materials that simulate human tissues. Among these is quoted: breast, fat, muscle, lungs (exhaled and inhaled) and bones with different densities. Monte Carlo simulations for dose calculation in these phantoms were held and subsequently validated. The model 6711 I-125 seed was considered because it is widely used as a brachytherapy permanent implant and the one used in clinics and hospitals in Brazil. Thermoluminescent dosimeters TLD-700 (LiF: Mg, Ti) were simulated for dose assess. Several tissue configurations and positioning of I-125 sources were studied by simulations for future dose measurements. The methodology of this study so far shall be suitable for accurate dosimetric evaluation for different types of brachytherapy treatments, contributing to brachytherapy planning systems complementation allowing a better assessment of the dose actually delivered to the patient. (author)

I-125 seed dose estimates in heterogeneous phantom

Energy Technology Data Exchange (ETDEWEB)

Branco, Isabela S.L.; Antunes, Paula C.G.; Cavalieri, Tassio A.; Moura, Eduardo S.; Zeituni, Carlos A.; Yoriyaz, Helio, E-mail: isabela.slbranco@gmail.com [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil)

2015-07-01

Brachytherapy plays an important role in the healing process involving tumors in a variety of diseases. Several studies are currently conducted to examine the heterogeneity effects of different tissues and organs in brachytherapy clinical situations and a great effort has been made to incorporate new methodologies to estimate doses with greater accuracy. The objective of this study is to contribute to the assessment of heterogeneous effects on dose due to I-125 brachytherapy source in the presence of different materials with different densities and chemical compositions. The study was performed in heterogeneous phantoms using materials that simulate human tissues. Among these is quoted: breast, fat, muscle, lungs (exhaled and inhaled) and bones with different densities. Monte Carlo simulations for dose calculation in these phantoms were held and subsequently validated. The model 6711 I-125 seed was considered because it is widely used as a brachytherapy permanent implant and the one used in clinics and hospitals in Brazil. Thermoluminescent dosimeters TLD-700 (LiF: Mg, Ti) were simulated for dose assess. Several tissue configurations and positioning of I-125 sources were studied by simulations for future dose measurements. The methodology of this study so far shall be suitable for accurate dosimetric evaluation for different types of brachytherapy treatments, contributing to brachytherapy planning systems complementation allowing a better assessment of the dose actually delivered to the patient. (author)

Incidental perifissural nodules on routine chest computed tomography. Lung cancer or not?

Energy Technology Data Exchange (ETDEWEB)

Mets, Onno M.; Veldhuis, Wouter B.; Jong, Pim A. de [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Chung, Kaman; Scholten, Ernst T.; Ginneken, Bram van [Radboud University Nijmegen Medical Centre, Diagnostic Image Analysis Group, Nijmegen (Netherlands); Prokop, M. [Radboud University Nijmegen Medical Centre, Department of Radiology, Nijmegen (Netherlands); Schaefer-Prokop, Cornelia M. [Radboud University Nijmegen Medical Centre, Diagnostic Image Analysis Group, Nijmegen (Netherlands); Meander Medical Center, Department of Radiology, Amersfoort (Netherlands)

2018-03-15

Perifissural nodules (PFNs) are a common finding on chest CT, and are thought to represent non-malignant lesions. However, data outside a lung cancer-screening setting are currently lacking. In a nested case-control design, out of a total cohort of 16,850 patients ≥ 40 years of age who underwent routine chest CT (2004-2012), 186 eligible subjects with incident lung cancer and 511 controls without were investigated. All non-calcified nodules ≥ 4 mm were semi-automatically annotated. Lung cancer location and subject characteristics were recorded. Cases (56 % male) had a median age of 64 years (IQR 59-70). Controls (60 % male) were slightly younger (p<0.01), median age of 61 years (IQR 51-70). A total of 262/1,278 (21 %) unique non-calcified nodules represented a PFN. None of these were traced to a lung malignancy over a median follow-up of around 4.5 years. PFNs were most often located in the lower lung zones (72 %, p<0.001). Median diameter was 4.6 mm (range: 4.0-8.1), volume 51 mm{sup 3} (range: 32-278). Some showed growth rates < 400 days. Our data show that incidental PFNs do not represent lung cancer in a routine care, heterogeneous population. This confirms prior screening-based results. (orig.)

Proton beam therapy in non-small cell lung cancer: state of the art

Directory of Open Access Journals (Sweden)

Harada H

2017-08-01

Full Text Available Hideyuki Harada, Shigeyuki Murayama Radiation and Proton Therapy Center, Shizuoka Cancer Center Hospital, Nagaizumi, Shizuoka, Japan Abstract: This review summarizes the past and present status of proton beam therapy (PBT for lung cancer. PBT has a unique characteristic called the Bragg peak that enables a reduction in the dose of normal tissue around the tumor, but is sensitive to the uncertainties of density changes. The heterogeneity in electron density for thoracic lesions, such as those in the lung and mediastinum, and tumor movement according to respiration necessitates respiratory management for PBT to be applied in lung cancer patients. There are two types of PBT – a passively scattered approach and a scanning approach. Typically, a passively scattered approach is more robust for respiratory movement and a scanning approach could result in a more conformal dose distribution even when the tumor shape is complex. Large tumors of centrally located lung cancer may be more suitably irradiated than with intensity-modulated radiotherapy (IMRT or stereotactic body radiotherapy (SBRT. For a locally advanced lung cancer, PBT can spare the lung and heart more than photon IMRT. However, no randomized controlled trial has reported differences between PBT and IMRT or SBRT for early-stage and locally advanced lung cancers. Therefore, a well-designed controlled trial is warranted. Keywords: proton beam therapy, non-small cell lung cancer, survival, SBRT, IMRT

SU-G-BRC-08: Evaluation of Dose Mass Histogram as a More Representative Dose Description Method Than Dose Volume Histogram in Lung Cancer Patients

Energy Technology Data Exchange (ETDEWEB)

Liu, J; Eldib, A; Ma, C [Fox Chase Cancer Center, Philadelphia, PA (United States); Lin, M [The University of Texas Southwestern Medical Ctr, Dallas, TX (United States); Li, J [Cyber Medical Inc, Xian, Shaanxi (China); Mora, G [Universidade de Lisboa, Codex, Lisboa (Portugal)

2016-06-15

Purpose: Dose-volume-histogram (DVH) is widely used for plan evaluation in radiation treatment. The concept of dose-mass-histogram (DMH) is expected to provide a more representative description as it accounts for heterogeneity in tissue density. This study is intended to assess the difference between DVH and DMH for evaluating treatment planning quality. Methods: 12 lung cancer treatment plans were exported from the treatment planning system. DVHs for the planning target volume (PTV), the normal lung and other structures of interest were calculated. DMHs were calculated in a similar way as DVHs expect that the voxel density converted from the CT number was used in tallying the dose histogram bins. The equivalent uniform dose (EUD) was calculated based on voxel volume and mass, respectively. The normal tissue complication probability (NTCP) in relation to the EUD was calculated for the normal lung to provide quantitative comparison of DVHs and DMHs for evaluating the radiobiological effect. Results: Large differences were observed between DVHs and DMHs for lungs and PTVs. For PTVs with dense tumor cores, DMHs are higher than DVHs due to larger mass weighing in the high dose conformal core regions. For the normal lungs, DMHs can either be higher or lower than DVHs depending on the target location within the lung. When the target is close to the lower lung, DMHs show higher values than DVHs because the lower lung has higher density than the central portion or the upper lung. DMHs are lower than DVHs for targets in the upper lung. The calculated NTCPs showed a large range of difference between DVHs and DMHs. Conclusion: The heterogeneity of lung can be well considered using DMH for evaluating target coverage and normal lung pneumonitis. Further studies are warranted to quantify the benefits of DMH over DVH for plan quality evaluation.

Lung tumor segmentation in PET images using graph cuts.

Science.gov (United States)

Ballangan, Cherry; Wang, Xiuying; Fulham, Michael; Eberl, Stefan; Feng, David Dagan

2013-03-01

The aim of segmentation of tumor regions in positron emission tomography (PET) is to provide more accurate measurements of tumor size and extension into adjacent structures, than is possible with visual assessment alone and hence improve patient management decisions. We propose a segmentation energy function for the graph cuts technique to improve lung tumor segmentation with PET. Our segmentation energy is based on an analysis of the tumor voxels in PET images combined with a standardized uptake value (SUV) cost function and a monotonic downhill SUV feature. The monotonic downhill feature avoids segmentation leakage into surrounding tissues with similar or higher PET tracer uptake than the tumor and the SUV cost function improves the boundary definition and also addresses situations where the lung tumor is heterogeneous. We evaluated the method in 42 clinical PET volumes from patients with non-small cell lung cancer (NSCLC). Our method improves segmentation and performs better than region growing approaches, the watershed technique, fuzzy-c-means, region-based active contour and tumor customized downhill. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Is sweat chloride predictive of severity of cystic fibrosis lung disease assessed by chest computed tomography?

NARCIS (Netherlands)

Caudri, Daan; Zitter, David; Bronsveld, Inez; Tiddens, Harm

BACKGROUND: Cystic Fibrosis (CF) lung disease is characterized by a marked heterogeneity. Sweat chloride-level is a functional marker of the CF Transmembrane Regulator (CFTR) protein and could be an important predictor of later disease severity. METHODS: In this retrospective analysis children from

New heterogeneous acid catalysts in the synthesis of biodiesel; Estudo de novos catalisadores heterogeneous acidos na sintese de biodiesel

Energy Technology Data Exchange (ETDEWEB)

Soldi, Rafael A.; Cesar-Oliveira, Maria Aparecida F. [Universidade Federal do Parana (UFPR), Curitiba, PR (Brazil). Dept. de Quimica. Lab. de Polimeros Sinteticos], e-mail: mafco@quimica.ufpr.br; Oliveira, Angelo R.S.; Ramos, Luiz P. [Universidade Federal do Parana (UFPR), Curitiba, PR (Brazil). Dept. de Quimica. Centro de Pesquisa em Quimica Aplicada (CEPESQ)

2007-07-01

In this work, sulfonated polystyrene compounds (PSS) were synthesized from linear polystyrene (PS). Several methods and experimental conditions were investigated for the sulfonation of PS, producing catalytically active polymeric materials with sulfonation degrees in the range of 5.0-6.2 mmol -SO{sub 3}H/g of dry polymer. The performance of these catalysts was evaluated in transesterification reactions of beef tallow and vegetable oils with ethanol and methanol. For the sake of comparison, the same reaction conditions employed for the PSS catalysts were also used for an Amberlyst 15 (3,7 mmol SO{sub 3}H/g - Aldrich). The PSS samples were shown to be insoluble in the reaction media, leading to conversion rates of 85%, 75% and 80% of the refined soybean oil, beef tallow and crude corn oil in to ethyl esters, respectively, and 94% of the refined soybean oil methyl esters. Amberlyst 15 was studied as an alternative to the process, but its conversion rate to alkyl esters was very low in the employed conditions. These results demonstrated that our synthetic PSS materials have a great potential to act as heterogeneous catalysts for transesterification. (author)

A Healthy Dietary Pattern Reduces Lung Cancer Risk: A Systematic Review and Meta-Analysis

Directory of Open Access Journals (Sweden)

Yanlai Sun

2016-03-01

Full Text Available Background: Diet and nutrients play an important role in cancer development and progress; a healthy dietary pattern has been found to be associated with several types of cancer. However, the association between a healthy eating pattern and lung cancer risk is still unclear. Objective: Therefore, we conducted a systematic review with meta-analysis to evaluate whether a healthy eating pattern might reduce lung cancer risk. Methods: We identified relevant studies from the PubMed and Embase databases up to October 2015, and the relative risks were extracted and combined by the fixed-effects model when no substantial heterogeneity was observed; otherwise, the random-effects model was employed. Subgroup and publication bias analyses were also performed. Results: Finally, eight observational studies were included in the meta-analysis. The pooled relative risk of lung cancer for the highest vs. lowest category of healthy dietary pattern was 0.81 (95% confidence interval, CI: 0.75–0.86, and no significant heterogeneity was detected. The relative risks (RRs for non-smokers, former smokers and current smokers were 0.89 (95% CI: 0.63–1.27, 0.74 (95% CI: 0.62–0.89 and 0.86 (95% CI: 0.79–0.93, respectively. The results remained stable in subgroup analyses by other confounders and sensitivity analysis. Conclusions: The results of our meta-analysis suggest that a healthy dietary pattern is associated with a lower lung cancer risk, and they provide more beneficial evidence for changing the diet pattern in the general population.

Central focused convolutional neural networks: Developing a data-driven model for lung nodule segmentation.

Science.gov (United States)

Wang, Shuo; Zhou, Mu; Liu, Zaiyi; Liu, Zhenyu; Gu, Dongsheng; Zang, Yali; Dong, Di; Gevaert, Olivier; Tian, Jie

2017-08-01

Accurate lung nodule segmentation from computed tomography (CT) images is of great importance for image-driven lung cancer analysis. However, the heterogeneity of lung nodules and the presence of similar visual characteristics between nodules and their surroundings make it difficult for robust nodule segmentation. In this study, we propose a data-driven model, termed the Central Focused Convolutional Neural Networks (CF-CNN), to segment lung nodules from heterogeneous CT images. Our approach combines two key insights: 1) the proposed model captures a diverse set of nodule-sensitive features from both 3-D and 2-D CT images simultaneously; 2) when classifying an image voxel, the effects of its neighbor voxels can vary according to their spatial locations. We describe this phenomenon by proposing a novel central pooling layer retaining much information on voxel patch center, followed by a multi-scale patch learning strategy. Moreover, we design a weighted sampling to facilitate the model training, where training samples are selected according to their degree of segmentation difficulty. The proposed method has been extensively evaluated on the public LIDC dataset including 893 nodules and an independent dataset with 74 nodules from Guangdong General Hospital (GDGH). We showed that CF-CNN achieved superior segmentation performance with average dice scores of 82.15% and 80.02% for the two datasets respectively. Moreover, we compared our results with the inter-radiologists consistency on LIDC dataset, showing a difference in average dice score of only 1.98%. Copyright © 2017. Published by Elsevier B.V.

Intratumor heterogeneity and chemotherapy-induced changes in EGFR status in non-small cell lung cancer

DEFF Research Database (Denmark)

Jakobsen, Jan Nyrop; Sørensen, Jens Benn

2012-01-01

Biomarker expression is increasingly being used to customize treatment in non-small cell lung cancer (NSCLC). The choice of systemic treatment usually depends on biomarker expression in the initial diagnostic biopsy taken before initiation of first-line treatment. Chemotherapy induces DNA damages...

Longitudinal study of spatially heterogeneous emphysema progression in current smokers with chronic obstructive pulmonary disease.

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Naoya Tanabe

Full Text Available BACKGROUND: Cigarette smoke is the main risk factor for emphysema, which is a key pathology in chronic obstructive pulmonary disease (COPD. Low attenuation areas (LAA in computed tomography (CT images reflect emphysema, and the cumulative size distribution of LAA clusters follows a power law characterized by the exponent D. This property of LAA clusters can be explained by model simulation, where mechanical force breaks alveolar walls causing local heterogeneous lung tissue destruction. However, a longitudinal CT study has not investigated whether continuous smoking causes the spatially heterogeneous progression of emphysema. METHODS: We measured annual changes in ratios of LAA (LAA%, D and numbers of LAA clusters (LAN in CT images acquired at intervals of ≥ 3 years from 22 current and 31 former smokers with COPD to assess emphysema progression. We constructed model simulations using CT images to morphologically interpret changes in current smokers. RESULTS: D was decreased in current and former smokers, whereas LAA% and LAN were increased only in current smokers. The annual changes in LAA%, D, and LAN were greater in current, than in former smokers (1.03 vs. 0.37%, p=0.008; -0.045 vs. -0.01, p=0.004; 13.9 vs. 1.1, p=0.007, respectively. When LAA% increased in model simulations, the coalescence of neighboring LAA clusters decreased D, but the combination of changes in D and LAN in current smokers could not be explained by the homogeneous emphysema progression model despite cluster coalescence. Conversely, a model in which LAAs heterogeneously increased and LAA clusters merged somewhat in relatively advanced emphysematous regions could reflect actual changes. CONCLUSIONS: Susceptibility to parenchymal destruction induced by continuous smoking is not uniform over the lung, but might be higher in local regions of relatively advanced emphysema. These could result in the spatially heterogeneous progression of emphysema in current smokers.

Single-cell RNA sequencing reveals metallothionein heterogeneity during hESC differentiation to definitive endoderm

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Junjie Lu

2018-04-01

Full Text Available Differentiation of human pluripotent stem cells towards definitive endoderm (DE is the critical first step for generating cells comprising organs such as the gut, liver, pancreas and lung. This in-vitro differentiation process generates a heterogeneous population with a proportion of cells failing to differentiate properly and maintaining expression of pluripotency factors such as Oct4. RNA sequencing of single cells collected at four time points during a 4-day DE differentiation identified high expression of metallothionein genes in the residual Oct4-positive cells that failed to differentiate to DE. Using X-ray fluorescence microscopy and multi-isotope mass spectrometry, we discovered that high intracellular zinc level corresponds with persistent Oct4 expression and failure to differentiate. This study improves our understanding of the cellular heterogeneity during in-vitro directed differentiation and provides a valuable resource to improve DE differentiation efficiency. Keywords: hPSC, Differentiation, Definitive endoderm, Heterogeneity, Single cell, RNA sequencing

Use of FDG-PET to guide dose prescription heterogeneity in stereotactic body radiation therapy for lung cancers with volumetric modulated arc therapy: a feasibility study

International Nuclear Information System (INIS)

Henriques de Figueiredo, Bénédicte; Antoine, Mikael; Trouette, Renaud; Lagarde, Philippe; Petit, Adeline; Lamare, Frédéric; Hatt, Mathieu; Fernandez, Philippe

2014-01-01

The aim of this study was to assess if FDG-PET could guide dose prescription heterogeneity and decrease arbitrary location of hotspots in SBRT. For three patients with stage I lung cancer, a CT-simulation and a FDG-PET were registered to define respectively the PTV CT and the biological target volume (BTV). Two plans involving volumetric modulated arc therapy (VMAT) and simultaneous integrated boost (SIB) were calculated. The first plan delivered 4 × 12 Gy within the PTV CT and the second plan, with SIB, 4 × 12 Gy and 13.8 Gy (115% of the prescribed dose) within the PTV CT and the BTV respectively. The Dmax-PTV CT had to be inferior to 60 Gy (125% of the prescribed dose). Plans were evaluated through the D95%, D99% and Dmax-PTV CT , the D2 cm, the R50% and R100% and the dice similarity coefficient (DSC) between the isodose 115% and BTV. DSC allows verifying the location of the 115% isodose (ideal value = 1). The mean PTV CT and BTV were 36.7 (±12.5) and 6.5 (±2.2) cm 3 respectively. Both plans led to similar target coverage, same doses to the OARs and equivalent fall-off of the dose outside the PTV CT . On the other hand, the location of hotspots, evaluated through the DSC, was improved for the SIB plans with a mean DSC of 0.31 and 0.45 for the first and the second plans respectively. Use of PET to decrease arbitrary location of hotspots is feasible with VMAT and SIB for lung cancer

Use of FDG-PET to guide dose prescription heterogeneity in stereotactic body radiation therapy for lung cancers with volumetric modulated arc therapy: a feasibility study.

Science.gov (United States)

de Figueiredo, Bénédicte Henriques; Antoine, Mikael; Trouette, Renaud; Lagarde, Philippe; Petit, Adeline; Lamare, Frédéric; Hatt, Mathieu; Fernandez, Philippe

2014-12-23

The aim of this study was to assess if FDG-PET could guide dose prescription heterogeneity and decrease arbitrary location of hotspots in SBRT. For three patients with stage I lung cancer, a CT-simulation and a FDG-PET were registered to define respectively the PTVCT and the biological target volume (BTV). Two plans involving volumetric modulated arc therapy (VMAT) and simultaneous integrated boost (SIB) were calculated. The first plan delivered 4 × 12 Gy within the PTV(CT) and the second plan, with SIB, 4 × 12 Gy and 13.8 Gy (115% of the prescribed dose) within the PTV(CT) and the BTV respectively. The Dmax-PTV(CT) had to be inferior to 60 Gy (125% of the prescribed dose). Plans were evaluated through the D95%, D99% and Dmax-PTV(CT), the D2 cm, the R50% and R100% and the dice similarity coefficient (DSC) between the isodose 115% and BTV. DSC allows verifying the location of the 115% isodose (ideal value = 1). The mean PTV(CT) and BTV were 36.7 (±12.5) and 6.5 (±2.2) cm3 respectively. Both plans led to similar target coverage, same doses to the OARs and equivalent fall-off of the dose outside the PTV(CT). On the other hand, the location of hotspots, evaluated through the DSC, was improved for the SIB plans with a mean DSC of 0.31 and 0.45 for the first and the second plans respectively. Use of PET to decrease arbitrary location of hotspots is feasible with VMAT and SIB for lung cancer.

Estudo do metabolismo da glicose na tuberculose pulmonar ativa utilizando a tomografia por emissão de pósitrons (18F-FDG PET Evaluation of glucose metabolism in active lung tuberculosis by positron-emission tomography (18F-FDG PET

Directory of Open Access Journals (Sweden)

SIDNEY BOMBARDA

2002-09-01

Full Text Available Os métodos de imagem utilizados na avaliação da tuberculose pulmonar incluem a radiografia e a tomografia computadorizada do tórax. As imagens obtidas pelos métodos de medicina nuclear permitem estudos funcionais e metabólicos dos órgãos de interesse, através do uso de radiofármacos específicos. Alterações do metabolismo da glicose podem ser detectadas pela tomografia por emissão de pósitrons (PET utilizando-se o 18F-fluorodesoxiglicose (18F-FDG. Essas alterações estão presentes nas doenças neoplásicas, inflamatórias e infecciosas. A tuberculose é uma doença granulomatosa causada pelo Mycobacterium tuberculosis, que se utiliza de glicose como fonte de energia. Objetivo: O estudo do metabolismo da glicose na tuberculose pulmonar através da PET e sua comparação com a tomografia computadorizada de tórax. Material e métodos: Foram avaliados 20 pacientes portadores de tuberculose pulmonar. Todos foram submetidos à PET e à tomografia computadorizada de tórax, em até 30 dias após o início do tratamento. Resultados: Todos os pacientes apresentaram captação positiva do 18F-FDG na PET. Na tomografia computadorizada do tórax, todos os pacientes apresentaram sinais compatíveis com atividade de tuberculose. A sensibilidade dos dois métodos foi de 100%. Houve concordância entre os achados do 18F-FDG PET e da tomografia computadorizada (K = 0,27 e p Current methods to evaluate lung tuberculosis include chest radiography and computed tomography. Nuclear medicine imaging techniques are performed after administration of specific radiopharmaceuticals that accumulate in the organs of interest. Alterations of glucose metabolism can be observed by positron-emission tomography, using 18F-fluorodeoxyglucose (18F-FDG PET. These findings are present in the neoplasms, but also in inflammatory and infectious diseases. Tuberculosis is a granulomatous disease caused by Mycobacterium tuberculosis , that uses glucose as an energy source

Spontaneous pneumothorax in diffuse cystic lung diseases.

Science.gov (United States)

Cooley, Joseph; Lee, Yun Chor Gary; Gupta, Nishant

2017-07-01

Diffuse cystic lung diseases (DCLDs) are a heterogeneous group of disorders with varying pathophysiologic mechanisms that are characterized by the presence of air-filled lung cysts. These cysts are prone to rupture, leading to the development of recurrent spontaneous pneumothoraces. In this article, we review the epidemiology, clinical features, and management DCLD-associated spontaneous pneumothorax, with a focus on lymphangioleiomyomatosis, Birt-Hogg-Dubé syndrome, and pulmonary Langerhans cell histiocytosis. DCLDs are responsible for approximately 10% of apparent primary spontaneous pneumothoraces. Computed tomography screening for DCLDs (Birt-Hogg-Dubé syndrome, lymphangioleiomyomatosis, and pulmonary Langerhans cell histiocytosis) following the first spontaneous pneumothorax has recently been shown to be cost-effective and can help facilitate early diagnosis of the underlying disorders. Patients with DCLD-associated spontaneous pneumothorax have a very high rate of recurrence, and thus pleurodesis should be considered following the first episode of spontaneous pneumothorax in these patients, rather than waiting for a recurrent episode. Prior pleurodesis is not a contraindication to future lung transplant. Although DCLDs are uncommon, spontaneous pneumothorax is often the sentinel event that provides an opportunity for diagnosis. By understanding the burden and implications of pneumothoraces in DCLDs, clinicians can facilitate early diagnosis and appropriate management of the underlying disorders.

Heterogeneity in induced thermal resistance of rat tumor cell clones

International Nuclear Information System (INIS)

Tomasovic, S.P.; Rosenblatt, P.L.; Heitzman, D.

1983-01-01

Four 13762NF rat mammary adenocarcinoma clones were examined for their survival response to heating under conditions that induced transient thermal resistance (thermotolerance). Clones MTC and MTF7 were isolated from the subcutaneous locally growing tumor, whereas clones MTLn2 and MTLn3 were derived from spontaneous lung metastases. There was heterogeneity among these clones in thermotolerance induced by either fractionated 45 0 C or continuous 42 0 C heating, but the order of sensitivity was not necessarily the same. The clones developed thermal resistance at different rates and to different degrees within the same time intervals. There was heterogeneity between clones isolated from within either the primary site or metastatic lesions. However, clones derived from metastatic foci did not intrinsically acquire more or less thermotolerance to fractionated 45 0 C or continuous 42 0 C heating than did clones from the primary tumor. Further, there was no apparent relationship between any phenotypic properties that conferred more or less thermotolerance in vitro and any phenotypic properties that conferred enhanced metastatic success of these same clones by spontaneous (subcutaneous) or experimental (intravenous) routes in vivo. These tumor clones also differ in their karyotype, metastatic potential, cell surface features, sensitivity to x-irradiation and drugs, and ability to repair sublethal radiation damage. These results provide further credence to the concept that inherent heterogeneity within tumors may be as important in therapeutic success as other known modifiers of outcome such as site and treatment heterogeneity

Prognostic significance of blood coagulation tests in carcinoma of the lung and colon.

Science.gov (United States)

Wojtukiewicz, M Z; Zacharski, L R; Moritz, T E; Hur, K; Edwards, R L; Rickles, F R

1992-08-01

Blood coagulation test results were collected prospectively in patients with previously untreated, advanced lung or colon cancer who entered into a clinical trial. In patients with colon cancer, reduced survival was associated (in univariate analysis) with higher values obtained at entry to the study for fibrinogen, fibrin(ogen) split products, antiplasmin, and fibrinopeptide A and accelerated euglobulin lysis times. In patients with non-small cell lung cancer, reduced survival was associated (in univariate analysis) with higher fibrinogen and fibrin(ogen) split products, platelet counts and activated partial thromboplastin times. In patients with small cell carcinoma of the lung, only higher activated partial thromboplastin times were associated (in univariate analysis) with reduced survival in patients with disseminated disease. In multivariate analysis, higher activated partial thromboplastin times were a significant independent predictor of survival for patients with non-small cell lung cancer limited to one hemithorax and with disseminated small cell carcinoma of the lung. Fibrin(ogen) split product levels were an independent predictor of survival for patients with disseminated non-small cell lung cancer as were both the fibrinogen and fibrinopeptide A levels for patients with disseminated colon cancer. These results suggest that certain tests of blood coagulation may be indicative of prognosis in lung and colon cancer. The heterogeneity of these results suggests that the mechanism(s), intensity, and pathophysiological significance of coagulation activation in cancer may differ between tumour types.

Low tumour cell content in a lung tumour bank: implications for molecular characterisation.

Science.gov (United States)

Goh, Felicia; Duhig, Edwina E; Clarke, Belinda E; McCaul, Elizabeth; Passmore, Linda; Courtney, Deborah; Windsor, Morgan; Naidoo, Rishendren; Franz, Louise; Parsonson, Kylie; Yang, Ian A; Bowman, Rayleen V; Fong, Kwun M

2017-10-01

Lung cancer encompasses multiple malignant epithelial tumour types, each with specific targetable, potentially actionable mutations, such that precision management mandates accurate tumour typing. Molecular characterisation studies require high tumour cell content and low necrosis content, yet lung cancers are frequently a heterogeneous mixture of tumour and stromal cells. We hypothesised that there may be systematic differences in tumour cell content according to histological subtype, and that this may have implications for tumour banks as a resource for comprehensive molecular characterisation studies in lung cancer. To investigate this, we estimated tumour cell and necrosis content of 4267 samples resected from 752 primary lung tumour specimens contributed to a lung tissue bank. We found that banked lung cancer samples had low tumour cell content (33%) generally, although it was higher in carcinoids (77.5%) than other lung cancer subtypes. Tumour cells comprise a variable and often small component of banked resected tumour samples, and are accompanied by stromal reaction, inflammation, fibrosis, and normal structures. This has implications for the adequacy of unselected tumour bank samples for diagnostic and molecular investigations, and further research is needed to determine whether tumour cell content has a significant impact on analytical results in studies using tissue from tumour bank resources. Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.

Cartography of Pathway Signal Perturbations Identifies Distinct Molecular Pathomechanisms in Malignant and Chronic Lung Diseases

Science.gov (United States)

Arakelyan, Arsen; Nersisyan, Lilit; Petrek, Martin; Löffler-Wirth, Henry; Binder, Hans

2016-01-01

Lung diseases are described by a wide variety of developmental mechanisms and clinical manifestations. Accurate classification and diagnosis of lung diseases are the bases for development of effective treatments. While extensive studies are conducted toward characterization of various lung diseases at molecular level, no systematic approach has been developed so far. Here we have applied a methodology for pathway-centered mining of high throughput gene expression data to describe a wide range of lung diseases in the light of shared and specific pathway activity profiles. We have applied an algorithm combining a Pathway Signal Flow (PSF) algorithm for estimation of pathway activity deregulation states in lung diseases and malignancies, and a Self Organizing Maps algorithm for classification and clustering of the pathway activity profiles. The analysis results allowed clearly distinguish between cancer and non-cancer lung diseases. Lung cancers were characterized by pathways implicated in cell proliferation, metabolism, while non-malignant lung diseases were characterized by deregulations in pathways involved in immune/inflammatory response and fibrotic tissue remodeling. In contrast to lung malignancies, chronic lung diseases had relatively heterogeneous pathway deregulation profiles. We identified three groups of interstitial lung diseases and showed that the development of characteristic pathological processes, such as fibrosis, can be initiated by deregulations in different signaling pathways. In conclusion, this paper describes the pathobiology of lung diseases from systems viewpoint using pathway centered high-dimensional data mining approach. Our results contribute largely to current understanding of pathological events in lung cancers and non-malignant lung diseases. Moreover, this paper provides new insight into molecular mechanisms of a number of interstitial lung diseases that have been studied to a lesser extent. PMID:27200087

Lung Volume Reduction Coil Treatment in Chronic Obstructive Pulmonary Disease Patients with Homogeneous Emphysema : A Prospective Feasibility Trial

NARCIS (Netherlands)

Klooster, Karin; ten Hacken, Nick H. T.; Franz, Ina; Kerstjens, Huib A. M.; van Rikxoort, Eva M.; Slebos, Dirk-Jan

2014-01-01

Background: In patients with heterogeneous emphysema, surgical and bronchoscopic lung volume reduction (LVR) treatments are available. However, for patients with homogeneous emphysema these treatments are hardly investigated and seem less effective. Bronchoscopic LVR coil treatment has been shown to

A Generic Data Harmonization Process for Cross-linked Research and Network Interaction. Construction and Application for the Lung Cancer Phenotype Database of the German Center for Lung Research.

Science.gov (United States)

Firnkorn, D; Ganzinger, M; Muley, T; Thomas, M; Knaup, P

2015-01-01

Joint data analysis is a key requirement in medical research networks. Data are available in heterogeneous formats at each network partner and their harmonization is often rather complex. The objective of our paper is to provide a generic approach for the harmonization process in research networks. We applied the process when harmonizing data from three sites for the Lung Cancer Phenotype Database within the German Center for Lung Research. We developed a spreadsheet-based solution as tool to support the harmonization process for lung cancer data and a data integration procedure based on Talend Open Studio. The harmonization process consists of eight steps describing a systematic approach for defining and reviewing source data elements and standardizing common data elements. The steps for defining common data elements and harmonizing them with local data definitions are repeated until consensus is reached. Application of this process for building the phenotype database led to a common basic data set on lung cancer with 285 structured parameters. The Lung Cancer Phenotype Database was realized as an i2b2 research data warehouse. Data harmonization is a challenging task requiring informatics skills as well as domain knowledge. Our approach facilitates data harmonization by providing guidance through a uniform process that can be applied in a wide range of projects.

Proton magnetic resonance imaging for assessment of lung function and respiratory dynamics

International Nuclear Information System (INIS)

Eichinger, Monika; Tetzlaff, Ralf; Puderbach, Michael; Woodhouse, Neil; Kauczor, H.-U.

2007-01-01

Since many pulmonary diseases present with a variable regional involvement, modalities for assessment of regional lung function gained increasing attention over the last years. Together with lung perfusion and gas exchange, ventilation, as a result of the interaction of the respiratory pump and the lungs, is an indispensable component of lung function. So far, this complex mechanism is still mainly assessed indirectly and globally. A differentiation between the individual determining factors of ventilation would be crucial for precise diagnostics and adequate treatment. By dynamic imaging of the respiratory pump, the mechanical components of ventilation can be assessed regionally. Amongst imaging modalities applicable to this topic, magnetic resonance imaging (MRI), as a tool not relying on ionising radiation, is the most attractive. Recent advances in MRI technology have made it possible to assess diaphragmatic and chest wall motion, static and dynamic lung volumes, as well as regional lung function. Even though existing studies show large heterogeneity in design and applied methods, it becomes evident that MRI is capable to visualise pulmonary function as well as diaphragmatic and thoracic wall movement, providing new insights into lung physiology. Partly contradictory results and conclusions are most likely caused by technical limitations, limited number of studies and small sample size. Existing studies mainly evaluate possible imaging techniques and concentrate on normal physiology. The few studies in patients with lung cancer and emphysema already give a promising outlook for these techniques from which an increasing impact on improved and quantitative disease characterization as well as better patient management can be expected

Tyrosine Kinase Receptor Landscape in Lung Cancer: Therapeutical Implications

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A. Quintanal-Villalonga

2016-01-01

Full Text Available Lung cancer is a heterogeneous disease responsible for the most cases of cancer-related deaths. The majority of patients are clinically diagnosed at advanced stages, with a poor survival rate. For this reason, the identification of oncodrivers and novel biomarkers is decisive for the future clinical management of this pathology. The rise of high throughput technologies popularly referred to as “omics” has accelerated the discovery of new biomarkers and drivers for this pathology. Within them, tyrosine kinase receptors (TKRs have proven to be of importance as diagnostic, prognostic, and predictive tools and, due to their molecular nature, as therapeutic targets. Along this review, the role of TKRs in the different lung cancer histologies, research on improvement of anti-TKR therapy, and the current approaches to manage anti-TKR resistance will be discussed.

Estudo epidemiológico do cancro do pulmão em Portugal nos anos de 2000/2002 Epidemiological study of lung cancer in Portugal (2000/2002

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Bárbara Parente

2007-03-01

Full Text Available O cancro do pulmão é a causa mais comum de cancro no Mundo. A sobrevida global aos 5 anos é de cerca de 15%, sem grandes previsões de mudança. Em Portugal, relativamente à doença oncológica, situa-se em terceiro lugar, sendo a primeira causa de morte por cancro. O tabaco é responsável por cerca de 85% dos casos. Um estudo efectuado em Portugal durante 3 anos (2000/2002 pela Comissão de Trabalho de Pneumologia Oncológica da Sociedade Portuguesa de Pneumologia em 22 hospitais, mostrou que, de um total de 4396 doentes com cancro do pulmão, 81,8% se referem ao sexo masculino e 18,2% ao sexo feminino, com uma média etária de 64,49 ± 11,28 anos. Cerca de 70% dos doentes era fumador ou ex-fumador, com 50,3% com performance status (PS grau I da escala de Zubrod. Do ponto de vista histológico, 37,5% eram adenocarcinomas, seguido do carcinoma epidermóide com 30,5% dos casos e dos tumores de pequenas células com 12,5%; carcinomas neuroendócrinos em 1,4 % dos casos; CPNPC 10,5%, mistos em 0,7%, carcinomas de grandes células em 2,3% e outros e não especificados em 4,6% dos casos. O estadiamento, efectuado em 4097 casos, mostrou 113 doentes no estádio IA (2,8% e 250 (6,1% no IB; no estádio IIA apenas 0,8 % e 4,5% no IIB; no estádio IIIA 9,1% dos doentes, comparativamente ao IIIB com 29,9% dos casos, encontrando-se 46,9 % dos doentes já no estádio IV na altura do diagnóstico. Em 3855 dos casos foi possível determinar a primeira opção terapêutica. Foi efectuada cirurgia em 8,2% e terapêuticas combinadas (combinações de cirurgia com quimioterapia, ou radioterapia, ou a associação de QT com RT em 21,8% dos casos; a QT isolada como primeira opção terapêutica foi efectuada em 43,7% dos doentes e em 20,3% apenas terapêutica de suporte.Lung cancer is the most common form of cancer death in the world. Five-year survival is about 15%, without any change to this picture envisaged. It is the 3rd most prevalent type of cancer in

[Mesh structure of two-dimensional tumor microvascular architecture phenotype heterogeneity in non-small cell lung cancer].

Science.gov (United States)

Xiong, Zeng; Zhou, Hui; Liu, Jin-Kang; Hu, Cheng-Ping; Zhou, Mo-Ling; Xia, Yu; Zhou, Jian-Hua

2009-11-01

To investigate the structural characteristics and clinical significance of two-dimensional tumor microvascular architecture phenotype (2D-TMAP) in non-small cell lung cancer (NSCLC). Thirty surgical specimens of NSCLC were collected. The sections of the tumor tissues corresponding to the slice of CT perfusion imaging were selected to construct the 2D-TMAP expression. Spearman correlation analysis was used to examine the relation between the 2D-TMAP expression and the clinicopathological features of NSCLC. A heterogeneity was noted in the 2D-TMAP expression of NSCLC. The microvascular density (MVD) in the area surrounding the tumor was higher than that in the central area, but the difference was not statistically significant. The density of the microvessels without intact lumen was significantly greater in the surrounding area than in the central area (P=0.030). The total MVD was not correlated to tumor differentiation (r=0.042, P=0.831). The density of the microvessels without intact lumen in the surrounding area was positively correlated to degree of tumor differentiation and lymph node metastasis (r=0.528 and 0.533, P=0.041 and 0.028, respectively), and also to the expressions of vascular endothelial growth factor (VEGF), ephrinB2, EphB4, and proliferating cell nuclear antigen (PCNA) (r=0.504, 0.549, 0.549, and 0.370; P=0.005, 0.002, 0.002, and 0.048, respectively). The degree of tumor differentiation was positively correlated to PCNA and VEGF expression (r=0.604 and 0.370, P=0.001 and 0.048, respectively), but inversely to the integrity of microvascular basement membrane (r=-0.531, P=0.033). The 2D-TMAP suggests the overall state of the micro-environment for tumor growth. The 2D-TMAP of NSCLC regulates angiogenesis and tumor cell proliferation through a mesh-like structure, and better understanding of the characteristics and possible mechanism of 2D-TMAP expression can be of great clinical importance.

Advances of Immunotherapy in Small Cell Lung Cancer

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Jingjing LIU

2014-06-01

Full Text Available Small cell lung cancer (SCLC is complex heterogeneous due to unclear biological characteristics in terms of cell origin, pathogenesis and driver genes etc. Diagnosis and treatment of SCLC has been slowly improved and few breakthroughs have been discovered up to now. Therefore new strategies are urgently needed to improve the efficacy of SCLC treatment. Tumor immunotherapy has potential to restore and trigger the immune system to recognize and eliminate tumor cells, notably it has only minimal adverse impact on normal tissue. Cancer vaccine, adoptive immunotherapy, cytokines and checkpoint inhibitors have now been launched for clinical treatment of SCLC. Ipilimumab is the most promising medicine of immunotherapy. Immunotherapy is expected to bring new vision to the treatment of SCLC. And further researches are needed on such problems affecting efficacy of immunotherapy as the heterogeneity of SCLC, the uncertainty of target for immunotherapy, the immune tolerance, etc.

A new assessment model for tumor heterogeneity analysis with [18]F-FDG PET images.

Science.gov (United States)

Wang, Ping; Xu, Wengui; Sun, Jian; Yang, Chengwen; Wang, Gang; Sa, Yu; Hu, Xin-Hua; Feng, Yuanming

2016-01-01

It has been shown that the intratumor heterogeneity can be characterized with quantitative analysis of the [18]F-FDG PET image data. The existing models employ multiple parameters for feature extraction which makes it difficult to implement in clinical settings for the quantitative characterization. This article reports an easy-to-use and differential SUV based model for quantitative assessment of the intratumor heterogeneity from 3D [18]F-FDG PET image data. An H index is defined to assess tumor heterogeneity by summing voxel-wise distribution of differential SUV from the [18]F-FDG PET image data. The summation is weighted by the distance of SUV difference among neighboring voxels from the center of the tumor and can thus yield increased values for tumors with peripheral sub-regions of high SUV that often serves as an indicator of augmented malignancy. Furthermore, the sign of H index is used to differentiate the rate of change for volume averaged SUV from its center to periphery. The new model with the H index has been compared with a widely-used model of gray level co-occurrence matrix (GLCM) for image texture characterization with phantoms of different configurations and the [18]F-FDG PET image data of 6 lung cancer patients to evaluate its effectiveness and feasibility for clinical uses. The comparison of the H index and GLCM parameters with the phantoms demonstrate that the H index can characterize the SUV heterogeneity in all of 6 2D phantoms while only 1 GLCM parameter can do for 1 and fail to differentiate for other 2D phantoms. For the 8 3D phantoms, the H index can clearly differentiate all of them while the 4 GLCM parameters provide complicated patterns in the characterization. Feasibility study with the PET image data from 6 lung cancer patients show that the H index provides an effective single-parameter metric to characterize tumor heterogeneity in terms of the local SUV variation, and it has higher correlation with tumor volume change after

Estudos de atmosfera

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Carlos Eduardo Riccioppo

2016-11-01

Full Text Available Joker e Estudos de balística possuíam formas distintas dos cadernos ou livros quando foram exibidos pela primeira vez, na mostra Dual Overdrive. De algum modo, o flagrante das imagens dos cartazes da campanha política parisiense e daquelas cusparadas sobre o asfalto era preservado no modo como eram mostrados os trabalhos, que repunham não apenas a orientação espacial dos objetos fotografados, mas, igualmente, sua escala: Joker apresentava-se na parede, em dimensões relativamente próximas às dos cartazes lambe-lambe que retratavam; e Estudos de balística, no chão da galeria, também com ampliação suficiente para que se tivesse a impressão de que se tratava de imagens “em tamanho real”.

Comparison of four software packages for CT lung volumetry in healthy individuals

Energy Technology Data Exchange (ETDEWEB)

Nemec, Stefan F. [Harvard Medical School, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA (United States); Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Vienna (Austria); Molinari, Francesco [Centre Hospitalier Regional Universitaire de Lille, Department of Radiology, Lille (France); Dufresne, Valerie [CHU de Charleroi - Hopital Vesale, Pneumologie, Montigny-le-Tilleul (Belgium); Gosset, Natacha [CHU Tivoli, Service d' Imagerie Medicale, La Louviere (Belgium); Silva, Mario; Bankier, Alexander A. [Harvard Medical School, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA (United States)

2015-06-01

To compare CT lung volumetry (CTLV) measurements provided by different software packages, and to provide normative data for lung densitometric measurements in healthy individuals. This retrospective study included 51 chest CTs of 17 volunteers (eight men and nine women; mean age, 30 ± 6 years), who underwent spirometrically monitored CT at total lung capacity (TLC), functional residual capacity (FRC), and mean inspiratory capacity (MIC). Volumetric differences assessed by four commercial software packages were compared with analysis of variance (ANOVA) for repeated measurements and benchmarked against the threshold for acceptable variability between spirometric measurements. Mean lung density (MLD) and parenchymal heterogeneity (MLD-SD) were also compared with ANOVA. Volumetric differences ranged from 12 to 213 ml (0.20 % to 6.45 %). Although 16/18 comparisons (among four software packages at TLC, MIC, and FRC) were statistically significant (P < 0.001 to P = 0.004), only 3/18 comparisons, one at MIC and two at FRC, exceeded the spirometry variability threshold. MLD and MLD-SD significantly increased with decreasing volumes, and were significantly larger in lower compared to upper lobes (P < 0.001). Lung volumetric differences provided by different software packages are small. These differences should not be interpreted based on statistical significance alone, but together with absolute volumetric differences. (orig.)

ESTUDOS ESTILÍSTICOS NO BRASIL

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Carlos Eduardo Falcão Uchôa

2013-06-01

Full Text Available Este artigo objetiva mostrar os inícios e a progressão dos estudos estilísticos no Brasil. Após uma introdução sobre o surgimento, na Europa, da Estilística como disciplina de pesquisa no campo da linguagem, detém-se, sucessivamente, nas contribuições de filólogos, linguistas, teóricos da literatura e gramáticos para o estudo dos mais variados recursos estilísticos ocorrentes sobretudo em autores brasileiros.

Editorial: The role of medical physics in lung SBRT.

Science.gov (United States)

Mancosu, Pietro; Nisbet, Andrew; Jornet, Núria

2018-01-01

Stereotactic body radiation therapy (SBRT) has become a standard treatment for non-operable patients with early stage non-small cell lung cancer (NSCLC). In this context, medical physics community has largely helped in the starting and the growth of this technique. In fact, SBRT requires the convergence of many different features for delivering large doses in few fractions to small moving target in an heterogeneous medium. The special issue of last month, was focused on the different physics challenges in lung SBRT. Eleven reviews were presented, covering: imaging for treatment planning and for treatment assessment; dosimetry and planning optimization; treatment delivery possibilities; image guidance during delivery; radiobiology. The current cutting edge role of medical physics was reported. We aimed to give a complete overview of different aspects of lung SBRT that would be of interest to both physicists implementing this technique in their institutions and more experienced physicists that would be inspired to start research projects in areas that still need further developments. We also feel that the role that medical physicists have played in the development and safe implementation of SBRT, particularly in lung region, can be taken as an excellent example to be translated to other areas, not only in Radiation Oncology but also in other health sectors. Copyright © 2018 Associazione Italiana di Fisica Medica. All rights reserved.

Dosimetric comparison of Acuros XB, AAA, and XVMC in stereotactic body radiotherapy for lung cancer

International Nuclear Information System (INIS)

Tsuruta, Yusuke; Nakata, Manabu; Higashimura, Kyoji; Nakamura, Mitsuhiro; Matsuo, Yukinori; Monzen, Hajime; Mizowaki, Takashi; Hiraoka, Masahiro

2014-01-01

Purpose: To compare the dosimetric performance of Acuros XB (AXB), anisotropic analytical algorithm (AAA), and x-ray voxel Monte Carlo (XVMC) in heterogeneous phantoms and lung stereotactic body radiotherapy (SBRT) plans. Methods: Water- and lung-equivalent phantoms were combined to evaluate the percentage depth dose and dose profile. The radiation treatment machine Novalis (BrainLab AG, Feldkirchen, Germany) with an x-ray beam energy of 6 MV was used to calculate the doses in the composite phantom at a source-to-surface distance of 100 cm with a gantry angle of 0°. Subsequently, the clinical lung SBRT plans for the 26 consecutive patients were transferred from the iPlan (ver. 4.1; BrainLab AG) to the Eclipse treatment planning systems (ver. 11.0.3; Varian Medical Systems, Palo Alto, CA). The doses were then recalculated with AXB and AAA while maintaining the XVMC-calculated monitor units and beam arrangement. Then the dose-volumetric data obtained using the three different radiation dose calculation algorithms were compared. Results: The results from AXB and XVMC agreed with measurements within ±3.0% for the lung-equivalent phantom with a 6 × 6 cm 2 field size, whereas AAA values were higher than measurements in the heterogeneous zone and near the boundary, with the greatest difference being 4.1%. AXB and XVMC agreed well with measurements in terms of the profile shape at the boundary of the heterogeneous zone. For the lung SBRT plans, AXB yielded lower values than XVMC in terms of the maximum doses of ITV and PTV; however, the differences were within ±3.0%. In addition to the dose-volumetric data, the dose distribution analysis showed that AXB yielded dose distribution calculations that were closer to those with XVMC than did AAA. Means ± standard deviation of the computation time was 221.6 ± 53.1 s (range, 124–358 s), 66.1 ± 16.0 s (range, 42–94 s), and 6.7 ± 1.1 s (range, 5–9 s) for XVMC, AXB, and AAA, respectively. Conclusions: In the phantom

Dosimetric comparison of Acuros XB, AAA, and XVMC in stereotactic body radiotherapy for lung cancer.

Science.gov (United States)

Tsuruta, Yusuke; Nakata, Manabu; Nakamura, Mitsuhiro; Matsuo, Yukinori; Higashimura, Kyoji; Monzen, Hajime; Mizowaki, Takashi; Hiraoka, Masahiro

2014-08-01

To compare the dosimetric performance of Acuros XB (AXB), anisotropic analytical algorithm (AAA), and x-ray voxel Monte Carlo (XVMC) in heterogeneous phantoms and lung stereotactic body radiotherapy (SBRT) plans. Water- and lung-equivalent phantoms were combined to evaluate the percentage depth dose and dose profile. The radiation treatment machine Novalis (BrainLab AG, Feldkirchen, Germany) with an x-ray beam energy of 6 MV was used to calculate the doses in the composite phantom at a source-to-surface distance of 100 cm with a gantry angle of 0°. Subsequently, the clinical lung SBRT plans for the 26 consecutive patients were transferred from the iPlan (ver. 4.1; BrainLab AG) to the Eclipse treatment planning systems (ver. 11.0.3; Varian Medical Systems, Palo Alto, CA). The doses were then recalculated with AXB and AAA while maintaining the XVMC-calculated monitor units and beam arrangement. Then the dose-volumetric data obtained using the three different radiation dose calculation algorithms were compared. The results from AXB and XVMC agreed with measurements within ± 3.0% for the lung-equivalent phantom with a 6 × 6 cm(2) field size, whereas AAA values were higher than measurements in the heterogeneous zone and near the boundary, with the greatest difference being 4.1%. AXB and XVMC agreed well with measurements in terms of the profile shape at the boundary of the heterogeneous zone. For the lung SBRT plans, AXB yielded lower values than XVMC in terms of the maximum doses of ITV and PTV; however, the differences were within ± 3.0%. In addition to the dose-volumetric data, the dose distribution analysis showed that AXB yielded dose distribution calculations that were closer to those with XVMC than did AAA. Means ± standard deviation of the computation time was 221.6 ± 53.1 s (range, 124-358 s), 66.1 ± 16.0 s (range, 42-94 s), and 6.7 ± 1.1 s (range, 5-9 s) for XVMC, AXB, and AAA, respectively. In the phantom evaluations, AXB and XVMC agreed better with

The effect of rib and lung heterogeneities on the computed dose to lung in Ir-192 High-Dose-Rate breast brachytherapy: Monte Carlo versus a treatment planning system

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Hossein Salehi Yazdi

2012-01-01

Conclusions: Taking into account the ribs and entering the actual data for breasts, ribs, and lungs, revealed an average overestimation of the dose by a factor of 8% in the lung for TPS calculations. Therefore, the accuracy of the TPS results may be limited to regions near the implants where the treatment is planned, and is a more conservative approach for regions at boundaries with curvatures or tissues with a different material than that in the breast.

O desamparo aprendido revisitado: estudos com animais

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Maria Helena Leite Hunziker

Full Text Available O desamparo aprendido tem sido definido como a dificuldade de aprendizagem apresentada por indivíduos que tiveram experiência prévia com estímulos aversivos incontroláveis. O objetivo deste trabalho é fazer uma revisão crítica dos estudos sobre o desamparo aprendido, com animais. Nessa análise, são considerados aspectos conceituais e metodológicos dos estudos em questão e as interpretações teóricas sobre esse efeito comportamental. Aborda-se a evolução histórica desses estudos, bem como alguns aspectos controversos das publicações que se acumularam ao longo de quatro décadas de pesquisa. A associação do desamparo aprendido com a depressão clínica é analisada criticamente, destacando-se a necessidade de maior rigor metodológico e conceitual nos estudos da área.

Heterogeneity in Immune Marker Expression after Acquisition of Resistance to EGFR Kinase Inhibitors: Analysis of a Case with Small Cell Lung Cancer Transformation.

Science.gov (United States)

Suda, Kenichi; Murakami, Isao; Yu, Hui; Kim, Jihye; Ellison, Kim; Rivard, Christopher J; Mitsudomi, Tetsuya; Hirsch, Fred R

2017-06-01

Expression of immune markers is of scientific interest because of their potential roles as predictive biomarkers for immunotherapy. Although the microenvironment of metastatic tumors and/or therapy-inducible histological transformation may affect the expression of these immune markers, there are few data regarding this context. A 76-year-old never-smoking female with EGFR-mutated lung adenocarcinoma (AC) acquired resistance to gefitinib. After her death, an autopsy revealed SCLC transformation and EGFR T790M secondary mutation (T790M) as mutually exclusive resistance mechanisms occurring differently in different metastases; two liver metastases (SCLC versus AC with T790M) and two lymph node metastases (SCLC versus AC with T790M) were analyzed to compare the expression status of immune markers by immunohistochemistry and by an immune oncology gene expression panel. Programmed death ligand 1 (PD-L1) protein was partially expressed in tumor cells with AC lesions (T790M) but not in tumor cells with SCLC transformation. The liver metastasis with SCLC transformation showed no stromal PD-L1 expression and scant tumor-infiltrating lymphocytes, whereas the other lesions demonstrated stromal PD-L1 staining and infiltration of CD8-positive T cells. Data generated using an immuno-oncology gene expression panel indicated a higher level of T-cell costimulatory molecules and lower expression of type I interferon-regulated genes in lesions with SCLC transformation. These data highlight the heterogeneity of expression of immune markers depending on the metastatic sites and histological transformation and indicate that the biopsy specimen from one lesion may not be representative of immune marker status for all lesions. Copyright © 2017 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.

Human Organotypic Lung Tumor Models: Suitable For Preclinical 18F-FDG PET-Imaging.

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David Fecher

Full Text Available Development of predictable in vitro tumor models is a challenging task due to the enormous complexity of tumors in vivo. The closer the resemblance of these models to human tumor characteristics, the more suitable they are for drug-development and -testing. In the present study, we generated a complex 3D lung tumor test system based on acellular rat lungs. A decellularization protocol was established preserving the architecture, important ECM components and the basement membrane of the lung. Human lung tumor cells cultured on the scaffold formed cluster and exhibited an up-regulation of the carcinoma-associated marker mucin1 as well as a reduced proliferation rate compared to respective 2D culture. Additionally, employing functional imaging with 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography (FDG-PET these tumor cell cluster could be detected and tracked over time. This approach allowed monitoring of a targeted tyrosine kinase inhibitor treatment in the in vitro lung tumor model non-destructively. Surprisingly, FDG-PET assessment of single tumor cell cluster on the same scaffold exhibited differences in their response to therapy, indicating heterogeneity in the lung tumor model. In conclusion, our complex lung tumor test system features important characteristics of tumors and its microenvironment and allows monitoring of tumor growth and -metabolism in combination with functional imaging. In longitudinal studies, new therapeutic approaches and their long-term effects can be evaluated to adapt treatment regimes in future.

Periodontal Disease and Incident Lung Cancer Risk: A Meta-Analysis of Cohort Studies.

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Zeng, Xian-Tao; Xia, Ling-Yun; Zhang, Yong-Gang; Li, Sheng; Leng, Wei-Dong; Kwong, Joey S W

2016-10-01

Periodontal disease is linked to a number of systemic diseases such as cardiovascular diseases and diabetes mellitus. Recent evidence has suggested periodontal disease might be associated with lung cancer. However, their precise relationship is yet to be explored. Hence, this study aims to investigate the association of periodontal disease and risk of incident lung cancer using a meta-analytic approach. PubMed, Scopus, and ScienceDirect were searched up to June 10, 2015. Cohort and nested case-control studies investigating risk of lung cancer in patients with periodontal disease were included. Hazard ratios (HRs) were calculated, as were their 95% confidence intervals (CIs) using a fixed-effect inverse-variance model. Statistical heterogeneity was explored using the Q test as well as the I(2) statistic. Publication bias was assessed by visual inspection of funnel plots symmetry and Egger's test. Five cohort studies were included, involving 321,420 participants in this meta-analysis. Summary estimates based on adjusted data showed that periodontal disease was associated with a significant risk of lung cancer (HR = 1.24, 95% CI = 1.13 to 1.36; I(2) = 30%). No publication bias was detected. Subgroup analysis indicated that the association of periodontal disease and lung cancer remained significant in the female population. Evidence from cohort studies suggests that patients with periodontal disease are at increased risk of developing lung cancer.

Connective tissue diseases, multimorbidity and the ageing lung.

Science.gov (United States)

Spagnolo, Paolo; Cordier, Jean-François; Cottin, Vincent

2016-05-01

Connective tissue diseases encompass a wide range of heterogeneous disorders characterised by immune-mediated chronic inflammation often leading to tissue damage, collagen deposition and possible loss of function of the target organ. Lung involvement is a common complication of connective tissue diseases. Depending on the underlying disease, various thoracic compartments can be involved but interstitial lung disease is a major contributor to morbidity and mortality. Interstitial lung disease, pulmonary hypertension or both are found most commonly in systemic sclerosis. In the elderly, the prevalence of connective tissue diseases continues to rise due to both longer life expectancy and more effective and better-tolerated treatments. In the geriatric population, connective tissue diseases are almost invariably accompanied by age-related comorbidities, and disease- and treatment-related complications, which contribute to the significant morbidity and mortality associated with these conditions, and complicate treatment decision-making. Connective tissue diseases in the elderly represent a growing concern for healthcare providers and an increasing burden of global health resources worldwide. A better understanding of the mechanisms involved in the regulation of the immune functions in the elderly and evidence-based guidelines specifically designed for this patient population are instrumental to improving the management of connective tissue diseases in elderly patients. Copyright ©ERS 2016.

Heterogeneity in coal composition and implications for lung cancer risk in Xuanwei and Fuyuan counties, China

NARCIS (Netherlands)

Downward, George S.; Hu, Wei; Large, David; Veld, Harry; Xu, Jun; Reiss, Boris; Wu, Guoping; Wei, Fusheng; Chapman, Robert S.; Rothman, Nat; Qing, Lan; Vermeulen, Roel

2014-01-01

Background: Xuanwei and Fuyuan counties in Yunnan Province, China have among the highest lung cancer rates in the country. This has been associated with the domestic combustion of bituminous coal (referred to as "smoky" coal). Additionally, significant geographical variation in cancer rates among

Candidates for Intensive Local Treatment in cIIIA-N2 Non-Small Cell Lung Cancer: Deciphering the Heterogeneity

Energy Technology Data Exchange (ETDEWEB)

Horinouchi, Hidehito, E-mail: hhorinou@ncc.go.jp [Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Japan); Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo (Japan); Goto, Yasushi; Kanda, Shintaro; Fujiwara, Yutaka; Nokihara, Hiroshi; Yamamoto, Noboru [Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Japan); Sumi, Minako [Department of Radiation Therapy, National Cancer Center Hospital, Tokyo (Japan); Tamura, Tomohide [Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Japan); Ohe, Yuichiro [Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Japan); Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo (Japan)

2016-01-01

Purpose: The purpose of this study was to refine the heterogeneous clinical stage IIIA non-small cell lung cancer (NSCLC) with N2 nodes status (cIIIA-N2) by clinicopathological characteristics before treatment. Methods and Materials: We analyzed data of consecutive patients with cIIIA-N2 NSCLC diagnosed between 1997 and 2010 and treated by chemoradiation therapy (CRT). The appearance of the mediastinal lymph nodes (MLNs) was classified into discrete or infiltrative according to the criteria proposed by the American College of Chest Physicians. In addition, the extent of MLN involvement (MLNI) was classified as limited (close to the primary tumor) or extensive (including upper MLNI in the case of tumors in the lower lobes and vice versa). Results: A total of 148 patients with cIIIA-N2 NSCLC was treated by CRT. The patient characteristics were as follows: males: 118; females: 30; median age: 62 years; appearance of the involved MLNs: 85 discrete, 63 infiltrative; extent of MLNI: 82 limited, 66 extensive; histology: 36 squamous, 112 nonsquamous. The median progression-free survival (PFS) and median overall survival (OS) in the entire subject population were 9.9 and 34.7 months, respectively. A discrete appearance of the involved MLNs and a limited extent of MLNI contributed significantly to a better PFS and OS. The percentages of cases with relapses within the irradiated field classified according to the characteristics of the MLNs were as follows; appearance of the MLNs (24.6% discrete, 18.9% infiltrative); extent of MLNI (25.9 limited, 17.9% extensive). Conclusions: Those with a discrete appearance of the involved MLNs and a limited extent of MLNI at diagnosis could show relatively more favorable outcomes and could be candidates for multimodality therapy.

A genetic approach to understanding asthma and lung function development

DEFF Research Database (Denmark)

Kreiner-Møller, Eskil

2014-01-01

that are most robustly associated with persistent and severe childhood onset asthma. However, it is unknown how the 17q21 common variants are associated with the persistence of symptoms into adulthood. In paper II,we investigated the effect of the 17q21 locus on current adult asthma and related traits......Asthma is a common heritable disease of the airways with recurrent episodes of symptoms and reversible airflow obstruction that has increased dramatically in prevalence. The disease is highly heterogeneous with varying age at onset and clinical presentation and most likely represents several...... responsiveness, but were associated with lung function growth. This suggests that these loci do not exert their effects prenatally and indicate a potential window of opportunity in early childhood for preventing lung function decline and maintaining respiratory health. The 17q21 locus harbors common variants...

Segurança e efetividade da fisioterapia respiratória em abscesso pulmonar: estudo de casos Safety and effectiveness of chest physiotherapy in lung abscess: a two-case study

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Josy Davidson

2010-12-01

Full Text Available O abscesso pulmonar é uma lesão necrótica geralmente devida a germes piogênicos. A fisioterapia respiratória (FR é indicada, porém há poucos relatos na literatura, não havendo consenso quanto ao uso e às técnicas de FR para esse caso. O objetivo deste estudo de dois casos foi verificar a segurança e efetividade da FR no tratamento do abcesso pulmonar. O caso 1 foi um paciente de 30 anos, internado; a terapia consistiu em posicioná-lo em Trendelenburg semi-lateral direito para ventral por 30 minutos, três vezes ao dia, com saída de grande quantidade de secreção. Após 5 dias, o radiograma de tórax demonstrou redução de 90% do nível hidroaéreo, verificando-se o esvaziamento completo do abscesso após 14 dias de internação. O caso 2 foi uma paciente de 28 anos igualmente com diagnóstico de abscesso pulmonar, também tratada com drenagem postural, nos mesmos posicionamento e freqüência que o caso 1, sendo drenada grande quantidade de secreção amarelada e fluida. Após 7 dias de tratamento evidenciou-se redução importante do nível líquido do abscesso pulmonar. Conclui-se que a drenagem postural isoladamente é uma técnica de fisioterapia efetiva e segura no tratamento do abcesso pulmonar.Lung abscess is a necrotic lesion mostly caused by pyogenic germs. Chest physical therapy (CPT is indicated, but there are few studies available and no consensus on CPT use and techniques for theses cases. The purpose of this study was to assess safety and effectiveness of postural drainage in treating lung abscess in two cases. Patient 1, male, 30 years old, was laid in Trendelenburg, in semi-lateral to ventral decubitus for 30 minutes, three times a day. After five days of therapy, X-ray showed a 90% decrease of sputum, and on the 14th day full drainage was achieved. Case 2 was a female patient, 28 years old, treated at the same position and frequency as case 1. After seven days of therapy, exams showed a great decrease of pus from

Clonal heterogeneity of small-cell anaplastic carcinoma of the lung demonstrated by flow-cytometric DNA analysis

DEFF Research Database (Denmark)

Vindeløv, L L; Hansen, H H; Christensen, I J

1980-01-01

Flow-cytometric DNA analysis yields information on ploidy and proliferative characteristics of a cell population. The analysis was implemented on small-cell anaplastic carcinoma of the lung using a rapid detergent technique for the preparation of fine-needle aspirates for DNA determination and a ...

Genome-wide association study in discordant sibships identifies multiple inherited susceptibility alleles linked to lung cancer.

Science.gov (United States)

Galvan, Antonella; Falvella, Felicia S; Frullanti, Elisa; Spinola, Monica; Incarbone, Matteo; Nosotti, Mario; Santambrogio, Luigi; Conti, Barbara; Pastorino, Ugo; Gonzalez-Neira, Anna; Dragani, Tommaso A

2010-03-01

We analyzed a series of young (median age = 52 years) non-smoker lung cancer patients and their unaffected siblings as controls, using a genome-wide 620 901 single-nucleotide polymorphism (SNP) array analysis and a case-control DNA pooling approach. We identified 82 putatively associated SNPs that were retested by individual genotyping followed by use of the sib transmission disequilibrium test, pointing to 36 SNPs associated with lung cancer risk in the discordant sibs series. Analysis of these 36 SNPs in a polygenic model characterized by additive and interchangeable effects of rare alleles revealed a highly statistically significant dosage-dependent association between risk allele carrier status and proportion of cancer cases. Replication of the same 36 SNPs in a population-based series confirmed the association with lung cancer for three SNPs, suggesting that phenocopies and genetic heterogeneity can play a major role in the complex genetics of lung cancer risk in the general population.

Evaluation of a cumulative SUV-volume histogram method for parameterizing heterogeneous intratumoural FDG uptake in non-small cell lung cancer PET studies

International Nuclear Information System (INIS)

Velden, Floris H.P. van; Cheebsumon, Patsuree; Yaqub, Maqsood; Hoekstra, Otto S.; Lammertsma, Adriaan A.; Boellaard, Ronald; Smit, Egbert F.

2011-01-01

Standardized uptake values (SUV) are commonly used for quantification of whole-body [ 18 F]fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) studies. Changes in SUV following therapy, however, only provide a proper measure of response in case of homogeneous FDG uptake in the tumour. The purpose of this study was therefore to implement and characterize a method that enables quantification of heterogeneity in tumour FDG uptake. Cumulative SUV-volume histograms (CSH), describing % of total tumour volume above % threshold of maximum SUV (SUV max ), were calculated. The area under a CSH curve (AUC) is a quantitative index of tumour uptake heterogeneity, with lower AUC corresponding to higher degrees of heterogeneity. Simulations of homogeneous and heterogeneous responses were performed to assess the value of AUC-CSH for measuring uptake and/or response heterogeneity. In addition, partial volume correction and image denoising was applied prior to calculating AUC-CSH. Finally, the method was applied to a number of human FDG scans. Partial volume correction and noise reduction improved CSH curves. Both simulations and clinical examples showed that AUC-CSH values corresponded with level of tumour heterogeneity and/or heterogeneity in response. In contrast, this correspondence was not seen with SUV max alone. The results indicate that the main advantage of AUC-CSH above other measures, such as 1/COV (coefficient of variation), is the possibility to measure or normalize AUC-CSH in different ways. AUC-CSH might be used as a quantitative index of heterogeneity in tracer uptake. In response monitoring studies it can be used to address heterogeneity in response. (orig.)

Extravascular Lung Water and Acute Lung Injury

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Ritesh Maharaj

2012-01-01

Full Text Available Acute lung injury carries a high burden of morbidity and mortality and is characterised by nonhydrostatic pulmonary oedema. The aim of this paper is to highlight the role of accurate quantification of extravascular lung water in diagnosis, management, and prognosis in “acute lung injury” and “acute respiratory distress syndrome”. Several studies have verified the accuracy of both the single and the double transpulmonary thermal indicator techniques. Both experimental and clinical studies were searched in PUBMED using the term “extravascular lung water” and “acute lung injury”. Extravascular lung water measurement offers information not otherwise available by other methods such as chest radiography, arterial blood gas, and chest auscultation at the bedside. Recent data have highlighted the role of extravascular lung water in response to treatment to guide fluid therapy and ventilator strategies. The quantification of extravascular lung water may predict mortality and multiorgan dysfunction. The limitations of the dilution method are also discussed.

Large epidemic thresholds emerge in heterogeneous networks of heterogeneous nodes

Science.gov (United States)

Yang, Hui; Tang, Ming; Gross, Thilo

2015-08-01

One of the famous results of network science states that networks with heterogeneous connectivity are more susceptible to epidemic spreading than their more homogeneous counterparts. In particular, in networks of identical nodes it has been shown that network heterogeneity, i.e. a broad degree distribution, can lower the epidemic threshold at which epidemics can invade the system. Network heterogeneity can thus allow diseases with lower transmission probabilities to persist and spread. However, it has been pointed out that networks in which the properties of nodes are intrinsically heterogeneous can be very resilient to disease spreading. Heterogeneity in structure can enhance or diminish the resilience of networks with heterogeneous nodes, depending on the correlations between the topological and intrinsic properties. Here, we consider a plausible scenario where people have intrinsic differences in susceptibility and adapt their social network structure to the presence of the disease. We show that the resilience of networks with heterogeneous connectivity can surpass those of networks with homogeneous connectivity. For epidemiology, this implies that network heterogeneity should not be studied in isolation, it is instead the heterogeneity of infection risk that determines the likelihood of outbreaks.

Large epidemic thresholds emerge in heterogeneous networks of heterogeneous nodes.

Science.gov (United States)

Yang, Hui; Tang, Ming; Gross, Thilo

2015-08-21

One of the famous results of network science states that networks with heterogeneous connectivity are more susceptible to epidemic spreading than their more homogeneous counterparts. In particular, in networks of identical nodes it has been shown that network heterogeneity, i.e. a broad degree distribution, can lower the epidemic threshold at which epidemics can invade the system. Network heterogeneity can thus allow diseases with lower transmission probabilities to persist and spread. However, it has been pointed out that networks in which the properties of nodes are intrinsically heterogeneous can be very resilient to disease spreading. Heterogeneity in structure can enhance or diminish the resilience of networks with heterogeneous nodes, depending on the correlations between the topological and intrinsic properties. Here, we consider a plausible scenario where people have intrinsic differences in susceptibility and adapt their social network structure to the presence of the disease. We show that the resilience of networks with heterogeneous connectivity can surpass those of networks with homogeneous connectivity. For epidemiology, this implies that network heterogeneity should not be studied in isolation, it is instead the heterogeneity of infection risk that determines the likelihood of outbreaks.

Percentage depth dose calculation accuracy of model based algorithms in high energy photon small fields through heterogeneous media and comparison with plastic scintillator dosimetry.

Science.gov (United States)

Alagar, Ananda Giri Babu; Mani, Ganesh Kadirampatti; Karunakaran, Kaviarasu

2016-01-08

Small fields smaller than 4 × 4 cm2 are used in stereotactic and conformal treatments where heterogeneity is normally present. Since dose calculation accuracy in both small fields and heterogeneity often involves more discrepancy, algorithms used by treatment planning systems (TPS) should be evaluated for achieving better treatment results. This report aims at evaluating accuracy of four model-based algorithms, X-ray Voxel Monte Carlo (XVMC) from Monaco, Superposition (SP) from CMS-Xio, AcurosXB (AXB) and analytical anisotropic algorithm (AAA) from Eclipse are tested against the measurement. Measurements are done using Exradin W1 plastic scintillator in Solid Water phantom with heterogeneities like air, lung, bone, and aluminum, irradiated with 6 and 15 MV photons of square field size ranging from 1 to 4 cm2. Each heterogeneity is introduced individually at two different depths from depth-of-dose maximum (Dmax), one setup being nearer and another farther from the Dmax. The central axis percentage depth-dose (CADD) curve for each setup is measured separately and compared with the TPS algorithm calculated for the same setup. The percentage normalized root mean squared deviation (%NRMSD) is calculated, which represents the whole CADD curve's deviation against the measured. It is found that for air and lung heterogeneity, for both 6 and 15 MV, all algorithms show maximum deviation for field size 1 × 1 cm2 and gradually reduce when field size increases, except for AAA. For aluminum and bone, all algorithms' deviations are less for 15 MV irrespective of setup. In all heterogeneity setups, 1 × 1 cm2 field showed maximum deviation, except in 6MV bone setup. All algorithms in the study, irrespective of energy and field size, when any heterogeneity is nearer to Dmax, the dose deviation is higher compared to the same heterogeneity far from the Dmax. Also, all algorithms show maximum deviation in lower-density materials compared to high-density materials.

Evaluation of a cumulative SUV-volume histogram method for parameterizing heterogeneous intratumoural FDG uptake in non-small cell lung cancer PET studies

Energy Technology Data Exchange (ETDEWEB)

Velden, Floris H.P. van; Cheebsumon, Patsuree; Yaqub, Maqsood; Hoekstra, Otto S.; Lammertsma, Adriaan A.; Boellaard, Ronald [VU University Medical Center, Department of Nuclear Medicine and PET Research, PO Box 7057, Amsterdam (Netherlands); Smit, Egbert F. [VU University Medical Center, Department of Pulmonary Diseases, Amsterdam (Netherlands)

2011-09-15

Standardized uptake values (SUV) are commonly used for quantification of whole-body [{sup 18}F]fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) studies. Changes in SUV following therapy, however, only provide a proper measure of response in case of homogeneous FDG uptake in the tumour. The purpose of this study was therefore to implement and characterize a method that enables quantification of heterogeneity in tumour FDG uptake. Cumulative SUV-volume histograms (CSH), describing % of total tumour volume above % threshold of maximum SUV (SUV{sub max}), were calculated. The area under a CSH curve (AUC) is a quantitative index of tumour uptake heterogeneity, with lower AUC corresponding to higher degrees of heterogeneity. Simulations of homogeneous and heterogeneous responses were performed to assess the value of AUC-CSH for measuring uptake and/or response heterogeneity. In addition, partial volume correction and image denoising was applied prior to calculating AUC-CSH. Finally, the method was applied to a number of human FDG scans. Partial volume correction and noise reduction improved CSH curves. Both simulations and clinical examples showed that AUC-CSH values corresponded with level of tumour heterogeneity and/or heterogeneity in response. In contrast, this correspondence was not seen with SUV{sub max} alone. The results indicate that the main advantage of AUC-CSH above other measures, such as 1/COV (coefficient of variation), is the possibility to measure or normalize AUC-CSH in different ways. AUC-CSH might be used as a quantitative index of heterogeneity in tracer uptake. In response monitoring studies it can be used to address heterogeneity in response. (orig.)

Lung cancer

International Nuclear Information System (INIS)

Aisner, J.

1985-01-01

This book contains 13 chapters. Some of the chapter titles are: The Pathology of Lung Cancer; Radiotherapy for Non-Small-Cell Cancer of the Lung; Chemotherapy for Non-Small-Cell Lung Cancer; Immunotherapy in the Management of Lung Cancer; Preoperative Staging and Surgery for Non-Small-Cell Lung Cancer; and Prognostic Factors in Lung Cancer

Neuroendocrine tumors of the lung: major radiologic findings in a series of 22 histopathologically confirmed cases

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Santos, Marcel Koenigkam, E-mail: marcelk46@yahoo.com.br [Hospital das Clinicas da Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Paulo (HCFMRP-USP), SP (Brazil); Department of Diagnostic and Interventional Radiology, Heidelberg University (Germany); Barreto, Andre Rodrigues Facanha [Clinica Radius, Clinica Sao Carlos Imagem and Santa Casa de Misericordia de Fortaleza, Fortaleza, CE (Brazil); Chagas Neto, Francisco Abaete [Program of Health Sciences Applied to the Locomotor System - Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Paulo (FMRP-USP), Ribeirao Preto, SP (Brazil); Muglia, Valdair Francisco; Elias Junior, Jorge [Division of Radiology, Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Paulo (FMRPUSP), Ribeirao Preto, SP (Brazil)

2012-07-15

Objective: To describe key imaging findings in a series of cases of primary neuroendocrine tumors of the lung (NTLs), with emphasis on computed tomography changes. Materials And Methods: Imaging studies of 22 patients (12 men, mean age 60 years) with histopathologically confirmed diagnosis, evaluated in the author's institution during the last five years were retrospectively reviewed by two radiologists, with findings being consensually described focusing on changes observed at computed tomography. Results: The authors have described five typical carcinoids, three atypical carcinoids, three large-cell neuroendocrine carcinomas (LCNCs), and 11 small-cell lung cancers (SCLCs). Only one typical carcinoid presented the characteristic appearance of central endobronchial nodule with distal pulmonary atelectasis, while the others were pulmonary nodules or masses. The atypical carcinoids corresponded to peripheral heterogeneous masses. One out of the three LCNCs was a peripheral homogeneous mass, while the others were ill-defined and heterogeneous. The 11 SCLCs corresponded to central, infiltrating and heterogeneous masses with secondary pleuropulmonary changes. Calcifications were absent both in LGNCs and SCLCs. Metastases were found initially and also at follow-up of all the cases of LCNCs and SCLCs. Conclusion: Although some imaging features may be similar, radiologic findings considered together with clinical information may play a relevant role in the differentiation of histological types of NTLs. (author)

Assessment of regional lung ventilation by electrical impedance tomography in a patient with unilateral bronchial stenosis and a history of tuberculosis.

Science.gov (United States)

Marinho, Liégina Silveira; Sousa, Nathalia Parente de; Barros, Carlos Augusto Barbosa da Silveira; Matias, Marcelo Silveira; Monteiro, Luana Torres; Beraldo, Marcelo do Amaral; Costa, Eduardo Leite Vieira; Amato, Marcelo Britto Passos; Holanda, Marcelo Alcantara

2013-01-01

Bronchial stenosis can impair regional lung ventilation by causing abnormal, asymmetric airflow limitation. Electrical impedance tomography (EIT) is an imaging technique that allows the assessment of regional lung ventilation and therefore complements the functional assessment of the lungs. We report the case of a patient with left unilateral bronchial stenosis and a history of tuberculosis, in whom regional lung ventilation was assessed by EIT. The EIT results were compared with those obtained by ventilation/perfusion radionuclide imaging. The patient was using nasal continuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnea syndrome. Therefore, we studied the effects of postural changes and of the use of nasal CPAP. The EIT revealed heterogeneous distribution of regional lung ventilation, the ventilation being higher in the right lung, and this distribution was influenced by postural changes and CPAP use. The EIT assessment of regional lung ventilation produced results similar to those obtained with the radionuclide imaging technique and had the advantage of providing a dynamic evaluation without radiation exposure.

Assessment of regional lung ventilation by electrical impedance tomography in a patient with unilateral bronchial stenosis and a history of tuberculosis

Directory of Open Access Journals (Sweden)

Liégina Silveira Marinho

2013-12-01

Full Text Available Bronchial stenosis can impair regional lung ventilation by causing abnormal, asymmetric airflow limitation. Electrical impedance tomography (EIT is an imaging technique that allows the assessment of regional lung ventilation and therefore complements the functional assessment of the lungs. We report the case of a patient with left unilateral bronchial stenosis and a history of tuberculosis, in whom regional lung ventilation was assessed by EIT. The EIT results were compared with those obtained by ventilation/perfusion radionuclide imaging. The patient was using nasal continuous positive airway pressure (CPAP for the treatment of obstructive sleep apnea syndrome. Therefore, we studied the effects of postural changes and of the use of nasal CPAP. The EIT revealed heterogeneous distribution of regional lung ventilation, the ventilation being higher in the right lung, and this distribution was influenced by postural changes and CPAP use. The EIT assessment of regional lung ventilation produced results similar to those obtained with the radionuclide imaging technique and had the advantage of providing a dynamic evaluation without radiation exposure.

Asthma in childhood: a complex, heterogeneous disease

Directory of Open Access Journals (Sweden)

Hai Lee Chung

2011-01-01

Full Text Available Asthma in childhood is a heterogeneous disease with different phenotypes and variable clinical manifestations, which depend on the age, gender, genetic background, and environmental influences of the patients. Several longitudinal studies have been conducted to classify the phenotypes of childhood asthma, on the basis of the symptoms, triggers of wheezing illness, or pathophysiological features of the disease. These studies have provided us with important information about the different wheezing phenotypes in young children and about potential mechanisms and risk factors for the development of chronic asthma. The goal of these studies was to provide a better insight into the causes and natural course of childhood asthma. It is well-known that complicated interactions between genes and environmental factors contribute to the development of asthma. Because childhood is a period of rapid growth in both the lungs and the immune system, developmental factors should be considered in the pathogenesis of childhood asthma. The pulmonary system continues to grow and develop until linear growth is completed. Longitudinal studies have reported significant age-related immune development during postnatal early life. These observations suggest that the phenotypes of childhood asthma vary among children and also in an individual child over time. Improved classification of heterogeneous conditions of the disease will help determine novel strategies for primary and secondary prevention and for the development of individualized treatment for childhood asthma.

WE-AB-202-04: Statistical Evaluation of Lung Function Using 4DCT Ventilation Imaging: Proton Therapy VS IMRT

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Huang, Q; Zhang, M; Chen, T; Yue, N; Zou, J [Rutgers University, New Brunswick, NJ (United States)

2016-06-15

Purpose: Variation in function of different lung regions has been ignored so far for conventional lung cancer treatment planning, which may lead to higher risk of radiation induced lung disease. 4DCT based lung ventilation imaging provides a novel yet convenient approach for lung functional imaging as 4DCT is taken as routine for lung cancer treatment. Our work aims to evaluate the impact of accounting for spatial heterogeneity in lung function using 4DCT based lung ventilation imaging for proton and IMRT plans. Methods: Six patients with advanced stage lung cancer of various tumor locations were retrospectively evaluated for the study. Proton and IMRT plans were designed following identical planning objective and constrains for each patient. Ventilation images were calculated from patients’ 4DCT using deformable image registration implemented by Velocity AI software based on Jacobian-metrics. Lung was delineated into two function level regions based on ventilation (low and high functional area). High functional region was defined as lung ventilation greater than 30%. Dose distribution and statistics in different lung function area was calculated for patients. Results: Variation in dosimetric statistics of different function lung region was observed between proton and IMRT plans. In all proton plans, high function lung regions receive lower maximum dose (100.2%–108.9%), compared with IMRT plans (106.4%–119.7%). Interestingly, three out of six proton plans gave higher mean dose by up to 2.2% than IMRT to high function lung region. Lower mean dose (lower by up to 14.1%) and maximum dose (lower by up to 9%) were observed in low function lung for proton plans. Conclusion: A systematic approach was developed to generate function lung ventilation imaging and use it to evaluate plans. This method hold great promise in function analysis of lung during planning. We are currently studying more subjects to evaluate this tool.

Interplay between the lung microbiome and lung cancer.

Science.gov (United States)

Mao, Qixing; Jiang, Feng; Yin, Rong; Wang, Jie; Xia, Wenjie; Dong, Gaochao; Ma, Weidong; Yang, Yao; Xu, Lin; Hu, Jianzhong

2018-02-28

The human microbiome confers benefits or disease susceptibility to the human body through multiple pathways. Disruption of the symbiotic balance of the human microbiome is commonly found in systematic diseases such as diabetes, obesity, and chronic gastric diseases. Emerging evidence has suggested that dysbiosis of the microbiota may also play vital roles in carcinogenesis at multiple levels, e.g., by affecting metabolic, inflammatory, or immune pathways. Although the impact of the gut microbiome on the digestive cancer has been widely explored, few studies have investigated the interplay between the microbiome and lung cancer. Some recent studies have shown that certain microbes and microbiota dysbiosis are correlated with development of lung cancer. In this mini-review, we briefly summarize current research findings describing the relationship between the lung microbiome and lung cancer. We further discuss the potential mechanisms through which the lung microbiome may play a role in lung carcinogenesis and impact lung cancer treatment. A better knowledge of the interplay between the lung microbiome and lung cancer may promote the development of innovative strategies for early prevention and personalized treatment in lung cancer. Copyright © 2017 Elsevier B.V. All rights reserved.

A Study on the Basic Criteria for Selecting Heterogeneity Parameters of F18-FDG PET Images.

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Attila Forgacs

Full Text Available Textural analysis might give new insights into the quantitative characterization of metabolically active tumors. More than thirty textural parameters have been investigated in former F18-FDG studies already. The purpose of the paper is to declare basic requirements as a selection strategy to identify the most appropriate heterogeneity parameters to measure textural features. Our predefined requirements were: a reliable heterogeneity parameter has to be volume independent, reproducible, and suitable for expressing quantitatively the degree of heterogeneity. Based on this criteria, we compared various suggested measures of homogeneity. A homogeneous cylindrical phantom was measured on three different PET/CT scanners using the commonly used protocol. In addition, a custom-made inhomogeneous tumor insert placed into the NEMA image quality phantom was imaged with a set of acquisition times and several different reconstruction protocols. PET data of 65 patients with proven lung lesions were retrospectively analyzed as well. Four heterogeneity parameters out of 27 were found as the most attractive ones to characterize the textural properties of metabolically active tumors in FDG PET images. These four parameters included Entropy, Contrast, Correlation, and Coefficient of Variation. These parameters were independent of delineated tumor volume (bigger than 25-30 ml, provided reproducible values (relative standard deviation< 10%, and showed high sensitivity to changes in heterogeneity. Phantom measurements are a viable way to test the reliability of heterogeneity parameters that would be of interest to nuclear imaging clinicians.

A Study on the Basic Criteria for Selecting Heterogeneity Parameters of F18-FDG PET Images

Science.gov (United States)

Forgacs, Attila; Pall Jonsson, Hermann; Dahlbom, Magnus; Daver, Freddie; D. DiFranco, Matthew; Opposits, Gabor; K. Krizsan, Aron; Garai, Ildiko; Czernin, Johannes; Varga, Jozsef; Tron, Lajos; Balkay, Laszlo

2016-01-01

Textural analysis might give new insights into the quantitative characterization of metabolically active tumors. More than thirty textural parameters have been investigated in former F18-FDG studies already. The purpose of the paper is to declare basic requirements as a selection strategy to identify the most appropriate heterogeneity parameters to measure textural features. Our predefined requirements were: a reliable heterogeneity parameter has to be volume independent, reproducible, and suitable for expressing quantitatively the degree of heterogeneity. Based on this criteria, we compared various suggested measures of homogeneity. A homogeneous cylindrical phantom was measured on three different PET/CT scanners using the commonly used protocol. In addition, a custom-made inhomogeneous tumor insert placed into the NEMA image quality phantom was imaged with a set of acquisition times and several different reconstruction protocols. PET data of 65 patients with proven lung lesions were retrospectively analyzed as well. Four heterogeneity parameters out of 27 were found as the most attractive ones to characterize the textural properties of metabolically active tumors in FDG PET images. These four parameters included Entropy, Contrast, Correlation, and Coefficient of Variation. These parameters were independent of delineated tumor volume (bigger than 25–30 ml), provided reproducible values (relative standard deviation< 10%), and showed high sensitivity to changes in heterogeneity. Phantom measurements are a viable way to test the reliability of heterogeneity parameters that would be of interest to nuclear imaging clinicians. PMID:27736888

Automated diagnosis of interstitial lung diseases and emphysema in MDCT imaging

Science.gov (United States)

Fetita, Catalin; Chang Chien, Kuang-Che; Brillet, Pierre-Yves; Prêteux, Françoise

2007-09-01

Diffuse lung diseases (DLD) include a heterogeneous group of non-neoplasic disease resulting from damage to the lung parenchyma by varying patterns of inflammation. Characterization and quantification of DLD severity using MDCT, mainly in interstitial lung diseases and emphysema, is an important issue in clinical research for the evaluation of new therapies. This paper develops a 3D automated approach for detection and diagnosis of diffuse lung diseases such as fibrosis/honeycombing, ground glass and emphysema. The proposed methodology combines multi-resolution 3D morphological filtering (exploiting the sup-constrained connection cost operator) and graph-based classification for a full characterization of the parenchymal tissue. The morphological filtering performs a multi-level segmentation of the low- and medium-attenuated lung regions as well as their classification with respect to a granularity criterion (multi-resolution analysis). The original intensity range of the CT data volume is thus reduced in the segmented data to a number of levels equal to the resolution depth used (generally ten levels). The specificity of such morphological filtering is to extract tissue patterns locally contrasting with their neighborhood and of size inferior to the resolution depth, while preserving their original shape. A multi-valued hierarchical graph describing the segmentation result is built-up according to the resolution level and the adjacency of the different segmented components. The graph nodes are then enriched with the textural information carried out by their associated components. A graph analysis-reorganization based on the nodes attributes delivers the final classification of the lung parenchyma in normal and ILD/emphysematous regions. It also makes possible to discriminate between different types, or development stages, among the same class of diseases.

Asthma and lung cancer, after accounting for co-occurring respiratory diseases and allergic conditions: a systematic review protocol.

Science.gov (United States)

Denholm, Rachel; Crellin, Elizabeth; Arvind, Ashwini; Quint, Jennifer

2017-01-16

Asthma is one of the most frequently diagnosed respiratory diseases in the UK, and commonly co-occurs with other respiratory and allergic diseases, such as chronic obstructive pulmonary disease (COPD) and atopic dermatitis. Previous studies have shown an increased risk of lung cancer related to asthma, but the evidence is mixed when accounting for co-occurring respiratory diseases and allergic conditions. A systematic review of published data that investigate the relationship between asthma and lung cancer, accounting for co-occurring respiratory and allergic diseases, will be conducted to investigate the independent association of asthma with lung cancer. A systematic review will be conducted, and include original reports of cohort, cross-sectional and case-control studies of the association of asthma with lung cancer after accounting for co-occurring respiratory diseases. Articles published up to June 2016 will be included, and their selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A standardised data extraction form will be developed and pretested, and descriptive analyses will be used to summarise the available literature. If appropriate, pooled effect estimates of the association between asthma and lung cancer, given adjustment for a specific co-occurring condition will be estimated using random effects models. Potential sources of heterogeneity and between study heterogeneity will also be investigated. The study will be a review of published data and does not require ethical approval. Results will be disseminated through a peer-reviewed publication. International Prospective Register for Systematic Reviews (PROSPERO) number CRD42016043341. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Impact of inhomogeneity corrections on dose coverage in the treatment of lung cancer using stereotactic body radiation therapy

International Nuclear Information System (INIS)

Ding, George X.; Duggan, Dennis M.; Lu Bo; Hallahan, Dennis E.; Cmelak, Anthony; Malcolm, Arnold; Newton, Jared; Deeley, Matthew; Coffey, Charles W.

2007-01-01

The purpose of this study is to assess the real target dose coverage when radiation treatments were delivered to lung cancer patients based on treatment planning according to the RTOG-0236 Protocol. We compare calculated dosimetric results between the more accurate anisotropic analytical algorithm (AAA) and the pencil beam algorithm for stereotactic body radiation therapy treatment planning in lung cancer. Ten patients with non-small cell lung cancer were given 60 Gy in three fractions using 6 and 10 MV beams with 8-10 fields. The patients were chosen in accordance with the lung RTOG-0236 protocol. The dose calculations were performed using the pencil beam algorithm with no heterogeneity corrections (PB-NC) and then recalculated with the pencil beam with modified Batho heterogeneity corrections (PB-MB) and the AAA using an identical beam setup and monitor units. The differences in calculated dose to 95% or 99% of the PTV, between using the PB-NC and the AAA, were within 10% of prescribed dose (60 Gy). However, the minimum dose to 95% and 99% of PTV calculated using the PB-MB were consistently overestimated by up to 40% and 36% of the prescribed dose, respectively, compared to that calculated by the AAA. Using the AAA as reference, the calculated maximum doses were underestimated by up to 27% using the PB-NC and overestimated by 19% using the PB-MB. The calculations of dose to lung from PB-NC generally agree with that of AAA except in the small high-dose region where PB-NC underestimates. The calculated dose distributions near the interface using the AAA agree with those from Monte Carlo calculations as well as measured values. This study indicates that the real minimum PTV dose coverage cannot be guaranteed when the PB-NC is used to calculate the monitor unit settings in dose prescriptions

Radiomics and its emerging role in lung cancer research, imaging biomarkers and clinical management: State of the art

International Nuclear Information System (INIS)

Lee, Geewon; Lee, Ho Yun; Park, Hyunjin; Schiebler, Mark L.; Beek, Edwin J.R. van; Ohno, Yoshiharu; Seo, Joon Beom; Leung, Ann

2017-01-01

Highlights: • Radiomics is the post-processing and analysis of large amounts of quantitative imaging features that can be derived from medical images. • Radiomics features can reflect the spatial complexity, genomic heterogeneity, and subregional identification of lung cancer. • Currently available radiomic features can be divided into four major categories. • The major challenge is to integrate radiomic data with clinical, pathological, and genomic information. - Abstract: With the development of functional imaging modalities we now have the ability to study the microenvironment of lung cancer and its genomic instability. Radiomics is defined as the use of automated or semi-automated post-processing and analysis of large amounts of quantitative imaging features that can be derived from medical images. The automated generation of these analytical features helps to quantify a number of variables in the imaging assessment of lung malignancy. These imaging features include: tumor spatial complexity, elucidation of the tumor genomic heterogeneity and composition, subregional identification in terms of tumor viability or aggressiveness, and response to chemotherapy and/or radiation. Therefore, a radiomic approach can help to reveal unique information about tumor behavior. Currently available radiomic features can be divided into four major classes: (a) morphological, (b) statistical, (c) regional, and (d) model-based. Each category yields quantitative parameters that reflect specific aspects of a tumor. The major challenge is to integrate radiomic data with clinical, pathological, and genomic information to decode the different types of tissue biology. There are many currently available radiomic studies on lung cancer for which there is a need to summarize the current state of the art.

Radiomics and its emerging role in lung cancer research, imaging biomarkers and clinical management: State of the art

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Lee, Geewon [Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Department of Radiology and Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan (Korea, Republic of); Lee, Ho Yun, E-mail: hoyunlee96@gmail.com [Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Park, Hyunjin [School of Electronic and Electrical Engineering and Center for Neuroscience Imaging Research, Sungkyunkwan University, Suwon (Korea, Republic of); Schiebler, Mark L. [Department of Radiology, UW-Madison School of Medicine and Public Health, Madison, WI (United States); Beek, Edwin J.R. van [Clinical Research Imaging Centre, Edinburgh Imaging, Queen' s Medical Research Institute, University of Edinburgh, Edinburgh (United Kingdom); Ohno, Yoshiharu [Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe-shi 650-0017 (Japan); Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe-shi 650-0017 (Japan); Seo, Joon Beom [Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Leung, Ann [Department of Radiology, Stanford University, Palo Alto, CA (United States)

2017-01-15

Highlights: • Radiomics is the post-processing and analysis of large amounts of quantitative imaging features that can be derived from medical images. • Radiomics features can reflect the spatial complexity, genomic heterogeneity, and subregional identification of lung cancer. • Currently available radiomic features can be divided into four major categories. • The major challenge is to integrate radiomic data with clinical, pathological, and genomic information. - Abstract: With the development of functional imaging modalities we now have the ability to study the microenvironment of lung cancer and its genomic instability. Radiomics is defined as the use of automated or semi-automated post-processing and analysis of large amounts of quantitative imaging features that can be derived from medical images. The automated generation of these analytical features helps to quantify a number of variables in the imaging assessment of lung malignancy. These imaging features include: tumor spatial complexity, elucidation of the tumor genomic heterogeneity and composition, subregional identification in terms of tumor viability or aggressiveness, and response to chemotherapy and/or radiation. Therefore, a radiomic approach can help to reveal unique information about tumor behavior. Currently available radiomic features can be divided into four major classes: (a) morphological, (b) statistical, (c) regional, and (d) model-based. Each category yields quantitative parameters that reflect specific aspects of a tumor. The major challenge is to integrate radiomic data with clinical, pathological, and genomic information to decode the different types of tissue biology. There are many currently available radiomic studies on lung cancer for which there is a need to summarize the current state of the art.

Critical roles of mucin-1 in sensitivity of lung cancer cells to tumor necrosis factor-alpha and dexamethasone.

Science.gov (United States)

Xu, Menglin; Wang, Xiangdong

2017-08-01

Lung cancer is the leading cause of death from cancer. Mucins are glycoproteins with high molecular weight, responsible for cell growth, differentiation, and signaling, and were proposed to be correlated with gene heterogeneity of lung cancer. Here, we report aberrant expression of mucin genes and tumor necrosis factor receptors in lung adenocarcinoma tissues compared with normal tissues in GEO datasets. Mucin-1 (MUC1) gene was selected and considered as the target gene; furthermore, the expression pattern of adenocarcinomic cells (A549, H1650, or H1299 cells) was validated under the stimulation with tumor necrosis factor-alpha (TNFα) or dexamethasone (DEX), separately. MUC1 gene interference was done to A549 cells to show its role in sensitivity of lung cancer cells to TNFα and DEX. Results of our experiments indicate that MUC1 may regulate the influence of inflammatory mediators in effects of glucocorticoids (GCs), as a regulatory target to improve therapeutics. It shows the potential effect of MUC1 and GCs in lung adenocarcinoma (LADC), which may help in LADC treatment in the future.

Effects of ventilation strategy on distribution of lung inflammatory cell activity

Science.gov (United States)

2013-01-01

endotoxemia, protective ventilation may reduce the magnitude and heterogeneity of pulmonary inflammatory cell metabolic activity in early lung injury and may improve gas exchange through its effects predominantly in dependent lung regions. Such effects are likely related to a reduction in the metabolic activity, but not in the number, of lung-infiltrating neutrophils. PMID:23947920

CT analysis of lung density changes in patients undergoing total body irradiation prior to bone marrow transplantation

International Nuclear Information System (INIS)

Lee, J.Y.; Shank, B.; Bonfiglio, P.; Reid, A.

1984-01-01

Sequential changes in lung density measured by CT are potentially sensitive and convenient monitors of lung abnormalities following total body irradiation (TBI). Methods have been developed to compare pre- and post-TBI CT of lung. The average local features of a cross-sectional lung slice are extracted from three peripheral regions of interest in the anterior, posterior, and lateral portions of the CT image. Also, density profiles across a specific region may be obtained. These may be compared first for verification of patient position and breathing status and then for changes between pre- and post-TBI. These may also be compared with radiation dose profiles through the lung. A preliminary study on 21 leukemia patients undergoing total body irradiation indicates the following: (a) Density gradients of patients' lungs in the antero-posterior direction show a marked heterogeneity before and after transplantation compared with normal lungs. The patients with departures from normal density gradients pre-TBI correlate with later pulmonary complications. (b) Measurements of average peripheral lung densities have demonstrated that the average lung density in the younger age group is substantially higher: pre-TBI, the average CT number (1,000 scale) is -638 +/- 39 Hounsfield unit (HU) for 0-10 years old and -739 +/- 53 HU for 21-40 years old. (c) Density profiles showed no post-TBI regional changes in lung density corresponding to the dose profile across the lung, so no differentiation of a radiation-specific effect has yet been possible. Computed tomographic density profiles in the antero-posterior direction are successfully used to verify positioning of the CT slice and the breathing level of the lung

LungMAP: The Molecular Atlas of Lung Development Program.

Science.gov (United States)

Ardini-Poleske, Maryanne E; Clark, Robert F; Ansong, Charles; Carson, James P; Corley, Richard A; Deutsch, Gail H; Hagood, James S; Kaminski, Naftali; Mariani, Thomas J; Potter, Steven S; Pryhuber, Gloria S; Warburton, David; Whitsett, Jeffrey A; Palmer, Scott M; Ambalavanan, Namasivayam

2017-11-01

The National Heart, Lung, and Blood Institute is funding an effort to create a molecular atlas of the developing lung (LungMAP) to serve as a research resource and public education tool. The lung is a complex organ with lengthy development time driven by interactive gene networks and dynamic cross talk among multiple cell types to control and coordinate lineage specification, cell proliferation, differentiation, migration, morphogenesis, and injury repair. A better understanding of the processes that regulate lung development, particularly alveologenesis, will have a significant impact on survival rates for premature infants born with incomplete lung development and will facilitate lung injury repair and regeneration in adults. A consortium of four research centers, a data coordinating center, and a human tissue repository provides high-quality molecular data of developing human and mouse lungs. LungMAP includes mouse and human data for cross correlation of developmental processes across species. LungMAP is generating foundational data and analysis, creating a web portal for presentation of results and public sharing of data sets, establishing a repository of young human lung tissues obtained through organ donor organizations, and developing a comprehensive lung ontology that incorporates the latest findings of the consortium. The LungMAP website (www.lungmap.net) currently contains more than 6,000 high-resolution lung images and transcriptomic, proteomic, and lipidomic human and mouse data and provides scientific information to stimulate interest in research careers for young audiences. This paper presents a brief description of research conducted by the consortium, database, and portal development and upcoming features that will enhance the LungMAP experience for a community of users. Copyright © 2017 the American Physiological Society.

Uma ferramenta para planejamento de estudos para concursos

Directory of Open Access Journals (Sweden)

Leonardo Pimentel

2015-11-01

Full Text Available De acordo com a constituição brasileira, a única forma de se tornar um empregado do governo é passar em um concurso público. O exame de conhecimento do cargo é um dos componentes mais importantes de um concurso. Estudar para esse exame é uma tarefa que requer planejamento. Um meio de obter um bom planejamento é construir uma grade de horários que relacione as matérias a serem estudadas com os respectivos horários disponíveis para o estudo. Esse tipo de problema se assemelha bastante à gerência de projetos, em que se procura estabelecer a distribuição das atividades ao longo do tempo disponível. Assim, torna-se interessante explorar a dinâmica de estudos para concursos como um projeto. O presente trabalho apresenta a ferramenta de apoio ao estudos - Passe-me, baseada no ciclo PDCA (do inglês, Plan-Do-Check-Act. Por se tratar de uma ferramenta web, o tempo de resposta para produzir uma grade de estudos é fundamental. A ferramenta faz uso de algoritmo genético para calcular a grade de horários priorizando a velocidade de resposta. A ferramenta foi avaliada em diferentes cenários de uso e obteve desempenho satisfatório durante a produção da grade de estudos.

Lung volumes and emphysema in smokers with interstitial lung abnormalities.

Science.gov (United States)

Washko, George R; Hunninghake, Gary M; Fernandez, Isis E; Nishino, Mizuki; Okajima, Yuka; Yamashiro, Tsuneo; Ross, James C; Estépar, Raúl San José; Lynch, David A; Brehm, John M; Andriole, Katherine P; Diaz, Alejandro A; Khorasani, Ramin; D'Aco, Katherine; Sciurba, Frank C; Silverman, Edwin K; Hatabu, Hiroto; Rosas, Ivan O

2011-03-10

Cigarette smoking is associated with emphysema and radiographic interstitial lung abnormalities. The degree to which interstitial lung abnormalities are associated with reduced total lung capacity and the extent of emphysema is not known. We looked for interstitial lung abnormalities in 2416 (96%) of 2508 high-resolution computed tomographic (HRCT) scans of the lung obtained from a cohort of smokers. We used linear and logistic regression to evaluate the associations between interstitial lung abnormalities and HRCT measurements of total lung capacity and emphysema. Interstitial lung abnormalities were present in 194 (8%) of the 2416 HRCT scans evaluated. In statistical models adjusting for relevant covariates, interstitial lung abnormalities were associated with reduced total lung capacity (-0.444 liters; 95% confidence interval [CI], -0.596 to -0.292; Ppulmonary disease (COPD) (odds ratio, 0.53; 95% CI, 0.37 to 0.76; P<0.001). The effect of interstitial lung abnormalities on total lung capacity and emphysema was dependent on COPD status (P<0.02 for the interactions). Interstitial lung abnormalities were positively associated with both greater exposure to tobacco smoke and current smoking. In smokers, interstitial lung abnormalities--which were present on about 1 of every 12 HRCT scans--were associated with reduced total lung capacity and a lesser amount of emphysema. (Funded by the National Institutes of Health and the Parker B. Francis Foundation; ClinicalTrials.gov number, NCT00608764.).

[Comparison of dose calculation algorithms in stereotactic radiation therapy in lung].

Science.gov (United States)

Tomiyama, Yuki; Araki, Fujio; Kanetake, Nagisa; Shimohigashi, Yoshinobu; Tominaga, Hirofumi; Sakata, Jyunichi; Oono, Takeshi; Kouno, Tomohiro; Hioki, Kazunari

2013-06-01

Dose calculation algorithms in radiation treatment planning systems (RTPSs) play a crucial role in stereotactic body radiation therapy (SBRT) in the lung with heterogeneous media. This study investigated the performance and accuracy of dose calculation for three algorithms: analytical anisotropic algorithm (AAA), pencil beam convolution (PBC) and Acuros XB (AXB) in Eclipse (Varian Medical Systems), by comparison against the Voxel Monte Carlo algorithm (VMC) in iPlan (BrainLab). The dose calculations were performed with clinical lung treatments under identical planning conditions, and the dose distributions and the dose volume histogram (DVH) were compared among algorithms. AAA underestimated the dose in the planning target volume (PTV) compared to VMC and AXB in most clinical plans. In contrast, PBC overestimated the PTV dose. AXB tended to slightly overestimate the PTV dose compared to VMC but the discrepancy was within 3%. The discrepancy in the PTV dose between VMC and AXB appears to be due to differences in physical material assignments, material voxelization methods, and an energy cut-off for electron interactions. The dose distributions in lung treatments varied significantly according to the calculation accuracy of the algorithms. VMC and AXB are better algorithms than AAA for SBRT.

Debates críticos: os Estudos de Segurança e o futuro dos Estudos da Paz e dos Conflitos 10.5102/uri.v11i2.2526

Directory of Open Access Journals (Sweden)

André Barrinha

2013-11-01

Full Text Available Irremediavelmente ligados pela proximidade dos respetivos objetos de estudo, Estudos de Segurança e Estudos da Paz e dos Conflitos constituíram-se e evoluíram ao longo da Guerra Fria como disciplinas antagónicas. Essa divisão operou-se sobretudo na Europa, onde Galtung e seus discípulos encaminharam o estudo das questões da guerra e da paz para uma agenda claramente normativa e crítica, enquanto o estudo das questões de segurança se centrava numa abordagem orientada para o policy-making. Como é defendido neste artigo, o final do conflito bipolar correspondeu, até certo ponto, a uma inversão de papéis, com os Estudos da Paz e dos Conflitos acomodados a um empirismo desprovido de normatividade e os Estudos de Segurança, pelo menos na Europa, a abrirem-se a novas abordagens de cariz mais crítico. É aqui sugerido que esta inversão contém, em si, importantes lições para os Estudos da Paz e da Segurança, nomeadamente sobre a centralidade da teoria na definição de uma nova agenda crítica que permita uma aproximação entre as duas disciplinas.

Cost-effectiveness of lung cancer screening and treatment methods: a systematic review of systematic reviews.

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Azar, Farbod Ebadifard; Azami-Aghdash, Saber; Pournaghi-Azar, Fatemeh; Mazdaki, Alireza; Rezapour, Aziz; Ebrahimi, Parvin; Yousefzadeh, Negar

2017-06-19

Due to extensive literature in the field of lung cancer and their heterogeneous results, the aim of this study was to systematically review of systematic reviews studies which reviewed the cost-effectiveness of various lung cancer screening and treatment methods. In this systematic review of systematic reviews study, required data were collected searching the following key words which selected from Mesh: "lung cancer", "lung oncology", "lung Carcinoma", "lung neoplasm", "lung tumors", "cost- effectiveness", "systematic review" and "Meta-analysis". The following databases were searched: PubMed, Cochrane Library electronic databases, Google Scholar, and Scopus. Two reviewers (RA and A-AS) evaluated the articles according to the checklist of "assessment of multiple systematic reviews" (AMSTAR) tool. Overall, information of 110 papers was discussed in eight systematic reviews. Authors focused on cost-effectiveness of lung cancer treatments in five systematic reviews. Targeted therapy options (bevacizumab, Erlotinib and Crizotinib) show an acceptable cost-effectiveness. Results of three studies failed to show cost-effectiveness of screening methods. None of the studies had used the meta-analysis method. The Quality of Health Economic Studies (QHES) tool and Drummond checklist were mostly used in assessing the quality of articles. Most perspective was related to the Payer (64 times) and the lowest was related to Social (11times). Most cases referred to Incremental analysis (82%) and also the lowest point of referral was related to Discounting (in 49% of the cases). The average quality score of included studies was calculated 9.2% from 11. Targeted therapy can be an option for the treatment of lung cancer. Evaluation of the cost-effectiveness of computerized tomographic colonography (CTC) in lung cancer screening is recommended. The perspective of the community should be more taken into consideration in studies of cost-effectiveness. Paying more attention to the topic of

Diagnostic Accuracy of Dynamic Contrast Enhanced Magnetic Resonance Imaging in Characterizing Lung Masses

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Inan, Nagihan; Arslan, Arzu; Donmez, Muhammed; Sarisoy, Hasan Tahsin

2016-01-01

Background Imaging plays a critical role not only in the detection, but also in the characterization of lung masses as benign or malignant. Objectives To determine the diagnostic accuracy of dynamic magnetic resonance imaging (MRI) in the differential diagnosis of benign and malignant lung masses. Patients and Methods Ninety-four masses were included in this prospective study. Five dynamic series of T1-weighted spoiled gradient echo (FFE) images were obtained, followed by a T1-weighted FFE sequence in the late phase (5th minutes). Contrast enhancement patterns in the early (25th second) and late (5th minute) phase images were evaluated. For the quantitative evaluation, signal intensity (SI)-time curves were obtained and the maximum relative enhancement, wash-in rate, and time-to-peak enhancement of masses in both groups were calculated. Results The early phase contrast enhancement patterns were homogeneous in 78.2% of the benign masses, while heterogeneous in 74.4% of the malignant tumors. On the late phase images, 70.8% of the benign masses showed homogeneous enhancement, while most of the malignant masses showed heterogeneous enhancement (82.4%). During the first pass, the maximum relative enhancement and wash-in rate values of malignant masses were significantly higher than those of the benign masses (P = 0.03 and 0.04, respectively). The cutoff value at 15% yielded a sensitivity of 85.4%, specificity of 61.2%, and positive predictive value of 68.7% for the maximum relative enhancement. Conclusion Contrast enhancement patterns and SI-time curve analysis of MRI are helpful in the differential diagnosis of benign and malignant lung masses. PMID:27703654

Pulmonary hypertension in childhood interstitial lung disease: A systematic review of the literature.

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Bromley, Susan; Vizcaya, David

2017-05-01

Childhood interstitial lung disease (chILD) comprises a wide heterogeneous group of rare parenchymal lung disorders associated with substantial morbidity and mortality. Pulmonary hypertension is a common comorbidity in adults with interstitial lung disease (ILD) and associated with poor survival. We aimed to systematically review the literature regarding the occurrence of pulmonary hypertension (PH) in chILD, its effect on prognosis and healthcare use, and its treatment in clinical practice. Searches of PubMed and EMBASE databases (up to February 2016), and American Thoracic Society conference abstracts (2009-2015) were conducted using relevant keywords. References from selected articles and review papers were scanned to identify further relevant articles. A total of 20 articles were included; estimates of PH in chILD ranged from 1% to 64% with estimates among specific chILD entities ranging from 0% to 43%. Comparisons between studies were limited by differences in the study populations, including the size, age range, and heterogeneous composition of the ILD case series in terms of the nature and severity of the clinical entities, and also the methods used to diagnose PH. Three studies found that among patients with chILD, those with PH had a significantly higher risk (up to sevenfold) of death compared with those without PH. Information on the treatment of pulmonary hypertension in chILD or the effect of PH on healthcare use was not available. Data on the use and effectiveness of treatments for pulmonary hypertension in chILD are required to address this area of unmet need. Pediatr Pulmonol. 2017;52:689-698. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Lung ventilation-perfusion imbalance in pulmonary emphysema: assessment with automated V/Q quotient SPECT.

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Suga, Kazuyoshi; Kawakami, Yasuhiko; Koike, Hiroaki; Iwanaga, Hideyuki; Tokuda, Osamu; Okada, Munemasa; Matsunaga, Naofumi

2010-05-01

Tc-99m-Technegas-MAA single photon emission computed tomography (SPECT)-derived ventilation (V)/perfusion (Q) quotient SPECT was used to assess lung V-Q imbalance in patients with pulmonary emphysema. V/Q quotient SPECT and V/Q profile were automatically built in 38 patients with pulmonary emphysema and 12 controls, and V/Q distribution and V/Q profile parameters were compared. V/Q distribution on V/Q quotient SPECT was correlated with low attenuation areas (LAA) on density-mask computed tomography (CT). Parameters of V/Q profile such as the median, standard deviation (SD), kurtosis and skewness were proposed to objectively evaluate the severity of lung V-Q imbalance. In contrast to uniform V/Q distribution on V/Q quotient SPECT and a sharp peak with symmetrical V/Q distribution on V/Q profile in controls, lung areas showing heterogeneously high or low V/Q and flattened peaks with broadened V/Q distribution were frequently seen in patients with emphysema, including lung areas with only slight LAA. V/Q distribution was also often asymmetric regardless of symmetric LAA. All the proposed parameters of V/Q profile in entire lungs of patients with emphysema showed large variations compared with controls; SD and kurtosis were significantly different from controls (P emphysema. SD and kurtosis of V/Q profile can be adequate parameters to assess the severity of lung V-Q imbalance causing gas-exchange impairment in patients with emphysema.

Biomarker Testing for Personalized Therapy in Lung Cancer in Low- and Middle-Income Countries.

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Hirsch, Fred R; Zaric, Bojan; Rabea, Ahmed; Thongprasert, Sumitra; Lertprasertsuke, Nirush; Dalurzo, Mercedes Liliana; Varella-Garcia, Marileila

2017-01-01

There have been many important advances in personalized therapy for patients with lung cancer, particularly for those with advanced disease. Molecular testing is crucial for implementation of personalized therapy. Although the United States and many Western countries have come far in the implementation of personalized therapy for lung cancer, there are substantial challenges for low- and middle-income countries (LMICs). Globally, the LMICs display great heterogeneity in the pattern of implementation of molecular testing and targeted therapy. The current review presents an attempt to identify the challenges and obstacles for the implementation of molecular testing and the use of targeted therapies in these areas. Lack of infrastructure, lack of technical expertise, economic factors, and lack of access to new drugs are among the substantial barriers.

Cannabis Smoking and Risk of Lung Cancer - A Systematic Review and Meta-Analysis

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khalid BOUTI

2014-12-01

Full Text Available Background: Cannabis is the illicit psychoactive substance the most consumed in the world. Little is known about the association between the use of cannabis and the risk of lung cancer.Objective:The objective of this meta-analysis is to determine whether use of cannabis is a risk factor for lung cancer.Methods: We conducted a systematic review and meta-analyses of all languages articles using relevant computerised databases. MEDLINE (online PubMed, Web of knowledge, Embase, EBSCO CINAHL, ScienceDirect, Scopus, Cochrane Library, and Directory of Open Access Journals were searched to September 2014 for cohorts and case-control studies that assessed the risk of lung cancer associated with cannabis smoking.  The literature search was performed with a combination of medical subject headings terms, "cannabis" and "lung neoplasms". Data extraction: Two investigators independently analysed and extracted results from eligible studies.Our study's registration number on PROSPERO is  CRD42014008872.Results: The search strategy identified 2476 citations. 13 studies were eligible for inclusion: 2 pooled analysis of 9 case-control studies, one case-control study and 3 cohorts.The cumulative analysis for all the studies under a fixed-effects model showed that cannabis smoking determined an increased risk of developing lung cancer in the future (relative risk 1.22, 95% confidence interval 0.999–1.5; p=0.051, with no evidence of heterogeneity across the studies (I2: 34%; p¼0.01.Conclusions: The use of cannabis with or without tobacco smoking is associated with an increased risk for lung cancer.

Lung cancer mimicking lung abscess formation on CT images.

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Taira, Naohiro; Kawabata, Tsutomu; Gabe, Atsushi; Ichi, Takaharu; Kushi, Kazuaki; Yohena, Tomofumi; Kawasaki, Hidenori; Yamashiro, Toshimitsu; Ishikawa, Kiyoshi

2014-01-01

Male, 64 FINAL DIAGNOSIS: Lung pleomorphic carcinoma Symptoms: Cough • fever - Clinical Procedure: - Specialty: Oncology. Unusual clinical course. The diagnosis of lung cancer is often made based on computed tomography (CT) image findings if it cannot be confirmed on pathological examinations, such as bronchoscopy. However, the CT image findings of cancerous lesions are similar to those of abscesses.We herein report a case of lung cancer that resembled a lung abscess on CT. We herein describe the case of 64-year-old male who was diagnosed with lung cancer using surgery. In this case, it was quite difficult to distinguish between the lung cancer and a lung abscess on CT images, and a lung abscess was initially suspected due to symptoms, such as fever and coughing, contrast-enhanced CT image findings showing a ring-enhancing mass in the right upper lobe and the patient's laboratory test results. However, a pathological diagnosis of lung cancer was confirmed according to the results of a rapid frozen section biopsy of the lesion. This case suggests that physicians should not suspect both a lung abscesses and malignancy in cases involving masses presenting as ring-enhancing lesions on contrast-enhanced CT.

Heterotypic mouse models of canine osteosarcoma recapitulate tumor heterogeneity and biological behavior

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Milcah C. Scott

2016-12-01

Full Text Available Osteosarcoma (OS is a heterogeneous and rare disease with a disproportionate impact because it mainly affects children and adolescents. Lamentably, more than half of patients with OS succumb to metastatic disease. Clarification of the etiology of the disease, development of better strategies to manage progression, and methods to guide personalized treatments are among the unmet health needs for OS patients. Progress in managing the disease has been hindered by the extreme heterogeneity of OS; thus, better models that accurately recapitulate the natural heterogeneity of the disease are needed. For this study, we used cell lines derived from two spontaneous canine OS tumors with distinctly different biological behavior (OS-1 and OS-2 for heterotypic in vivo modeling that recapitulates the heterogeneous biology and behavior of this disease. Both cell lines demonstrated stability of the transcriptome when grown as orthotopic xenografts in athymic nude mice. Consistent with the behavior of the original tumors, OS-2 xenografts grew more rapidly at the primary site and had greater propensity to disseminate to lung and establish microscopic metastasis. Moreover, OS-2 promoted formation of a different tumor-associated stromal environment than OS-1 xenografts. OS-2-derived tumors comprised a larger percentage of the xenograft tumors than OS-1-derived tumors. In addition, a robust pro-inflammatory population dominated the stromal cell infiltrates in OS-2 xenografts, whereas a mesenchymal population with a gene signature reflecting myogenic signaling dominated those in the OS-1 xenografts. Our studies show that canine OS cell lines maintain intrinsic features of the tumors from which they were derived and recapitulate the heterogeneous biology and behavior of bone cancer in mouse models. This system provides a resource to understand essential interactions between tumor cells and the stromal environment that drive the progression and metastatic propensity of

Heterotypic mouse models of canine osteosarcoma recapitulate tumor heterogeneity and biological behavior.

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Scott, Milcah C; Tomiyasu, Hirotaka; Garbe, John R; Cornax, Ingrid; Amaya, Clarissa; O'Sullivan, M Gerard; Subramanian, Subbaya; Bryan, Brad A; Modiano, Jaime F

2016-12-01

Osteosarcoma (OS) is a heterogeneous and rare disease with a disproportionate impact because it mainly affects children and adolescents. Lamentably, more than half of patients with OS succumb to metastatic disease. Clarification of the etiology of the disease, development of better strategies to manage progression, and methods to guide personalized treatments are among the unmet health needs for OS patients. Progress in managing the disease has been hindered by the extreme heterogeneity of OS; thus, better models that accurately recapitulate the natural heterogeneity of the disease are needed. For this study, we used cell lines derived from two spontaneous canine OS tumors with distinctly different biological behavior (OS-1 and OS-2) for heterotypic in vivo modeling that recapitulates the heterogeneous biology and behavior of this disease. Both cell lines demonstrated stability of the transcriptome when grown as orthotopic xenografts in athymic nude mice. Consistent with the behavior of the original tumors, OS-2 xenografts grew more rapidly at the primary site and had greater propensity to disseminate to lung and establish microscopic metastasis. Moreover, OS-2 promoted formation of a different tumor-associated stromal environment than OS-1 xenografts. OS-2-derived tumors comprised a larger percentage of the xenograft tumors than OS-1-derived tumors. In addition, a robust pro-inflammatory population dominated the stromal cell infiltrates in OS-2 xenografts, whereas a mesenchymal population with a gene signature reflecting myogenic signaling dominated those in the OS-1 xenografts. Our studies show that canine OS cell lines maintain intrinsic features of the tumors from which they were derived and recapitulate the heterogeneous biology and behavior of bone cancer in mouse models. This system provides a resource to understand essential interactions between tumor cells and the stromal environment that drive the progression and metastatic propensity of OS. © 2016

Pensamento, Teoria e Estudos Latino-americanos

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Jacques de Novion

2014-12-01

Full Text Available RESUMO O presente trabalho configura como artigo inicial do Dossiê Especial – Pensamento, Teoria e Estudos Latino-americanos, organizado conjuntamente por nós, a pedido da Revista de Estudos e Pesquisas sobre as Américas (CEPPAC, do Instituto de Ciências Sociais (ICS, da Universidade de Brasília (UnB. De forma breve, este artigo apresenta a importância alcançada pelo Pensamento, pela Teoria, e, sobre tudo, pelos Estudos Latino-americanos nas últimas décadas. Em seguida, o artigo apresenta os quatorze trabalhos e uma resenha que compõem este Dossiê, resultado da contribuição de diferentes pesquisadores de distintas localidades da região, organizados em três blocos: Ciências Sociais Latino-americanas, Pensamento e Estudos. PALAVRAS CHAVE: Ciências Sociais Latino-americanas; Pensamento Latino-americanos; Teoria Latino-americana; Estudos Latino-americanos. --- RESUMEN El presente trabajo configura como articulo inicial del Dossier Especial – Pensamiento Teoría y Estudios Latinoamericanos, organizado conjuntamente por nosotros, a pedido de la Revista de Estudos e Pesquisas sobre as Américas (CEPPAC, del Instituto de Ciências Sociais (ICS, de la Universidade de Brasília (UnB. De forma breve, este articulo presenta la importancia alcanzada por el Pensamiento, por la Teoría, y, sobre todo, por los Estudios Latinoamericanos en las últimas décadas. En seguida, el articulo presenta los catorce trabajos e una reseña que componen este Dossier, resultado de la contribución de diferentes investigadores de distintas localidades de la región, organizados en tres bloques: Ciencias Sociales Latinoamericanas, Pensamiento y Estudios. PALABRAS CLAVE: Ciencias Sociales Latinoamericanas; Pensamiento Latinoamericano; Teoría Latinoamericana; Estudios Latinoamericanos. --- ABSTRACT This paper is set up as the initial article of this Special Dossier - Thought, Theory and Latin American Studies, which we organized collectively, at the request

Metal dust exposure and lung function deterioration among steel workers: an exposure-response relationship.

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Hamzah, Nurul Ainun; Mohd Tamrin, Shamsul Bahri; Ismail, Noor Hassim

2016-07-01

Metallic dust is a heterogeneous substance with respiratory sensitizing properties. Its long term exposure adversely affected lung function, thus may cause acute or chronic respiratory diseases. A cross-sectional study was conducted in a steel factory in Terengganu, Malaysia to assess the metal dust exposure and its relationship to lung function values among 184 workers. Metal dust concentrations values (Co, Cr, and Ni) for each worker were collected using air personal sampling. Lung function values (FEV 1 , FVC, and %FEV 1 /FVC) were determined using spirometer. Exposure to cobalt and chromium were 1-3 times higher than permissible exposure limit (PEL) while nickel was not exceeding the PEL. Cumulative of chromium was the predictor to all lung function values (FEV 1 , FVC, and %FEV 1 /FVC). Frequency of using mask was positively associated with FVC (Adj b = 0.263, P = 0.011) while past respiratory illnesses were negatively associated with %FEV 1 /FVC (Adj b = -1.452, P = 0.026). Only few workers (36.4%) were found to wear their masks all times during the working hours. There was an exposure-response relationship of cumulative metal dust exposure with the deterioration of lung function values. Improvement of control measures as well as proper and efficient use or personal protection equipment while at work could help to protect the respiratory health of workers.

Lung density

DEFF Research Database (Denmark)

Garnett, E S; Webber, C E; Coates, G

1977-01-01

The density of a defined volume of the human lung can be measured in vivo by a new noninvasive technique. A beam of gamma-rays is directed at the lung and, by measuring the scattered gamma-rays, lung density is calculated. The density in the lower lobe of the right lung in normal man during quiet...... breathing in the sitting position ranged from 0.25 to 0.37 g.cm-3. Subnormal values were found in patients with emphsema. In patients with pulmonary congestion and edema, lung density values ranged from 0.33 to 0.93 g.cm-3. The lung density measurement correlated well with the findings in chest radiographs...... but the lung density values were more sensitive indices. This was particularly evident in serial observations of individual patients....

Hard metal lung disease: a case series.

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Mizutani, Rafael Futoshi; Terra-Filho, Mário; Lima, Evelise; Freitas, Carolina Salim Gonçalves; Chate, Rodrigo Caruso; Kairalla, Ronaldo Adib; Carvalho-Oliveira, Regiani; Santos, Ubiratan Paula

2016-01-01

To describe diagnostic and treatment aspects of hard metal lung disease (HMLD) and to review the current literature on the topic. This was a retrospective study based on the medical records of patients treated at the Occupational Respiratory Diseases Clinic of the Instituto do Coração, in the city of São Paulo, Brazil, between 2010 and 2013. Of 320 patients treated during the study period, 5 (1.56%) were diagnosed with HMLD. All of those 5 patients were male (mean age, 42.0 ± 13.6 years; mean duration of exposure to hard metals, 11.4 ± 8.0 years). Occupational histories were taken, after which the patients underwent clinical evaluation, chest HRCT, pulmonary function tests, bronchoscopy, BAL, and lung biopsy. Restrictive lung disease was found in all subjects. The most common chest HRCT finding was ground glass opacities (in 80%). In 4 patients, BALF revealed multinucleated giant cells. In 3 patients, lung biopsy revealed giant cell interstitial pneumonia. One patient was diagnosed with desquamative interstitial pneumonia associated with cellular bronchiolitis, and another was diagnosed with a hypersensitivity pneumonitis pattern. All patients were withdrawn from exposure and treated with corticosteroid. Clinical improvement occurred in 2 patients, whereas the disease progressed in 3. Although HMLD is a rare entity, it should always be included in the differential diagnosis of respiratory dysfunction in workers with a high occupational risk of exposure to hard metal particles. A relevant history (clinical and occupational) accompanied by chest HRCT and BAL findings suggestive of the disease might be sufficient for the diagnosis. Descrever aspectos relacionados ao diagnóstico e tratamento de pacientes com doença pulmonar por metal duro (DPMD) e realizar uma revisão da literatura. Estudo retrospectivo dos prontuários médicos de pacientes atendidos no Serviço de Doenças Respiratórias Ocupacionais do Instituto do Coração, localizado na cidade de S�

Dosimetry using radiochromic film and planning algorithms in heterogeneous phantoms; Estudo dosimetrico com filme radiocromico e algoritmos de planejamento em fantomas heterogeneos

Energy Technology Data Exchange (ETDEWEB)

Leite, Vinicius Freitas

2012-07-01

This work analyzes, through the study of the interaction of electromagnetic radiation with matter, two schemes of heterogeneous phantoms schematised to simulate real cases of planning with different electronic densities through the Pencil Beam, Collapsed Cone and Analytical Anisotropic Algorithm algorithms and compare with measurements Of relative absorbed dose in an IBA CC13 ionization chamber and Gafchromic® EBT2 radiochromic film. Epichlorohydrin rubber and its compatibility in comparison with human bone has also been evaluated. The assembly of the heterogeneous phantoms was feasible and the results regarding the density and attenuation of the rubber presented consistent values. However, the study of PDPs in constructed phantoms showed a considerable percentage discrepancy between measurements and planning.

Optimization of an algorithm for 3D calculation of radiation dose distribution in heterogeneous media for use in radiotherapy planning

International Nuclear Information System (INIS)

Perles, L.A.; Chinellato, C.D.; Rocha, J.R.O.

2001-01-01

In this paper has been presented a modification of a algorithm for three-dimensional (3D) radiation dose distribution in heterogeneous media by convolutions. This modification has maintained good accordance between calculated and simulated data in EGS4 code. The results of algorithm have been compared with commercial program PLATO, where have been noticed inconsistency for equivalent density regions in a muscle-lung-muscle interface system

Desafios dos Estudos Gays, Lésbicos e Transgêneros

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Denilson Lopes

2008-09-01

Full Text Available Resumo: Este ensaio introduz algumas questões relativas aos estudos feministas, gays, lésbicos, transgênecos e teoria queer na busca de contribuições teórico-metodológicas na análise da cultura contemporânea. Palavras-chave: Estudos gays e lésbicos, estudos transgêneros, teoria queer, cultura. Abstrat: This essay introduces some issues related tofeminist studies, gay and lesbian studies, transgender studies and queer theory in the search of theoretical and methodological contributions in the analysis of contemporary culture. Key-words: Gay and Lesbian Studies, transgender studies, queer theory, culture

Evaluating which plan quality metrics are appropriate for use in lung SBRT.

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Yaparpalvi, Ravindra; Garg, Madhur K; Shen, Jin; Bodner, William R; Mynampati, Dinesh K; Gafar, Aleiya; Kuo, Hsiang-Chi; Basavatia, Amar K; Ohri, Nitin; Hong, Linda X; Kalnicki, Shalom; Tome, Wolfgang A

2018-02-01

Several dose metrics in the categories-homogeneity, coverage, conformity and gradient have been proposed in literature for evaluating treatment plan quality. In this study, we applied these metrics to characterize and identify the plan quality metrics that would merit plan quality assessment in lung stereotactic body radiation therapy (SBRT) dose distributions. Treatment plans of 90 lung SBRT patients, comprising 91 targets, treated in our institution were retrospectively reviewed. Dose calculations were performed using anisotropic analytical algorithm (AAA) with heterogeneity correction. A literature review on published plan quality metrics in the categories-coverage, homogeneity, conformity and gradient was performed. For each patient, using dose-volume histogram data, plan quality metric values were quantified and analysed. For the study, the radiation therapy oncology group (RTOG) defined plan quality metrics were: coverage (0.90 ± 0.08); homogeneity (1.27 ± 0.07); conformity (1.03 ± 0.07) and gradient (4.40 ± 0.80). Geometric conformity strongly correlated with conformity index (p plan quality guidelines-coverage % (ICRU 62), conformity (CN or CI Paddick ) and gradient (R 50% ). Furthermore, we strongly recommend that RTOG lung SBRT protocols adopt either CN or CI Padddick in place of prescription isodose to target volume ratio for conformity index evaluation. Advances in knowledge: Our study metrics are valuable tools for establishing lung SBRT plan quality guidelines.

Sintomas depressivos em crianças: estudos com duas versões do CDI

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Miriam Cruvinel

Full Text Available O objetivo deste estudo foi identificar o número de crianças com sintomas depressivos em duas amostras de estudantes da cidade de campinas. Utilizou-se, no estudo 1, a versão brasileira do Inventário de Depressão Infantil (CDI e, no estudo 2, a versão original. Do estudo 1, realizado em 2001, participaram 169 estudantes de 3ª, 4ª e 5ª séries, e, do estudo 2, conduzido em 2005, 157 alunos de 3ª e 4ª séries. A prevalência de sintomatologia depressiva no estudo 1 foi de 3,55%, e, no estudo 2, de 17%. Em ambos os estudos, não foram encontradas diferenças significativas entre a média no CDI em relação às variáveis demográficas. conclui-se pela necessidade de mais estudos nacionais de prevalência no ensino fundamental e de esforços direcionados não só para a identificação dos fatores de risco, de proteção e das variáveis associadas mas também do refinamento dos instrumentos de medidas da depressão infantil.

Lung Cancer Screening

Science.gov (United States)

... factors increase or decrease the risk of lung cancer. Lung cancer is a disease in which malignant (cancer) ... following PDQ summaries for more information about lung cancer: Lung Cancer Prevention Non-Small Cell Lung Cancer Treatment ...

Primary Nocardia Infection Causing a Fluorodeoxyglucose-Avid Right Renal Mass in a Redo Lung Transplant Recipient

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Sreeja Biswas Roy

2018-01-01

Full Text Available Immunosuppression after lung transplantation may increase susceptibility to opportunistic infection and is associated with early and delayed deaths in lung transplant recipients. Factors that may predispose lung transplant recipients to opportunistic bacterial and fungal infections include prolonged corticosteroid use, renal impairment, treatment of acute rejection, and post-transplant diabetes mellitus. We present a unique case of a 63-year-old woman with diabetes mellitus who underwent redo lung transplantation. Three years after her right-sided single redo lung transplant, she presented with right-sided abdominal pain, nausea, and vomiting. Upon examination, computed tomography showed a 4.5 × 3.3 cm heterogeneous, enhancing right renal mass with a patent renal vein. Magnetic resonance imaging confirmed a T1/T2 hypointense, diffusion-restricting, right mid-renal mass that was fluorodeoxyglucose-avid on positron emission tomography. We initially suspected primary renal cell carcinoma. However, after a right nephrectomy, no evidence of neoplasia was observed; instead, a renal abscess containing filamentous bacteria was noted, raising suspicion for infection of the Nocardia species. Special stains confirmed a diagnosis of Nocardia renal abscess. Computed tomography of the chest and brain revealed no lesions consistent with infection. We initiated a long-term therapeutic regimen of anti-Nocardia therapy with imipenem and trimethoprim-sulfamethoxazole.

Analysis of radon-induced lung cancer risk by a stochastic state-vector model of radiation carcinogenesis

International Nuclear Information System (INIS)

Crawford-Brown, Douglas J.; Hofmann, Werner

2002-01-01

A biologically based state-vector model (SVM) of radiation carcinogenesis has been extended to incorporate stochasticity of cellular transitions and specific in vivo irradiation conditions in the lungs. Dose-rate-dependent cellular transitions related to the formation of double-stranded DNA breaks, repair of breaks, interactions (translocations) between breaks, fixation of breaks, cellular inactivation, stimulated mitosis and promotion through loss of intercellular communication are simulated by Monte Carlo methods. The stochastic SVM has been applied to the analysis of lung cancer incidence in uranium miners exposed to alpha-emitting radon progeny. When incorporating in vivo features of cell differentiation, stimulated cell division and heterogeneity of cellular doses into the model, excellent agreement between epidemiological data and modelling results could be obtained. At low doses, the model predicts a non-linear dose-response relationship; e.g., computed lung cancer risk at 20 WLM is about half of current lung cancer estimates based on the linear hypothesis. The model also predicts a slight dose rate effect; e.g., at a cumulative exposure of 20 WLM, calculated lung cancer incidence for an exposure rate 0.27 WLM/year (assuming an exposure time of 73 years) is smaller by a factor of 1.2 than that for an exposure rate of 10 WLM/year. (author)

estudo comparativo

OpenAIRE

Álvaro, Rocha

2005-01-01

O sítio web é um importante meio de comunicação e competitividade das universidades. Há diferentes razões para acreditar que os sítios possam variar entre universidades, mas contudo há certeza da existência de requisitos de qualidade comuns e transversais a todas. Este estudo visou avaliar, de forma quantitativa e objectiva, o cumprimento de requisitos de qualidade pelos sítios web das Universidades Portuguesas, com base nas características de alto nível da norma ISO 9126-1 que interessam aos...

Oxygen-enhanced MRI of the lungs. Intraindividual comparison between 1.5 and 3 Tesla

International Nuclear Information System (INIS)

Dietrich, Olaf; Thieme, S.F.; Maxien, D.; Nikolaou, K.; Reiser, M.; Schoenberg, S.O.; Fink, C.

2011-01-01

Purpose: To assess the feasibility of oxygen-enhanced MRI of the lung at 3 Tesla and to compare signal characteristics with 1.5 Tesla. Materials and Methods: 13 volunteers underwent oxygen-enhanced lung MRI at 1.5 and 3 T with a T 1-weighted single-slice non-selective inversion-recovery single-shot half-Fourier fast-spin-echo sequence with simultaneous respiratory and cardiac triggering in coronal orientation. 40 measurements were acquired during room air breathing and subsequently during oxygen breathing (15 L/min, close-fitting face-mask). The signal-to-noise ratio (SNR) of the lung tissue was determined with a difference image method. The image quality of all acquisitions was visually assessed. The mean values of the oxygen-induced relative signal enhancement and its regional coefficient of variation were calculated and the signal enhancement was displayed as color-coded parameter maps. Oxygen-enhancement maps were visually assessed with respect to the distribution and heterogeneity of the oxygen-related signal enhancement at both field strengths. Results: The mean relative signal enhancement due to oxygen breathing was 13 % (± 5.6 %) at 1.5 T and of 9.0 % (± 8.0 %) at 3 T. The regional coefficient of variation was significantly higher at 3 T. Visual and quantitative assessment of the enhancement maps showed considerably less homogeneous distribution of the signal enhancement at 3 T. The SNR was not significantly different but showed a trend to slightly higher values (increase of about 10 %) at 3 T. Conclusion: Oxygen-enhanced pulmonary MRI is feasible at 3 Tesla. However, signal enhancement is currently more heterogeneous and slightly lower at 3 T. (orig.)

Nutrition for Lung Cancer

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... Become An Advocate Volunteer Ways To Give Lung Cancer www.lung.org > Lung Health and Diseases > Lung Disease Lookup > ... Cancer Learn About Lung Cancer What Is Lung Cancer Lung Cancer Basics Causes & Risk Factors Lung Cancer Staging ...

Emphysema. Imaging for endoscopic lung volume reduction; Lungenemphysem. Bildgebung bei endoskopischer Lungenvolumenreduktion

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Storbeck, B. [LungenClinic Grosshansdorf (Germany). Dept. of Radiology; Schroeder, T.H. [Amalie Sieveking-Hospital, Diagnostic and Interventional Radiology, Hamburg (Germany); Oldigs, M.; Rabe, K.F. [LungenClinic Grosshansdorf (Germany). Dept. of Pulmonology; Weber, C. [Amalie Sieveking-Hospital, Diagnostic and Interventional Radiology, Hamburg (Germany); University Medical Center Hamburg-Eppendorf (Germany). Diagnostic and Interventional Radiology

2015-07-15

Chronic obstructive pulmonary disease (COPD) is characterized by two entities, the more airway-predominant type (''bronchitis'') on the one hand, and emphysema-predominant type on the other. Imaging via high-resolution computed tomography plays an important role in phenotyping COPD. For patients with advanced lung emphysema, new endoscopic lung volume reduction therapies (ELVR) have been developed. Proper selection of suitable patients requires thin-section reconstruction of volumetric CT image data sets also in coronal and sagittal orientation are required. In the current manuscript we will describe emphysema subtypes (centrilobular, paraseptal, panlobular), options for quantifying emphysema and this importance of regional distribution (homogeneous or heterogeneous, target area) as this is crucial for patient selection. Analysis of the interlobular fissures is obligatory despite the lack of standardization, as incomplete fissures indicate collateral ventilation (CV) via parenchymal bridges, which is an important criterion in choosing endoscopic methods of LVR. Every radiologist should be familiar with modern LVR therapies such as valves and coils, and furthermore should know what a lung doctor expects from radiologic evaluation (before and after ELVR). Finally we present a checklist as a quick reference for all steps concerning imaging for ELVR.

Advances in lung ultrasound.

Science.gov (United States)

Francisco, Miguel José; Rahal, Antonio; Vieira, Fabio Augusto Cardillo; Silva, Paulo Savoia Dias da; Funari, Marcelo Buarque de Gusmão

2016-01-01

Ultrasound examination of the chest has advanced in recent decades. This imaging modality is currently used to diagnose several pathological conditions and provides qualitative and quantitative information. Acoustic barriers represented by the aerated lungs and the bony framework of the chest generate well-described sonographic artifacts that can be used as diagnostic aids. The normal pleural line and A, B, C, E and Z lines (also known as false B lines) are artifacts with specific characteristics. Lung consolidation and pneumothorax sonographic patterns are also well established. Some scanning protocols have been used in patient management. The Blue, FALLS and C.A.U.S.E. protocols are examples of algorithms using artifact combinations to achieve accurate diagnoses. Combined chest ultrasonography and radiography are often sufficient to diagnose and manage lung and chest wall conditions. Chest ultrasonography is a highly valuable diagnostic tool for radiologists, emergency and intensive care physicians. RESUMO O exame ultrassonográfico do tórax avançou nas últimas décadas, sendo utilizado para o diagnóstico de inúmeras condições patológicas, e fornecendo informações qualitativas e quantitativas. Os pulmões aerados e o arcabouço ósseo do tórax representam barreira sonora para o estudo ultrassonográfico, gerando artefatos que, bem conhecidos, são utilizados como ferramentas diagnósticas. Eco pleural normal, linhas A, linhas B, linhas C, linhas E e Z (conhecidas como falsas linhas B) são artefatos com características peculiares. Os padrões de consolidação e de pneumotórax também são bem estabelecidos. Alguns protocolos têm sido utilizados no manuseio dos pacientes: Blue Protocol, Protocolo FALLS e Protocolo C.A.U.S.E são exemplos de três propostas que, por meio da associação entre os artefatos, permitem sugerir diagnósticos precisos. A ultrassonografia de tórax, aliada à radiografia de tórax, muitas vezes é suficiente para o diagn

Geriatric Assessment and Functional Decline in Older Patients with Lung Cancer.

Science.gov (United States)

Decoster, L; Kenis, C; Schallier, D; Vansteenkiste, J; Nackaerts, K; Vanacker, L; Vandewalle, N; Flamaing, J; Lobelle, J P; Milisen, K; De Grève, J; Wildiers, H

2017-10-01

Older patients with lung cancer are a heterogeneous population making treatment decisions complex. This study aims to evaluate the value of geriatric assessment (GA) as well as the evolution of functional status (FS) in older patients with lung cancer, and to identify predictors associated with functional decline and overall survival (OS). At baseline, GA was performed in patients ≥70 years with newly diagnosed lung cancer. FS measured by activities of daily living (ADL) and instrumental activities of daily living (IADL) was reassessed at follow-up to define functional decline and OS was collected. Predictors for functional decline and OS were determined. Two hundred and forty-five patients were included in this study. At baseline, GA deficiencies were present in all domains and ADL and IADL were impaired in 51 and 63% of patients, respectively. At follow-up, functional decline in ADL was observed in 23% and in IADL in 45% of patients. In multivariable analysis, radiotherapy was predictive for ADL decline. No other predictors for ADL or IADL decline were identified. Stage and baseline performance status were predictive for OS. Older patients with lung cancer present with multiple deficiencies covering all geriatric domains. During treatment, functional decline is observed in almost half of the patients. None of the specific domains of the GA were predictive for functional decline or survival, probably because of the high impact of the aggressiveness of this tumor type leading to a poor prognosis.

Case-control study of radon and lung cancer in New Jersey

International Nuclear Information System (INIS)

Wilcox, H. B.; Al-Zoughool, M.; Garner, M. J.; Jiang, H.; Klotz, J. B.; Krewski, D.; Nicholson, W. J.; Schoenberg, J. B.; Villeneuve, P. J.; Zielinski, J. M.

2008-01-01

Radon is known to cause lung cancer in humans; however, there remain uncertainties about the effects associated with residential exposures. This case-control study of residential radon and lung cancer was conducted in five counties in New Jersey and involved 561 cases and 740 controls. A yearlong α-track detector measurement of radon was completed for ∼93% of all residences lived in at the time of interview (a total of 2063). While the odds ratios (ORs) for whole data were suggestive of an increased risk for exposures >75 Bq m -3 , these associations were not statistically significant. The adjusted excess OR (EOR) per 100 Bq m -3 was -0.13 (95% CI: -0.30 to 0.44) for males, 0.29 (95% CI: -0.12 to 1.70) for females and 0.05 (95% CI: -0.14 to 0.56) for all subjects combined. An analysis of radon effects by histological type of lung cancer showed that the OR was strongest for small/oat cell carcinomas in both males and females. There was no statistical heterogeneity of radon effects by demographic factors (age at disease occurrence, education level and type of respondent). Analysis by categories of smoking status, frequency or duration did not modify the risk estimates of radon on lung cancer. The findings of this study are consistent with an earlier population-based study of radon and lung cancer among New Jersey women, and with the North American pooling of case control radon seven studies, including the previous New Jersey study. Several uncertainties regarding radon measurements and assumptions of exposure history may have resulted in underestimation of a true exposure-response relationship. (authors)

The role of three dimensional functional lung imaging in radiation treatment planning: the functional dose-volume histogram

International Nuclear Information System (INIS)

Marks, Lawrence B.; Spencer, David P.; Sherouse, George W.; Bentel, Gunilla; Clough, Robert; Vann, Karen; Jaszczak, Ronald; Coleman, R. Edward; Prosnitz, Leonard R.

1995-01-01

Purpose: During thoracic irradiation (XRT), treatment fields are usually designed to minimize the volume of nontumor-containing lung included. Generally, functional heterogeneities within the lung are not considered. The three dimensional (3D) functional information provided by single photon emission computed tomography (SPECT) lung perfusion scans might be useful in designing beams that minimize incidental irradiation of functioning lung tissue. We herein review the pretreatment SPECT scans in 86 patients (56 with lung cancer) to determine which are likely to benefit from this technology. Methods and Materials: Prior to thoracic XRT, SPECT lung perfusion scans were obtained following the intravenous injection of ∼4 mCi of 99m Tc-labeled macro-aggregated albumin. The presence of areas of decreased perfusion, their location relative to the tumor, and the potential clinical usefulness of their recognition, were scored. Patients were grouped and compared (two-tailed chi-square) based on clinical factors. Conventional dose-volume histograms (DVHs) and functional DVHs (DV F Hs) are calculated based on the dose distribution throughout the computed tomography (CT)-defined lung and SPECT-defined perfused lung, respectively. Results: Among 56 lung cancer patients, decreases in perfusion were observed at the tumor, adjacent to the tumor, and separate from the tumor in 94%, 74%, and 42% of patients, respectively. Perfusion defects adjacent to the tumor were often large with centrally placed tumors. Hypoperfusion in regions separate from the tumor were statistically most common in patients with relatively poor pulmonary function and chronic obstructive pulmonary disease (COPD). Considering all SPECT defects adjacent to and separate from the tumor, corresponding CT abnormalities were seen in only ∼50% and 20% of patients, respectively, and were generally not as impressive. Following XRT, hypoperfusion at and separate from the tumor persisted, while defects adjacent to the

Single-Lung Ventilation with Contralateral Lung Deflation

Science.gov (United States)

Dallan, Luís Alberto O.; Lisboa, Luiz Augusto F.; Platania, Fernando; Oliveira, Sérgio A.; Stolf, Noedir A.

2007-01-01

There are many new alternative methods of minimally invasive myocardial revascularization that can be applied in selected patients who have multivessel coronary artery disease. However, these techniques often require new and expensive equipment. Most multivessel myocardial revascularization is performed via median sternotomy and involves the use of a conventional endotracheal tube. Both lungs are ventilated, and frequently the left pleural cavity is opened. In contrast, single-lung deflation naturally moves the mediastinum within the thorax toward the collapsed lung, without the need to open the pleural cavities. Herein, we describe a simple alternative procedure that facilitates off-pump multivessel coronary artery bypass grafting via complete median sternotomy: single-lung ventilation with contralateral lung deflation. This technique better exposes the more distal right and circumflex coronary artery branches with or without the opening of the pleural cavities. PMID:17622364

SU-E-T-50: A Multi-Institutional Study of Independent Dose Verification Software Program for Lung SBRT

International Nuclear Information System (INIS)

Kawai, D; Takahashi, R; Kamima, T; Baba, H; Yamamoto, T; Kubo, Y; Ishibashi, S; Higuchi, Y; Takahashi, H; Tachibana, H

2015-01-01

Purpose: The accuracy of dose distribution depends on treatment planning system especially in heterogeneity-region. The tolerance level (TL) of the secondary check using the independent dose verification may be variable in lung SBRT plans. We conducted a multi-institutional study to evaluate the tolerance level of lung SBRT plans shown in the AAPM TG114. Methods: Five institutes in Japan participated in this study. All of the institutes used a same independent dose verification software program (Simple MU Analysis: SMU, Triangle Product, Ishikawa, JP), which is Clarkson-based and CT images were used to compute radiological path length. Analytical Anisotropic Algorithm (AAA), Pencil Beam Convolution with modified Batho-method (PBC-B) and Adaptive Convolve (AC) were used for lung SBRT planning. A measurement using an ion-chamber was performed in a heterogeneous phantom to compare doses from the three different algorithms and the SMU to the measured dose. In addition to it, a retrospective analysis using clinical lung SBRT plans (547 beams from 77 patients) was conducted to evaluate the confidence limit (CL, Average±2SD) in dose between the three algorithms and the SMU. Results: Compared to the measurement, the AAA showed the larger systematic dose error of 2.9±3.2% than PBC-B and AC. The Clarkson-based SMU showed larger error of 5.8±3.8%. The CLs for clinical plans were 7.7±6.0 % (AAA), 5.3±3.3 % (AC), 5.7±3.4 % (PBC -B), respectively. Conclusion: The TLs from the CLs were evaluated. A Clarkson-based system shows a large systematic variation because of inhomogeneous correction. The AAA showed a significant variation. Thus, we must consider the difference of inhomogeneous correction as well as the dependence of dose calculation engine

SU-E-T-50: A Multi-Institutional Study of Independent Dose Verification Software Program for Lung SBRT

Energy Technology Data Exchange (ETDEWEB)

Kawai, D [Kanagawa Cancer Center, Yokohama, Kanagawa-prefecture (Japan); Takahashi, R; Kamima, T [The Cancer Institute Hospital of JFCR, Koutou-ku, Tokyo (Japan); Baba, H [The National Cancer Center Hospital East, Kashiwa-city, Chiba prefecture (Japan); Yamamoto, T; Kubo, Y [Otemae Hospital, Chuou-ku, Osaka-city (Japan); Ishibashi, S; Higuchi, Y [Sasebo City General Hospital, Sasebo, Nagasaki (Japan); Takahashi, H [St Lukes International Hospital, Chuou-ku, Tokyo (Japan); Tachibana, H [National Cancer Center Hospital East, Kashiwa, Chiba (Japan)

2015-06-15

Purpose: The accuracy of dose distribution depends on treatment planning system especially in heterogeneity-region. The tolerance level (TL) of the secondary check using the independent dose verification may be variable in lung SBRT plans. We conducted a multi-institutional study to evaluate the tolerance level of lung SBRT plans shown in the AAPM TG114. Methods: Five institutes in Japan participated in this study. All of the institutes used a same independent dose verification software program (Simple MU Analysis: SMU, Triangle Product, Ishikawa, JP), which is Clarkson-based and CT images were used to compute radiological path length. Analytical Anisotropic Algorithm (AAA), Pencil Beam Convolution with modified Batho-method (PBC-B) and Adaptive Convolve (AC) were used for lung SBRT planning. A measurement using an ion-chamber was performed in a heterogeneous phantom to compare doses from the three different algorithms and the SMU to the measured dose. In addition to it, a retrospective analysis using clinical lung SBRT plans (547 beams from 77 patients) was conducted to evaluate the confidence limit (CL, Average±2SD) in dose between the three algorithms and the SMU. Results: Compared to the measurement, the AAA showed the larger systematic dose error of 2.9±3.2% than PBC-B and AC. The Clarkson-based SMU showed larger error of 5.8±3.8%. The CLs for clinical plans were 7.7±6.0 % (AAA), 5.3±3.3 % (AC), 5.7±3.4 % (PBC -B), respectively. Conclusion: The TLs from the CLs were evaluated. A Clarkson-based system shows a large systematic variation because of inhomogeneous correction. The AAA showed a significant variation. Thus, we must consider the difference of inhomogeneous correction as well as the dependence of dose calculation engine.

Empirical evaluation of lung solubilities of airborne contamination at Harwell facilities

International Nuclear Information System (INIS)

Bull, R. K.; Wilson, G.

2011-01-01

Lung solubility is the key parameter in determining intakes and doses from inhalation of airborne contamination. However, information on lung solubility can be difficult to acquire, particularly for the historical exposures that are of relevance to lifetime-dose reconstruction. In this study, an empirical approach has been made in which over 200 dose assessments, mainly for Pu and Am, from the period 1986 to 2005 were re-evaluated and the solubility mix required for the best fit to the data was determined. The average of these solubility mixtures for any building or facility can be used as the default solubility for retrospective dose assessments for that facility. Results are presented for a radiochemistry facility, a materials development facility and a waste-storage/handling building at Harwell. The latter two areas are characterised by aerosols that are predominantly insoluble (type S), whereas the radiochemistry facility has a heterogeneous mixture of insoluble and soluble aerosols. The implications of these results for dose reconstruction are discussed in the paper. (authors)

Lung volume reduction of pulmonary emphysema: the radiologist task.

Science.gov (United States)

Milanese, Gianluca; Silva, Mario; Sverzellati, Nicola

2016-03-01

Several lung volume reduction (LVR) techniques have been increasingly evaluated in patients with advanced pulmonary emphysema, especially in the last decade. Radiologist plays a pivotal role in the characterization of parenchymal damage and, thus, assessment of eligibility criteria. This review aims to discuss the most common LVR techniques, namely LVR surgery, endobronchial valves, and coils LVR, with emphasis on the role of computed tomography (CT). Several trials have recently highlighted the importance of regional quantification of emphysema by computerized CT-based segmentation of hyperlucent parenchyma, which is strongly recommended for candidates to any LVR treatment. In particular, emphysema distribution pattern and fissures integrity are evaluated to tailor the choice of the most appropriate LVR technique. Furthermore, a number of CT measures have been tested for the personalization of treatment, according to imaging detected heterogeneity of parenchymal disease. CT characterization of heterogeneous parenchymal abnormalities provides criteria for selection of the preferable treatment in each patient and improves outcome of LVR as reflected by better quality of life, higher exercise tolerance, and lower mortality.

FDG uptake heterogeneity evaluated by fractal analysis improves the differential diagnosis of pulmonary nodules

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Miwa, Kenta, E-mail: kenta5710@gmail.com [Department of Nuclear Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550 (Japan); Division of Medical Quantum Science, Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582 (Japan); Inubushi, Masayuki, E-mail: inubushi@med.kawasaki-m.ac.jp [Department of Nuclear Medicine, Kawasaki Medical School, 577 Matsushima Kurashiki, Okayama 701-0192 (Japan); Wagatsuma, Kei, E-mail: kei1192@hotmail.co.jp [Department of Nuclear Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550 (Japan); Nagao, Michinobu, E-mail: minagao@radiol.med.kyushu-u.ac.jp [Department of Molecular Imaging and Diagnosis, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582 (Japan); Murata, Taisuke, E-mail: taisuke113@gmail.com [Department of Nuclear Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550 (Japan); Koyama, Masamichi, E-mail: masamichi.koyama@jfcr.or.jp [Department of Nuclear Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550 (Japan); Koizumi, Mitsuru, E-mail: mitsuru@jfcr.or.jp [Department of Nuclear Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550 (Japan); Sasaki, Masayuki, E-mail: msasaki@hs.med.kyushu-u.ac.jp [Division of Medical Quantum Science, Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582 (Japan)

2014-04-15

Purpose: The present study aimed to determine whether fractal analysis of morphological complexity and intratumoral heterogeneity of FDG uptake can help to differentiate malignant from benign pulmonary nodules. Materials and methods: We retrospectively analyzed data from 54 patients with suspected non-small cell lung cancer (NSCLC) who were examined by FDG PET/CT. Pathological assessments of biopsy specimens confirmed 35 and 19 nodules as NSCLC and inflammatory lesions, respectively. The morphological fractal dimension (m-FD), maximum standardized uptake value (SUV{sub max}) and density fractal dimension (d-FD) of target nodules were calculated from CT and PET images. Fractal dimension is a quantitative index of morphological complexity and tracer uptake heterogeneity; higher values indicate increased complexity and heterogeneity. Results: The m-FD, SUV{sub max} and d-FD significantly differed between malignant and benign pulmonary nodules (p < 0.05). Although the diagnostic ability was better for d-FD than m-FD and SUV{sub max}, the difference did not reach statistical significance. Tumor size correlated significantly with SUV{sub max} (r = 0.51, p < 0.05), but not with either m-FD or d-FD. Furthermore, m-FD combined with either SUV{sub max} or d-FD improved diagnostic accuracy to 92.6% and 94.4%, respectively. Conclusion: The d-FD of intratumoral heterogeneity of FDG uptake can help to differentially diagnose malignant and benign pulmonary nodules. The SUV{sub max} and d-FD obtained from FDG-PET images provide different types of information that are equally useful for differential diagnoses. Furthermore, the morphological complexity determined by CT combined with heterogeneous FDG uptake determined by PET improved diagnostic accuracy.

The unresolved issue of oxygen therapy in lung fibrosis: Some clues from a Spanish cohort

Directory of Open Access Journals (Sweden)

Irene Martin-Robles

2014-01-01

Full Text Available Indication of oxygen therapy in fibrotic interstitial lung diseases is not standardized and its specific requirements are not well defined. The objective of this study was to evaluate ambulatory oxygen therapy features in lung fibrotic patients. Clinical and exploratory　data, including 6-minute walking test and pulmonary hypertension, from one hundred and seven patients with fibrotic interstitial lung disease that received ambulatory oxygen treatment were studied. In up to 40% of cases the prescription of oxygen therapy was made after performing a 6-minute walking test. Patients who required ambulatory oxygen only during exercise presented a mild to moderate reduction of the predicted % FVC (62.1 ± 19 and DLCO (49 ± 14.4 while patients who had respiratory failure at rest (mean PaO2 51.9 ± 6.7 presented a moderate reduction of %FVC (56.8 ± 15.6 but a severe decrease of %DLCO (31.67 ± 12. Pulmonary hypertension (PH was evaluated in 47.7% of patients and occurred in 60.8% of them. In conclusion, there is no pulmonary functional predictor of oxyhaemoglobin desaturation during exercise. PH is frequently associated with interstitial lung diseases, mainly when respiratory failure at rest appears. The heterogeneity of the patients and limitation of retrospective studies could be the cause of the tributes for potential benefits of oxygen treatment in interstitial lung diseases.

Two cases with giant lung abscess originating in the irradiated lung field following the concurrent chemo-radiotherapy of lung cancer

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Ikeda, Takeshi; Inui, Hiroyuki; Yukawa, Susumu; Nomoto, Hiroshi (Wakayama Medical Coll. (Japan)); Minakata, Yoshiaki; Yamagata, Toshiyuki

1992-05-01

Two patients with giant lung abscess originating in the irradiated lung field are reported. Lung abscesses occurred during the term of leukopenia following the concurrent chemo-radiotherapy of lung cancer. Both patients were diagnosed as small cell lung cancer, and were treated concurrently with chemotherapy (Cisplatin + Etoposide) and radiotherapy (total 40-50 Gy). Case 1 was a 59 years old male. Seven weeks after the first irradiation, a giant lung abscess was caused by methicillin resistant staphylococcus aureus (MRSA) originated in the lung field with radiation pneumonitis, and giant bronchial fistula was formed, that showed the specific bronchofiberscopic findings. Case 2 was a 67 years old male. Twelve weeks after the first irradiation, a giant lung abscess was caused by pseudomonas aeruginosa originated in the irradiated lung field following the formation of a pneumatocele. MRSA and pseudomonas aeruginosa are important as cause of hospital infection, and both can cause lung abscess. However, in our cases, lung abscess were formed just in the irradiated lung field and rapidly enlarged. These clinical findings suggested that myelosuppression and radiation injury of lung tissue might cause such giant lung abscess. (author).

Two cases with giant lung abscess originating in the irradiated lung field following the concurrent chemo-radiotherapy of lung cancer

International Nuclear Information System (INIS)

Ikeda, Takeshi; Inui, Hiroyuki; Yukawa, Susumu; Nomoto, Hiroshi; Minakata, Yoshiaki; Yamagata, Toshiyuki.

1992-01-01

Two patients with giant lung abscess originating in the irradiated lung field are reported. Lung abscesses occurred during the term of leukopenia following the concurrent chemo-radiotherapy of lung cancer. Both patients were diagnosed as small cell lung cancer, and were treated concurrently with chemotherapy (Cisplatin + Etoposide) and radiotherapy (total 40-50 Gy). Case 1 was a 59 years old male. Seven weeks after the first irradiation, a giant lung abscess was caused by methicillin resistant staphylococcus aureus (MRSA) originated in the lung field with radiation pneumonitis, and giant bronchial fistula was formed, that showed the specific bronchofiberscopic findings. Case 2 was a 67 years old male. Twelve weeks after the first irradiation, a giant lung abscess was caused by pseudomonas aeruginosa originated in the irradiated lung field following the formation of a pneumatocele. MRSA and pseudomonas aeruginosa are important as cause of hospital infection, and both can cause lung abscess. However, in our cases, lung abscess were formed just in the irradiated lung field and rapidly enlarged. These clinical findings suggested that myelosuppression and radiation injury of lung tissue might cause such giant lung abscess. (author)

Differential diagnosis of granulomatous lung disease: clues and pitfalls: Number 4 in the Series "Pathology for the clinician" Edited by Peter Dorfmüller and Alberto Cavazza.

Science.gov (United States)

Ohshimo, Shinichiro; Guzman, Josune; Costabel, Ulrich; Bonella, Francesco

2017-09-30

Granulomatous lung diseases are a heterogeneous group of disorders that have a wide spectrum of pathologies with variable clinical manifestations and outcomes. Precise clinical evaluation, laboratory testing, pulmonary function testing, radiological imaging including high-resolution computed tomography and often histopathological assessment contribute to make a confident diagnosis of granulomatous lung diseases. Differential diagnosis is challenging, and includes both infectious (mycobacteria and fungi) and noninfectious lung diseases (sarcoidosis, necrotising sarcoid granulomatosis, hypersensitivity pneumonitis, hot tub lung, berylliosis, granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, rheumatoid nodules, talc granulomatosis, Langerhans cell histiocytosis and bronchocentric granulomatosis). Bronchoalveolar lavage, endobronchial ultrasound-guided transbronchial needle aspiration, transbronchial cryobiopsy, positron emission tomography and genetic evaluation are potential candidates to improve the diagnostic accuracy for granulomatous lung diseases. As granuloma alone is a nonspecific histopathological finding, the multidisciplinary approach is important for a confident diagnosis. Copyright ©ERS 2017.

Lung Emergencies

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... The Marfan Foundation Marfan & Related Disorders What is Marfan Syndrome? What are Related Disorders? What are the Signs? ... Emergencies Lung Emergencies Surgeries Lung Emergencies People with Marfan syndrome can be at increased risk of sudden lung ...

Chronic exposure to chlorophenol related compounds in the pesticide production workplace and lung cancer: a meta-analysis.

Science.gov (United States)

Zendehdel, Rezvan; Tayefeh-Rahimian, Raana; Kabir, Ali

2014-01-01

Chlorophenols (CPs) and related phenoxyacetic acids (PAs) are pesticide groups contaminated with highly toxic 2, 3, 7, 8-tetrachlorodibenzo-p-dioxin (TCDD) during production. PAs and CPs exposure is associated with risk of cancer, but the situation regarding lung cancer has not been clearly defined. We proposed a meta-analysis of published researches to evaluate relationship between chronic exposure to PAs and CPs in pesticide production workplaces and the risk of lung cancer. After searching PubMed, Scopus, Scholar Google, Web of Sciences until August 2013, the association between chronic PAs and CPs exposure in production workplace and lung cancer was studied in 15 cohort studies. The standardized mortality rate (SMR) and 95% confidence intervals (CI) were collected from the papers. We used random or fixed-effects models, Egger test, funnel plot and meta regression in our analysis. Five papers with six reports were included in the final analysis. The standardized mortality rate for lung cancer from the random model was 1.18 (95% CI: 1.03-1.35, p=0.014) with moderate heterogeneity. Publication bias was not found for included studies in meta-analysis (p=0.9). Our findings has strengthen the evidence of lung cancer from chronic exposure to chlorophenol related compounds (PAs, CPs).

ACREDITAÇÃO HOSPITALAR: UM ESTUDO DE CASO

Directory of Open Access Journals (Sweden)

Felipe Antunes

2005-06-01

Full Text Available Este artigo aborda a qualidade e acreditação hospitalar através do Manual das Organizações Prestadoras de Serviços Hospitalares, desenvolvido pela Organização Nacional de Acreditação (ONA. O objetivo geral deste trabalho é avaliar o processo de acreditação, identificando dificuldades e benefícios advindos da implantação deste  Manual. Após a realização de uma revisão bibliográfica sobre qualidade em hospitais e normas da qualidade aplicáveis a hospitais, é feita uma análise crítica teórica do Manual das Organizações Prestadoras de Serviços Hospitalares. Tal análise crítica inclui um estudo comparativo entre os requisitos do Manual e da norma NBR ISO 9001/2000. A seguir, a análise teórica é complementada através de um estudo de caso contemplando a implantação do Manual junto a um hospital de grande porte. Finalmente, são apresentadas as conclusões, baseadas tanto no estudo teórico como no estudo prático.

Lung Cancer

International Nuclear Information System (INIS)

Maghfoor, Irfan; Perry, M.C.

2005-01-01

Lung cancer is the leading cause of cancer-related mortality. Since tobacco smoking is the cause in vast majority of cases, the incidence of lung cancer is expected to rise in those countries with high or rising incidence of tobacco smoking. Even though population at a risk of developing lung cancer are easily identified, mass screening for lung cancer is not supported by currently available evidence. In case of non-small cell lung cancer, a cure may be possible with surgical resection followed by post-operative chemotherapy in those diagnosed at an early stage. A small minority of patients who present with locally advanced disease may also benefit from preoperative chemotherapy and/or radiation therapy to down stage the tumor to render it potentially operable. In a vast majority of patients, however, lung cancer presents at an advanced stage and a cure is not possible with currently available therapeutic strategies. Similarly small cell lung cancer confined to one hemi-thorax may be curable with a combination of chemotherapy and thoracic irradiation followed by prophylactic cranial irradiation, if complete remission is achieved at the primary site. Small cell lung cancer that is spread beyond the confines of one hemi-thorax is however, considered incurable. In this era of molecular targeted therapies, new agents are constantly undergoing pre-clinical and clinical testing with the aim of targeting the molecular pathways thought to involved in etiology and pathogenesis of lung cancer. (author)

High-throughput molecular analysis in lung cancer: insights into biology and potential clinical applications.

Science.gov (United States)

Ocak, S; Sos, M L; Thomas, R K; Massion, P P

2009-08-01

During the last decade, high-throughput technologies including genomic, epigenomic, transcriptomic and proteomic have been applied to further our understanding of the molecular pathogenesis of this heterogeneous disease, and to develop strategies that aim to improve the management of patients with lung cancer. Ultimately, these approaches should lead to sensitive, specific and noninvasive methods for early diagnosis, and facilitate the prediction of response to therapy and outcome, as well as the identification of potential novel therapeutic targets. Genomic studies were the first to move this field forward by providing novel insights into the molecular biology of lung cancer and by generating candidate biomarkers of disease progression. Lung carcinogenesis is driven by genetic and epigenetic alterations that cause aberrant gene function; however, the challenge remains to pinpoint the key regulatory control mechanisms and to distinguish driver from passenger alterations that may have a small but additive effect on cancer development. Epigenetic regulation by DNA methylation and histone modifications modulate chromatin structure and, in turn, either activate or silence gene expression. Proteomic approaches critically complement these molecular studies, as the phenotype of a cancer cell is determined by proteins and cannot be predicted by genomics or transcriptomics alone. The present article focuses on the technological platforms available and some proposed clinical applications. We illustrate herein how the "-omics" have revolutionised our approach to lung cancer biology and hold promise for personalised management of lung cancer.

Heterogeneous network architectures

DEFF Research Database (Denmark)

Christiansen, Henrik Lehrmann

2006-01-01

is flexibility. This thesis investigates such heterogeneous network architectures and how to make them flexible. A survey of algorithms for network design is presented, and it is described how using heuristics can increase the speed. A hierarchical, MPLS based network architecture is described......Future networks will be heterogeneous! Due to the sheer size of networks (e.g., the Internet) upgrades cannot be instantaneous and thus heterogeneity appears. This means that instead of trying to find the olution, networks hould be designed as being heterogeneous. One of the key equirements here...... and it is discussed that it is advantageous to heterogeneous networks and illustrated by a number of examples. Modeling and simulation is a well-known way of doing performance evaluation. An approach to event-driven simulation of communication networks is presented and mixed complexity modeling, which can simplify...

Experimental validation of the DPM Monte Carlo code using minimally scattered electron beams in heterogeneous media

International Nuclear Information System (INIS)

Chetty, Indrin J.; Moran, Jean M.; Nurushev, Teamor S.; McShan, Daniel L.; Fraass, Benedick A.; Wilderman, Scott J.; Bielajew, Alex F.

2002-01-01

A comprehensive set of measurements and calculations has been conducted to investigate the accuracy of the Dose Planning Method (DPM) Monte Carlo code for electron beam dose calculations in heterogeneous media. Measurements were made using 10 MeV and 50 MeV minimally scattered, uncollimated electron beams from a racetrack microtron. Source distributions for the Monte Carlo calculations were reconstructed from in-air ion chamber scans and then benchmarked against measurements in a homogeneous water phantom. The in-air spatial distributions were found to have FWHM of 4.7 cm and 1.3 cm, at 100 cm from the source, for the 10 MeV and 50 MeV beams respectively. Energy spectra for the electron beams were determined by simulating the components of the microtron treatment head using the code MCNP4B. Profile measurements were made using an ion chamber in a water phantom with slabs of lung or bone-equivalent materials submerged at various depths. DPM calculations are, on average, within 2% agreement with measurement for all geometries except for the 50 MeV incident on a 6 cm lung-equivalent slab. Measurements using approximately monoenergetic, 50 MeV, 'pencil-beam'-type electrons in heterogeneous media provide conditions for maximum electronic disequilibrium and hence present a stringent test of the code's electron transport physics; the agreement noted between calculation and measurement illustrates that the DPM code is capable of accurate dose calculation even under such conditions. (author)

Survival benefits from follow-up of patients with lung cancer: a systematic review and meta-analysis.

Science.gov (United States)

Calman, Lynn; Beaver, Kinta; Hind, Daniel; Lorigan, Paul; Roberts, Chris; Lloyd-Jones, Myfanwy

2011-12-01

The burden of lung cancer is high for patients and carers. Care after treatment may have the potential to impact on this. We reviewed the published literature on follow-up strategies intended to improve survival and quality of life. We systematically reviewed studies comparing follow-up regimes in lung cancer. Primary outcomes were overall survival (comparing more intensive versus less intensive follow-up) and survival comparing symptomatic with asymptomatic recurrence. Quality of life was identified as a secondary outcome measure. Hazard ratios (HRs) and 95% confidence intervals from eligible studies were synthesized. Nine studies that examined the role of more intensive follow-up for patients with lung cancer were included (eight observational studies and one randomized controlled trial). The studies of curative resection included patients with non-small cell lung cancer Stages I to III disease, and studies of palliative treatment follow-up included limited and extensive stage patients with small cell lung cancer. A total of 1669 patients were included in the studies. Follow-up programs were heterogeneous and multifaceted. A nonsignificant trend for intensive follow-up to improve survival was identified, for the curative intent treatment subgroup (HR: 0.83; 95% confidence interval: 0.66-1.05). Asymptomatic recurrence was associated with increased survival, which was statistically significant HR: 0.61 (0.50-0.74) (p impact of follow-up regimes on living with lung cancer and psychosocial well-being.

Lung Cancer—Patient Version

Science.gov (United States)

The two main types of lung cancer are non-small cell lung cancer and small cell lung cancer. Smoking causes most lung cancers, but nonsmokers can also develop lung cancer. Start here to find information on lung cancer treatment, causes and prevention, screening, research, and statistics on lung cancer.

Enhanced tumor growth in the remaining lung after major lung resection.

Science.gov (United States)

Sano, Fumiho; Ueda, Kazuhiro; Murakami, Junichi; Hayashi, Masataro; Nishimoto, Arata; Hamano, Kimikazu

2016-05-01

Pneumonectomy induces active growth of the remaining lung in order to compensate for lost lung tissue. We hypothesized that tumor progression is enhanced in the activated local environment. We examined the effects of mechanical strain on the activation of lung growth and tumor progression in mice. The mechanical strain imposed on the right lung after left pneumonectomy was neutralized by filling the empty space that remained after pneumonectomy with a polypropylene prosthesis. The neutralization of the strain prevented active lung growth. According to an angiogenesis array, stronger monocyte chemoattractant protein-1 (MCP-1) expression was found in the strain-induced growing lung. The neutralization of the strain attenuated the release of MCP-1 from the lung cells. The intravenous injection of Lewis lung cancer cells resulted in the enhanced development of metastatic foci in the strain-induced growing lung, but the enhanced development was canceled by the neutralization of the strain. An immunohistochemical analysis revealed the prominent accumulation of tumor-associated macrophages in tumors arising in the strain-induced growing lung, and that there was a relationship between the accumulation and the MCP-1 expression status. Our results suggested that mechanical lung strain, induced by pulmonary resection, triggers active lung growth, thereby creating a tumor-friendly environment. The modification of that environment, as well as the minimizing of surgical stress, may be a meaningful strategy to improve the therapeutic outcome after lung cancer surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

Hypoplastic left heart syndrome and the nutmeg lung pattern in utero: a cause and effect relationship or prognostic indicator?

Energy Technology Data Exchange (ETDEWEB)

Saul, David; Johnson, Ann M.; Victoria, Teresa [The Children' s Hospital of Philadelphia, Radiology Department, Philadelphia, PA (United States); Degenhardt, Karl; Rychik, Jack [The Children' s Hospital of Philadelphia, Cardiac Center and Fetal Heart Program, Philadelphia, PA (United States); Iyoob, Suzanne D.; Johnson, Mark P. [The Children' s Hospital of Philadelphia, Center for Fetal Diagnosis and Treatment, Philadelphia, PA (United States); Surrey, Lea F. [The Children' s Hospital of Philadelphia, Pathology Department, Philadelphia, PA (United States)

2016-04-15

Hypoplastic left heart syndrome (HLHS) is the third most common cause of critical congenital heart disease in newborns, and one of the most challenging forms to treat. Secondary pulmonary lymphangiectasia has been recognized in association with HLHS, an appearance described on fetal MRI as the ''nutmeg lung.'' To investigate the association of fetal nutmeg lung with HLHS survival. A retrospective search of the fetal MRI database was performed. The nutmeg lung pattern was defined as T2 heterogeneous signal with tubular structures radiating peripherally from the hila. Postnatal echocardiograms and charts were reviewed. Forty-four fetal MR studies met inclusion criteria, of which 4 patients (9%) had the nutmeg lung pattern and 3 of whom also had restrictive lesions. Mortality in this nutmeg lung group was 100% by 5 months of age. Of the 40 patients without nutmeg lung, mortality/orthotopic heart transplant (OHT) was 35%. Of these 40 patients without nutmeg lung, 5 had restriction on echo, 3 of whom died/had OHT before 5 months of age (60% of patients with restriction and non-nutmeg lung). There was a significantly higher incidence of restrictive lesions (P = 0.02) and mortality/OHT (P = 0.02) in patients with nutmeg lung compared to those without. The nutmeg lung MR appearance in HLHS fetuses is associated with increased mortality/OHT (100% in the first 5 months of life compared to 35% with HLHS alone). Not all patients with restrictive lesions develop nutmeg lung, and outcome is not as poor when restriction is present in isolation. Dedicated evaluation for nutmeg lung pattern on fetal MR studies may be useful to guide prognostication and aid clinicians in counseling parents of fetuses with HLHS. (orig.)

Hypoplastic left heart syndrome and the nutmeg lung pattern in utero: a cause and effect relationship or prognostic indicator?

International Nuclear Information System (INIS)

Saul, David; Johnson, Ann M.; Victoria, Teresa; Degenhardt, Karl; Rychik, Jack; Iyoob, Suzanne D.; Johnson, Mark P.; Surrey, Lea F.

2016-01-01

Hypoplastic left heart syndrome (HLHS) is the third most common cause of critical congenital heart disease in newborns, and one of the most challenging forms to treat. Secondary pulmonary lymphangiectasia has been recognized in association with HLHS, an appearance described on fetal MRI as the ''nutmeg lung.'' To investigate the association of fetal nutmeg lung with HLHS survival. A retrospective search of the fetal MRI database was performed. The nutmeg lung pattern was defined as T2 heterogeneous signal with tubular structures radiating peripherally from the hila. Postnatal echocardiograms and charts were reviewed. Forty-four fetal MR studies met inclusion criteria, of which 4 patients (9%) had the nutmeg lung pattern and 3 of whom also had restrictive lesions. Mortality in this nutmeg lung group was 100% by 5 months of age. Of the 40 patients without nutmeg lung, mortality/orthotopic heart transplant (OHT) was 35%. Of these 40 patients without nutmeg lung, 5 had restriction on echo, 3 of whom died/had OHT before 5 months of age (60% of patients with restriction and non-nutmeg lung). There was a significantly higher incidence of restrictive lesions (P = 0.02) and mortality/OHT (P = 0.02) in patients with nutmeg lung compared to those without. The nutmeg lung MR appearance in HLHS fetuses is associated with increased mortality/OHT (100% in the first 5 months of life compared to 35% with HLHS alone). Not all patients with restrictive lesions develop nutmeg lung, and outcome is not as poor when restriction is present in isolation. Dedicated evaluation for nutmeg lung pattern on fetal MR studies may be useful to guide prognostication and aid clinicians in counseling parents of fetuses with HLHS. (orig.)

Lung Cancer Prevention

Science.gov (United States)

... Colorectal Cancer Kidney (Renal Cell) Cancer Leukemia Liver Cancer Lung Cancer Lymphoma Pancreatic Cancer Prostate Cancer Skin Cancer ... following PDQ summaries for more information about lung cancer: Lung Cancer Screening Non-Small Cell Lung Cancer Treatment ...

Abscess in the Lungs

Science.gov (United States)

... Home Lung and Airway Disorders Abscess in the Lungs Abscess in the Lungs Causes Symptoms Diagnosis Treatment Resources ... here for the Professional Version Abscess in the Lungs Abscess in the Lungs A lung abscess is a ...

Lung ventilation-perfusion imbalance in pulmonary emphysema. Assessment with automated V/Q quotient SPECT

International Nuclear Information System (INIS)

Suga, Kazuyoshi; Kawakami, Yasuhiko; Koike, Hiroaki; Iwanaga, Hideyuki; Tokuda, Osamu; Okada, Munemasa; Matsunaga, Naofumi

2010-01-01

Tc-99m-Technegas-macro-aggregated albumin (MAA) single photon emission computed tomography (SPECT)-derived ventilation (V)/perfusion (Q) quotient SPECT was used to assess lung V-Q imbalance in patients with pulmonary emphysema. V/Q quotient SPECT and V/Q profile were automatically built in 38 patients with pulmonary emphysema and 12 controls, and V/Q distribution and V/Q profile parameters were compared. V/Q distribution on V/Q quotient SPECT was correlated with low attenuation areas (LAA) on density-mask computed tomography (CT). Parameters of V/Q profile such as the median, standard deviation (SD), kurtosis and skewness were proposed to objectively evaluate the severity of lung V-Q imbalance. In contrast to uniform V/Q distribution on V/Q quotient SPECT and a sharp peak with symmetrical V/Q distribution on V/Q profile in controls, lung areas showing heterogeneously high or low V/Q and flattened peaks with broadened V/Q distribution were frequently seen in patients with emphysema, including lung areas with only slight LAA. V/Q distribution was also often asymmetric regardless of symmetric LAA. All the proposed parameters of V/Q profile in entire lungs of patients with emphysema showed large variations compared with controls; SD and kurtosis were significantly different from controls (P<0.0001 and P<0.001, respectively), and a significant correlation was found between SD and A-aDO2 (P<0.0001). V/Q quotient SPECT appears to be more sensitive to detect emphysematous lungs compared with morphologic CT in patients with emphysema. SD and kurtosis of V/Q profile can be adequate parameters to assess the severity of lung V-Q imbalance causing gas-exchange impairment in patients with emphysema. (author)

Lung nodules after whole lung radiation

International Nuclear Information System (INIS)

Cohen, M.D.; Mirkin, D.L.; Provisor, A.; Hornback, N.B.; Smith, J.A.; Slabaugh, R.D.

1983-01-01

It is essential to recognize radiation pneumonitis after whole lung irradiation, or nodular changes in response to chemotherapy, so that such conditions are not mistaken for tumor metastases, causing grave error in patient management and the possibility of further lung damage

Increased mean lung density: Another independent predictor of lung cancer?

Energy Technology Data Exchange (ETDEWEB)

Sverzellati, Nicola, E-mail: nicola.sverzellati@unipr.it [Department of Department of Surgical Sciences, Section of Diagnostic Imaging, University of Parma, Padiglione Barbieri, University Hospital of Parma, V. Gramsci 14, 43100 Parma (Italy); Randi, Giorgia, E-mail: giorgia.randi@marionegri.it [Department of Epidemiology, Mario Negri Institute, Via La Masa 19, 20156 Milan (Italy); Spagnolo, Paolo, E-mail: paolo.spagnolo@unimore.it [Respiratory Disease Unit, Center for Rare Lung Disease, Department of Oncology, Hematology and Respiratory Disease, University of Modena and Reggio Emilia, Via del Pozzo 71, 44124 Modena (Italy); Marchianò, Alfonso, E-mail: alfonso.marchiano@istitutotumori.mi.it [Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan (Italy); Silva, Mario, E-mail: mac.mario@hotmail.it [Department of Department of Surgical Sciences, Section of Diagnostic Imaging, University of Parma, Padiglione Barbieri, University Hospital of Parma, V. Gramsci 14, 43100 Parma (Italy); Kuhnigk, Jan-Martin, E-mail: Jan-Martin.Kuhnigk@mevis.fraunhofer.de [Fraunhofer MEVIS, Universitaetsallee 29, 28359 Bremen (Germany); La Vecchia, Carlo, E-mail: carlo.lavecchia@marionegri.it [Department of Occupational Health, University of Milan, Via Venezian 1, 20133 Milan (Italy); Zompatori, Maurizio, E-mail: maurizio.zompatori@unibo.it [Department of Radiology, Cardio-Thoracic Section, S. Orsola-Malpighi Hospital, Via Albertoni 15, 40138 Bologna (Italy); Pastorino, Ugo, E-mail: ugo.pastorino@istitutotumori.mi.it [Department of Surgery, Section of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan (Italy)

2013-08-15

Objectives: To investigate the relationship between emphysema phenotype, mean lung density (MLD), lung function and lung cancer by using an automated multiple feature analysis tool on thin-section computed tomography (CT) data. Methods: Both emphysema phenotype and MLD evaluated by automated quantitative CT analysis were compared between outpatients and screening participants with lung cancer (n = 119) and controls (n = 989). Emphysema phenotype was defined by assessing features such as extent, distribution on core/peel of the lung and hole size. Adjusted multiple logistic regression models were used to evaluate independent associations of CT densitometric measurements and pulmonary function test (PFT) with lung cancer risk. Results: No emphysema feature was associated with lung cancer. Lung cancer risk increased with decreasing values of forced expiratory volume in 1 s (FEV{sub 1}) independently of MLD (OR 5.37, 95% CI: 2.63–10.97 for FEV{sub 1} < 60% vs. FEV{sub 1} ≥ 90%), and with increasing MLD independently of FEV{sub 1} (OR 3.00, 95% CI: 1.60–5.63 for MLD > −823 vs. MLD < −857 Hounsfield units). Conclusion: Emphysema per se was not associated with lung cancer whereas decreased FEV{sub 1} was confirmed as being a strong and independent risk factor. The cross-sectional association between increased MLD and lung cancer requires future validations.

What Is Lung Cancer?

Science.gov (United States)

... Shareable Graphics Infographics “African-American Men and Lung Cancer” “Lung Cancer Is the Biggest Cancer Killer in Both ... starts in the lungs, it is called lung cancer. Lung cancer begins in the lungs and may spread ...

Lung Cancer: Glossary

Science.gov (United States)

... professional support team today. Learn More . Find more lung cancer resources. Learn More Donate Today! What is Lung ... to Give How Your Support Helps Events Lung Cancer Awareness © Lung Cancer Alliance. The information presented in this website ...

Benefits and harms of CT screening for lung cancer: a systematic review.

Science.gov (United States)

Bach, Peter B; Mirkin, Joshua N; Oliver, Thomas K; Azzoli, Christopher G; Berry, Donald A; Brawley, Otis W; Byers, Tim; Colditz, Graham A; Gould, Michael K; Jett, James R; Sabichi, Anita L; Smith-Bindman, Rebecca; Wood, Douglas E; Qaseem, Amir; Detterbeck, Frank C

2012-06-13

some degree of follow-up, while approximately 1% had lung cancer. There was marked heterogeneity in this finding and in the frequency of follow-up investigations, biopsies, and percentage of surgical procedures performed in patients with benign lesions. Major complications in those with benign conditions were rare. Low-dose computed tomography screening may benefit individuals at an increased risk for lung cancer, but uncertainty exists about the potential harms of screening and the generalizability of results.

Open lung biopsy

Science.gov (United States)

Biopsy - open lung ... An open lung biopsy is done in the hospital using general anesthesia . This means you will be asleep and ... The open lung biopsy is done to evaluate lung problems seen on x-ray or CT scan .

Enhanced recovery programs in lung cancer surgery: systematic review and meta-analysis of randomized controlled trials

Directory of Open Access Journals (Sweden)

Li S

2017-11-01

Full Text Available Shuangjiang Li,1 Kun Zhou,1 Guowei Che,1 Mei Yang,1 Jianhua Su,2 Cheng Shen,1 Pengming Yu2 1Department of Thoracic Surgery, 2Department of Rehabilitation, Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, China Background: Enhanced recovery after surgery (ERAS program is an effective evidence-based multidisciplinary protocol of perioperative care, but its roles in thoracic surgery remain unclear. This systematic review of randomized controlled trials (RCTs aims to investigate the efficacy and safety of the ERAS programs for lung cancer surgery. Materials and methods: We searched the PubMed and EMBASE databases to identify the RCTs that implemented an ERAS program encompassing more than four care elements within at least two phases of perioperative care in lung cancer surgery. The heterogeneity levels between studies were estimated by the Cochrane Collaborations. A qualitative review was performed if considerable heterogeneity was revealed. Relative risk (RR and weighted mean difference served as the summarized statistics for the meta-analyses. Additional analyses were also performed to perceive potential bias risks. Results: A total of seven RCTs enrolling 486 patients were included. The meta-analysis indicated that the ERAS group patients had significantly lower morbidity rates (RR=0.64; p<0.001, especially the rates of pulmonary (RR=0.43; p<0.001 and surgical complications (RR=0.46; p=0.010, than those of control group patients. No significant reduction was found in the in-hospital mortality (RR=0.70; p=0.58 or cardiovascular complications (RR=1.46; p=0.25. In the qualitative review, most of the evidence reported significantly shortened length of hospital and intensive care unit stay and decreased hospitalization costs in the ERAS-treated patients. No significant publication bias was detected in the meta-analyses. Conclusion: Our review demonstrates that the implementation of an ERAS program for lung cancer

CYP2E1 Rsa Ι/Pst Ι polymorphism and lung cancer susceptibility: a meta-analysis involving 10,947 subjects.

Science.gov (United States)

Shen, Ze-Tian; Wu, Xin-Hu; Li, Bing; Shen, Jun-shu; Wang, Zhen; Li, Jing; Zhu, Xi-Xu

2015-09-01

Many studies have examined the association between the CYP2E1 Rsa Ι/Pst Ι (rs3813867) polymorphism gene polymorphisms and lung cancer risk in various populations, but their results have been inconsistent. The PubMed and CNKI database was searched for case-control studies published up to October 2013. Data were extracted and pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated. In this meta-analysis, we assessed 23 published studies involving comprising 4727 lung cancer cases and 6220 controls of the association between CYP2E1 Rsa Ι/Pst Ι polymorphism and lung cancer risk. For the homozygote c2/c2 and c2 allele carriers (c1/c2 + c2/c2), the pooled ORs for all studies were 0.73(95% CI = 0.62-0.84; P = 0.005 for heterogeneity) and 0.84 (95% CI = 0.77-0.92; P = 0.001 for heterogeneity) when compared with the homozygous wild-type genotype (c1/c1). In the stratified analysis by ethnicity, the same significantly risks were found among Asians and mixed population for both the c2 allele carriers and homozygote c2/c2. However, no significant associations were found in Caucasian population all genetic models. This updated meta-analysis suggests that CYP2E1 Rsa Ι/Pst Ι c2 allele is a decreased risk factor for the developing lung cancer among Asians and mixed population. © 2015 The Authors. Journal of Cellular and Molecular Medicine published by John Wiley & Sons Ltd and Foundation for Cellular and Molecular Medicine.

High spatiotemporal resolution measurement of regional lung air volumes from 2D phase contrast x-ray images.

Science.gov (United States)

Leong, Andrew F T; Fouras, Andreas; Islam, M Sirajul; Wallace, Megan J; Hooper, Stuart B; Kitchen, Marcus J

2013-04-01

Described herein is a new technique for measuring regional lung air volumes from two-dimensional propagation-based phase contrast x-ray (PBI) images at very high spatial and temporal resolution. Phase contrast dramatically increases lung visibility and the outlined volumetric reconstruction technique quantifies dynamic changes in respiratory function. These methods can be used for assessing pulmonary disease and injury and for optimizing mechanical ventilation techniques for preterm infants using animal models. The volumetric reconstruction combines the algorithms of temporal subtraction and single image phase retrieval (SIPR) to isolate the image of the lungs from the thoracic cage in order to measure regional lung air volumes. The SIPR algorithm was used to recover the change in projected thickness of the lungs on a pixel-by-pixel basis (pixel dimensions ≈ 16.2 μm). The technique has been validated using numerical simulation and compared results of measuring regional lung air volumes with and without the use of temporal subtraction for removing the thoracic cage. To test this approach, a series of PBI images of newborn rabbit pups mechanically ventilated at different frequencies was employed. Regional lung air volumes measured from PBI images of newborn rabbit pups showed on average an improvement of at least 20% in 16% of pixels within the lungs in comparison to that measured without the use of temporal subtraction. The majority of pixels that showed an improvement was found to be in regions occupied by bone. Applying the volumetric technique to sequences of PBI images of newborn rabbit pups, it is shown that lung aeration at birth can be highly heterogeneous. This paper presents an image segmentation technique based on temporal subtraction that has successfully been used to isolate the lungs from PBI chest images, allowing the change in lung air volume to be measured over regions as small as the pixel size. Using this technique, it is possible to measure

Investigation of elemental distribution in lung samples by X-ray fluorescence microtomography

International Nuclear Information System (INIS)

Pereira, Gabriela R.; Rocha, Henrique S.; Lopes, Ricardo T.

2007-01-01

X-Ray Fluorescence Microtomography (XRFCT) is a suitable technique to find elemental distributions in heterogeneous samples. While x-ray transmission microtomography provides information about the linear attenuation coefficient distribution, XRFCT allows one to map the most important elements in the sample. The x-ray fluorescence tomography is based on the use of the X-ray fluorescence emitted from the elements contained in a sample so as to give additional information to characterize the object under study. In this work a rat lung and two human lung tissue samples have been investigated in order to verify the efficiency of the system in determination of the internal distribution of detected elements in these kinds of samples and to compare the elemental distribution in the lung tissue of an old human and a fetus. The experiments were performed at the X-Ray Fluorescence beamline (XRF) of the Brazilian Synchrotron Light Source (LNLS), Campinas, Brazil. A white beam was used for the excitation of the elements and the fluorescence photons have been detected by a HPGe detector. All the tomographies have been reconstructed using a filtered-back projection algorithm. It was possible to visualize the distribution of high atomic number elements on both, artificial and tissues samples. It was compared the quantity of Zn, Cu and Fe for the lung human tissue samples and verify that these elements have a higher concentration on the fetus tissue sample than the adult tissue sample. (author)

Marketing do mercado de luxo: Estudo de caso Victoria's Secret

OpenAIRE

Ana Francisca Giuliani

2013-01-01

Este artigo teve por objetivo identificar quais são as estratégias de marketing utilizadas pela empresa varejista Victoria’s Secret para a fidelização do consumidor de luxo em nível global. O estudo caracterizou-se como uma pesquisa qualitativa, utilizando-se como estratégia de campo o estudo de caso de caráter ilustrativo. Para o alcance do objetivo proposto, dividiu-se o estudo em duas fases. Na primeira, denominada exploratória, buscou-se em dados secundários o embasamento para a construçã...

Bacterial lung abscess

International Nuclear Information System (INIS)

Groskin, S.A.; Panicek, D.M.; Ewing, D.K.; Rivera, F.; Math, K.; Teixeira, J.; Heitzman, E.R.

1987-01-01

A retrospective review of patients with bacterial lung abscess was carried out. Demographic, clinical, and radiographical features of this patient group are compared with similar data from patients with empyema and/or cavitated lung carcinoma; differential diagnostic points are stressed. The entity of radiographically occult lung abscess is discussed. Complications associated with bacterial lung abscess are discussed. Current therapeutic options and treatment philosophy for patients with bacterial lung abscess are noted

The Murine Lung Microbiome Changes During Lung Inflammation and Intranasal Vancomycin Treatment

Science.gov (United States)

Barfod, Kenneth Klingenberg; Vrankx, Katleen; Mirsepasi-Lauridsen, Hengameh Chloé; Hansen, Jitka Stilund; Hougaard, Karin Sørig; Larsen, Søren Thor; Ouwenhand, Arthur C.; Krogfelt, Karen Angeliki

2015-01-01

Most microbiome research related to airway diseases has focused on the gut microbiome. This is despite advances in culture independent microbial identification techniques revealing that even healthy lungs possess a unique dynamic microbiome. This conceptual change raises the question; if lung diseases could be causally linked to local dysbiosis of the local lung microbiota. Here, we manipulate the murine lung and gut microbiome, in order to show that the lung microbiota can be changed experimentally. We have used four different approaches: lung inflammation by exposure to carbon nano-tube particles, oral probiotics and oral or intranasal exposure to the antibiotic vancomycin. Bacterial DNA was extracted from broncho-alveolar and nasal lavage fluids, caecum samples and compared by DGGE. Our results show that: the lung microbiota is sex dependent and not just a reflection of the gut microbiota, and that induced inflammation can change lung microbiota. This change is not transferred to offspring. Oral probiotics in adult mice do not change lung microbiome detectible by DGGE. Nasal vancomycin can change the lung microbiome preferentially, while oral exposure does not. These observations should be considered in future studies of the causal relationship between lung microbiota and lung diseases. PMID:26668669

Lung needle biopsy

Science.gov (United States)

... if you have certain lung diseases such as emphysema. Usually, a collapsed lung after a biopsy does not need treatment. But ... any type Bullae (enlarged alveoli that occur with emphysema) Cor pulmonale (condition ... of the lung High blood pressure in the lung arteries Severe ...

Correlation of intra-tumour heterogeneity on 18F-FDG PET with pathologic features in non-small cell lung cancer: A feasibility study

International Nuclear Information System (INIS)

Baardwijk, Angela van; Bosmans, Geert; Suylen, Robert Jan van; Kroonenburgh, Marinus van; Hochstenbag, Monique; Geskes, Gijs; Lambin, Philippe; De Ruysscher, Dirk

2008-01-01

We evaluated the feasibility to correlate intra-tumour heterogeneity as visualized on 18 F-FDG PET with histology for NSCLC. For this purpose we used an ex-vivo model. The procedure was feasible in all operated patients. We have shown that this method is suitable for correlating intra-tumour heterogeneity in tracer uptake with histology

A system for tumor heterogeneity evaluation and diagnosis based on tumor markers measured routinely in the laboratory.

Science.gov (United States)

Hui, Liu; Rixv, Liu; Xiuying, Zhou

2015-12-01

To develop an efficient and reliable approach to estimate tumor heterogeneity and improve tumor diagnosis using multiple tumor markers measured routinely in the clinical laboratory. A total of 161 patients with different cancers were recruited as the cancer group, and 91 patients with non-oncological conditions were required as the non-oncological disease group. The control group comprised 90 randomly selected healthy subjects. AFP, CEA, CYFRA, CA125, CA153, CA199, CA724, and NSE levels were measured in all these subjects with a chemiluminescent microparticle immunoassay. The tumor marker with the maximum S/CO value (sample test value:cutoff value for discriminating individuals with and without tumors) was considered as a specific tumor marker (STM) for an individual. Tumor heterogeneity index (THI)=N/P (N: number of STMs; P: percentage of individuals with STMs in a certain tumor population) was used to quantify tumor heterogeneity: high THI indicated high tumor heterogeneity. The tumor marker index (TMI), TMI = STM×(number of positive tumor markers+1), was used for diagnosis. The THIs of lung, gastric, and liver cancers were 8.33, 9.63, and 5.2, respectively, while the ROC-areas under the curve for TMI were 0.862, 0.809, and 0.966. In this study, we developed a novel index for tumor heterogeneity based on the expression of various routinely evaluated serum tumor markers. Development of an evaluation system for tumor heterogeneity on the basis of this index could provide an effective diagnostic tool for some cancers. Copyright © 2015 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

Dynamic heterogeneity in life histories

DEFF Research Database (Denmark)

Tuljapurkar, Shripad; Steiner, Uli; Orzack, Steven Hecht

2009-01-01

or no fixed heterogeneity influences this trait. We propose that dynamic heterogeneity provides a 'neutral' model for assessing the possible role of unobserved 'quality' differences between individuals. We discuss fitness for dynamic life histories, and the implications of dynamic heterogeneity...... generate dynamic heterogeneity: life-history differences produced by stochastic stratum dynamics. We characterize dynamic heterogeneity in a range of species across taxa by properties of the Markov chain: the entropy, which describes the extent of heterogeneity, and the subdominant eigenvalue, which...... distributions of lifetime reproductive success. Dynamic heterogeneity contrasts with fixed heterogeneity: unobserved differences that generate variation between life histories. We show by an example that observed distributions of lifetime reproductive success are often consistent with the claim that little...

Pragmatismo e os pragmáticos nos estudos organizacionais

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Francis Kanashiro Meneghetti

Full Text Available O objetivo central deste ensaio teórico é avaliar as contribuições do pragmatismo nos Estudos Organizacionais e, os específicos, avaliar se as contribuições teóricas de Charles Peirce e John Dewey possibilitam afirmar o pragmatismo como senso comum, ciência ou teoria do conhecimento; analisar as contribuições - possibilidadese limites - do pragmatismo como conhecimento científico; compreender os percursos do pragmatismo nos Estudos Organizacionais. Chaga-se a conclusão de que ser pragmático é diferente de conceber estudos articulados no campo epistemológico do pragmatismo. O sujeito pragmático vê na sua utilidade e na necessidade deação, o ponto de tensão que coloca em dúvida a veracidade dos pressupostos do pragmatismo como ciência. O que ocorre nos Estudos Organizacionais éa conversão do pragmatismo como conhecimento científico emsubordinação irracional à utilidade e à ação prática, sobretudo, no campo da economia, da política, da ciência, da cultura, da educação, e assim por diante.

Mitogen-activated protein kinase phosphatase-1 modulates regional effects of injurious mechanical ventilation in rodent lungs.

Science.gov (United States)

Park, Moo Suk; He, Qianbin; Edwards, Michael G; Sergew, Amen; Riches, David W H; Albert, Richard K; Douglas, Ivor S

2012-07-01

Mechanical ventilation induces heterogeneous lung injury by mitogen-activated protein kinase (MAPK) and nuclear factor-κB. Mechanisms regulating regional injury and protective effects of prone positioning are unclear. To determine the key regulators of the lung regional protective effects of prone positioning in rodent lungs exposed to injurious ventilation. Adult rats were ventilated with high (18 ml/kg, positive end-expiratory pressure [PEEP] 0) or low Vt (6 ml/kg; PEEP 3 cm H(2)O; 3 h) in supine or prone position. Dorsal-caudal lung mRNA was analyzed by microarray and MAPK phosphatases (MKP)-1 quantitative polymerase chain reaction. MKP-1(-/-) or wild-type mice were ventilated with very high (24 ml/kg; PEEP 0) or low Vt (6-7 ml/kg; PEEP 3 cm H(2)O). The MKP-1 regulator PG490-88 (MRx-108; 0.75 mg/kg) or phosphate-buffered saline was administered preventilation. Injury was assessed by lung mechanics, bronchioalveolar lavage cell counts, protein content, and lung injury scoring. Immunoblotting for MKP-1, and IκBα and cytokine ELISAs were performed on lung lysates. Prone positioning was protective against injurious ventilation in rats. Expression profiling demonstrated MKP-1 20-fold higher in rats ventilated prone rather than supine and regional reduction in p38 and c-jun N-terminal kinase activation. MKP-1(-/-) mice experienced amplified injury. PG490-88 improved static lung compliance and injury scores, reduced bronchioalveolar lavage cell counts and cytokine levels, and induced MKP-1 and IκBα. Injurious ventilation induces MAPK in an MKP-1-dependent fashion. Prone positioning is protective and induces MKP-1. PG490-88 induced MKP-1 and was protective against high Vt in a nuclear factor-κB-dependent manner. MKP-1 is a potential target for modulating regional effects of injurious ventilation.

Perfil do doador de pulmão disponibilizado no estado de São Paulo, Brasil, em 2006 Lung donor profile in the state of São Paulo, Brazil, in 2006

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Paulo Manuel Pêgo Fernandes

2008-07-01

Full Text Available OBJETIVO: Analisar a taxa de aproveitamento de pulmões disponibilizados em São Paulo no ano de 2006, bem como caracterizar o perfil dos doadores de pulmão deste período. MÉTODOS: Estudo retrospectivo de 497 prontuários de doadores de pulmão, no período de janeiro a dezembro de 2006. RESULTADOS: Não houve oferta de doação de pulmões para transplante em 149 (30% dos prontuários analisados, sendo excluídos do estudo. A idade média dos 348 doadores eleitos para o estudo foi de 37,4 ± 16,1 anos, e 56,9% deles eram do sexo masculino. As principais causas da morte cerebral dos doadores foram: acidente vascular cerebral (40,5%; trauma cranioencefálico (34,2%; e hemorragia subaracnóidea (10,9%. A grande maioria dos doadores recebia drogas vasoativas (90,5%, sendo que 13,5% haviam apresentado parada cárdio-respiratória. Do ponto de vista infeccioso, o leucograma médio foi de 15.008 ± 6.467 células/mm³, 67,8% recebiam antibioticoterapia e 26,1% apresentavam infecção pulmonar. Quase 40% dos doadores apresentavam alterações radiográficas. Apenas 4,9% dos doadores foram aceitos, representando 28 pulmões (taxa de aproveitamento de órgãos de 4%. Os motivos de recusa foram: alteração gasométrica (30,1%; infecção (23,7%; e distância (10,9%. CONCLUSÕES: A taxa de aproveitamento de pulmões em nosso meio é baixa quando comparada às taxas médias de aproveitamento mundial. Além disso, mais de 50% das recusas deveram-se à gasometria arterial inadequada e infecção pulmonar. Aliar melhor cuidado ao potencial doador à menor rigidez nos critérios de seleção poderia aumentar a utilização dos órgãos doados.OBJECTIVE: To analyze the rate at which lungs available for transplantation in the state of São Paulo in 2006 were utilized and to determine the lung donor profile in the same period. METHODS: A retrospective study of 497 clinical charts of lung tissue donors from January to December of 2006. RESULTS: According to the

Lung Cancer Susceptibility and hOGG1 Ser326Cys Polymorphism: A Meta-Analysis

International Nuclear Information System (INIS)

Kiyohara, Chikako; Takayama, Koichi; Nakanishi, Yoichi

2010-01-01

Recent lung cancer studies have focused on identifying the effects of single nucleotide polymorphisms (SNPs) in candidate genes, among which DNA repair genes are increasingly being studied. Genetic variations in DNA repair genes are thought to modulate DNA repair capacity and are suggested to be related to lung cancer risk. In this study, we tried to assess reported studies of association between polymorphism of human 8-oxoguanine DNA glycosylase 1 (hOGG1) Ser326Cys and lung cancer. We conducted MEDLINE, Current Contents and Web of Science searches using 'hOGG1', 'lung cancer' and 'polymorphism' as keywords to search for papers published (from January 1995 through August 2010). Data were combined using both a fixed effects (the inverse variance-weighted method) and a random effects (DerSimonian and Laird method) models. The Cochran Q test was used for the assessment of heterogeneity. Publication bias was assessed by both Begg’s and Egger’s tests. We identified 20 case-control studies in 21 different ethnic populations. As two studies were not in the Hardy-Weinberg equilibrium, 18 case-control studies in 19 different ethnic populations (7,792 cases and 9,358 controls) were included in our meta-analysis. Summary frequencies of the Cys allele among Caucasians and Asians based on the random effects model were 20.9% (95% confidence interval (CI) = 18.9–22.9) and 46.1% (95% CI = 40.2–52.0), respectively. The distribution of the Cys allele was significantly different between Asians and Caucasians (P < 0.001). The Cys/Cys genotype was significantly associated with lung cancer risk in Asian populations (odds ratio = 1.27, 95% CI = 1.09–1.48) but not in Caucasian populations. This ethnic difference in lung cancer risk may be due to environmental factors such as cigarette smoking and dietary factors. Although the summary risk for developing lung cancer may not be large, lung cancer is such a common malignancy that even a small increase

Lung Cancer Susceptibility and hOGG1 Ser326Cys Polymorphism: A Meta-Analysis

Energy Technology Data Exchange (ETDEWEB)

Kiyohara, Chikako, E-mail: chikako@phealth.med.kyushu-u.ac.jp [Department of Preventive Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582 (Japan); Takayama, Koichi; Nakanishi, Yoichi [Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582 (Japan)

2010-10-28

Recent lung cancer studies have focused on identifying the effects of single nucleotide polymorphisms (SNPs) in candidate genes, among which DNA repair genes are increasingly being studied. Genetic variations in DNA repair genes are thought to modulate DNA repair capacity and are suggested to be related to lung cancer risk. In this study, we tried to assess reported studies of association between polymorphism of human 8-oxoguanine DNA glycosylase 1 (hOGG1) Ser326Cys and lung cancer. We conducted MEDLINE, Current Contents and Web of Science searches using 'hOGG1', 'lung cancer' and 'polymorphism' as keywords to search for papers published (from January 1995 through August 2010). Data were combined using both a fixed effects (the inverse variance-weighted method) and a random effects (DerSimonian and Laird method) models. The Cochran Q test was used for the assessment of heterogeneity. Publication bias was assessed by both Begg’s and Egger’s tests. We identified 20 case-control studies in 21 different ethnic populations. As two studies were not in the Hardy-Weinberg equilibrium, 18 case-control studies in 19 different ethnic populations (7,792 cases and 9,358 controls) were included in our meta-analysis. Summary frequencies of the Cys allele among Caucasians and Asians based on the random effects model were 20.9% (95% confidence interval (CI) = 18.9–22.9) and 46.1% (95% CI = 40.2–52.0), respectively. The distribution of the Cys allele was significantly different between Asians and Caucasians (P < 0.001). The Cys/Cys genotype was significantly associated with lung cancer risk in Asian populations (odds ratio = 1.27, 95% CI = 1.09–1.48) but not in Caucasian populations. This ethnic difference in lung cancer risk may be due to environmental factors such as cigarette smoking and dietary factors. Although the summary risk for developing lung cancer may not be large, lung cancer is such a common malignancy that even a small increase

The matching of ventilation and perfusion in the lung of the Tegu lizard, Tupinambis nigropunctatus.

Science.gov (United States)

Hlastala, M P; Standaert, T A; Pierson, D J; Luchtel, D L

1985-06-01

Ventilation-perfusion (VA/Q) distribution was evaluated in the Tegu lizard, Tupinambis nigropunctatus, using the multiple inert gas elimination technique (MIGET) in order to define the limitations to gas exchange in the large chambered unicameral lung. The lizards (0.52-1.1 kg) were anesthetized with halothane and ventilated. Body temperature was maintained at 35 degrees C. Arterial and sinus venosus PO2 averaged 79.4 +/- 5.9 and 47.3 +/- 6.4 torr while breathing air and 232.1 +/- 31 and 64.8 +/- 11.5 torr while breathing oxygen. VA/Q distributions were broad and right-to-left shunt averaged 21% while breathing air and 27% while breathing oxygen. Gas exchange was significantly impaired due to the presence of both shunt and VA/Q heterogeneity. The walls of the lung enclose a large axial air chamber. Microscopic examination revealed approximately three generations of septa which subdivided the wall into tubular-shaped gas-exchange chambers. Wall thickness averages 2.8 mm at the anterior end of the lung, 2.1 mm in the middle portion of the lung and 1.4 mm at the posterior end. The thickness of the blood-air barrier (epithelial-basal lamina-endothelial cell layer) ranged from 0.35 to 0.90 micron. Although this barrier is slightly thicker than in the mammalian lung (0.1-0.5 micron), it is unlikely to be a source of diffusion limitation in gas exchange at rest.

Lung scintigraphy

International Nuclear Information System (INIS)

Dalenz, Roberto.

1994-01-01

A review of lung scintigraphy, perfusion scintigraphy with SPECT, lung ventilation SPECT, blood pool SPECT. The procedure of lung perfusion studies, radiopharmaceutical, administration and clinical applications, imaging processing .Results encountered and evaluation criteria after Biello and Pioped. Recommendations and general considerations have been studied about relation of this radiopharmaceutical with other pathologies

Unevenness on aerosol inhalation lung images and lung function

International Nuclear Information System (INIS)

Teshima, Takeo; Isawa, Toyoharu; Hirano, Tomio; Ebina, Akio; Shiraishi, Koichiro; Konno, Kiyoshi

1985-01-01

The unevenness or inhomogeneity of aerosol deposition patterns on radioaerosol inhalation lung images has been interpreted rather qualitatively in the clinical practice. We have reported our approach to quantitatively analyze the radioactive count distribution on radioaerosol inhalation lung images in relation to the actual lung function data. We have defined multiple indexes to express the shape and the unevenness of the count distribution of the lung images. To reduce as much as possible the number of indexes to be used in the regression functions, the method of selection of variables was introduced to the multiple regression analysis. Because some variables showed greater coefficients of simple correlation, while others did not, multicollinearity of variables had to be taken into consideration. For this reason, we chose a principal components regression analysis. The multiple regression function for each item of pulmonary function data thus established from analysis of 67 subjects appeared usable as a predictor of the actual lung function: for example, % VC (vital capacity) could be estimated by using four indexes out of the multiple ones with a coefficient of multiple correlation (R) of 0.753, and FEVsub(1.0) % (forced expiratory volume in one second divided by forced expiratory volume), by 7 indexes with R = 0.921. Pulmonary function data regarding lung volumes and lung mechanics were estimated more accurately with greater R's than those for lung diffusion, but even in the latter the prediction was still statistically significant at p less than 0.01. We believe the multiple regression functions thus obtained are useful for estimating not only the overall but also the regional function of the lungs. (author)

Assessment of cumulative evidence for the association between glutathione S-transferase polymorphisms and lung cancer: application of the Venice interim guidelines.

Science.gov (United States)

Langevin, Scott M; Ioannidis, John P A; Vineis, Paolo; Taioli, Emanuela

2010-10-01

There is an overwhelming abundance of genetic association studies available in the literature, which can often be collectively difficult to interpret. To address this issue, the Venice interim guidelines were established for determining the credibility of the cumulative evidence. The objective of this report is to evaluate the literature on the association of common glutathione S-transferase (GST) variants (GSTM1 null, GSTT1 null and GSTP1 Ile105Val polymorphism) and lung cancer, and to assess the credibility of the associations using the newly proposed cumulative evidence guidelines. Information from the literature was enriched with an updated meta-analysis and a pooled analysis using data from the Genetic Susceptibility to Environmental Carcinogens database. There was a significant association between GSTM1 null and lung cancer for the meta-analysis (meta odds ratio=1.17, 95% confidence interval: 1.10-1.25) and pooled analysis (adjusted odds ratio=1.10, 95% confidence interval: 1.04-1.16), although substantial heterogeneity was present. No overall association between lung cancer and GSTT1 null or GSTP1 Ile105Val was found. When the Venice criteria was applied, cumulative evidence for all associations were considered 'weak', with the exception of East Asian carriers of the G allele of GSTP1 Ile105Val, which was graded as 'moderate' evidence. Despite the large amounts of studies, and several statistically significant summary estimates produced by meta-analyses, the application of the Venice criteria suggests extensive heterogeneity and susceptibility to bias for the studies on association of common genetic polymorphisms, such as with GST variants and lung cancer.

Celularidade do líquido de LBA em crianças e adolescentes saudáveis e com doenças pulmonares Cell profile of BAL fluid in children and adolescents with and without lung disease

Directory of Open Access Journals (Sweden)

Isabela Furtado de Mendonça Picinin

2010-06-01

Full Text Available Este estudo teve como objetivo rever a literatura existente sobre a celularidade do LBA em crianças e adolescentes saudáveis, bem como sobre sua utilização como método propedêutico e de acompanhamento nas afecções pulmonares neste grupo etário. Para tanto, utilizamos o banco de dados médico Medline com a seleção de artigos publicados entre 1989 e 2009 utilizando os seguintes descritores MeSH com operadores boolianos: bronchoalveolar lavage AND cytology OR cell AND child. Em crianças saudáveis, a celularidade é composta por macrófagos alveolares (> 80%, linfócitos (cerca de 10%, neutrófilos (cerca de 2% e eosinófilos (The objective of this study was to review the literature on bronchoalveolar lavage fluid cell profiles in healthy children and adolescents, as well as on the use of BAL as a diagnostic and follow-up tool for lung disease patients in this age bracket. To that end, we used the Medline database, compiling studies published between 1989 and 2009 employing the following MeSH descriptors (with Boolean operators as search terms: bronchoalveolar lavage AND cytology OR cell AND child. In healthy children, the cell profile includes alveolar macrophages (> 80%, lymphocytes (approximately 10%, neutrophils (approximately 2% and eosinophils (< 1%. The profile varies depending on the disease under study. The number of neutrophils is greater in wheezing children, especially in non-atopic children, as well as in those with pulmonary infectious and inflammatory profiles, including cystic fibrosis and interstitial lung disease. Eosinophil counts are elevated in children/adolescents with asthma and can reach high levels in those with allergic bronchopulmonary aspergillosis or eosinophilic syndromes. In a heterogenous group of diseases, the number of lymphocytes can increase. Evaluation of the BAL fluid cell profile, when used in conjunction with clinical and imaging findings, has proven to be an essential tool in the investigation of

A Teoria Queer e os Estudos Organizacionais: Revisando Conceitos sobre Identidade

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Eloisio Moulin de Souza

2017-05-01

Full Text Available A teoria queer desenvolveu-se incialmente na década de noventa, nas ciências sociais e humanas, principalmente nos estudos literários e linguísticos, sendo posteriormente incorporada aos estudos organizacionais. Entretanto, apesar de sua aplicação aos estudos organizacionais, ainda existe uma lacuna acerca do debate sobre seus conceitos e significados. Por isso, este artigo objetiva aprofundar e revisar o debate sobre os aspectos desenvolvidos por essa teoria, focando-se nos conceitos relacionados à produção identitária e subjetiva. Para cumprir este intento, as ideias queer sobre identidade, sujeito, performatividade, performance e identificação são apresentadas e debatidas. Defende-se que a teoria queer é um verbo (ação ao invés de um substantivo (identidade e a aplicação de seus conceitos não se restringe somente aos estudos sobre gênero, sexualidade e minorias. Por fim, discute-se a expansão da utilização dos conceitos queer no estudo de outras formas hegemônicas de categorias identitárias presentes no mundo corporativo.

Prone positioning ventilation for treatment of acute lung injury and acute respiratory distress syndrome.

Science.gov (United States)

Lan, Mei-juan; He, Xiao-di

2009-08-01

Patients who are diagnosed with acute lung injury/acute respiratory distress syndrome (ALI/ARDS) usually have ventilation-perfusion mismatch, severe decrease in lung capacity, and gas exchange abnormalities. Health care workers have implemented various strategies in an attempt to compensate for these pathological alterations. By rotating patients with ALI/ARDS between the supine and prone position, it is possible to achieve a significant improvement in PaO2/FiO2, decrease shunting and therefore improve oxygenation without use of expensive, invasive and experimental procedures. Prone positioning is a safe and effective way to improve ventilation when conventional strategies fail to initiate a patient response. Because a specific cure for ARDS is not available, the goal is to support the patients with therapies that cause the least amount of injury while the lungs have an opportunity to heal. Based on current data, a trial of prone positioning ventilation should be offered to the patients who have ALI/ARDS in the early course of the disease. Published studies exhibit substantial heterogeneity in clinical results, suggesting that an adequately sized study optimizing the duration of proning ventilation strategy is warranted to enable definitive conclusions to be drawn.

Dengue, geoprocessamento e indicadores socioeconômicos e ambientais: um estudo de revisão Dengue, geoprocessing, and socioeconomic and environmental indicators: a review

Directory of Open Access Journals (Sweden)

Regina Fernandes Flauzino

2009-05-01

Full Text Available OBJETIVO: Analisar os estudos que abordaram o tema dengue e geoprocessamento juntamente com indicadores socioeconômicos e ambientais na busca de uma melhor compreensão do comportamento da doença. MÉTODO: Conduziu-se uma busca nas bases MEDLINE, SciELO, Lilacs e banco de teses CAPES com os termos "dengue, sistema de informação geográfica, análise espacial, geoprocessamento, sensoriamento remotoe indicadores socioeconômicos e ambientais". Também foi conduzida uma busca manual de artigos selecionados das listas de referências. Foram incluídos todos os trabalhos publicados nos idiomas inglês, português ou espanhol até dezembro de 2007 que abordaram o tema dengue e geoprocessamento e indicadores socioeconômicos e ambientais. Os estudos foram agrupados conforme tipo (inquérito sorológico ou estudo com dados secundários e unidade espacial de análise (município, distritos sanitários, bairros, regiões administrativas, setores censitários e quarteirões. RESULTADOS: Foram avaliados 22 estudos, todos da América Latina (19 do Brasil. Seis eram inquéritos sorológicos e 16 utilizaram dados secundários. Sistemas de informação geográfica foram utilizados em um inquérito e em 11 estudos da outra categoria. A agregação espacial utilizada foi semelhante em ambos os tipos. A pobreza não foi fator preponderante para o risco da doença. A heterogeneidade espacial de condições de vida e incidência esteve presente em 15 dos 16 trabalhos com dados secundários. CONCLUSÕES: Como a complexidade da dengue está intimamente relacionada com as características ecológicas do ambiente, os estudos que utilizam agregados de unidades espaciais aliados à análise das características ambientais locais fornecem uma visão mais completa da doença e permitem a identificação de heterogeneidade espacial, que mostrou ser um aspecto importante para o entendimento do desenrolar da epidemia de dengue.OBJECTIVE: To further understand the disease

Estimation of 123I-metaiodobenzylguanidine lung uptake in heart and lung diseases. With reference to lung uptake ratio and decrease of lung uptake

International Nuclear Information System (INIS)

Fujii, Tadashige; Tanaka, Masao; Yazaki, Yoshikazu; Kitabayashi, Hiroshi; Koizumi, Tomonori; Sekiguchi, Morie; Gomi, Tsutomu; Yano, Kesato; Itoh, Atsuko.

1997-01-01

123 I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy was performed in 64 patients with heart and lung diseases. Distribution of MIBG in the chest was evaluated by planar images, using counts ratios of the heart to the mediastinum (H/M) and the unilateral lung to the mediastinum (Lu/M). Most of patients with heart diseases showed obvious lung uptake of MIBG. The ratios of H/M were 1.75±0.20 in the group without heart failure and 1.55±0.19 in the group with heart failure. The ratios of Lu/M in the right and left lung were 1.56±0.16 and 1.28±0.16 in the group without heart failure. And those were 1.45±0.16 and 1.19±0.15 in the group with heart failure. But 3 patients complicated with chronic pulmonary emphysema and one patient with interstitial pneumonia due to dermatomyositis showed markedly decreased lung uptake. The ratios of Lu/M in the right and left lung of these patients were 1.20, 1.17; 1.17, 1.13; 1.01, 0.97 and 1.27, 0.94, respectively. These results suggest that the lung uptake of MIBG may reflect the state of pulmonary endothelial cell function in clinical situations, considering that it has been demonstrated that MIBG may be useful as a marker of pulmonary endothelial cell function in the isolated rat lung. (author)

The link between chronic obstructive pulmonary disease phenotypes and histological subtypes of lung cancer: a case–control study

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Wang W

2018-04-01

Full Text Available Wei Wang,* Mengshuang Xie,* Shuang Dou, Liwei Cui, Chunyan Zheng, Wei Xiao Department of Pulmonary Medicine, Qilu Hospital, Shandong University, Jinan, Shandong, China *These authors contributed equally to this work Background: COPD is considered an independent risk factor for lung cancer. COPD and lung cancer are both very heterogeneous diseases, and the study herein investigates the link between COPD phenotypes and specific histological subtypes of lung cancer.Methods: This case–control study comprised 2,283 patients with newly diagnosed pathological lung cancer and 2,323 non-lung cancer controls. All participants underwent pulmonary function tests. The diagnosis of COPD was based on Global Initiative for Chronic Obstructive Lung Disease criteria. Subtypes of the two diseases were categorized according to 2015 World Health Organization classification of lung cancer and computer quantification of airway collapse on maximum expiratory flow volume. ORs were estimated using logistic regression analysis.Results: The prevalence of COPD was higher (32.8% in lung cancer patients compared to controls (16.0%. After adjustment for age, sex, body-mass index, and smoking status, the presence of COPD significantly increased the risk of lung cancer (OR 2.88, 95% CI 2.48–3.34 and all common histological subtypes (ORs 2.04–5.26. Both emphysema-predominant and non-emphysema-predominant phenotypes of COPD significantly increased the risk of lung cancer (OR 4.43, 95% CI 2.85–6.88; OR 2.82, 95% CI 2.40–3.31. Higher risk of squamous-cell carcinoma and small-cell lung cancer was observed in patients with the emphysema-predominant than the non-emphysema-predominant phenotype (OR 1.73, 95% CI 1.03–2.89; OR 3.74, 95% CI 1.64–8.53. Conclusion: COPD was an independent risk factor for lung cancer and all common histological subtypes. Both emphysema-predominant and non-emphysema-predominant phenotypes of COPD significantly increased the risk of lung cancer

Nonrespiratory lung function

Energy Technology Data Exchange (ETDEWEB)

Isawa, Toyoharu [Tohoku University Research Institute for Chest Disease and Cancer, Sendai (Japan)

1994-07-01

The function of the lungs is primarily the function as a gas exchanger: the venous blood returning to the lungs is arterialized with oxygen in the lungs and the arterialized blood is sent back again to the peripheral tissues of the whole body to be utilized for metabolic oxygenation. Besides the gas exchanging function which we call ''respiratory lung function'' the lungs have functions that have little to do with gas exchange itself. We categorically call the latter function of the lungs as ''nonrespiratory lung function''. The lungs consist of the conductive airways, the gas exchanging units like the alveoli, and the interstitial space that surrounds the former two compartments. The interstitial space contains the blood and lymphatic capillaries, collagen and elastic fibers and cement substances. The conductive airways and the gas exchanging units are directly exposed to the atmosphere that contains various toxic and nontoxic gases, fume and biological or nonbiological particles. Because the conductive airways are equipped with defense mechanisms like mucociliary clearance or coughs to get rid of these toxic gases, particles or locally produced biological debris, we are usually free from being succumbed to ill effects of inhaled materials. By use of nuclear medicine techniques, we can now evaluate mucociliary clearance function, and other nonrespiratory lung functions as well in vivo.

Nonrespiratory lung function

International Nuclear Information System (INIS)

Isawa, Toyoharu

1994-01-01

The function of the lungs is primarily the function as a gas exchanger: the venous blood returning to the lungs is arterialized with oxygen in the lungs and the arterialized blood is sent back again to the peripheral tissues of the whole body to be utilized for metabolic oxygenation. Besides the gas exchanging function which we call ''respiratory lung function'' the lungs have functions that have little to do with gas exchange itself. We categorically call the latter function of the lungs as ''nonrespiratory lung function''. The lungs consist of the conductive airways, the gas exchanging units like the alveoli, and the interstitial space that surrounds the former two compartments. The interstitial space contains the blood and lymphatic capillaries, collagen and elastic fibers and cement substances. The conductive airways and the gas exchanging units are directly exposed to the atmosphere that contains various toxic and nontoxic gases, fume and biological or nonbiological particles. Because the conductive airways are equipped with defense mechanisms like mucociliary clearance or coughs to get rid of these toxic gases, particles or locally produced biological debris, we are usually free from being succumbed to ill effects of inhaled materials. By use of nuclear medicine techniques, we can now evaluate mucociliary clearance function, and other nonrespiratory lung functions as well in vivo

Study of the ventilatory lung motion imaging in primary lung cancer

International Nuclear Information System (INIS)

Fujii, Tadashige; Tanaka, Masao; Yazaki, Yosikazu; Kitabayashi, Hiroshi; Sekiguchi, Morie.

1996-01-01

Using perfusion lung scintigrams with Tc-99m macroaggregated alubumin at maximal inspiration (I) and expiration (E), images of the ventilatory lung motion, which was calculated and delineated by an expression as (E-I)/I, were obtained in 84 cases with primary lung cancer, and its clinical significance in the diagnosis of primary lung cancer was studied. The image of (E-I)/I consisted of positive and negative components. The former visualized the motion of the regional intrapulmonary areas and the latter showed the motion of the lung border. The sum of positive (E-I)/I in the lung with the primary lesion which was lower than that in the contralateral lung, was significantly low in cases with hilar mass, pleural effusion and TNM classification of T3+T4. The sum of positive (E-I)/I in both lungs and vital capacity was relatively low in cases with hilar mass, pleural effusion, TNM classification of T3+T4 and M1. The distribution pattern of pulmonary perfusion and positive (E-I)/I was fairly matched in 48 cases, but mismatch was observed in 36 cases. In the image of negative (E-I)/I, decreased motion of the lung border including the diaphragm was shown in cases with pleural adhesion and thickening, pleural effusion, phrenic nerve palsy and other conditions with hypoventilation. This technique seems to be useful for the estimation of regional pulmonary function of pulmonary perfusion and lung motion, the extent and pathophysiology of primary lung cancer. (author)

Study of the ventilatory lung motion imaging in primary lung cancer

Energy Technology Data Exchange (ETDEWEB)

Fujii, Tadashige [Shinshu Univ., Matsumoto, Nagano (Japan). Shool of Allied Medical Sciences; Tanaka, Masao; Yazaki, Yosikazu; Kitabayashi, Hiroshi; Sekiguchi, Morie

1996-12-01

Using perfusion lung scintigrams with Tc-99m macroaggregated alubumin at maximal inspiration (I) and expiration (E), images of the ventilatory lung motion, which was calculated and delineated by an expression as (E-I)/I, were obtained in 84 cases with primary lung cancer, and its clinical significance in the diagnosis of primary lung cancer was studied. The image of (E-I)/I consisted of positive and negative components. The former visualized the motion of the regional intrapulmonary areas and the latter showed the motion of the lung border. The sum of positive (E-I)/I in the lung with the primary lesion which was lower than that in the contralateral lung, was significantly low in cases with hilar mass, pleural effusion and TNM classification of T3+T4. The sum of positive (E-I)/I in both lungs and vital capacity was relatively low in cases with hilar mass, pleural effusion, TNM classification of T3+T4 and M1. The distribution pattern of pulmonary perfusion and positive (E-I)/I was fairly matched in 48 cases, but mismatch was observed in 36 cases. In the image of negative (E-I)/I, decreased motion of the lung border including the diaphragm was shown in cases with pleural adhesion and thickening, pleural effusion, phrenic nerve palsy and other conditions with hypoventilation. This technique seems to be useful for the estimation of regional pulmonary function of pulmonary perfusion and lung motion, the extent and pathophysiology of primary lung cancer. (author)

Heterogeneous cellular networks

CERN Document Server

Hu, Rose Qingyang

2013-01-01

A timely publication providing coverage of radio resource management, mobility management and standardization in heterogeneous cellular networks The topic of heterogeneous cellular networks has gained momentum in industry and the research community, attracting the attention of standardization bodies such as 3GPP LTE and IEEE 802.16j, whose objectives are looking into increasing the capacity and coverage of the cellular networks. This book focuses on recent progresses,  covering the related topics including scenarios of heterogeneous network deployment, interference management i

Intra-tumour 18F-FDG uptake heterogeneity decreases the reliability on target volume definition with positron emission tomography/computed tomography imaging

International Nuclear Information System (INIS)

Dong, Xinzhe; Wu, Peipei; Yu, Jinming; Xing, Ligang; Sun, Xiaorong; Li, Wenwu; Wan, Honglin

2015-01-01

This study aims to explore whether the intra-tumour 18 F-fluorodeoxyglucose (FDG) uptake heterogeneity affects the reliability of target volume definition with FDG positron emission tomography/computed tomography (PET/CT) imaging for nonsmall cell lung cancer (NSCLC) and squamous cell oesophageal cancer (SCEC). Patients with NSCLC (n = 50) or SCEC (n = 50) who received 18 F-FDG PET/CT scanning before treatments were included in this retrospective study. Intra-tumour FDG uptake heterogeneity was assessed by visual scoring, the coefficient of variation (COV) of the standardised uptake value (SUV) and the image texture feature (entropy). Tumour volumes (gross tumour volume (GTV) ) were delineated on the CT images (GTV CT ), the fused PET/CT images (GTV PET-CT ) and the PET images, using a threshold at 40% SUV max (GTV PET40% ) or the SUV cut-off value of 2.5 (GTV PET2.5 ). The correlation between the FDG uptake heterogeneity parameters and the differences in tumour volumes among GTV CT , GTV PET-CT , GTV PET40% and GTV PET2.5 was analysed. For both NSCLC and SCEC, obvious correlations were found between uptake heterogeneity, SUV or tumour volumes. Three types of heterogeneity parameters were consistent and closely related to each other. Substantial differences between the four methods of GTV definition were found. The differences between the GTV correlated significantly with PET heterogeneity defined with the visual score, the COV or the textural feature-entropy for NSCLC and SCEC. In tumours with a high FDG uptake heterogeneity, a larger GTV delineation difference was found. Advance image segmentation algorithms dealing with tracer uptake heterogeneity should be incorporated into the treatment planning system.

High-resolution pulmonary ventilation and perfusion PET/CT allows for functionally adapted intensity modulated radiotherapy in lung cancer

International Nuclear Information System (INIS)

Siva, Shankar; Thomas, Roshini; Callahan, Jason; Hardcastle, Nicholas; Pham, Daniel; Kron, Tomas; Hicks, Rodney J.; MacManus, Michael P.; Ball, David L.; Hofman, Michael S.

2015-01-01

Background and purpose: To assess the utility of functional lung avoidance using IMRT informed by four-dimensional (4D) ventilation/perfusion (V/Q) PET/CT. Materials and methods: In a prospective clinical trial, patients with non-small cell lung cancer (NSCLC) underwent 4D-V/Q PET/CT scanning before 60 Gy of definitive chemoradiation. Both “highly perfused” (HPLung) and “highly ventilated” (HVLung) lung volumes were delineated using a 70th centile SUV threshold, and a “ventilated lung volume” (VLung) was created using a 50th centile SUV threshold. For each patient four IMRT plans were created, optimised to the anatomical lung, HPLung, HVLung and VLung volumes, respectively. Improvements in functional dose volumetrics when optimising to functional volumes were assessed using mean lung dose (MLD), V5, V10, V20, V30, V40, V50 and V60 parameters. Results: The study cohort consisted of 20 patients with 80 IMRT plans. Plans optimised to HPLung resulted in a significant reduction of functional MLD by a mean of 13.0% (1.7 Gy), p = 0.02. Functional V5, V10 and V20 were improved by 13.2%, 7.3% and 3.8% respectively (p-values < 0.04). There was no significant sparing of dose to functional lung when adapting to VLung or HVLung. Plan quality was highly consistent with a mean PTV D95 and D5 ranging from 60.8 Gy to 61.0 Gy and 63.4 Gy to 64.5 Gy, respectively, and mean conformity and heterogeneity index ranging from 1.11 to 1.17 and 0.94 to 0.95, respectively. Conclusion: IMRT plans adapted to perfused but not ventilated lung on 4D-V/Q PET/CT allowed for reduced dose to functional lung whilst maintaining consistent plan quality

Comparison of lung preservation solutions in human lungs using an ex vivo lung perfusion experimental model

Directory of Open Access Journals (Sweden)

Israel L. Medeiros

2012-09-01

Full Text Available OBJECTIVE: Experimental studies on lung preservation have always been performed using animal models. We present ex vivo lung perfusion as a new model for the study of lung preservation. Using human lungs instead of animal models may bring the results of experimental studies closer to what could be expected in clinical practice. METHOD: Brain-dead donors whose lungs had been declined by transplantation teams were used. The cases were randomized into two groups. In Group 1, Perfadex®was used for pulmonary preservation, and in Group 2, LPDnac, a solution manufactured in Brazil, was used. An ex vivo lung perfusion system was used, and the lungs were ventilated and perfused after 10 hours of cold ischemia. The extent of ischemic-reperfusion injury was measured using functional and histological parameters. RESULTS: After reperfusion, the mean oxygenation capacity was 405.3 mmHg in Group 1 and 406.0 mmHg in Group 2 (p = 0.98. The mean pulmonary vascular resistance values were 697.6 and 378.3 dyn·s·cm-5, respectively (p =0.035. The mean pulmonary compliance was 46.8 cm H20 in Group 1 and 49.3 ml/cm H20 in Group 2 (p =0.816. The mean wet/dry weight ratios were 2.06 and 2.02, respectively (p=0.87. The mean Lung Injury Scores for the biopsy performed after reperfusion were 4.37 and 4.37 in Groups 1 and 2, respectively (p = 1.0, and the apoptotic cell counts were 118.75/mm² and 137.50/mm², respectively (p=0.71. CONCLUSION: The locally produced preservation solution proved to be as good as Perfadex®. The clinical use of LPDnac may reduce costs in our centers. Therefore, it is important to develop new models to study lung preservation.

Pemetrexed plus carboplatin versus pemetrexed in pretreated patients with advanced non-squamous non-small-cell lung cancer : treating the right patients based on individualized treatment effect prediction

NARCIS (Netherlands)

van Kruijsdijk, R. C. M.; Visseren, F. L. J.; Boni, L.; Groen, H. J. M.; Dingemans, A. M. C.; Aerts, J. G. J. V.; van der Graaf, Y.; Ardizzoni, A.; Smit, E. F.

In this study, it is shown that there is important heterogeneity in the effects of pemetrexed-carboplatin versus pemetrexed on progression-free survival in pretreated patients with advanced non-squamous non-small-cell lung cancer. Treatment effect can be predicted for individual patients using a

Frequency and number of ultrasound lung rockets (B-lines) using a regionally based lung ultrasound examination named vet BLUE (veterinary bedside lung ultrasound exam) in dogs with radiographically normal lung findings.

Science.gov (United States)

Lisciandro, Gregory R; Fosgate, Geoffrey T; Fulton, Robert M

2014-01-01

Lung ultrasound is superior to lung auscultation and supine chest radiography for many respiratory conditions in human patients. Ultrasound diagnoses are based on easily learned patterns of sonographic findings and artifacts in standardized images. By applying the wet lung (ultrasound lung rockets or B-lines, representing interstitial edema) versus dry lung (A-lines with a glide sign) concept many respiratory conditions can be diagnosed or excluded. The ultrasound probe can be used as a visual stethoscope for the evaluation of human lungs because dry artifacts (A-lines with a glide sign) predominate over wet artifacts (ultrasound lung rockets or B-lines). However, the frequency and number of wet lung ultrasound artifacts in dogs with radiographically normal lungs is unknown. Thus, the primary objective was to determine the baseline frequency and number of ultrasound lung rockets in dogs without clinical signs of respiratory disease and with radiographically normal lung findings using an 8-view novel regionally based lung ultrasound examination called Vet BLUE. Frequency of ultrasound lung rockets were statistically compared based on signalment, body condition score, investigator, and reasons for radiography. Ten left-sided heart failure dogs were similarly enrolled. Overall frequency of ultrasound lung rockets was 11% (95% confidence interval, 6-19%) in dogs without respiratory disease versus 100% (95% confidence interval, 74-100%) in those with left-sided heart failure. The low frequency and number of ultrasound lung rockets observed in dogs without respiratory disease and with radiographically normal lungs suggests that Vet BLUE will be clinically useful for the identification of canine respiratory conditions. © 2014 American College of Veterinary Radiology.

Epidemiology of Lung Cancer

Science.gov (United States)

Brock, Malcolm V.; Ford, Jean G.; Samet, Jonathan M.; Spivack, Simon D.

2013-01-01

Background: Ever since a lung cancer epidemic emerged in the mid-1900s, the epidemiology of lung cancer has been intensively investigated to characterize its causes and patterns of occurrence. This report summarizes the key findings of this research. Methods: A detailed literature search provided the basis for a narrative review, identifying and summarizing key reports on population patterns and factors that affect lung cancer risk. Results: Established environmental risk factors for lung cancer include smoking cigarettes and other tobacco products and exposure to secondhand tobacco smoke, occupational lung carcinogens, radiation, and indoor and outdoor air pollution. Cigarette smoking is the predominant cause of lung cancer and the leading worldwide cause of cancer death. Smoking prevalence in developing nations has increased, starting new lung cancer epidemics in these nations. A positive family history and acquired lung disease are examples of host factors that are clinically useful risk indicators. Risk prediction models based on lung cancer risk factors have been developed, but further refinement is needed to provide clinically useful risk stratification. Promising biomarkers of lung cancer risk and early detection have been identified, but none are ready for broad clinical application. Conclusions: Almost all lung cancer deaths are caused by cigarette smoking, underscoring the need for ongoing efforts at tobacco control throughout the world. Further research is needed into the reasons underlying lung cancer disparities, the causes of lung cancer in never smokers, the potential role of HIV in lung carcinogenesis, and the development of biomarkers. PMID:23649439

Exosomes derived from mesenchymal non-small cell lung cancer cells promote chemoresistance.

Science.gov (United States)

Lobb, Richard J; van Amerongen, Rosa; Wiegmans, Adrian; Ham, Sunyoung; Larsen, Jill E; Möller, Andreas

2017-08-01

Non-small cell lung cancer (NSCLC) is the most common lung cancer type and the most common cause of mortality in lung cancer patients. NSCLC is often associated with resistance to chemotherapeutics and together with rapid metastatic spread, results in limited treatment options and poor patient survival. NSCLCs are heterogeneous, and consist of epithelial and mesenchymal NSCLC cells. Mesenchymal NSCLC cells are thought to be responsible for the chemoresistance phenotype, but if and how this phenotype can be transferred to other NSCLC cells is currently not known. We hypothesised that small extracellular vesicles, exosomes, secreted by mesenchymal NSCLC cells could potentially transfer the chemoresistance phenotype to surrounding epithelial NSCLC cells. To explore this possibility, we used a unique human bronchial epithelial cell (HBEC) model in which the parental cells were transformed from an epithelial to mesenchymal phenotype by introducing oncogenic alterations common in NSCLC. We found that exosomes derived from the oncogenically transformed, mesenchymal HBECs could transfer chemoresistance to the parental, epithelial HBECs and increase ZEB1 mRNA, a master EMT transcription factor, in the recipient cells. Additionally, we demonstrate that exosomes from mesenchymal, but not epithelial HBECs contain the ZEB1 mRNA, thereby providing a potential mechanism for the induction of a mesenchymal phenotype in recipient cells. Together, this work demonstrates for the first time that exosomes derived from mesenchymal, oncogenically transformed lung cells can transfer chemoresistance and mesenchymal phenotypes to recipient cells, likely via the transfer of ZEB1 mRNA in exosomes. © 2017 UICC.

RANK rewires energy homeostasis in lung cancer cells and drives primary lung cancer.

Science.gov (United States)

Rao, Shuan; Sigl, Verena; Wimmer, Reiner Alois; Novatchkova, Maria; Jais, Alexander; Wagner, Gabriel; Handschuh, Stephan; Uribesalgo, Iris; Hagelkruys, Astrid; Kozieradzki, Ivona; Tortola, Luigi; Nitsch, Roberto; Cronin, Shane J; Orthofer, Michael; Branstetter, Daniel; Canon, Jude; Rossi, John; D'Arcangelo, Manolo; Botling, Johan; Micke, Patrick; Fleur, Linnea La; Edlund, Karolina; Bergqvist, Michael; Ekman, Simon; Lendl, Thomas; Popper, Helmut; Takayanagi, Hiroshi; Kenner, Lukas; Hirsch, Fred R; Dougall, William; Penninger, Josef M

2017-10-15

Lung cancer is the leading cause of cancer deaths. Besides smoking, epidemiological studies have linked female sex hormones to lung cancer in women; however, the underlying mechanisms remain unclear. Here we report that the receptor activator of nuclear factor-kB (RANK), the key regulator of osteoclastogenesis, is frequently expressed in primary lung tumors, an active RANK pathway correlates with decreased survival, and pharmacologic RANK inhibition reduces tumor growth in patient-derived lung cancer xenografts. Clonal genetic inactivation of KRas G12D in mouse lung epithelial cells markedly impairs the progression of KRas G12D -driven lung cancer, resulting in a significant survival advantage. Mechanistically, RANK rewires energy homeostasis in human and murine lung cancer cells and promotes expansion of lung cancer stem-like cells, which is blocked by inhibiting mitochondrial respiration. Our data also indicate survival differences in KRas G12D -driven lung cancer between male and female mice, and we show that female sex hormones can promote lung cancer progression via the RANK pathway. These data uncover a direct role for RANK in lung cancer and may explain why female sex hormones accelerate lung cancer development. Inhibition of RANK using the approved drug denosumab may be a therapeutic drug candidate for primary lung cancer. © 2017 Rao et al.; Published by Cold Spring Harbor Laboratory Press.

Estudos de atmosfera

OpenAIRE

Carlos Eduardo Riccioppo

2016-01-01

Joker e Estudos de balística possuíam formas distintas dos cadernos ou livros quando foram exibidos pela primeira vez, na mostra Dual Overdrive. De algum modo, o flagrante das imagens dos cartazes da campanha política parisiense e daquelas cusparadas sobre o asfalto era preservado no modo como eram mostrados os trabalhos, que repunham não apenas a orientação espacial dos objetos fotografados, mas, igualmente, sua escala: Joker apresentava-se na parede, em dimensões relativamente próximas às d...

Lung growth and development.

Science.gov (United States)

Joshi, Suchita; Kotecha, Sailesh

2007-12-01

Human lung growth starts as a primitive lung bud in early embryonic life and undergoes several morphological stages which continue into postnatal life. Each stage of lung growth is a result of complex and tightly regulated events governed by physical, environmental, hormonal and genetic factors. Fetal lung liquid and fetal breathing movements are by far the most important determinants of lung growth. Although timing of the stages of lung growth in animals do not mimic that of human, numerous animal studies, mainly on sheep and rat, have given us a better understanding of the regulators of lung growth. Insight into the genetic basis of lung growth has helped us understand and improve management of complex life threatening congenital abnormalities such as congenital diaphragmatic hernia and pulmonary hypoplasia. Although advances in perinatal medicine have improved survival of preterm infants, premature birth is perhaps still the most important factor for adverse lung growth.

Summary of presentations from the 46th Annual Meeting of the American Society of Clinical Oncology: focus on non-small cell lung cancer (2010).

Science.gov (United States)

Stinchcombe, Thomas E; Baggstrom, Maria Q; Somaiah, Neeta; Simon, George R; Govindan, Ramaswamy

2011-01-01

The promising results of crizotinib in molecularly selected patients with advanced non-small cell lung cancer (NSCLC) whose tumor cells had a novel fusion protein involving anaplastic lymphoma kinase presented at the 2010 American Society of Clinical Oncology reinforce once again the importance of understanding molecular heterogeneity of lung cancer and careful patient selection. Several other important issues were the subject of presentations related to lung cancer at the recently concluded American Society of Clinical Oncology annual meeting. The articles covered a wide variety of topics including optimal staging techniques to detect mediastinal nodal involvement, the role of platinum-based doublet chemotherapy in the management of elderly patients with advanced NSCLC, use of maintenance therapy with gemcitabine, and the impact of early introduction of organized palliative care in improving the quality of life of patients with advanced NSCLC. This report provides a brief overview of the presentations related to lung cancer that are relevant to clinical practice and future research.

How Lungs Work

Science.gov (United States)

... Diseases > How Lungs Work How Lungs Work The Respiratory System Your lungs are part of the respiratory system, ... your sense of smell. The Parts of the Respiratory System and How They Work Airways SINUSES are hollow ...

The role of mismatch repair in small-cell lung cancer cells

DEFF Research Database (Denmark)

Hansen, L T; Thykjaer, T; Ørntoft, T F

2003-01-01

The role of mismatch repair (MMR) in small-cell lung cancer (SCLC) is controversial, as the phenotype of a MMR-deficiency, microsatellite instability (MSI), has been reported to range from 0 to 76%. We studied the MMR pathway in a panel of 21 SCLC cell lines and observed a highly heterogeneous...... pattern of MMR gene expression. A significant correlation between the mRNA and protein levels was found. We demonstrate that low hMLH1 gene expression was not linked to promoter CpG methylation. One cell line (86MI) was found to be deficient in MMR and exhibited resistance to the alkylating agent MNNG...

Lung scintigraphy in differential diagnosis of peripheral lung cancer and community-acquired pneumonia

Energy Technology Data Exchange (ETDEWEB)

Krivonogov, Nikolay G., E-mail: kng@cardio-tomsk.ru [Research Institute of Cardiology, Kievskaya Street 111a, Tomsk, 634012 (Russian Federation); Efimova, Nataliya Y., E-mail: efimova@cardio-tomsk.ru; Zavadovsky, Konstantin W.; Lishmanov, Yuri B. [Research Institute of Cardiology, Kievskaya Street 111a, Tomsk, 634012 (Russian Federation); Tomsk Polytechnic University, Lenin Avenue 30, Tomsk, 634050 (Russian Federation)

2016-08-02

Ventilation/perfusion lung scintigraphy was performed in 39 patients with verified diagnosis of community-acquired pneumonia (CAP) and in 14 patients with peripheral lung cancer. Ventilation/perfusion ratio, apical-basal gradients of ventilation (U/L(V)) and lung perfusion (U/L(P)), and alveolar capillary permeability of radionuclide aerosol were determined based on scintigraphy data. The study demonstrated that main signs of CAP were increases in ventilation/perfusion ratio, perfusion and ventilation gradient on a side of the diseased lung, and two-side increase in alveolar capillary permeability rate for radionuclide aerosol. Unlike this, scintigraphic signs of peripheral lung cancer comprise an increase in ventilation/perfusion ratio over 1.0 on a side of the diseased lung with its simultaneous decrease on a contralateral side, normal values of perfusion and ventilation gradients of both lungs, and delayed alveolar capillary clearance in the diseased lung compared with the intact lung.

Lung scintigraphy in differential diagnosis of peripheral lung cancer and community-acquired pneumonia

Science.gov (United States)

Krivonogov, Nikolay G.; Efimova, Nataliya Y.; Zavadovsky, Konstantin W.; Lishmanov, Yuri B.

2016-08-01

Ventilation/perfusion lung scintigraphy was performed in 39 patients with verified diagnosis of community-acquired pneumonia (CAP) and in 14 patients with peripheral lung cancer. Ventilation/perfusion ratio, apical-basal gradients of ventilation (U/L(V)) and lung perfusion (U/L(P)), and alveolar capillary permeability of radionuclide aerosol were determined based on scintigraphy data. The study demonstrated that main signs of CAP were increases in ventilation/perfusion ratio, perfusion and ventilation gradient on a side of the diseased lung, and two-side increase in alveolar capillary permeability rate for radionuclide aerosol. Unlike this, scintigraphic signs of peripheral lung cancer comprise an increase in ventilation/perfusion ratio over 1.0 on a side of the diseased lung with its simultaneous decrease on a contralateral side, normal values of perfusion and ventilation gradients of both lungs, and delayed alveolar capillary clearance in the diseased lung compared with the intact lung.

Lung cancer - small cell

Science.gov (United States)

Cancer - lung - small cell; Small cell lung cancer; SCLC ... About 15% of all lung cancer cases are SCLC. Small cell lung cancer is slightly more common in men than women. Almost all cases of SCLC are ...

Radioisotope albumin flux measurement of microvascular lung permeability: an independent parameter in acute respiratory failure?

International Nuclear Information System (INIS)

Hoegerle, S.; Nitzsche, E.U.; Reinhardt, M.J.; Moser, E.; Benzing, A.; Geiger, K.; Schulte Moenting, J.

2001-01-01

Aim: To evaluate the extent to which single measurements of microvascular lung permeability may be relevant as an additional parameter in a heterogenous clinical patient collective with Acute Lung Injury (ALI) and Acute Respiratory Distress Syndrome (ARDS). Methods: In 36 patients with pneumonia (13), non pneumogenic sepsis (9) or trauma (14) meeting the consensus conference criteria of ALI or ARDS double-isotope protein flux measurements ( 51 Cr erythrocytes as intravascular tracer, Tc-99m human albumin as diffusible tracer) of microvascular lung permeability were performed using the Normalized Slope Index (NSI). The examination was to determine whether there is a relationship between the clinical diagnosis of ALI/ARDS, impaired permeability and clinical parameters, that is the underlying disease, oxygenation, duration of mechanical ventilation and mean pulmonary-artery pressure (PAP). Results: At the time of study, 25 patients presented with increased permeability (NSI > 1 x 10 -3 min -1 ) indicating an exudative stage of disease, and 11 patients with normal permeability. The permeability impairment correlated with the underlying disease (p > 0.05). With respect to survival, there was a negative correlation to PAP (p [de

Surgical and survival outcomes of lung cancer patients with intratumoral lung abscesses.

Science.gov (United States)

Yamanashi, Keiji; Okumura, Norihito; Takahashi, Ayuko; Nakashima, Takashi; Matsuoka, Tomoaki

2017-05-26

Intratumoral lung abscess is a secondary lung abscess that is considered to be fatal. Therefore, surgical procedures, although high-risk, have sometimes been performed for intratumoral lung abscesses. However, no studies have examined the surgical outcomes of non-small cell lung cancer patients with intratumoral lung abscesses. The aim of this study was to investigate the surgical and survival outcomes of non-small cell lung cancer patients with intratumoral lung abscesses. Eleven consecutive non-small cell lung cancer patients with intratumoral lung abscesses, who had undergone pulmonary resection at our institution between January 2007 and December 2015, were retrospectively analysed. The post-operative prognoses were investigated and prognostic factors were evaluated. Ten of 11 patients were male and one patient was female. The median age was 64 (range, 52-80) years. Histopathologically, 4 patients had Stage IIA, 2 patients had Stage IIB, 2 patients had Stage IIIA, and 3 patients had Stage IV tumors. The median operative time was 346 min and the median amount of bleeding was 1327 mL. The post-operative morbidity and mortality rates were 63.6% and 0.0%, respectively. Recurrence of respiratory infections, including lung abscesses, was not observed in all patients. The median post-operative observation period was 16.1 (range, 1.3-114.5) months. The 5-year overall survival rate was 43.3%. No pre-operative, intra-operative, or post-operative prognostic factors were identified in the univariate analyses. Surgical procedures for advanced-stage non-small cell lung cancer patients with intratumoral lung abscesses, although high-risk, led to satisfactory post-operative mortality rates and acceptable prognoses.

Lipodistrofia em indivíduos vivendo com HIV/AIDS: fatores de risco para lipoatrofia e acúmulo de gordura corporal e associação com síndrome metabólica. Um estudo de coorte

OpenAIRE

Oliveira, Thais Gelenske Braga e

2014-01-01

O presente estudo teve como objetivo determinar as densidades de incidência e fatores associados com lipoatrofia(LA) e acúmulo de gordura corporal (AGC), determinar a densidade de incidência de síndrome metabólica (SM) de acordo com três critérios diferentes [American Heart Association/National Heart, Lung and Blood Institute (AHA/NHLBI), International Diabetes Federation (IDF) e Harmonizing Metabolic Syndrome: a Joint Interim Statement (JIS)] e verificar a associação de LA e AGC com o desenv...

Protecting Your Lungs

Science.gov (United States)

... lung capacity. Specific breathing exercises can also help improve your lung function if you have certain lung diseases, like COPD. Exercise and breathing techniques are also great for improving your mood and helping you relax. Public Health and Your ...

Estudo multicasos sobre atividades inovativas

Directory of Open Access Journals (Sweden)

Sonia Regina Hierro Parolin

2013-09-01

Full Text Available Em estudos sobre competitividade argumenta-se que as empresas necessitam de estratégias baseadas em inovações e de capacidades internas em constantes e intensas transformações, não somente nos padrões tecnológicos, mas também no encadeamento do processo de gestão das atividades inovativas, como processos dinâmicos, não lineares e diversificados, em função de múltiplos fatores dos ambientes interno e externo. Para contribuir com essas discussões, neste artigo apresenta-se um estudo multicasos em quatro indústrias de médio e grande portes, de segmentos, densidades tecnológicas e históricos com inovações diferentes entre si. Como principais resultados, salientam-se o encadeamento das atividades inovativas como parte de uma estratégia organizacional para obter resultados com inovação e a afluência de todas as pessoas, e não somente as alocadas em pesquisa e desenvolvimento, para o cumprimento dessa estratégia.

Lung regeneration by fetal lung tissue implantation in a mouse pulmonary emphysema model.

Science.gov (United States)

Uyama, Koh; Sakiyama, Shoji; Yoshida, Mitsuteru; Kenzaki, Koichiro; Toba, Hiroaki; Kawakami, Yukikiyo; Okumura, Kazumasa; Takizawa, Hiromitsu; Kondo, Kazuya; Tangoku, Akira

2016-01-01

The mortality and morbidity of chronic obstructive pulmonary disease are high. However, no radical therapy has been developed to date. The purpose of this study was to evaluate whether fetal mouse lung tissue can grow and differentiate in the emphysematous lung. Fetal lung tissue from green fluorescent protein C57BL/6 mice at 16 days' gestation was used as donor material. Twelve-month-old pallid mice were used as recipients. Donor lungs were cut into small pieces and implanted into the recipient left lung by performing thoracotomy under anesthesia. The recipient mice were sacrificed at day 7, 14, and 28 after implantation and used for histological examination. Well-developed spontaneous pulmonary emphysema was seen in 12-month-old pallid mice. Smooth and continuous connection between implanted fetal lung tissue and recipient lung was recognized. Air space expansion and donor tissue differentiation were observed over time. We could clearly distinguish the border zones between injected tissue and native tissue by the green fluorescence of grafts. Fetal mouse lung fragments survived and differentiated in the emphysematous lung of pallid mice. Implantation of fetal lung tissue in pallid mice might lead to further lung regeneration research from the perspective of respiratory and exercise function. J. Med. Invest. 63: 182-186, August, 2016.

Serial perfusion in native lungs in patients with idiopathic pulmonary fibrosis and other interstitial lung diseases after single lung transplantation.

Science.gov (United States)

Sokai, Akihiko; Handa, Tomohiro; Chen, Fengshi; Tanizawa, Kiminobu; Aoyama, Akihiro; Kubo, Takeshi; Ikezoe, Kohei; Nakatsuka, Yoshinari; Oguma, Tsuyoshi; Hirai, Toyohiro; Nagai, Sonoko; Chin, Kazuo; Date, Hiroshi; Mishima, Michiaki

2016-04-01

Lung perfusions after single lung transplantation (SLT) have not been fully clarified in patients with interstitial lung disease (ILD). The present study aimed to investigate temporal changes in native lung perfusion and their associated clinical factors in patients with ILD who have undergone SLT. Eleven patients were enrolled. Perfusion scintigraphy was serially performed up to 12 months after SLT. Correlations between the post-operative perfusion ratio in the native lung and clinical parameters, including pre-operative perfusion ratio and computed tomography (CT) volumetric parameters, were evaluated. On average, the perfusion ratio of the native lung was maintained at approximately 30% until 12 months after SLT. However, the ratio declined more significantly in idiopathic pulmonary fibrosis (IPF) than in other ILDs (p = 0.014). The perfusion ratio before SLT was significantly correlated with that at three months after SLT (ρ = 0.64, p = 0.048). The temporal change of the perfusion ratio in the native lung did not correlate with those of the CT parameters. The pre-operative perfusion ratio may predict the post-operative perfusion ratio of the native lung shortly after SLT in ILD. Perfusion of the native lung may decline faster in IPF compared with other ILDs. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Quantification of ventilation distribution in regional lung injury by electrical impedance tomography and xenon computed tomography

International Nuclear Information System (INIS)

Elke, Gunnar; Weiler, Norbert; Frerichs, Inéz; Fuld, Matthew K; Halaweish, Ahmed F; Hoffman, Eric A; Grychtol, Bartłomiej

2013-01-01

Validation studies of electrical impedance tomography (EIT) based assessment of regional ventilation under pathological conditions are required to prove that EIT can reliably quantify heterogeneous ventilation distribution with sufficient accuracy. The objective of our study was to validate EIT measurements of regional ventilation through a comparison with xenon-multidetector-row computed tomography (XeCT) in an animal model of sub-lobar lung injury. Nine anesthetized mechanically ventilated supine pigs were examined before and after the induction of lung injury in two adjacent sub-lobar segments of the right lung by saline lavage or endotoxin instillation. Regional ventilation was determined in 32 anteroposterior regions of interest in the right and left lungs and the ventilation change quantified by difference images between injury and control. Six animals were included in the final analysis. Measurements of regional ventilation by EIT and XeCT correlated well before (r s = 0.89 right, r s = 0.90 left lung) and after local injury (r s = 0.79 and 0.92, respectively). No bias and narrow limits of agreement were found during both conditions. The ventilation decrease in the right injured lung was correspondingly measured by both modalities (5.5%±1.1% by EIT and 5.4%±1.9% by XeCT, p = 0.94). EIT was inferior to clearly separate the exact anatomical location of the regional injuries. Regional ventilation was overestimated (<2%) in the most ventral and dorsal regions and underestimated (2%) in the middle regions by EIT compared to XeCT. This study shows that EIT is able to reliably discern even small ventilation changes on sub-lobar level. (paper)

A new approach to assess COPD by identifying lung function break-points

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Eriksson G

2015-10-01

Full Text Available Göran Eriksson,1,* Linnea Jarenbäck,1,* Stefan Peterson,2 Jaro Ankerst,1 Leif Bjermer,1 Ellen Tufvesson11Respiratory Medicine and Allergology, Department of Clinical Sciences, Lund University, 2Regional Cancer Center South, Skåne University Hospital, Lund, Sweden*These authors contributed equally to this workPurpose: COPD is a progressive disease, which can take different routes, leading to great heterogeneity. The aim of the post-hoc analysis reported here was to perform continuous analyses of advanced lung function measurements, using linear and nonlinear regressions.Patients and methods: Fifty-one COPD patients with mild to very severe disease (Global Initiative for Chronic Obstructive Lung Disease [GOLD] Stages I–IV and 41 healthy smokers were investigated post-bronchodilation by flow-volume spirometry, body plethysmography, diffusion capacity testing, and impulse oscillometry. The relationship between COPD severity, based on forced expiratory volume in 1 second (FEV1, and different lung function parameters was analyzed by flexible nonparametric method, linear regression, and segmented linear regression with break-points.Results: Most lung function parameters were nonlinear in relation to spirometric severity. Parameters related to volume (residual volume, functional residual capacity, total lung capacity, diffusion capacity [diffusion capacity of the lung for carbon monoxide], diffusion capacity of the lung for carbon monoxide/alveolar volume and reactance (reactance area and reactance at 5Hz were segmented with break-points at 60%–70% of FEV1. FEV1/forced vital capacity (FVC and resonance frequency had break-points around 80% of FEV1, while many resistance parameters had break-points below 40%. The slopes in percent predicted differed; resistance at 5 Hz minus resistance at 20 Hz had a linear slope change of -5.3 per unit FEV1, while residual volume had no slope change above and -3.3 change per unit FEV1 below its break-point of 61

Emphysema lung lobe volume reduction: effects on the ipsilateral and contralateral lobes

Energy Technology Data Exchange (ETDEWEB)

Brown, Matthew S.; Kim, Hyun J.; Abtin, Fereidoun G.; Galperin-Aizenberg, Maya; Pais, Richard; Da Costa, Irene G.; Ordookhani, Arash; Chong, Daniel; Ni, Chiayi; McNitt-Gray, Michael F.; Goldin, Jonathan G. [David Geffen School of Medicine at UCLA, Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, Los Angeles, CA (United States); Strange, Charlie [Medical University of South Carolina, Department of Pulmonary and Critical Care Medicine, Columbia, SC (United States); Tashkin, Donald P. [David Geffen School of Medicine at UCLA, Division of Pulmonary and Critical Care Medicine, Los Angeles, CA (United States)

2012-07-15

To investigate volumetric and density changes in the ipsilateral and contralateral lobes following volume reduction of an emphysematous target lobe. The study included 289 subjects with heterogeneous emphysema, who underwent bronchoscopic volume reduction of the most diseased lobe with endobronchial valves and 132 untreated controls. Lobar volume and low-attenuation relative area (RA) changes post-procedure were measured from computed tomography images. Regression analysis (Spearman's rho) was performed to test the association between change in the target lobe volume and changes in volume and density variables in the other lobes. The target lobe volume at full inspiration in the treatment group had a mean reduction of -0.45 L (SE = 0.034, P < 0.0001), and was associated with volume increases in the ipsilateral lobe (rho = -0.68, P < 0.0001) and contralateral lung (rho = -0.16, P = 0.006), and overall reductions in expiratory RA (rho = 0.31, P < 0.0001) and residual volume (RV)/total lung capacity (TLC) (rho = 0.13, P = 0.03). When the volume of an emphysematous target lobe is reduced, the volume is redistributed primarily to the ipsilateral lobe, with an overall reduction. Image-based changes in lobar volumes and densities indicate that target lobe volume reduction is associated with statistically significant overall reductions in air trapping, consistent with expansion of the healthier lung. (orig.)

Emphysema lung lobe volume reduction: effects on the ipsilateral and contralateral lobes

International Nuclear Information System (INIS)

Brown, Matthew S.; Kim, Hyun J.; Abtin, Fereidoun G.; Galperin-Aizenberg, Maya; Pais, Richard; Da Costa, Irene G.; Ordookhani, Arash; Chong, Daniel; Ni, Chiayi; McNitt-Gray, Michael F.; Goldin, Jonathan G.; Strange, Charlie; Tashkin, Donald P.

2012-01-01

To investigate volumetric and density changes in the ipsilateral and contralateral lobes following volume reduction of an emphysematous target lobe. The study included 289 subjects with heterogeneous emphysema, who underwent bronchoscopic volume reduction of the most diseased lobe with endobronchial valves and 132 untreated controls. Lobar volume and low-attenuation relative area (RA) changes post-procedure were measured from computed tomography images. Regression analysis (Spearman's rho) was performed to test the association between change in the target lobe volume and changes in volume and density variables in the other lobes. The target lobe volume at full inspiration in the treatment group had a mean reduction of -0.45 L (SE = 0.034, P < 0.0001), and was associated with volume increases in the ipsilateral lobe (rho = -0.68, P < 0.0001) and contralateral lung (rho = -0.16, P = 0.006), and overall reductions in expiratory RA (rho = 0.31, P < 0.0001) and residual volume (RV)/total lung capacity (TLC) (rho = 0.13, P = 0.03). When the volume of an emphysematous target lobe is reduced, the volume is redistributed primarily to the ipsilateral lobe, with an overall reduction. Image-based changes in lobar volumes and densities indicate that target lobe volume reduction is associated with statistically significant overall reductions in air trapping, consistent with expansion of the healthier lung. (orig.)

Lung inhomogeneity effect in the radiotherapy treatments using the BPW-34 photodiode detector; Estudo do efeito do pulmao na dose em tratamentos radioterapicos utilizando o fotodiodo BPW-34

Energy Technology Data Exchange (ETDEWEB)

Jesus Lopes Filho, F de

1990-09-01

The presence, in the radiation field, of regions with composition and/or differing from soft tissue may significantly affect the tumoral dose distribution in radiotherapy treatments. The effect of the lung on the dose distribution in the near by tissues was studied with high energy rays c{gamma} of {sup 60} Co and 10 MV, 6 MV - X-ray and using a BPW-34 photodiode as a detector. The results obtained showed that the tumoral dose is reduced in the region anterior to the lung, due to backscattering reduction, whereas it is enhanced beyond the lung due to the lower attenuation in the inhomogeneity. (author). 36 refs, 11 figs, 12 tabs.

Staging of Lung Cancer

Science.gov (United States)

... LUNG CANCER MINI-SERIES #2 Staging of Lung Cancer Once your lung cancer is diagnosed, staging tells you and your health care provider about ... at it under a microscope. The stages of lung cancer are listed as I, II, III, and IV ...

Intra-tumour 18F-FDG uptake heterogeneity decreases the reliability on target volume definition with positron emission tomography/computed tomography imaging.

Science.gov (United States)

Dong, Xinzhe; Wu, Peipei; Sun, Xiaorong; Li, Wenwu; Wan, Honglin; Yu, Jinming; Xing, Ligang

2015-06-01

This study aims to explore whether the intra-tumour (18) F-fluorodeoxyglucose (FDG) uptake heterogeneity affects the reliability of target volume definition with FDG positron emission tomography/computed tomography (PET/CT) imaging for nonsmall cell lung cancer (NSCLC) and squamous cell oesophageal cancer (SCEC). Patients with NSCLC (n = 50) or SCEC (n = 50) who received (18)F-FDG PET/CT scanning before treatments were included in this retrospective study. Intra-tumour FDG uptake heterogeneity was assessed by visual scoring, the coefficient of variation (COV) of the standardised uptake value (SUV) and the image texture feature (entropy). Tumour volumes (gross tumour volume (GTV)) were delineated on the CT images (GTV(CT)), the fused PET/CT images (GTV(PET-CT)) and the PET images, using a threshold at 40% SUV(max) (GTV(PET40%)) or the SUV cut-off value of 2.5 (GTV(PET2.5)). The correlation between the FDG uptake heterogeneity parameters and the differences in tumour volumes among GTV(CT), GTV(PET-CT), GTV(PET40%) and GTV(PET2.5) was analysed. For both NSCLC and SCEC, obvious correlations were found between uptake heterogeneity, SUV or tumour volumes. Three types of heterogeneity parameters were consistent and closely related to each other. Substantial differences between the four methods of GTV definition were found. The differences between the GTV correlated significantly with PET heterogeneity defined with the visual score, the COV or the textural feature-entropy for NSCLC and SCEC. In tumours with a high FDG uptake heterogeneity, a larger GTV delineation difference was found. Advance image segmentation algorithms dealing with tracer uptake heterogeneity should be incorporated into the treatment planning system. © 2015 The Royal Australian and New Zealand College of Radiologists.

Feasibility of using intensity-modulated radiotherapy to improve lung sparing in treatment planning for distal esophageal cancer

International Nuclear Information System (INIS)

Chandra, Anurag; Guerrero, Thomas M.; Liu, H. Helen; Tucker, Susan L.; Liao Zhongxing; Wang Xiaochun; Murshed, Hasan; Bonnen, Mark D.; Garg, Amit K.; Stevens, Craig W.; Chang, Joe Y.; Jeter, Melinda D.; Mohan, Radhe; Cox, James D.; Komaki, Ritsuko

2005-01-01

Background and purpose: To evaluate the feasibility whether intensity-modulated radiotherapy (IMRT) can be used to reduce doses to normal lung than three-dimensional conformal radiotherapy (3DCRT) in treating distal esophageal malignancies. Patients and methods: Ten patient cases with cancer of the distal esophagus were selected for a retrospective treatment-planning study. IMRT plans using four, seven, and nine beams (4B, 7B, and 9B) were developed for each patient and compared with the 3DCRT plan used clinically. IMRT and 3DCRT plans were evaluated with respect to PTV coverage and dose-volumes to irradiated normal structures, with statistical comparison made between the two types of plans using the Wilcoxon matched-pair signed-rank test. Results: IMRT plans (4B, 7B, 9B) reduced total lung volume treated above 10 Gy (V 1 ), 20 Gy (V 2 ), mean lung dose (MLD), biological effective volume (V eff ), and lung integral dose (P 1 , 5% for V 2 , and 2.5 Gy for MLD. IMRT improved the PTV heterogeneity (P<0.05), yet conformity was better with 7B-9B IMRT plans. No clinically meaningful differences were observed with respect to the irradiated volumes of spinal cord, heart, liver, or total body integral doses. Conclusions: Dose-volume of exposed normal lung can be reduced with IMRT, though clinical investigations are warranted to assess IMRT treatment outcome of esophagus cancers

MRI and CT lung biomarkers: Towards an in vivo understanding of lung biomechanics.

Science.gov (United States)

Young, Heather M; Eddy, Rachel L; Parraga, Grace

2017-09-29

The biomechanical properties of the lung are necessarily dependent on its structure and function, both of which are complex and change over time and space. This makes in vivo evaluation of lung biomechanics and a deep understanding of lung biomarkers, very challenging. In patients and animal models of lung disease, in vivo evaluations of lung structure and function are typically made at the mouth and include spirometry, multiple-breath gas washout tests and the forced oscillation technique. These techniques, and the biomarkers they provide, incorporate the properties of the whole organ system including the parenchyma, large and small airways, mouth, diaphragm and intercostal muscles. Unfortunately, these well-established measurements mask regional differences, limiting their ability to probe the lung's gross and micro-biomechanical properties which vary widely throughout the organ and its subcompartments. Pulmonary imaging has the advantage in providing regional, non-invasive measurements of healthy and diseased lung, in vivo. Here we summarize well-established and emerging lung imaging tools and biomarkers and how they may be used to generate lung biomechanical measurements. We review well-established and emerging lung anatomical, microstructural and functional imaging biomarkers generated using synchrotron x-ray tomographic-microscopy (SRXTM), micro-x-ray computed-tomography (micro-CT), clinical CT as well as magnetic resonance imaging (MRI). Pulmonary imaging provides measurements of lung structure, function and biomechanics with high spatial and temporal resolution. Imaging biomarkers that reflect the biomechanical properties of the lung are now being validated to provide a deeper understanding of the lung that cannot be achieved using measurements made at the mouth. Copyright © 2017 Elsevier Ltd. All rights reserved.

[Construction of 2-dimensional tumor microvascular architecture phenotype in non-small cell lung cancer].

Science.gov (United States)

Liu, Jin-kang; Wang, Xiao-yi; Xiong, Zeng; Zhou, Hui; Zhou, Jian-hua; Fu, Chun-yan; Li, Bo

2008-08-01

To construct a technological platform of 2-dimensional tumor microvascular architecture phenotype (2D-TAMP) expression. Thirty samples of non-small cell lung cancer (NSCLC) were collected after surgery. The corresponding sections of tumor tissue specimens to the slice of CT perfusion imaging were selected. Immunohistochemical staining,Gomori methenamine silver stain, and electron microscope observation were performed to build a technological platform of 2D-TMAP expression by detecting the morphology and the integrity of basement membrane of microvasculature, microvascular density, various microvascular subtype, the degree of the maturity and lumenization of microvasculature, and the characteristics of immunogenetics of microvasculature. The technological platform of 2D-TMAP expression was constructed successfully. There was heterogeneity in 2D-TMAP expression of non-small cell lung cancer. The microvascular of NSCLC had certain characteristics. 2D-TMAP is a key technology that can be used to observe the overall state of micro-environment in tumor growth.

Lung cancer mimicking lung abscess formation on CT images

OpenAIRE

Taira, Naohiro; Kawabata, Tsutomu; Gabe, Atsushi; Ichi, Takaharu; Kushi, Kazuaki; Yohena, Tomofumi; Kawasaki, Hidenori; Yamashiro, Toshimitsu; Ishikawa, Kiyoshi

2014-01-01

Patient: Male, 64 Final Diagnosis: Lung pleomorphic carcinoma Symptoms: Cough • fever Medication: — Clinical Procedure: — Specialty: Oncology Objective: Unusual clinical course Background: The diagnosis of lung cancer is often made based on computed tomography (CT) image findings if it cannot be confirmed on pathological examinations, such as bronchoscopy. However, the CT image findings of cancerous lesions are similar to those of abscesses.We herein report a case of lung cancer that resemble...

Pulmonary Rehabilitation in Lung Transplant Candidates: A Systematic Review

Directory of Open Access Journals (Sweden)

Stefanie Tonguino Rosero

2013-09-01

Full Text Available Pulmonary rehabilitation (PR aims to improve physical fitness and to decrease symptoms in patients with chronic lung disease; however there is not clear evidence regarding the benefits of PR in candidates for lung transplantation (LT. Objective. To determine the effectiveness of PR in LT candidates and also to find out how quality of life and exercise tolerance affects the survival of these patients. Methodology. Electronic databases (Medline, Cochrane, PEDro, Scient Direct and SciELO Search of articles in spanish, english or portuguese; controlled clinical trials and cohort studies published between 2000-2011 regarding PR in candidates for LT, the model of Cochrane systematic reviews was used. Results. The papers included were four cohort, two of which regarded of survival pre LT using the six minutes walking test (6MWT; a study of quality of life related to post LT survival and an exercise tolerance study. Controlled clinical trial was not found. Conclusions. The information found in the included studies had clinical and methodological heterogeneity therefore a meta-analysis could not been undertaken. The PR should be considered as an essential part to maintain the exercise tolerance and the patient’s survival. Research regarding this subject is important and should be carried out.

Estudos organizacionais, (descolonialidade e estudos da dependência: as contribuições da Cepal

Directory of Open Access Journals (Sweden)

Sergio Wanderley

Full Text Available O objetivo deste artigo é (revisitar o conceito de dependência como categoria de investigação da (e a partir da América Latina, por meio de uma perspectiva histórica crítica descolonial, a fim de ampliar o espaço de debates em estudos organizacionais e promover alternativas à ordem neoliberal. Este ensaio terá como foco os estudos da dependência realizados pela Comissão Econômica para a América Latina e o Caribe (Cepal durante a década de 1950 e o início dos anos 1960. A perspectiva descolonial é um constructo teórico de autores latino-americanos que se consideram herdeiros da longa tradição do pensamento social crítico da região, na qual a teoria da dependência está inserida. As propostas dos autores da dependência confrontaram as principais teorias ortodoxas do Norte produzidas à época. A partir do conceito de centro-periferia, da denúncia de assimetrias nas relações entre essas regiões, do reconhecimento da interdependência entre desenvolvimento e subdesenvolvimento, o conceito de dependência foi sendo (reelaborado nas décadas de 1950 e 1960 por diversos autores latino-americanos como uma categoria de investigação da realidade da (e a partir da região. Essas investigações tinham por objetivo não somente elaborar constructos teóricos, mas, também, transformar a realidade por meio da criação de diversas organizações e instituições que deveriam servir ao propósito de superar o subdesenvolvimento. A denúncia da historicidade da situação de subdesenvolvimento desnudou o caráter de neutralidade do economicismo das teorias produzidas no Norte e promoveu um encontro teórico entre economia e política que muito tem a contribuir com a área dos estudos organizacionais.

Stochastic rat lung dosimetry for inhaled radon progeny: a surrogate for the human lung for lung cancer risk assessment

Energy Technology Data Exchange (ETDEWEB)

Winkler-Heil, R.; Hofmann, W. [University of Salzburg, Division of Physics and Biophysics, Department of Materials Research and Physics, Salzburg (Austria); Hussain, M. [University of Salzburg, Division of Physics and Biophysics, Department of Materials Research and Physics, Salzburg (Austria); Higher Education Commission of Pakistan, Islamabad (Pakistan)

2015-05-15

Laboratory rats are frequently used in inhalation studies as a surrogate for human exposures. The objective of the present study was therefore to develop a stochastic dosimetry model for inhaled radon progeny in the rat lung, to predict bronchial dose distributions and to compare them with corresponding dose distributions in the human lung. The most significant difference between human and rat lungs is the branching structure of the bronchial tree, which is relatively symmetric in the human lung, but monopodial in the rat lung. Radon progeny aerosol characteristics used in the present study encompass conditions typical for PNNL and COGEMA rat inhalation studies, as well as uranium miners and human indoor exposure conditions. It is shown here that depending on exposure conditions and modeling assumptions, average bronchial doses in the rat lung ranged from 5.4 to 7.3 mGy WLM{sup -1}. If plotted as a function of airway generation, bronchial dose distributions exhibit a significant maximum in large bronchial airways. If, however, plotted as a function of airway diameter, then bronchial doses are much more uniformly distributed throughout the bronchial tree. Comparisons between human and rat exposures indicate that rat bronchial doses are slightly higher than human bronchial doses by about a factor of 1.3, while lung doses, averaged over the bronchial (BB), bronchiolar (bb) and alveolar-interstitial (AI) regions, are higher by about a factor of about 1.6. This supports the current view that the rat lung is indeed an appropriate surrogate for the human lung in case of radon-induced lung cancers. Furthermore, airway diameter seems to be a more appropriate morphometric parameter than airway generations to relate bronchial doses to bronchial carcinomas. (orig.)

Lung-derived growth factors: possible paracrine effectors of fetal lung development

International Nuclear Information System (INIS)

Montes, A.M.

1985-01-01

A potential role for paracrine secretions in lung organogenesis has been hypothesized (Alescio and Piperno, 1957). These studies present direct support for the paracrine model by demonstrating the presence of locally produced mitogenic/maturational factors in fetal rat lung tissue. Conditioned serum free medium (CSFM) from nineteen-day fetal rat lung cultures was shown to contain several bioactive peptides as detected by 3 H-Thymidine incorporation into chick embryo and rat lung fibroblasts, as well as 14 C-choline incorporation into surfactant in mixed cell cultures. Using ion-exchange chromatography and Sephadex gel filtration, a partially purified mitogen, 11-III, was obtained. The partially purified 11-III stimulates mitosis in chick embryo fibroblasts and post-natal rat lung fibroblasts. Multiplication in fetal rat lung fibroblasts cultures is stimulated only when these are pre-incubated with a competence factor or unprocessed CSFM. This suggests the existence of an endogenously produced competence factor important in the regulation of fetal lung growth. Preparation 11-III does not possess surfactant stimulating activity as assessed by 3 H-choline incorporation into lipids in predominantly type-II cell cultures. These data demonstrate the presence of a maturational/mitogenic factor, influencing type-II mixed cell cultures. In addition, 11-III had been shown to play an autocrine role stimulating the proliferation of fetal lung fibroblasts. Finally, these data suggest the existence of a local produced competence factor

Amebic lung abscess with coexisting lung adenocarcinoma: a unusual case of amebiasis.

Science.gov (United States)

Zhu, Hailong; Min, Xiangyang; Li, Shuai; Feng, Meng; Zhang, Guofeng; Yi, Xianghua

2014-01-01

Amebic lung abscess with concurrent lung cancer, but without either a liver abscess or amebic colitis, is extremely uncommon. Here, we report a 70-year-old man presenting with pulmonary amebiasis and coexisting lung adenocarcinoma. During his first-time hospitalization, the diagnosis of lung amebiasis was confirmed by morphological observation and PCR in formalin-fixed and paraffin-embedded sediments of pleural effusion. Almost four months later, the patient was readmitted to hospital for similar complaints. On readmission, lung adenocarcinoma was diagnosed by liquid-based sputum cytology and thought to be delayed because coexisting amebic lung abscess. This case demonstrated that sediments of pleural effusion may be used for further pathological examination after routine cytology has shown negative results. At the same time, we concluded that lung cancer may easily go undetected in the patients with pulmonary amebiasis and repetitive evaluation by cytology and imaging follow-up are useful to find potential cancer.

Regeneration of the lung: Lung stem cells and the development of lung mimicking devices

NARCIS (Netherlands)

Schilders, K.; Eenjes, E.; van Riet, S.; Poot, Andreas A.; Stamatialis, Dimitrios; Truckenmüller, R.K.; Hiemstra, P.; Rottier, R.

2016-01-01

Inspired by the increasing burden of lung associated diseases in society and an growing demand to accommodate patients, great efforts by the scientific community produce an increasing stream of data that are focused on delineating the basic principles of lung development and growth, as well as

SU-E-T-290: Dosimetric Accuracy of Acuros XB and Analytical Anisotropic Algorithm in Stereotactic Ablative Radiotherapy of Small Lung Lesions

International Nuclear Information System (INIS)

Yu, Amy S; Yang, Y; Bush, K; Fahimian, B; Hsu, A

2015-01-01

Purpose: The accuracy of dose calculation for lung stereotactic ablative radiotherapy (SABR) of small lesions critically depends on the proper modeling of the lateral scatter in heterogeneous media. In recent years, grid-based Boltzman solvers such as Acuros XB (AXB) have been introduced for enhanced modeling of radiation transport in heterogeneous media. The purpose of this study is to evaluate the dosimetric impact of dose calculation between AXB and convolution-superposition algorithms such as analytical anisotropic algorithm (AAA) for small lesion sizes and different beam energies. Methods: Five lung SABR VMAT cases with GTV ranged from 0.8cm to 2.5cm in diameter were studied. For each case, doses were calculated by AAA, AXB (V11031) and Monte Carlo simulation (MC) with the same plan parameters for 10MV and 6MV. The dose calculation accuracy were evaluated by comparing DVHs and dose distributions with MC as the benchmark. The accuracy of calculated dose was also validated by EBT3 film measurement with a field size of 3cmx3cm in a thorax phantom. Results: For 10MV and GTV less than 1cm, dose calculated by AXB agrees well with MC compared to AAA. Dose difference calculated with AXB and AAA could be up to 30%. For GTV greater than 2cm, calculation results of AXB and AAA agree within 5% in GTV. For 6MV, the difference between calculated doses by AXB and AAA is less 10% for GTV less than 1cm. Based on film measurements, lung dose was overestimated 10% and 20% by AAA for 6MV and 10MV. Conclusion: Lateral scatter and transport is modeled more accurately by AXB than AAA in heterogeneous media, especially for small field size and high energy beams. The accuracy depends on the assigned material in calculation. If grid-based Boltzman solvers or MC are not available for calculation, lower energy beams should be used for treatment

Effects of lung elasticity on the sound propagation in the lung

International Nuclear Information System (INIS)

Yoneda, Takahiro; Wada, Shigeo; Nakamura, Masanori; Horii, Noriaki; Mizushima, Koichiro

2011-01-01

Sound propagation in the lung was simulated for gaining insight into its acoustic properties. A thorax model consisting of lung parenchyma, thoracic bones, trachea and other tissues was made from human CT images. Acoustic nature of the lung parenchyma and bones was expressed with the Biot model of poroelastic material, whereas trachea and tissues were modeled with gas and an elastic material. A point sound source of white noises was placed in the first bifurcation of trachea. The sound propagation in the thorax model was simulated in a frequency domain. The results demonstrated the significant attenuation of sound especially in frequencies larger than 1,000 Hz. Simulations with a stiffened lung demonstrated suppression of the sound attenuation for higher frequencies observed in the normal lung. These results indicate that the normal lung has the nature of a low-pass filter, and stiffening helps the sound at higher frequencies to propagate without attenuations. (author)

Estudo sobre reciclagem de lâmpadas fluorescentes

OpenAIRE

Bacila,Danniele Miranda; Fischer,Klaus; Kolicheski,Mônica Beatriz

2014-01-01

Lâmpadas fluorescentes (LF) contêm mercúrio em sua composição, um metal pesado que pode causar danos à saúde e ao meio ambiente. As LF são amplamente consumidas no Brasil, porém o descarte correto de LF usadas não é amplamente divulgado e os índices de reciclagem são baixos. O objetivo deste estudo foi demonstrar a relevância do descarte adequado, avaliar as tecnologias de reciclagem e a destinação dos materiais, por meio de estudo comparativo entre Brasil e Alemanha. Através de visitas a rec...

A DRD1 polymorphism predisposes to lung cancer among those exposed to secondhand smoke during childhood.

Science.gov (United States)

Robles, Ana I; Yang, Ping; Jen, Jin; McClary, Andrew C; Calhoun, Kara; Bowman, Elise D; Vähäkangas, Kirsi; Greathouse, K Leigh; Wang, Yi; Olivo-Marston, Susan; Wenzlaff, Angela S; Deng, Bo; Schwartz, Ann G; Ryan, Bríd M

2014-12-01

Lung cancer has a familial component which suggests a genetic contribution to its etiology. Given the strong evidence linking smoking with lung cancer, we studied miRNA-related loci in genes associated with smoking behavior. CHRNA, CHRNB gene families, CYP2A6, and DRD1 (dopamine receptor D1) were mined for SNPs that fell within the seed region of miRNA binding sites and then tested for associations with risk in a three-stage validation approach. A 3'UTR (untranslated region) SNP in DRD1 was associated with a lower risk of lung cancer among individuals exposed to secondhand smoke during childhood [OR, 0.69; 95% confidence interval (CI), 0.60-0.79; P secondhand smoke and heterogeneity between individuals in regard to their susceptibility to the effects of secondhand smoke, our data show an interaction between an SNP in the 3'UTR of DRD1 and exposure to secondhand smoke during childhood. Further work is needed to explore the mechanistic underpinnings of this SNP and the nature of the interaction between DRD1 and exposure to secondhand smoke during childhood. ©2014 American Association for Cancer Research.

Lung structure and function relation in systemic sclerosis: Application of lung densitometry

Energy Technology Data Exchange (ETDEWEB)

Ninaber, Maarten K., E-mail: m.k.ninaber@lumc.nl [Department of Pulmonology, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden (Netherlands); Stolk, Jan; Smit, Jasper; Le Roy, Ernest J. [Department of Pulmonology, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden (Netherlands); Kroft, Lucia J.M. [Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden (Netherlands); Els Bakker, M. [Division of Image Processing, Radiology, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden (Netherlands); Vries Bouwstra, Jeska K. de; Schouffoer, Anne A. [Department of Rheumatology, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden (Netherlands); Staring, Marius; Stoel, Berend C. [Division of Image Processing, Radiology, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden (Netherlands)

2015-05-15

Highlights: • A quantitative CT parameter of lung parenchyma in systemic sclerosis is presented. • We examine the optimal percentage threshold for the percentile density. • The 85th percentile density threshold correlated significantly with lung function. • A lung structure–function relation is confirmed. • We report applicability of Perc85 in progression mapping of interstitial lung disease. - Abstract: Introduction: Interstitial lung disease occurs frequently in patients with systemic sclerosis (SSc). Quantitative computed tomography (CT) densitometry using the percentile density method may provide a sensitive assessment of lung structure for monitoring parenchymal damage. Therefore, we aimed to evaluate the optimal percentile density score in SSc by quantitative CT densitometry, against pulmonary function. Material and methods: We investigated 41 SSc patients by chest CT scan, spirometry and gas transfer tests. Lung volumes and the nth percentile density (between 1 and 99%) of the entire lungs were calculated from CT histograms. The nth percentile density is defined as the threshold value of densities expressed in Hounsfield units. A prerequisite for an optimal percentage was its correlation with baseline DLCO %predicted. Two patients showed distinct changes in lung function 2 years after baseline. We obtained CT scans from these patients and performed progression analysis. Results: Regression analysis for the relation between DLCO %predicted and the nth percentile density was optimal at 85% (Perc85). There was significant agreement between Perc85 and DLCO %predicted (R = −0.49, P = 0.001) and FVC %predicted (R = −0.64, P < 0.001). Two patients showed a marked change in Perc85 over a 2 year period, but the localization of change differed clearly. Conclusions: We identified Perc85 as optimal lung density parameter, which correlated significantly with DLCO and FVC, confirming a lung parenchymal structure–function relation in SSc. This provides

Lung structure and function relation in systemic sclerosis: Application of lung densitometry

International Nuclear Information System (INIS)

Ninaber, Maarten K.; Stolk, Jan; Smit, Jasper; Le Roy, Ernest J.; Kroft, Lucia J.M.; Els Bakker, M.; Vries Bouwstra, Jeska K. de; Schouffoer, Anne A.; Staring, Marius; Stoel, Berend C.

2015-01-01

Highlights: • A quantitative CT parameter of lung parenchyma in systemic sclerosis is presented. • We examine the optimal percentage threshold for the percentile density. • The 85th percentile density threshold correlated significantly with lung function. • A lung structure–function relation is confirmed. • We report applicability of Perc85 in progression mapping of interstitial lung disease. - Abstract: Introduction: Interstitial lung disease occurs frequently in patients with systemic sclerosis (SSc). Quantitative computed tomography (CT) densitometry using the percentile density method may provide a sensitive assessment of lung structure for monitoring parenchymal damage. Therefore, we aimed to evaluate the optimal percentile density score in SSc by quantitative CT densitometry, against pulmonary function. Material and methods: We investigated 41 SSc patients by chest CT scan, spirometry and gas transfer tests. Lung volumes and the nth percentile density (between 1 and 99%) of the entire lungs were calculated from CT histograms. The nth percentile density is defined as the threshold value of densities expressed in Hounsfield units. A prerequisite for an optimal percentage was its correlation with baseline DLCO %predicted. Two patients showed distinct changes in lung function 2 years after baseline. We obtained CT scans from these patients and performed progression analysis. Results: Regression analysis for the relation between DLCO %predicted and the nth percentile density was optimal at 85% (Perc85). There was significant agreement between Perc85 and DLCO %predicted (R = −0.49, P = 0.001) and FVC %predicted (R = −0.64, P < 0.001). Two patients showed a marked change in Perc85 over a 2 year period, but the localization of change differed clearly. Conclusions: We identified Perc85 as optimal lung density parameter, which correlated significantly with DLCO and FVC, confirming a lung parenchymal structure–function relation in SSc. This provides

67Ga lung scan

International Nuclear Information System (INIS)

Niden, A.H.; Mishkin, F.S.; Khurana, M.M.L.; Pick, R.

1977-01-01

Twenty-three patients with clinical signs of pulmonary embolic disease and lung infiltrates were studied to determine the value of gallium citrate 67 Ga lung scan in differentiating embolic from inflammatory lung disease. In 11 patients without angiographically proved embolism, only seven had corresponding ventilation-perfusion defects compatible with inflammatory disease. In seven of these 11 patients, the 67 Ga concentration indicated inflammatory disease. In the 12 patients with angiographically proved embolic disease, six had corresponding ventilation-perfusion defects compatible with inflammatory disease. None had an accumulation of 67 Ga in the area of pulmonary infiltrate. Thus, ventilation-perfusion lung scans are of limited value when lung infiltrates are present. In contrast, the accumulation of 67 Ga in the lung indicates an inflammatory process. Gallium imaging can help select those patients with lung infiltrates who need angiography

Os estudos brasileiros e os 'brazilianists'

Directory of Open Access Journals (Sweden)

José Honório Rodrigues

1976-09-01

Full Text Available (primeiro parágrafo do artigo Quando, em 1943-1944, estive nos Estados Unidos, estudando e pesquisando, conheci muitas bibliotecas públicas e universitárias, e o grande Arquivo Nacional dos Estados Unidos. Nas Universidades já se ofereciam cursos de estudos latino-americanos, centralizados sobretudo no estudo da língua espanhola, portuguesa em menor escala, estenografía em espanhol, e raras propunham o ensino da literatura comparativa, antropologia, economia, geografia, política e história latino-americana, sempre em conjunto; raríssimas, como a Columbia, ofereciam aulas de história social e econômica do Brasil, e tambem do México e da América Central, e ainda da Argentina, Uruguai e Paraguai. Havia pouca especialização por paises e áreas, e se via predominantemente a América Latina como um bloco uno e uniforme.

Genetic heterogeneity of retinitis pigmentosa

OpenAIRE

Hartono, Hartono

2015-01-01

Genetic heterogeneity is a phenomenon in which a genetic disease can be transmitted by several modes of inheritance. The understanding of genetic heterogeneity is important in giving genetic counselling.The presence of genetic heterogeneity can be explained by the existence of:1.different mutant alleles at a single locus, and2.mutant alleles at different loci affecting the same enzyme or protein, or affecting different enzymes or proteins.To have an overall understanding of genetic heterogene...

History of Lung Transplantation.

Science.gov (United States)

Dabak, Gül; Şenbaklavacı, Ömer

2016-04-01

History of lung transplantation in the world can be traced back to the early years of the 20 th century when experimental vascular anastomotic techniques were developed by Carrel and Guthrie, followed by transplantation of thoracic organs on animal models by Demikhov and finally it was James Hardy who did the first lung transplantation attempt on human. But it was not until the discovery of cyclosporine and development of better surgical techniques that success could be achieved in that field by the Toronto Lung Transplant Group led by Joel Cooper. Up to the present day, over 51.000 lung transplants were performed in the world at different centers. The start of lung transplantation in Turkey has been delayed for various reasons. From 1998 on, there were several attempts but the first successful lung transplant was performed at Sureyyapasa Hospital in 2009. Today there are four lung transplant centers in Turkey; two in Istanbul, one in Ankara and another one in Izmir. Three lung transplant centers from Istanbul which belong to private sector have newly applied for licence from the Ministry of Health.

MRI of the lung

Energy Technology Data Exchange (ETDEWEB)

Kauczor, Hans-Ulrich (ed.) [University Clinic Heidelberg (Germany). Diagnostic and Interventional Radiology

2009-07-01

For a long time, only chest X-ray and CT were used to image lung structure, while nuclear medicine was employed to assess lung function. During the past decade significant developments have been achieved in the field of magnetic resonance imaging (MRI), enabling MRI to enter the clinical arena of chest imaging. Standard protocols can now be implemented on up-to-date scanners, allowing MRI to be used as a first-line imaging modality for various lung diseases, including cystic fibrosis, pulmonary hypertension and even lung cancer. The diagnostic benefits stem from the ability of MRI to visualize changes in lung structure while simultaneously imaging different aspects of lung function, such as perfusion, respiratory motion, ventilation and gas exchange. On this basis, novel quantitative surrogates for lung function can be obtained. This book provides a comprehensive overview of how to use MRI for imaging of lung disease. Special emphasis is placed on benign diseases requiring regular monitoring, given that it is patients with these diseases who derive the greatest benefit from the avoidance of ionizing radiation. (orig.)

American Lung Association

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... see if you should get screened. Learn more EDUCATION ADVOCACY RESEARCH Our vision is a world free of lung disease The American Lung Association is ... by lung disease. Help us continue to deliver education, advocacy and research to those who need it. $250 $100 $50 Your best gift Donate now Learn More ... nonprofit software

Unexpandable lung.

Science.gov (United States)

Pereyra, Marco F; Ferreiro, Lucía; Valdés, Luis

2013-02-01

Unexpandable lung is a mechanical complication by which the lung does not expand to the chest wall, impeding a normal apposition between the two pleural layers. The main mechanism involved is the restriction of the visceral pleura due to the formation of a fibrous layer along this pleural membrane. This happens because of the presence of an active pleural disease (lung entrapment), which can be resolved if proper therapeutic measures are taken, or a remote disease (trapped lung), in which an irreversible fibrous pleural layer has been formed. The clinical suspicion arises with the presence of post-thoracocentesis hydropneumothorax or a pleural effusion that cannot be drained due to the appearance of thoracic pain. The diagnosis is based on the analysis of the pleural liquid, the determination of pleural pressures as we drain the effusion and on air-contrast chest CT. As both represent the continuity of one same process, the results will depend on the time at which these procedures are done. If, when given a lung that is becoming entrapped, the necessary therapeutic measures are not taken, the final result will be a trapped lung. In this instance, most patients are asymptomatic or have mild exertional dyspnea and therefore they do not require treatment. Nevertheless, in cases of incapacitating dyspnea, it may be necessary to use pleural decortication in order to resolve the symptoms. Copyright © 2012 SEPAR. Published by Elsevier Espana. All rights reserved.

Epidemiology of Lung Cancer.

Science.gov (United States)

Schwartz, Ann G; Cote, Michele L

2016-01-01

Lung cancer continues to be one of the most common causes of cancer death despite understanding the major cause of the disease: cigarette smoking. Smoking increases lung cancer risk 5- to 10-fold with a clear dose-response relationship. Exposure to environmental tobacco smoke among nonsmokers increases lung cancer risk about 20%. Risks for marijuana and hookah use, and the new e-cigarettes, are yet to be consistently defined and will be important areas for continued research as use of these products increases. Other known environmental risk factors include exposures to radon, asbestos, diesel, and ionizing radiation. Host factors have also been associated with lung cancer risk, including family history of lung cancer, history of chronic obstructive pulmonary disease and infections. Studies to identify genes associated with lung cancer susceptibility have consistently identified chromosomal regions on 15q25, 6p21 and 5p15 associated with lung cancer risk. Risk prediction models for lung cancer typically include age, sex, cigarette smoking intensity and/or duration, medical history, and occupational exposures, however there is not yet a risk prediction model currently recommended for general use. As lung cancer screening becomes more widespread, a validated model will be needed to better define risk groups to inform screening guidelines.

The CD44(high tumorigenic subsets in lung cancer biospecimens are enriched for low miR-34a expression.

Directory of Open Access Journals (Sweden)

Saroj K Basak

Full Text Available Cellular heterogeneity is an integral part of cancer development and progression. Progression can be associated with emergence of cells that exhibit high phenotypic plasticity (including "de-differentiation" to primitive developmental states, and aggressive behavioral properties (including high tumorigenic potentials. We observed that many biomarkers that are used to identify Cancer Stem Cells (CSC can label cell subsets in an advanced clinical stage of lung cancer (malignant pleural effusions, or MPE. Thus, CSC-biomarkers may be useful for live sorting functionally distinct cell subsets from individual tumors, which may enable investigators to hone in on the molecular basis for functional heterogeneity. We demonstrate that the CD44(hi (CD44-high cancer cell subsets display higher clonal, colony forming potential than CD44(lo cells (n=3 and are also tumorigenic (n=2/2 when transplanted in mouse xenograft model. The CD44(hi subsets express different levels of embryonal (de-differentiation markers or chromatin regulators. In archived lung cancer tissues, ALDH markers co-localize more with CD44 in squamous cell carcinoma (n=5/7 than Adeno Carcinoma (n=1/12. MPE cancer cells and a lung cancer cell line (NCI-H-2122 exhibit chromosomal abnormalities and 1p36 deletion (n=3/3. Since miR-34a maps to the 1p36 deletion site, low miR-34a expression levels were detected in these cells. The colony forming efficiency of CD44(hi cells, characteristic property of CSC, can be inhibited by mir-34a replacement in these samples. In addition the highly tumorigenic CD44(hi cells are enriched for cells in the G2 phase of cell cycle.

The relationship between ventilatory lung motion and pulmonary perfusion shown by ventilatory lung motion imaging

International Nuclear Information System (INIS)

Fujii, Tadashige; Tanaka, Masao; Nakatsuka, Tatsuya; Yoshimura, Kazuhiko; Hirose, Yoshiki; Hirayama, Jiro; Kobayashi, Toshio; Handa, Kenjiro

1991-01-01

Using ventilatory lung motion imaging, which was obtained from two perfusion lung scintigrams with 99m Tc-macroaggregated albumin taken in maximal inspiration and maximal expiration, the lung motion (E-I/I) of the each unilateral lung was studied in various cardiopulmonary diseases. The sum of (E-I)/I(+) of the unilateral lung was decreased in the diseased lung for localized pleuropulmonary diseases, including primary lung cancer and pleural thickening, and in both lungs for heart diseases, and diffuse pulmonary diseases including diffuse interstitial pneumonia and diffuse panbronchiolitis. The sum of (E-I)/I(+) of the both lungs, which correlated with vital capacity and PaO 2 , was decreased in diffuse interstitial pneumonia, pulmonary emphysema, diffuse panbronchiolitis, primary lung cancer, pleural diseases and so on. (E-I)/I(+), correlated with pulmonary perfusion (n=49, r=0.51, p 81m Kr or 133 Xe (n=49, r=0.61, p<0.001) than pulmonary perfusion. The ventilatory lung motion imaging, which demonstrates the motion of the intra-pulmonary areas and lung edges, appears useful for estimating pulmonary ventilation of the perfused area as well as pulmonary perfusion. (author)

First Danish experience with ex vivo lung perfusion of donor lungs before transplantation

DEFF Research Database (Denmark)

Henriksen, Ian Sune Iversen; Møller-Sørensen, Hasse; Møller, Christian Holdfold

2014-01-01

INTRODUCTION: The number of lung transplantations is limited by a general lack of donor organs. Ex vivo lung perfusion (EVLP) is a novel method to optimise and evaluate marginal donor lungs prior to transplantation. We describe our experiences with EVLP in Denmark during the first year after its...... introduction. MATERIAL AND METHODS: The study was conducted by prospective registration of donor offers and lung transplantations in Denmark from 1 May 2012 to 30 April 2013. Donor lungs without any contraindications were transplanted in the traditional manner. Taken for EVLP were donor lungs that were...... otherwise considered transplantable, but failed to meet the usual criteria due to possible contusions or because they were from donors with sepsis or unable to pass the oxygenation test. RESULTS: In the study period, seven of 33 Danish lung transplantations were made possible due to EVLP. One patient died...

Angiogenin and vascular endothelial growth factor expression in lungs of lung cancer patients.

Science.gov (United States)

Rozman, Ales; Silar, Mira; Kosnik, Mitja

2012-12-01

BACKGROUND.: Lung cancer is the leading cause of cancer deaths. Angiogenesis is crucial process in cancer growth and progression. This prospective study evaluated expression of two central regulatory molecules: angiogenin and vascular endothelial growth factor (VEGF) in patients with lung cancer. PATIENTS AND METHODS.: Clinical data, blood samples and broncho-alveolar lavage (BAL) from 23 patients with primary lung carcinoma were collected. BAL fluid was taken from part of the lung with malignancy, and from corresponding healthy side of the lung. VEGF and angiogenin concentrations were analysed by an enzyme-linked immunosorbent assay. Dilution of bronchial secretions in the BAL fluid was calculated from urea concentration ratio between serum and BAL fluid. RESULTS.: We found no statistical correlation between angiogenin concentrations in serum and in bronchial secretions from both parts of the lung. VEGF concentrations were greater in bronchial secretions in the affected side of the lung than on healthy side. Both concentrations were greater than serum VEGF concentration. VEGF concentration in serum was in positive correlation with tumour size (p = 0,003) and with metastatic stage of disease (p = 0,041). There was correlation between VEGF and angiogenin concentrations in bronchial secretions from healthy side of the lung and between VEGF and angiogenin concentrations in bronchial secretions from part of the lung with malignancy. CONCLUSION.: Angiogenin and VEGF concentrations in systemic, background and local samples of patients with lung cancer are affected by different mechanisms. Pro-angiogenic activity of lung cancer has an important influence on the levels of angiogenin and VEGF.

Variable tidal volumes improve lung protective ventilation strategies in experimental lung injury.

Science.gov (United States)

Spieth, Peter M; Carvalho, Alysson R; Pelosi, Paolo; Hoehn, Catharina; Meissner, Christoph; Kasper, Michael; Hübler, Matthias; von Neindorff, Matthias; Dassow, Constanze; Barrenschee, Martina; Uhlig, Stefan; Koch, Thea; de Abreu, Marcelo Gama

2009-04-15

Noisy ventilation with variable Vt may improve respiratory function in acute lung injury. To determine the impact of noisy ventilation on respiratory function and its biological effects on lung parenchyma compared with conventional protective mechanical ventilation strategies. In a porcine surfactant depletion model of lung injury, we randomly combined noisy ventilation with the ARDS Network protocol or the open lung approach (n = 9 per group). Respiratory mechanics, gas exchange, and distribution of pulmonary blood flow were measured at intervals over a 6-hour period. Postmortem, lung tissue was analyzed to determine histological damage, mechanical stress, and inflammation. We found that, at comparable minute ventilation, noisy ventilation (1) improved arterial oxygenation and reduced mean inspiratory peak airway pressure and elastance of the respiratory system compared with the ARDS Network protocol and the open lung approach, (2) redistributed pulmonary blood flow to caudal zones compared with the ARDS Network protocol and to peripheral ones compared with the open lung approach, (3) reduced histological damage in comparison to both protective ventilation strategies, and (4) did not increase lung inflammation or mechanical stress. Noisy ventilation with variable Vt and fixed respiratory frequency improves respiratory function and reduces histological damage compared with standard protective ventilation strategies.

Endotoxin exposure and lung cancer risk: a systematic review and meta-analysis of the published literature on agriculture and cotton textile workers.

Science.gov (United States)

Lenters, Virissa; Basinas, Ioannis; Beane-Freeman, Laura; Boffetta, Paolo; Checkoway, Harvey; Coggon, David; Portengen, Lützen; Sim, Malcolm; Wouters, Inge M; Heederik, Dick; Vermeulen, Roel

2010-04-01

To examine the association between exposure to endotoxins and lung cancer risk by conducting a systematic review and meta-analysis of epidemiologic studies of workers in the cotton textile and agricultural industries; industries known for high exposure levels of endotoxins. Risk estimates were extracted from studies published before 2009 that met predefined quality criteria, including 8 cohort, 1 case-cohort, and 2 case-control studies of cotton textile industry workers, and 15 cohort and 2 case-control studies of agricultural workers. Summary risk estimates were calculated using random effects meta-analyses. Potential sources of heterogeneity were explored through subgroup analyses. The summary risk of lung cancer was 0.72 (95% CI, 0.57-0.90) for textile workers and 0.62 (0.52-0.75) for agricultural workers. The relative risk of lung cancer was below 1.0 for most subgroups defined according to sex, study design, outcome, smoking adjustment, and geographic area. Two studies provided quantitative estimates of endotoxin exposure and both studies tended to support a dose-dependent protective effect of endotoxins on lung cancer risk. Despite several limitations, this meta-analysis based on high-quality studies adds weight to the hypothesis that occupational exposure to endotoxin in cotton textile production and agriculture is protective against lung cancer.

Amebic lung abscess with coexisting lung adenocarcinoma: a unusual case of amebiasis

OpenAIRE

Zhu, Hailong; Min, Xiangyang; Li, Shuai; Feng, Meng; Zhang, Guofeng; Yi, Xianghua

2014-01-01

Amebic lung abscess with concurrent lung cancer, but without either a liver abscess or amebic colitis, is extremely uncommon. Here, we report a 70-year-old man presenting with pulmonary amebiasis and coexisting lung adenocarcinoma. During his first-time hospitalization, the diagnosis of lung amebiasis was confirmed by morphological observation and PCR in formalin-fixed and paraffin-embedded sediments of pleural effusion. Almost four months later, the patient was readmitted to hospital for sim...

Differentiating invasive and pre-invasive lung cancer by quantitative analysis of histopathologic images

Science.gov (United States)

Zhou, Chuan; Sun, Hongliu; Chan, Heang-Ping; Chughtai, Aamer; Wei, Jun; Hadjiiski, Lubomir; Kazerooni, Ella

2018-02-01

We are developing automated radiopathomics method for diagnosis of lung nodule subtypes. In this study, we investigated the feasibility of using quantitative methods to analyze the tumor nuclei and cytoplasm in pathologic wholeslide images for the classification of pathologic subtypes of invasive nodules and pre-invasive nodules. We developed a multiscale blob detection method with watershed transform (MBD-WT) to segment the tumor cells. Pathomic features were extracted to characterize the size, morphology, sharpness, and gray level variation in each segmented nucleus and the heterogeneity patterns of tumor nuclei and cytoplasm. With permission of the National Lung Screening Trial (NLST) project, a data set containing 90 digital haematoxylin and eosin (HE) whole-slide images from 48 cases was used in this study. The 48 cases contain 77 regions of invasive subtypes and 43 regions of pre-invasive subtypes outlined by a pathologist on the HE images using the pathological tumor region description provided by NLST as reference. A logistic regression model (LRM) was built using leave-one-case-out resampling and receiver operating characteristic (ROC) analysis for classification of invasive and pre-invasive subtypes. With 11 selected features, the LRM achieved a test area under the ROC curve (AUC) value of 0.91+/-0.03. The results demonstrated that the pathologic invasiveness of lung adenocarcinomas could be categorized with high accuracy using pathomics analysis.

Cervical lung hernia

Science.gov (United States)

Lightwood, Robin G.; Cleland, W. P.

1974-01-01

Lightwood, R. G., and Cleland, W. P. (1974).Thorax, 29, 349-351. Cervical lung hernia. Lung hernias occur in the cervical position in about one third of cases. The remainder appear through the chest wall. Some lung hernias are congenital, but trauma is the most common cause. The indications for surgery depend upon the severity of symptoms. Repair by direct suture can be used for small tears in Sibson's (costovertebral) fascia while larger defects have been closed using prosthetic materials. Four patients with cervical lung hernia are described together with an account of their operations. PMID:4850946

ESTUDOS NACIONAIS SOBRE O ENSINO PARA CEGOS: UMA REVISÃO BIBLIOGRÁFICA

Directory of Open Access Journals (Sweden)

Rosana Mendes Éleres de FIGUEIREDO

2015-12-01

Full Text Available RESUMO O presente artigo tem como objetivo apresentar uma revisão bibliográfica dos estudos nacionais acerca do ensino curricular para cegos. Foi realizada uma busca sistemática em três bases de dados: Google Acadêmico, Scielo e Lilacs, de estudos publicados no período de 2004 a 2014, que tivessem em seu título um dos seguintes descritores: alunos cegos; alunos deficientes visuais; crianças cegas; crianças deficientes visuais. Foram localizados 188 estudos e 56 selecionados dentro dos critérios estabelecidos. Fez-se a leitura integral desses e definiram-se cinco categorias de análise: tipo de estudo; participantes; tipo de abordagem; tipo de discussão e matrizes curriculares. Para cada categoria, foram estabelecidas subcategorias. Ao total 26 subcategorias foram descritas. Os resultados indicam que o Google Acadêmico é a base de dados com maior número de títulos encontrados (188/156; a Scielo apresenta melhor eficiência na relação encontrado x selecionado (12/10. Nas subcategorias de análise, as maiores frequências são identificadas nos estudos empíricos (22; junto a crianças (19; de análises qualitativas (21; na matriz curricular de Educação Física (sete e na subcategoria relacionamento social (16. Contudo, os estudos são convergentes em apontar que as principais dificuldades no ensino às pessoas cegas se referem a deficiências na formação de professores, onde, normalmente, não são discutidos métodos de ensino e produção de material para trabalhar com essa população específica. Em conclusão, além de realizar um mapeamento dos estudos que têm sido conduzidos junto a alunos cegos nos últimos dez anos, este artigo aponta para lacunas na literatura e direciona futuras investigações na área.

The Azygous Lobe of the Lung: in the Case of Lung Cancer.

Science.gov (United States)

Darlong, L M; Ram, Dharma; Sharma, Ashwani; Sharma, Anil Kumar; Iqbal, Sayed Assif; Nagar, Anand; Hazarika, Dibyamohan

2017-06-01

The azygous lobe of the lung is an uncommon developmental anomaly. Its surgical importance is hardly being described in literature. Here, we are presenting a case of lung cancer with incidental azygous lobe, with its surgical relevance during lung cancer surgery.

Evaluation of lung injury induced by pingyangmycin with 99Tcm-HMPAO lung imaging

International Nuclear Information System (INIS)

Zhao Changjiu; Yang Zhijie; Fu Peng; Zhang Rui

2005-01-01

Objective: To investigate the lung uptake of 99 Tc m -hexamethyl propylene amine oxime (HMPAO) in pingyangmycin-induced lung injury and its mechanism. Methods: 24 white rabbits were randomly divided into 4 groups. Group I: the control with normal diet. In group II, III and IV 0.2, 0.3 and 0.5 mg/kg pingyangmycin were given respectively by marginal vein of ear every other day. 99 Tc m -HMPAO static lung imaging was performed before and 8, 16, 24, 32 d after injection of pingyangmycin. 7 pixel x 5 pixel regions of interest (ROIs) were drawn on the right lung(R) and right upper limb(B), R/B were calculated. Also, 2 ml venous blood was withdrawn for measurement of endothelin by radioimmunoassay. 16 d after pingyangmycin in group IV and 32 d in group I, II and III, all the rabbits were sacrificed. Both lungs were examined immediately under light and electron microscopy. Results: Compared with the control group, there were statistical differences of 99 Tc m -HMPAO lung uptake in group II, III and IV (P 99 Tc m -HMPAO lung imaging can detect early pingyangmycin-induced lung injury. The endothelium of lung microcapillary is presumably the main location site of 99 Tc m -HMPAO abnormal concentration. (authors)

Heterogeneous reactors

International Nuclear Information System (INIS)

Moura Neto, C. de; Nair, R.P.K.

1979-08-01

The microscopic study of a cell is meant for the determination of the infinite multiplication factor of the cell, which is given by the four factor formula: K(infinite) = n(epsilon)pf. The analysis of an homogeneous reactor is similar to that of an heterogeneous reactor, but each factor of the four factor formula can not be calculated by the formulas developed in the case of an homogeneous reactor. A great number of methods was developed for the calculation of heterogeneous reactors and some of them are discussed. (Author) [pt

Heterogeneous gas core reactor

International Nuclear Information System (INIS)

Han, K.I.

1977-01-01

Preliminary investigations of a heterogeneous gas core reactor (HGCR) concept suggest that this potential power reactor offers distinct advantages over other existing or conceptual reactor power plants. One of the most favorable features of the HGCR is the flexibility of the power producing system which allows it to be efficiently designed to conform to a desired optimum condition without major conceptual changes. The arrangement of bundles of moderator/coolant channels in a fissionable gas or mixture of gases makes a truly heterogeneous nuclear reactor core. It is this full heterogeneity for a gas-fueled reactor core which accounts for the novelty of the heterogeneous gas core reactor concept and leads to noted significant advantages over previous gas core systems with respect to neutron and fuel economy, power density, and heat transfer characteristics. The purpose of this work is to provide an insight into the design, operating characteristics, and safety of a heterogeneous gas core reactor system. The studies consist mainly of neutronic, energetic and kinetic analyses of the power producing and conversion systems as a preliminary assessment of the heterogeneous gas core reactor concept and basic design. The results of the conducted research indicate a high potential for the heterogeneous gas core reactor system as an electrical power generating unit (either large or small), with an overall efficiency as high as 40 to 45%. The HGCR system is found to be stable and safe, under the conditions imposed upon the analyses conducted in this work, due to the inherent safety of ann expanding gaseous fuel and the intrinsic feedback effects of the gas and water coolant

"Open lung ventilation optimizes pulmonary function during lung surgery".

Science.gov (United States)

Downs, John B; Robinson, Lary A; Steighner, Michael L; Thrush, David; Reich, Richard R; Räsänen, Jukka O

2014-12-01

We evaluated an "open lung" ventilation (OV) strategy using low tidal volumes, low respiratory rate, low FiO2, and high continuous positive airway pressure in patients undergoing major lung resections. In this phase I pilot study, twelve consecutive patients were anesthetized using conventional ventilator settings (CV) and then OV strategy during which oxygenation and lung compliance were noted. Subsequently, a lung resection was performed. Data were collected during both modes of ventilation in each patient, with each patient acting as his own control. The postoperative course was monitored for complications. Twelve patients underwent open thoracotomies for seven lobectomies and five segmentectomies. The OV strategy provided consistent one-lung anesthesia and improved static compliance (40 ± 7 versus 25 ± 4 mL/cm H2O, P = 0.002) with airway pressures similar to CV. Postresection oxygenation (SpO2/FiO2) was better during OV (433 ± 11 versus 386 ± 15, P = 0.008). All postoperative chest x-rays were free of atelectasis or infiltrates. No patient required supplemental oxygen at any time postoperatively or on discharge. The mean hospital stay was 4 ± 1 d. There were no complications or mortality. The OV strategy, previously shown to have benefits during mechanical ventilation of patients with respiratory failure, proved safe and effective in lung resection patients. Because postoperative pulmonary complications may be directly attributable to the anesthetic management, adopting an OV strategy that optimizes lung mechanics and gas exchange may help reduce postoperative problems and improve overall surgical results. A randomized trial is planned to ascertain whether this technique will reduce postoperative pulmonary complications. Copyright © 2014 Elsevier Inc. All rights reserved.

Factors affecting the local control of stereotactic body radiotherapy for lung tumors including primary lung cancer and metastatic lung tumors

International Nuclear Information System (INIS)

Hamamoto, Yasushi; Kataoka, Masaaki; Yamashita, Motohiro

2012-01-01

The purpose of this study was to identify factors affecting local control of stereotactic body radiotherapy (SBRT) for lung tumors including primary lung cancer and metastatic lung tumors. Between June 2006 and June 2009, 159 lung tumors in 144 patients (primary lung cancer, 128; metastatic lung tumor, 31) were treated with SBRT with 48-60 Gy (mean 50.1 Gy) in 4-5 fractions. Higher doses were given to larger tumors and metastatic tumors in principle. Assessed factors were age, gender, tumor origin (primary vs. metastatic), histological subtype, tumor size, tumor appearance (solid vs. ground glass opacity), maximum standardized uptake value of positron emission tomography using 18 F-fluoro-2-deoxy-D-glucose, and SBRT doses. Follow-up time was 1-60 months (median 18 months). The 1-, 2-, and 3-year local failure-free rates of all lesions were 90, 80, and 77%, respectively. On univariate analysis, metastatic tumors (p<0.0001), solid tumors (p=0.0246), and higher SBRT doses (p=0.0334) were the statistically significant unfavorable factors for local control. On multivariate analysis, only tumor origin was statistically significant (p=0.0027). The 2-year local failure-free rates of primary lung cancer and metastatic lung tumors were 87 and 50%, respectively. A metastatic tumor was the only independently significant unfavorable factor for local control after SBRT. (author)

Diet and lung cancer

DEFF Research Database (Denmark)

Fabricius, P; Lange, Peter

2003-01-01

Lung cancer is the leading cause of cancer-related deaths worldwide. While cigarette smoking is of key importance, factors such as diet also play a role in the development of lung cancer. MedLine and Embase were searched with diet and lung cancer as the key words. Recently published reviews and l...... are only ameliorated to a minor degree by a healthy diet.......Lung cancer is the leading cause of cancer-related deaths worldwide. While cigarette smoking is of key importance, factors such as diet also play a role in the development of lung cancer. MedLine and Embase were searched with diet and lung cancer as the key words. Recently published reviews...... and large well designed original articles were preferred to form the basis for the present article. A diet rich in fruit and vegetables reduces the incidence of lung cancer by approximately 25%. The reduction is of the same magnitude in current smokers, ex-smokers and never smokers. Supplementation...

Lung Focused Resuscitation at a Specialized Donor Care Facility Improves Lung Procurement Rates.

Science.gov (United States)

Chang, Stephanie H; Kreisel, Daniel; Marklin, Gary F; Cook, Lindsey; Hachem, Ramsey; Kozower, Benjamin D; Balsara, Keki R; Bell, Jennifer M; Frederiksen, Christine; Meyers, Bryan F; Patterson, G Alexander; Puri, Varun

2018-05-01

Lung procurement for transplantation occurs in approximately 20% of brain dead donors and is a major impediment to wider application of lung transplantation. We investigated the effect of lung protective management at a specialized donor care facility on lung procurement rates from brain dead donors. Our local organ procurement organization instituted a protocol of lung protective management at a freestanding specialized donor care facility in 2008. Brain dead donors from 2001 to 2007 (early period) were compared with those from 2009 to 2016 (current period) for lung procurement rates and other solid-organ procurement rates using a prospectively maintained database. An overall increase occurred in the number of brain dead donors during the study period (early group, 791; late group, 1,333; p procurement rate (lung donors/all brain dead donors) improved markedly after the introduction of lung protective management (early group, 157 of 791 [19.8%]; current group, 452 of 1,333 [33.9%]; p procurement rate (total number of organs procured/donor) also increased during the study period (early group, 3.5 organs/donor; current group, 3.8 organs/donor; p = 0.006). Lung protective management in brain dead donors at a specialized donor care facility is associated with higher lung utilization rates compared with conventional management. This strategy does not adversely affect the utilization of other organs in a multiorgan donor. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Lung cancer in women

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Barrera-Rodriguez R

2012-12-01

Full Text Available Raúl Barrera-Rodriguez,1 Jorge Morales-Fuentes2 1Biochemistry and Environmental Medicine Laboratory, National Institute of Respiratory Disease, 2Lung Cancer Medical Service, National Institute of Respiratory Disease, Tlalpan, Mexico City, Distrito Federal, Mexico Both authors contributed equally to this workAbstract: Recent biological advances in tumor research provide clear evidence that lung cancer in females is different from that in males. These differences appear to have a direct impact on the clinical presentation, histology, and outcomes of lung cancer. Women are more likely to present with lung adenocarcinoma, tend to receive a diagnosis at an earlier age, and are more likely to be diagnosed with localized disease. Women may also be more predisposed to molecular aberrations resulting from the carcinogenic effects of tobacco, but do not appear to be more susceptible than men to developing lung cancer. The gender differences found in female lung cancer make it mandatory that gender stratification is used in clinical trials in order to improve the survival rates of patients with lung cancer.Keywords: lung cancer, adenocarcinoma, women, genetic susceptibility, genetic differences, tobacco

Heterogeneity in pineapple fruit quality results from plant heterogeneity at flower induction.

Science.gov (United States)

Fassinou Hotegni, V Nicodème; Lommen, Willemien J M; Agbossou, Euloge K; Struik, Paul C

2014-01-01

Heterogeneity in fruit quality constitutes a major constraint in agri-food chains. In this paper the sources of the heterogeneity in pineapple in the field were studied in four experiments in commercial pineapple fields. The aims were to determine (a) whether differences in pineapple fruit quality among individual fruits are associated with differences in vigor of the individual plants within the crop at the time of artificial flower induction; and (b) whether the side shoots produced by the plant during the generative phase account for the fruit quality heterogeneity. Two pineapple cultivars were considered: cv. Sugarloaf and cv. Smooth Cayenne. Plant vigor at the time of artificial flower induction was measured by three variates: the number of functional leaves, the D-leaf length and their cross product. Fruit quality attributes measured at harvest time included external attributes (weight and height of fruit, infructescence and crown) and internal quality attributes [total soluble solids (TSS), pH, translucent flesh]. Results showed that the heterogeneity in fruit weight was a consequence of the heterogeneity in vigor of the plants at the moment of flower induction; that effect was mainly on the infructescence weight and less or not on the crown weight. The associations between plant vigor variates at flower induction and the internal quality attributes of the fruit were poor and/or not consistent across experiments. The weight of the slips (side shoots) explained part of the heterogeneity in fruit weight, infructescence weight and fruit height in cv. Sugarloaf. Possibilities for reducing the variation in fruit quality by precise cultural practices are discussed.

Heterogeneity in pineapple fruit quality results from plant heterogeneity at flower induction

Directory of Open Access Journals (Sweden)

V. Nicodeme eFassinou Hotegni

2014-12-01

Full Text Available Heterogeneity in fruit quality constitutes a major constraint in agri-food chains. In this paper the sources of the heterogeneity in pineapple in the field were studied in four experiments in commercial pineapple fields. The aims were to determine (a whether differences in pineapple fruit quality among individual fruits are associated with differences in vigor of the individual plants within the crop at the time of artificial flower induction; and (b whether the side shoots produced by the plant during the generative phase account for the fruit quality heterogeneity. Two pineapple cultivars were considered: cv. Sugarloaf and cv. Smooth Cayenne. Plant vigor at the time of artificial flower induction was measured by three variates: the number of functional leaves, the D-leaf length and their cross product. Fruit quality attributes measured at harvest time included external attributes (weight and height of fruit, infructescence and crown and internal quality attributes (total soluble solids, pH, translucent flesh. Results showed that the heterogeneity in fruit weight was a consequence of the heterogeneity in vigor of the plants at the moment of flower induction; that effect was mainly on the infructescence weight and less or not on the crown weight. The association between plant vigor variates at flower induction and the internal quality attributes of the fruit were poor and/or not consistent across experiments. The weight of the slips (side shoots, explained part of the heterogeneity in fruit weight, infructescence weight and fruit height in cv. Sugarloaf. Possibilities for reducing the variation in fruit quality by precise cultural practices are discussed.

Lung Cancer

Science.gov (United States)

Lung cancer is one of the most common cancers in the world. It is a leading cause of cancer death in men and women in the United States. Cigarette smoking causes most lung cancers. The more cigarettes you smoke per day and ...

Lung cancer after internal alpha-exposure of the lung from incorporated plutonium

International Nuclear Information System (INIS)

Mikhail, S.

2004-01-01

Several epidemiological studies among workers of first Russian nuclear complex Mayak which produced weapon-grade plutonium showed significant increase of lung cancer mortality. The estimated shape of the dose-response was linear with both alpha and gamma dose but risk coefficients for gamma-exposure are on the edge of the significance level. This study was performed in the cohort of male Mayak nuclear workers initially hired in 1948-1958 with known levels of plutonium exposure. Number of observed lung cancer cases available for analyses in this cohort was 217. The relative risk of death from lung cancer among smokers was 10.7 (5.5-25.2) comparatively to non-smokers. This is in good correspondence with results of other studies. The excess relative risk per one Gray was 63. (4.1-9.7) for internal alpha-exposure and 0.18 (0.01-0.5) for external gamma-exposure. According to a model this gives 16:112:60:29 cases of lung cancer attributed to background, smoking, internal alpha-and external gamma-exposure, correspondingly. The relative risks of death from lung cancer were also estimated in a nested case-control study with lung cancer deaths as cases. Controls were selected from the cohort and matched for birth year to account for trend in lung cancer mortality with time. The analyses with nested case-control approach gave relative risks for smoking 14.7 (6.8-38.9). Relative risk of lung cancer among non-smokers after accumulating 0.34 Gy of alpha-exposure to lung was 3.7 (1.7-9.0). It should be emphasized that in fact after accumulation 0.3-0.4 Gy of absorbed dose 3-4 fold increase in lung cancer mortality was observed. This dose is very close to the dose which would be produced after intake of plutonium in quantities which are permissible today. (Author)

Metastatic tumors of lungs

International Nuclear Information System (INIS)

Rozenshtraukh, L.C.; Rybakova, N.I.; Vinner, M.G.

1987-01-01

Roentgenologic semiotics of lung metastases and their complications, as well as peculiarities of lung metastases of separate localization tumours are presented. Definition table for primary tumour by roentgenologic aspect of lung metastases is given

Caso de estudo: a entrada do azeite Gallo no mercado chinês

OpenAIRE

Costa, Miguel Maria Portugal Martins

2014-01-01

Mestrado em Gestão 7 Classificação JEL: M16; F23 A elaboração desta dissertação consiste na criação de um caso de estudo pedagógico com o objectivo de tirar ilações sobre a entrada da marca “Azeite Gallo” no mercado Chinês. Optamos por desenvolver este caso de estudo através de um estudo qualitativo, suportado por um referencial teórico. O intuito do projecto é de documentar um exemplo paradigmático de um produto consumível de marca portuguesa que sucedeu em ultrapassar as barreiras ...

Helical Tomotherapy Planning for Lung Cancer Based on Ventilation Magnetic Resonance Imaging

Energy Technology Data Exchange (ETDEWEB)

Cai Jing; McLawhorn, Robert [Department of Radiation Oncology, University of Virginia, Charlottesville, VA (United States); Altes, Tallisa A.; Lange, Eduard de [Department of Radiology, University of Virginia, Charlottesville, VA (United States); Read, Paul W.; Larner, James M.; Benedict, Stanley H. [Department of Radiation Oncology, University of Virginia, Charlottesville, VA (United States); Sheng Ke, E-mail: ks2mc@virginia.edu [Department of Radiation Oncology, University of Virginia, Charlottesville, VA (United States)

2011-01-01

To investigate the feasibility of lung ventilation-based treatment planning, computed tomography and hyperpolarized (HP) helium-3 (He-3) magnetic resonance imaging (MRI) ventilation images of 6 subjects were coregistered for intensity-modulated radiation therapy planning in Tomotherapy. Highly-functional lungs (HFL) and less-functional lungs (LFL) were contoured based on their ventilation image intensities, and a cylindrical planning-target-volume was simulated at locations adjacent to both HFL and LFL. Annals of an anatomy-based plan (Plan 1) and a ventilation-based plan (Plan 2) were generated. The following dosimetric parameters were determined and compared between the 2 plans: percentage of total/HFL volume receiving {>=}20 Gy, 15 Gy, 10 Gy, and 5 Gy (TLV{sub 20}, HFLV{sub 20}, TLV{sub 15}, HFLV{sub 15}, TLV{sub 10}, HFLV{sub 10}, TLV{sub 5}, HFLV{sub 5}), mean total/HFL dose (MTLD/HFLD), maximum doses to all organs at risk (OARs), and target dose conformality. Compared with Plan 1, Plan 2 reduced mean HFLD (mean reduction, 0.8 Gy), MTLD (mean reduction, 0.6 Gy), HFLV{sub 20} (mean reduction, 1.9%), TLV{sub 20} (mean reduction, 1.5%), TLV{sub 15} (mean reduction, 1.7%), and TLV{sub 10} (mean reduction, 2.1%). P-values of the above comparisons are less than 0.05 using the Wilcoxon signed rank test. For HFLV{sub 15}, HFLV{sub 10}, TLV{sub 5}, and HTLV{sub 5}, Plan 2 resulted in lower values than plan 1 but the differences are not significant (P-value range, 0.063-0.219). Plan 2 did not significantly change maximum doses to OARs (P-value range, 0.063-0.563) and target conformality (P = 1.000). HP He-3 MRI of patients with lung disease shows a highly heterogeneous ventilation capacity that can be utilized for functional treatment planning. Moderate but statistically significant improvements in sparing functional lungs were achieved using helical tomotherapy plans.

Lung cancer - non-small cell

Science.gov (United States)

Cancer - lung - non-small cell; Non-small cell lung cancer; NSCLC; Adenocarcinoma - lung; Squamous cell carcinoma - lung ... Research shows that smoking marijuana may help cancer cells grow. But there is no direct link between ...

Dosimetric lung models

International Nuclear Information System (INIS)

James, A.C.; Roy, M.

1986-01-01

The anatomical and physiological factors that vary with age and influence the deposition of airborne radionuclides in the lung are reviewed. The efficiency with which aerosols deposit in the lung for a given exposure at various ages from birth to adulthood is evaluated. Deposition within the lung is considered in relation to the clearance mechanisms acting in different regions or compartments. The procedure for evaluating dose to sensitive tissues in lung and transfer to other organs that is being considered by the Task Group established by ICRP to review the Lung Model is outlined. Examples of the application of this modelling procedure to evaluate lung dose as a function of age are given, for exposure to radon daughters in dwellings, and for exposure to an insoluble 239 Pu aerosol. The former represents exposure to short-lived radionuclides that deliver relatively high doses to bronchial tissue. In this case, dose rates are marginally higher in children than in adults. Plutonium exposure represents the case where dose is predominantly delivered to respiratory tissue and lymph nodes. In this case, the life-time doses tend to be lower for exposure in childhood. Some of the uncertainties in this modelling procedure are noted

IMPACTOS MICROCLIMÁTICOS DO DESENHO URBANO: ESTUDOS REALIZADOS EM CURITIBA

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Eduardo KRUGER

2011-04-01

Full Text Available O artigo busca compreender as relações entre atributos da geometria urbana e alterações no microclima. São apresentados dois estudos distintos conduzidos na mesma área central de Curitiba, PR, a partir de medições de campo realizadas em 2009 e de simulações de clima urbano no software ENVI-met. Os estudos, embora utilizem a mesma campanha de coleta de dados, possuem objetivos e metodologias diferentes. O primeiro estudo foca no impacto da geometria urbana, na temperatura ambiente e nos níveis de conforto em ruas de pedestre no período diurno, sendo o fator de visão do céu utilizado como indicador da complexa geometria urbana. O segundo estudo trata do impacto da orientação das vias em relação ao vento dominante, quanto às taxas de ventilação resultantes (velocidade do ar e distribuição espacial, visando à dispersão de poluentes gerados pelo tráfego, no contexto urbano. Os resultados auferidos evidenciam a influência da forma urbana para a determinação do conforto térmico em ruas de pedestres, restringindo-se a um período diurno específico, e para a criação de cenários de poluição.

Lung abscess

International Nuclear Information System (INIS)

Ha, H.K.; Kang, M.W.; Park, J.M.; Yang, W.J.; Shinn, K.S.; Bahk, Y.W.

1993-01-01

Lung abscess was successfully treated with percutaneous drainage in 5 of 6 patients. Complete abscess resolution occurred in 4 patients, partial resolution in one, and no response in one. The duration of drainage ranged from 7 to 18 days (mean 15.5 days) in successful cases. The failure of drainage in one neurologicall impaired patient was attributed to persistent aspiration. In 2 patients, concurrent pleural empyema was also cured. CT provided the anatomic details necessary for choosing the puncture site and avoiding puncture of the lung parenchyma. Percutaneous catheter drainage is a safe and effective method for treating lung abscess. (orig.)

Lung function

International Nuclear Information System (INIS)

Sorichter, S.

2009-01-01

The term lung function is often restricted to the assessment of volume time curves measured at the mouth. Spirometry includes the assessment of lung volumes which can be mobilised with the corresponding flow-volume curves. In addition, lung volumes that can not be mobilised, such as the residual volume, or only partially as FRC and TLC can be measured by body plethysmography combined with the determination of the airway resistance. Body plethysmography allows the correct positioning of forced breathing manoeuvres on the volume-axis, e.g. before and after pharmacotherapy. Adding the CO single breath transfer factor (T LCO ), which includes the measurement of the ventilated lung volume using He, enables a clear diagnosis of different obstructive, restrictive or mixed ventilatory defects with and without trapped air. Tests of reversibility and provocation, as well as the assessment of inspiratory mouth pressures (PI max , P 0.1 ) help to classify the underlying disorder and to clarify treatment strategies. For further information and to complete the diagnostic of disturbances of the ventilation, diffusion and/or perfusion (capillar-)arterial bloodgases at rest and under physical strain sometimes amended by ergospirometry are recommended. Ideally, lung function measurements are amended by radiological and nuclear medicine techniques. (orig.) [de

Comparison of lung protective ventilation strategies in a rabbit model of acute lung injury.

Science.gov (United States)

Rotta, A T; Gunnarsson, B; Fuhrman, B P; Hernan, L J; Steinhorn, D M

2001-11-01

To determine the impact of different protective and nonprotective mechanical ventilation strategies on the degree of pulmonary inflammation, oxidative damage, and hemodynamic stability in a saline lavage model of acute lung injury. A prospective, randomized, controlled, in vivo animal laboratory study. Animal research facility of a health sciences university. Forty-six New Zealand White rabbits. Mature rabbits were instrumented with a tracheostomy and vascular catheters. Lavage-injured rabbits were randomized to receive conventional ventilation with either a) low peak end-expiratory pressure (PEEP; tidal volume of 10 mL/kg, PEEP of 2 cm H2O); b) high PEEP (tidal volume of 10 mL/kg, PEEP of 10 cm H2O); c) low tidal volume with PEEP above Pflex (open lung strategy, tidal volume of 6 mL/kg, PEEP set 2 cm H2O > Pflex); or d) high-frequency oscillatory ventilation. Animals were ventilated for 4 hrs. Lung lavage fluid and tissue samples were obtained immediately after animals were killed. Lung lavage fluid was assayed for measurements of total protein, elastase activity, tumor necrosis factor-alpha, and malondialdehyde. Lung tissue homogenates were assayed for measurements of myeloperoxidase activity and malondialdehyde. The need for inotropic support was recorded. Animals that received a lung protective strategy (open lung or high-frequency oscillatory ventilation) exhibited more favorable oxygenation and lung mechanics compared with the low PEEP and high PEEP groups. Animals ventilated by a lung protective strategy also showed attenuation of inflammation (reduced tracheal fluid protein, tracheal fluid elastase, tracheal fluid tumor necrosis factor-alpha, and pulmonary leukostasis). Animals treated with high-frequency oscillatory ventilation had attenuated oxidative injury to the lung and greater hemodynamic stability compared with the other experimental groups. Both lung protective strategies were associated with improved oxygenation, attenuated inflammation, and

Heterogeneity in pineapple fruit quality results from plant heterogeneity at flower induction

NARCIS (Netherlands)

Fassinou Hotegni, V.N.; Lommen, W.J.M.; Agbossou, E.K.; Struik, P.C.

2014-01-01

Heterogeneity in fruit quality constitutes a major constraint in agri-food chains. In this paper the sources of the heterogeneity in pineapple in the field were studied in four experiments in commercial pineapple fields. The aims were to determine (a) whether differences in pineapple fruit quality

Association Between RT-Induced Changes in Lung Tissue Density and Global Lung Function

International Nuclear Information System (INIS)

Ma Jinli; Zhang Junan; Zhou Sumin; Hubbs, Jessica L.; Foltz, Rodney J.; Hollis, Donna R.; Light, Kim L.; Wong, Terence Z.; Kelsey, Christopher R.; Marks, Lawrence B.

2009-01-01

Purpose: To assess the association between radiotherapy (RT)-induced changes in computed tomography (CT)-defined lung tissue density and pulmonary function tests (PFTs). Methods and Materials: Patients undergoing incidental partial lung RT were prospectively assessed for global (PFTs) and regional (CT and single photon emission CT [SPECT]) lung function before and, serially, after RT. The percent reductions in the PFT and the average changes in lung density were compared (Pearson correlations) in the overall group and subgroups stratified according to various clinical factors. Comparisons were also made between the CT- and SPECT-based computations using the Mann-Whitney U test. Results: Between 1991 and 2004, 343 patients were enrolled in this study. Of these, 111 patients had a total of 203 concurrent post-RT evaluations of changes in lung density and PFTs available for the analyses, and 81 patients had a total of 141 concurrent post-RT SPECT images. The average increases in lung density were related to the percent reductions in the PFTs, albeit with modest correlation coefficients (range, 0.20-0.43). The analyses also indicated that the association between lung density and PFT changes is essentially equivalent to the corresponding association with SPECT-defined lung perfusion. Conclusion: We found a weak quantitative association between the degree of increase in lung density as defined by CT and the percent reduction in the PFTs.

Radiation Therapy for Lung Cancer

Science.gov (United States)

... is almost always due to smoking. TREATING LUNG CANCER Lung cancer treatment depends on several factors, including the ... org TARGETING CANCER CARE Radiation Therapy for Lung Cancer Lung cancer is the second most common cancer in ...

Genetic alterations in lung cancer: Assessing limitations in routine clinical use

Directory of Open Access Journals (Sweden)

Joana Espiga Macedo

2007-01-01

das técnicas da genética molecular no estudo do cancro do pulmão, o seu uso na rotina clínica em Portugal tem sido limitado.No presente estudo, utilizou-se a pesquisa de mutações no anti-oncogene p53 em amostras clínicas de doentes com diagnóstico de cancro do pulmão como método para identificar as dificuldades práticas à integração da genética molecular na rotina clínica. Os resultados obtidos sugerem que o principal factor limitante a essa integração é a obtenção de amostras de ADN de qualidade, um problema que pode ser superado pela alteração das práticas correntes de recolha de amostras. Key-words: Cancer, lung, clinical, molecular genetics, mutation, p53, Palavras-chave: Cancro, pulmão, clínica, genética molecular, mutação, p53

Efeito da exposição prolongada a ruído ocupacional na função respiratória de trabalhadores da indústria têxtil Effects of long term exposure to occupational noise on textile industry workers' lung function

Directory of Open Access Journals (Sweden)

António Paes Cardoso

2006-01-01

Full Text Available O presente estudo procurou detectar eventuais alterações da função respiratória em 28 operárias de uma fábrica de fiação, submetidas a uma exposição prolongada ao ruído (> 10 anos com amplitude elevada e baixa frequência, susceptível de causar doença vibro-acústica (DVA. Foram realizados testes da função respiratória, incluindo espirometria, oscilometria de impulso e estudo da Capacidade de difusão alvéolo-capilar pelo CO. Os resultados foram comparados com os de outra população de igual número de mulheres, do mesmo grupo etário, consideradas normais no aspecto respiratório, com cargos administrativos, não sujeitas a agressão acústica detectável. Realizou-se um estudo estatístico dos resultados obtidos comparando as duas populações, tendo sido calculado para cada um dos parâmetros, escolhidos a partir do estudo funcional respiratório, os valores médios, o desvio-padrão e o grau de significância (pVibroacoustic disease is a pathology caused by long occupational exposure to large pressure amplitude and low frequency noise. It is a systemic disease, with evolvement of respiratory structures. The exposure workers to this noise of textile industry may favour alterations in lung function. We studied 28 women working more than ten years in cotton-mill rooms to evaluate their lung function, including Spirometry, forced oscillation technique (I.O.S. and Diffusion capacity. These results were compared with those of 30 women of similar ages not exposed to similar noise and not presenting respiratory disease. Statistical significance (p <0.05 was found with FEV25, R5 and D Rs5-Rs20. There was a resistance frequency dependence in 36% of the population exposed to noise, not statistically confirmed. Neither restriction nor changes in diffusing capacity where detected. Conclusion: The analysis of global alterations of lung function parameters suggests small airways aggression by noise. However we cannot definitively exclude

SU-F-T-415: Differences in Lung Sparing in Deep Inspiration Breath-Hold and Free Breathing Breast Plans Calculated in Pinnacle and Monaco

Energy Technology Data Exchange (ETDEWEB)

Saenz, D; Stathakis, S [University of Texas Health Science Center San Antonio, San Antonio, TX (United States)

2016-06-15

Purpose: Deep inspiration breath-hold (DIBH) is used for left-sided breast radiotherapy to spare the heart and lung. The magnitude of sparing has been shown to be significant. Monte Carlo, furthermore, has the potential to calculate most accurately the dose in the heterogeneous lung medium at the interface with the lung wall. The lung dose was investigated in Monaco to determine the level of sparing relative to that calculated in Pinnacle{sup 3}. Methods: Five patients undergoing DIBH radiotherapy on an Elekta Versa HD linear accelerator in conjunction with the Catalyst C-RAD surface imaging system were planned using Phillips Pinnacle{sup 3}. Free breathing plans were also created to clinically assure a benefit. Both plans were re-calculated in Monaco to determine if there were any significant differences. The mean heart dose, mean left lung, and mean total lung dose were compared in addition to the V20 for left and both lungs. Dose was calculated as dose to medium as well as dose to water with a statistical precision of 0.7%. Results: Mean lung dose was significantly different (p < 0.003) between the two calculations for both DIBH (11.6% higher in Monaco) and free breathing (14.2% higher in Monaco). V20 was also higher in Monaco (p < 0.05) for DIBH (5.7% higher) and free breathing (4.9% higher). The mean heart dose was not significantly different between the dose calculations for either DIBH or free breathing. Results were no more than 0.1% different when calculated as dose to water. Conclusion: The use of Monte Carlo can provide insight on the lung dose for both free breathing and DIBH techniques for whole breast irradiation. While the sparing (dose reductions with DIBH as compared to free breathing) is equivalent for either planning system, the lung doses themselves are higher when calculated with Monaco.

Genetics Home Reference: lung cancer

Science.gov (United States)

... Share: Email Facebook Twitter Home Health Conditions Lung cancer Lung cancer Printable PDF Open All Close All Enable Javascript ... cancer, childhood Additional NIH Resources (3 links) National Cancer Institute: Lung Cancer Overview National Cancer Institute: Lung Cancer Prevention ...

Ultrasound-guided intrapleural positioning of pleural catheters: influence on immediate lung expansion and pleurodesis in patients with recurrent malignant pleural effusion.

Science.gov (United States)

Araujo, Pedro Henrique Xavier Nabuco de; Terra, Ricardo Mingarini; Santos, Thiago da Silva; Chate, Rodrigo Caruso; Paiva, Antonio Fernando Lins de; Pêgo-Fernandes, Paulo Manuel

2017-01-01

To evaluate the role of intrapleural positioning of a pleural catheter in early lung expansion and pleurodesis success in patients with recurrent malignant pleural effusion (RMPE). This was a retrospective study nested into a larger prospective cohort study including patients with RMPE recruited from a tertiary university teaching hospital between June of 2009 and September of 2014. The patients underwent pleural catheter insertion followed by bedside pleurodesis. Chest CT scans were performed twice: immediately before pleurodesis (iCT) and 30 days after pleurodesis (CT30). Catheter positioning was categorized based on iCT scans as posterolateral, anterior, fissural, and subpulmonary. We used the pleural volume on iCT scans to estimate early lung expansion and the difference between the pleural volumes on CT30 and iCT scans to evaluate radiological success of pleurodesis. Clinical pleurodesis success was defined as no need for any other pleural procedure. Of the 131 eligible patients from the original study, 85 were included in this nested study (64 women; mean age: 60.74 years). Catheter tip positioning was subpulmonary in 35 patients (41%), anterior in 23 (27%), posterolateral in 17 (20%), and fissural in 10 (12%). No significant differences were found among the groups regarding early lung expansion (median residual pleural cavity = 377 mL; interquartile range: 171-722 mL; p = 0.645), radiological success of pleurodesis (median volume = 33 mL; interquartile range: -225 to 257 mL; p = 0.923), and clinical success of pleurodesis (85.8%; p = 0.676). Our results suggest that the position of the tip of the pleural catheter influences neither early lung expansion nor bedside pleurodesis success in patients with RMPE. Avaliar o papel do posicionamento intrapleural do cateter pleural na expansão pulmonar precoce e no sucesso da pleurodese em pacientes com derrame pleural maligno recorrente (DPMR). Trata-se de um estudo retrospectivo aninhado em um estudo prospectivo de

Estimation of Lung Ventilation

Science.gov (United States)

Ding, Kai; Cao, Kunlin; Du, Kaifang; Amelon, Ryan; Christensen, Gary E.; Raghavan, Madhavan; Reinhardt, Joseph M.

Since the primary function of the lung is gas exchange, ventilation can be interpreted as an index of lung function in addition to perfusion. Injury and disease processes can alter lung function on a global and/or a local level. MDCT can be used to acquire multiple static breath-hold CT images of the lung taken at different lung volumes, or with proper respiratory control, 4DCT images of the lung reconstructed at different respiratory phases. Image registration can be applied to this data to estimate a deformation field that transforms the lung from one volume configuration to the other. This deformation field can be analyzed to estimate local lung tissue expansion, calculate voxel-by-voxel intensity change, and make biomechanical measurements. The physiologic significance of the registration-based measures of respiratory function can be established by comparing to more conventional measurements, such as nuclear medicine or contrast wash-in/wash-out studies with CT or MR. An important emerging application of these methods is the detection of pulmonary function change in subjects undergoing radiation therapy (RT) for lung cancer. During RT, treatment is commonly limited to sub-therapeutic doses due to unintended toxicity to normal lung tissue. Measurement of pulmonary function may be useful as a planning tool during RT planning, may be useful for tracking the progression of toxicity to nearby normal tissue during RT, and can be used to evaluate the effectiveness of a treatment post-therapy. This chapter reviews the basic measures to estimate regional ventilation from image registration of CT images, the comparison of them to the existing golden standard and the application in radiation therapy.

Heterogeneity effects in neutron transport computations

International Nuclear Information System (INIS)

Gelbard, E.M.

1975-01-01

A nuclear reactor is, generally, an intricate heterogeneous structure whose adjacent components may differ radically in their neutronic properties. The heterogeneities in the structure of the reactor complicate the work of the reactor analyst and tend to degrade the efficiency of the numerical methods used in reactor computations. Two types of heterogeneity effects are considered. First, certain singularities in the solution of the neutron transport equation, induced by heterogeneities, are briefly described. Second, the effect of heterogeneities on neutron leakage rates, and consequently on effective diffusion coefficients, are discussed. (5 figures) (U.S.)

Heterogeneity of pulmonary perfusion as a mechanistic image-based phenotype in emphysema susceptible smokers.

Science.gov (United States)

Alford, Sara K; van Beek, Edwin J R; McLennan, Geoffrey; Hoffman, Eric A

2010-04-20

Recent evidence suggests that endothelial dysfunction and pathology of pulmonary vascular responses may serve as a precursor to smoking-associated emphysema. Although it is known that emphysematous destruction leads to vasculature changes, less is known about early regional vascular dysfunction which may contribute to and precede emphysematous changes. We sought to test the hypothesis, via multidetector row CT (MDCT) perfusion imaging, that smokers showing early signs of emphysema susceptibility have a greater heterogeneity in regional perfusion parameters than emphysema-free smokers and persons who had never smoked (NS). Assuming that all smokers have a consistent inflammatory response, increased perfusion heterogeneity in emphysema-susceptible smokers would be consistent with the notion that these subjects may have the inability to block hypoxic vasoconstriction in patchy, small regions of inflammation. Dynamic ECG-gated MDCT perfusion scans with a central bolus injection of contrast were acquired in 17 NS, 12 smokers with normal CT imaging studies (SNI), and 12 smokers with subtle CT findings of centrilobular emphysema (SCE). All subjects had normal spirometry. Quantitative image analysis determined regional perfusion parameters, pulmonary blood flow (PBF), and mean transit time (MTT). Mean and coefficient of variation were calculated, and statistical differences were assessed with one-way ANOVA. MDCT-based MTT and PBF measurements demonstrate globally increased heterogeneity in SCE subjects compared with NS and SNI subjects but demonstrate similarity between NS and SNI subjects. These findings demonstrate a functional lung-imaging measure that provides a more mechanistically oriented phenotype that differentiates smokers with and without evidence of emphysema susceptibility.

The concentration of iron in real-world geogenic PM₁₀ is associated with increased inflammation and deficits in lung function in mice.

Directory of Open Access Journals (Sweden)

Graeme R Zosky

Full Text Available BACKGROUND: There are many communities around the world that are exposed to high levels of particulate matter <10 µm (PM₁₀ of geogenic (earth derived origin. Mineral dusts in the occupational setting are associated with poor lung health, however very little is known about the impact of heterogeneous community derived particles. We have preliminary evidence to suggest that the concentration of iron (Fe may be associated with the lung inflammatory response to geogenic PM₁₀. We aimed to determine which physico-chemical characteristics of community sampled geogenic PM₁₀ are associated with adverse lung responses. METHODS: We collected geogenic PM₁₀ from four towns in the arid regions of Western Australia. Adult female BALB/c mice were exposed to 100 µg of particles and assessed for inflammatory and lung function responses 6 hours, 24 hours and 7 days post-exposure. We assessed the physico-chemical characteristics of the particles and correlated these with lung outcomes in the mice using principal components analysis and multivariate linear regression. RESULTS: Geogenic particles induced an acute inflammatory response that peaked 6 hours post-exposure and a deficit in lung mechanics 7 days post-exposure. This deficit in lung mechanics was positively associated with the concentration of Fe and particle size variability and inversely associated with the concentration of Si. CONCLUSIONS: The lung response to geogenic PM₁₀ is complex and highly dependent on the physico-chemical characteristics of the particles. In particular, the concentration of Fe in the particles may be a key indicator of the potential population health consequences for inhaling geogenic PM₁₀.

Treatment of intractable interstitial lung injury with alemtuzumab after lung transplantation

DEFF Research Database (Denmark)

Kohno, M; Perch, M; Andersen, E

2011-01-01

A 44-year-old woman underwent left single-lung transplantation for end-stage emphysema due to α1-antitrypsin deficiency in January 2010. Cyclosporine, azathioprine, and prednisolone were administered for immunosuppression and antithymocyte globulin for induction therapy at the time...... of transplantation. Routine examination of a lung biopsy, 4 months after transplantation, showed nonspecific, diffuse interstitial inflammation with alveolar septal fibrosis. The patient's clinical status and imaging studies, consistent with nonspecific interstitial pneumonitis, which was considered as signs......, posttransplant antirejection drug regimen. We have since successfully treated with alemtuzumab three additional patients who developed interstitial lung injury after lung transplantation, who are also summarized in this report....

Circulating tumor DNA functions as an alternative for tissue to overcome tumor heterogeneity in advanced gastric cancer.

Science.gov (United States)

Gao, Jing; Wang, Haixing; Zang, Wanchun; Li, Beifang; Rao, Guanhua; Li, Lei; Yu, Yang; Li, Zhongwu; Dong, Bin; Lu, Zhihao; Jiang, Zhi; Shen, Lin

2017-09-01

Overcoming tumor heterogeneity is a major challenge for personalized treatment of gastric cancer, especially for human epidermal growth factor receptor-2 targeted therapy. Analysis of circulating tumor DNA allows a more comprehensive analysis of tumor heterogeneity than traditional biopsies in lung cancer and breast cancer, but little is known in gastric cancer. We assessed mutation profiles of ctDNA and primary tumors from 30 patients with advanced gastric cancer, then performed a comprehensive analysis of tumor mutations by multiple biopsies from five patients, and finally analyzed the concordance of HER2 amplification in ctDNA and paired tumor tissues in 70 patients. By comparing with a single tumor sample, ctDNA displayed a low concordance of mutation profile, only approximately 50% (138/275) somatic mutations were found in paired tissue samples, however, when compared with multiple biopsies, most DNA mutations in ctDNA were also shown in paired tumor tissues. ctDNA had a high concordance (91.4%, Kappa index = 0.784, P < 0.001) of HER2 amplification with tumor tissues, suggesting it might be an alternative for tissue. It implied that ctDNA-based assessment could partially overcome the tumor heterogeneity, and might serve as a potential surrogate for HER2 analysis in gastric cancer. © 2017 The Authors. Cancer Science published by John Wiley & Sons Australia, Ltd on behalf of Japanese Cancer Association.

um estudo de caso

OpenAIRE

Costa, Cátia Filipa Pereira da

2011-01-01

Dissertação apresentada à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Psicologia Jurídica As situações de abuso sexual de crianças nas quais o perpetrador pertence ao sexo feminino obtiveram ao longo dos últimos anos um acrescido reconhecimento por parte da comunidade científica, evidenciado pelo significativo incremento das investigações no âmbito desta temática consistindo na sua maioria estudos de caso. Um conjunto de particularidades encont...

Aprendizagem Organizacional, Teoria Ator-Rede e Estudos Foucaultianos: Tempo, Espaço e Poder

OpenAIRE

Bruno Luiz Américo

2016-01-01

Esse trabalho baseia-se no mapeamento de lacunas encontradas nos desenvolvimentos dos estudos organizacionais de conhecimento e aprendizagem, e busca contribuir para a consolidação da aprendizagem organizacional como uma teoria do movimento organizacional/social. Para isso, propõe diálogo entre a Perspectiva Social-Política da Aprendizagem social, a Teoria Ator-Rede e os estudos foucaultianos. O trabalho conclui destacando o potencial da teoria ator-rede e dos estudos foucaultianos para anali...

Monte Carlo Investigation on the Effect of Heterogeneities on Strut Adjusted Volume Implant (SAVI) Dosimetry

Science.gov (United States)

Koontz, Craig

Breast cancer is the most prevalent cancer for women with more than 225,000 new cases diagnosed in the United States in 2012 (ACS, 2012). With the high prevalence, comes an increased emphasis on researching new techniques to treat this disease. Accelerated partial breast irradiation (APBI) has been used as an alternative to whole breast irradiation (WBI) in order to treat occult disease after lumpectomy. Similar recurrence rates have been found using ABPI after lumpectomy as with mastectomy alone, but with the added benefit of improved cosmetic and psychological results. Intracavitary brachytherapy devices have been used to deliver the APBI prescription. However, inability to produce asymmetric dose distributions in order to avoid overdosing skin and chest wall has been an issue with these devices. Multi-lumen devices were introduced to overcome this problem. Of these, the Strut-Adjusted Volume Implant (SAVI) has demonstrated the greatest ability to produce an asymmetric dose distribution, which would have greater ability to avoid skin and chest wall dose, and thus allow more women to receive this type of treatment. However, SAVI treatments come with inherent heterogeneities including variable backscatter due to the proximity to the tissue-air and tissue-lung interfaces and variable contents within the cavity created by the SAVI. The dose calculation protocol based on TG-43 does not account for heterogeneities and thus will not produce accurate dosimetry; however Acuros, a model-based dose calculation algorithm manufactured by Varian Medical Systems, claims to accurately account for heterogeneities. Monte Carlo simulation can calculate the dosimetry with high accuracy. In this thesis, a model of the SAVI will be created for Monte Carlo, specifically using MCNP code, in order to explore the affects of heterogeneities on the dose distribution. This data will be compared to TG-43 and Acuros calculated dosimetry to explore their accuracy.

Is sweat chloride predictive of severity of cystic fibrosis lung disease assessed by chest computed tomography?

Science.gov (United States)

Caudri, Daan; Zitter, David; Bronsveld, Inez; Tiddens, Harm

2017-09-01

Cystic Fibrosis (CF) lung disease is characterized by a marked heterogeneity. Sweat chloride-level is a functional marker of the CF Transmembrane Regulator (CFTR) protein and could be an important predictor of later disease severity. In this retrospective analysis children from the Rotterdam CF clinic with available sweat chloride level at diagnosis and at least one routine spirometry-controlled volumetric chest CT scan in follow-up were included. CT scans were scored using the CF-CT scoring system (% of maximum). Associations between sweat chloride-levels and CF-CT scores were calculated using linear regression models, adjusting for age at sweat test and age at follow-up. Because structural lung damage develops over the course of many years, effect modification by the age at follow-up CT-scan was tested for by age-stratification. In 59 children (30 male) sweat chloride was measured at diagnosis (median age 0.5 years, range 0-13) and later chest CT performed (median age 14 years, range 6-18). Sweat chloride was associated with significantly higher CT-CT total score, bronchiectasis score, and mucus plugging score. Stratification for age at follow-up in tertiles showed this association remained only in the oldest age group (range 15-18 years). In that subgroup associations were found with all but one of the CF-CT subscores, as well as with all tested lung functions parameters. Sweat chloride-level is a significant predictor of CF lung disease severity as determined by chest CT and lung function. This association could only be demonstrated in children with follow-up to age 15 years and above. © 2017 Wiley Periodicals, Inc.

Precision cut lung slices as an efficient tool for in vitro lung physio-pharmacotoxicology studies.

Science.gov (United States)

Morin, Jean-Paul; Baste, Jean-Marc; Gay, Arnaud; Crochemore, Clément; Corbière, Cécile; Monteil, Christelle

2013-01-01

1.We review the specific approaches for lung tissue slices preparation and incubation systems and the research application fields in which lung slices proved to be a very efficient alternative to animal experimentation for biomechanical, physiological, pharmacological and toxicological approaches. 2.Focus is made on air-liquid interface dynamic organ culture systems that allow direct tissue exposure to complex aerosol and that best mimic in vivo lung tissue physiology. 3.A compilation of research applications in the fields of vascular and airway reactivity, mucociliary transport, polyamine transport, xenobiotic biotransformation, chemicals toxicology and complex aerosols supports the concept that precision cut lung slices are a very efficient tool maintaining highly differentiated functions similar to in vivo lung organ when kept under dynamic organ culture. They also have been successfully used for lung gene transfer efficiency assessment, for lung viral infection efficiency assessment, for studies of tissue preservation media and tissue post-conditioning to optimize lung tissue viability before grafting. 4.Taken all together, the reviewed studies point to a great interest for precision cut lung slices as an efficient and valuable alternative to in vivo lung organ experimentation.

Traumatic lung hernia

International Nuclear Information System (INIS)

Rabaza, M. J.; Alcazar, P. P.; Touma, C.

2001-01-01

Lung hernia is an uncommon entity that is defined as the protrusion of the lung parenchyma through a defect in the thoracic cavity. It is classified on the basis of its location (cervical, intercostal and diaphragmatic) and etiology (congenital and acquired). Acquired lung hernias can be further grouped as spontaneous, traumatic or pathological, depending on the responsible mechanism. Nearly half of them are secondary to chest trauma, whether penetrating or blunt. We present a case of lung hernia in a patient with penetrating chest trauma. The diagnosis was suspected from the radiographic images and was confirmed by computed tomography. We also review the literature concerning its classification and incidence, diagnostic methods used and treatment. (Author) 9 refs

Characterizing heterogeneous cellular responses to perturbations.

Science.gov (United States)

Slack, Michael D; Martinez, Elisabeth D; Wu, Lani F; Altschuler, Steven J

2008-12-09

Cellular populations have been widely observed to respond heterogeneously to perturbation. However, interpreting the observed heterogeneity is an extremely challenging problem because of the complexity of possible cellular phenotypes, the large dimension of potential perturbations, and the lack of methods for separating meaningful biological information from noise. Here, we develop an image-based approach to characterize cellular phenotypes based on patterns of signaling marker colocalization. Heterogeneous cellular populations are characterized as mixtures of phenotypically distinct subpopulations, and responses to perturbations are summarized succinctly as probabilistic redistributions of these mixtures. We apply our method to characterize the heterogeneous responses of cancer cells to a panel of drugs. We find that cells treated with drugs of (dis-)similar mechanism exhibit (dis-)similar patterns of heterogeneity. Despite the observed phenotypic diversity of cells observed within our data, low-complexity models of heterogeneity were sufficient to distinguish most classes of drug mechanism. Our approach offers a computational framework for assessing the complexity of cellular heterogeneity, investigating the degree to which perturbations induce redistributions of a limited, but nontrivial, repertoire of underlying states and revealing functional significance contained within distinct patterns of heterogeneous responses.

Magnetic resonance imaging biomarkers of chronic obstructive pulmonary disease prior to radiation therapy for non-small cell lung cancer

International Nuclear Information System (INIS)

Sheikh, Khadija; Capaldi, Dante P.I.; Hoover, Douglas A.; Palma, David A.; Yaremko, Brian P.; Parraga, Grace

2015-01-01

•Three imaging phenotypes of COPD and ventilation heterogeneity.•We examine relationships for non-tumour lobe ventilation voids and clinical tests.•Smoking history and airflow obstruction were diagnostics for imaging phenotypes. Three imaging phenotypes of COPD and ventilation heterogeneity. We examine relationships for non-tumour lobe ventilation voids and clinical tests. Smoking history and airflow obstruction were diagnostics for imaging phenotypes. In this prospectively planned interim-analysis, the prevalence of chronic obstructive lung disease (COPD) phenotypes was determined using magnetic resonance imaging (MRI) and X-ray computed tomography (CT) in non-small-cell-lung-cancer (NSCLC) patients. Stage-III-NSCLC patients provided written informed consent for pulmonary function tests, imaging and the 6-min-walk-test. Ventilation defect percent (VDP) and CT lung density (relative-of-CT-density-histogram <−950, RA 950 ) were measured. Patients were classified into three subgroups based on qualitative and quantitative COPD and tumour-specific imaging phenotypes: (1) tumour-specific ventilation defects (TSD), (2) tumour-specific and other ventilation defects without emphysema (TSD V ), and, (3) tumour-specific and other ventilation defects with emphysema (TSD VE ). Seventeen stage-III NSCLC patients were evaluated (68 ± 7 years, 7 M/10 F, mean FEV 1 = 77% pred ) including seven current and 10 ex-smokers and eight patients with a prior lung disease diagnosis. There was a significant difference for smoking history (p = .02) and FEV 1 /FVC (p = .04) for subgroups classified using quantitative imaging. Patient subgroups classified using qualitative imaging findings were significantly different for emphysema (RA 950 , p < .001). There were significant relationships for whole-lung VDP (p < .05), but not RECIST or tumour-lobe VDP measurements with pulmonary function and exercise measurements. Preliminary analysis for non-tumour burden ventilation abnormalities

The mean lung dose (MLD). Predictive criterion for lung damage

Energy Technology Data Exchange (ETDEWEB)

Geyer, Peter; Appold, Steffen [Dresden University of Technology (TU Dresden), Clinic and Polyclinic for Radiotherapy and Radiation Oncology, Carl Gustav Carus Medical Faculty, Dresden (Germany); Herrmann, Thomas

2015-07-15

The purpose of this work was to prove the validity of the mean lung dose (MLD), widely used in clinical practice to estimate the lung toxicity of a treatment plan, by reevaluating experimental data from mini pigs. A total of 43 mini pigs were irradiated in one of four dose groups (25, 29, 33, and 37 Gy). Two regimens were applied: homogeneous irradiation of the right lung or partial irradiation of both lungs - including parts with lower dose - but with similar mean lung doses. The animals were treated with five fractions with a linear accelerator applying a CT-based treatment plan. The clinical lung reaction (breathing frequency) and morphological changes in CT scans were examined frequently during the 48 weeks after irradiation. A clear dose-effect relationship was found for both regimens of the trial. However, a straightforward relationship between the MLD and the relative number of responders with respect to different grades of increased breathing frequency for both regimens was not found. A morphologically based parameter NTCP{sub lung} was found to be more suitable for this purpose. The dependence of this parameter on the MLD is markedly different for the two regimens. In clinical practice, the MLD can be used to predict lung toxicity of a treatment plan, except for dose values that could lead to severe side effects. In the latter mentioned case, limitations to the predictive value of the MLD are possible. Such severe developments of a radiation-induced pneumopathy are better predicted by the NTCP{sub lung} formalism. The predictive advantage of this parameter compared to the MLD seems to remain in the evaluation and comparison of widely differing dose distributions, like in the investigated trial. (orig.) [German] Es soll unter Reevaluation von Tierversuchsdaten am Minischwein geprueft werden, ob die in der klinischen Praxis zur Beurteilung der Lungentoxizitaet eines Bestrahlungsregims regelhaft verwendete mittlere Lungendosis (MLD) eine zuverlaessige

Estimation of gas and tissue lung volumes by MRI: functional approach of lung imaging.

Science.gov (United States)

Qanadli, S D; Orvoen-Frija, E; Lacombe, P; Di Paola, R; Bittoun, J; Frija, G

1999-01-01

The purpose of this work was to assess the accuracy of MRI for the determination of lung gas and tissue volumes. Fifteen healthy subjects underwent MRI of the thorax and pulmonary function tests [vital capacity (VC) and total lung capacity (TLC)] in the supine position. MR examinations were performed at inspiration and expiration. Lung volumes were measured by a previously validated technique on phantoms. Both individual and total lung volumes and capacities were calculated. MRI total vital capacity (VC(MRI)) was compared with spirometric vital capacity (VC(SP)). Capacities were correlated to lung volumes. Tissue volume (V(T)) was estimated as the difference between the total lung volume at full inspiration and the TLC. No significant difference was seen between VC(MRI) and VC(SP). Individual capacities were well correlated (r = 0.9) to static volume at full inspiration. The V(T) was estimated to be 836+/-393 ml. This preliminary study demonstrates that MRI can accurately estimate lung gas and tissue volumes. The proposed approach appears well suited for functional imaging of the lung.

Lung PET scan

Science.gov (United States)

... Chest PET scan; Lung positron emission tomography; PET - chest; PET - lung; PET - tumor imaging; ... Grainger & Allison's Diagnostic Radiology: A Textbook of Medical Imaging . 6th ed. Philadelphia, ...

HETEROGENEOUS INTEGRATION TECHNOLOGY

Science.gov (United States)

2017-08-24

AFRL-RY-WP-TR-2017-0168 HETEROGENEOUS INTEGRATION TECHNOLOGY Dr. Burhan Bayraktaroglu Devices for Sensing Branch Aerospace Components & Subsystems...Final September 1, 2016 – May 1, 2017 4. TITLE AND SUBTITLE HETEROGENEOUS INTEGRATION TECHNOLOGY 5a. CONTRACT NUMBER In-house 5b. GRANT NUMBER N/A...provide a structure for this review. The history and the current status of integration technologies in each category are examined and product examples are

Fluid biopsy for circulating tumor cell identification in patients with early-and late-stage non-small cell lung cancer: a glimpse into lung cancer biology

International Nuclear Information System (INIS)

Wendel, Marco; Kolatkar, Anand; Honnatti, Meghana; Cho, Edward H; Marrinucci, Dena; Kuhn, Peter

2012-01-01

Circulating tumor cell (CTC) counts are an established prognostic marker in metastatic prostate, breast and colorectal cancer, and recent data suggest a similar role in late stage non-small cell lung cancer (NSCLC). However, due to sensitivity constraints in current enrichment-based CTC detection technologies, there are few published data about CTC prevalence rates and morphologic heterogeneity in early-stage NSCLC, or the correlation of CTCs with disease progression and their usability for clinical staging. We investigated CTC counts, morphology and aggregation in early stage, locally advanced and metastatic NSCLC patients by using a fluid-phase biopsy approach that identifies CTCs without relying on surface-receptor-based enrichment and presents them in sufficiently high definition (HD) to satisfy diagnostic pathology image quality requirements. HD-CTCs were analyzed in blood samples from 78 chemotherapy-naïve NSCLC patients. 73% of the total population had a positive HD-CTC count (>0 CTC in 1 mL of blood) with a median of 4.4 HD-CTCs mL −1 (range 0–515.6) and a mean of 44.7 (±95.2) HD-CTCs mL −1 . No significant difference in the medians of HD-CTC counts was detected between stage IV (n = 31, range 0–178.2), stage III (n = 34, range 0–515.6) and stages I/II (n = 13, range 0–442.3). Furthermore, HD-CTCs exhibited a uniformity in terms of molecular and physical characteristics such as fluorescent cytokeratin intensity, nuclear size, frequency of apoptosis and aggregate formation across the spectrum of staging. Our results demonstrate that despite stringent morphologic inclusion criteria for the definition of HD-CTCs, the HD-CTC assay shows high sensitivity in the detection and characterization of both early- and late-stage lung cancer CTCs. Extensive studies are warranted to investigate the prognostic value of CTC profiling in early-stage lung cancer. This finding has implications for the design of extensive studies examining screening, therapy and

Postoperative complications do not influence the pattern of early lung function recovery after lung resection for lung cancer in patients at risk.

Science.gov (United States)

Ercegovac, Maja; Subotic, Dragan; Zugic, Vladimir; Jakovic, Radoslav; Moskovljevic, Dejan; Bascarevic, Slavisa; Mujovic, Natasa

2014-05-19

The pattern and factors influencing the lung function recovery in the first postoperative days are still not fully elucidated, especially in patients at increased risk. Prospective study on 60 patients at increased risk, who underwent a lung resection for primary lung cancer. complete resection and one or more known risk factors in form of COPD, cardiovascular disorders, advanced age or other comorbidities. Previous myocardial infarction, myocardial revascularization or stenting, cardiac rhythm disorders, arterial hypertension and myocardiopathy determined the increased cardiac risk. The severity of COPD was graded according to GOLD criteria. The trend of the postoperative lung function recovery was assessed by performing spirometry with a portable spirometer. Cardiac comorbidity existed in 55%, mild and moderate COPD in 20% and 35% of patients respectively. Measured values of FVC% and FEV1% on postoperative days one, three and seven, showed continuous improvement, with significant difference between the days of measurement, especially between days three and seven. There was no difference in the trend of the lung function recovery between patients with and without postoperative complications. Whilst pO2 was decreasing during the first three days in a roughly parallel fashion in patients with respiratory, surgical complications and in patients without complications, a slight hypercapnia registered on the first postoperative day was gradually abolished in all groups except in patients with cardiac complications. Extent of the lung resection and postoperative complications do not significantly influence the trend of the lung function recovery after lung resection for lung cancer.

Lung cancer in elderly

International Nuclear Information System (INIS)

Wagnerova, M.

2007-01-01

Lung cancer is the leading cause of cancer deaths in Europe and USA. The median age of diagnosis is currently 69 years, however this is gradually increasing with the aging population. Patients over age of 70 represent 40 % of all patients with non-small cell lung cancer. Age alone has not been found to be a significant prognostic factor in many malignancies, including lung cancer with performance status and stage being of greater importance. In lung cancer it is also evident that older patients gain equivalent benefit from cancer therapies as their younger counterparts. Elderly patients are under-treated in all aspects of their disease course from histological diagnosis to active therapy with surgical resection, radiotherapy or chemotherapy, irrespective of performance status or co-morbidities. Elderly patients are also underrepresented in lung cancer clinical trials. In this review is presented knowledge about lung cancer in elderly. (author)

Diet and lung cancer

DEFF Research Database (Denmark)

Fabricius, P; Lange, Peter

2003-01-01

Lung cancer is the leading cause of cancer-related deaths worldwide. While cigarette smoking is of key importance, factors such as diet also play a role in the development of lung cancer. MedLine and Embase were searched with diet and lung cancer as the key words. Recently published reviews...... and large well designed original articles were preferred to form the basis for the present article. A diet rich in fruit and vegetables reduces the incidence of lung cancer by approximately 25%. The reduction is of the same magnitude in current smokers, ex-smokers and never smokers. Supplementation...... with vitamins A, C and E and beta-carotene offers no protection against the development of lung cancer. On the contrary, beta-carotene supplementation has, in two major randomised intervention trials, resulted in an increased mortality. Smoking remains the leading cause of lung cancer. The adverse effects...

Estudo de ligas de ouro por XRF e SEM-EDS

OpenAIRE

Coxito, Afonso Maria Teixeira

2016-01-01

Serve o presente estudo para testar uma metodologia para análise de ligas metálicas, em particular ligas de ouro, utilizando as técnicas de fluorescência de raios-X e microscopia electrónica de varrimento. No contexto do presente estudo, foi identificada a composição das folhas de ouro utilizadas em obras de arte. As técnicas laboratoriais utilizadas foram: Microscopia óptica; Espectroscopia de fluorescência de raios-X com dispersão de energia (EDXRF); Microscopi...

Caspase 3 activity in isolated fetal rat lung fibroblasts and rat periodontal ligament fibroblasts: cigarette smoke-induced alterations

Directory of Open Access Journals (Sweden)

James Elliot Scott

2016-03-01

Full Text Available Background Cigarette smoking is the leading cause of preventable death in the world. It has been implicated in the pathogenesis of pulmonary, oral and systemic diseases. Smoking during pregnancy is clearly a risk factor for the developing fetus and may be a major cause of infant mortality. Moreover, the oral cavity is the first site of exposure to cigarette smoke and may be a possible source for the spread of toxins to other organs of the body. Fibroblasts in general are morphologically heterogeneous connective tissue cells with diverse functions. Apoptosis or programmed cell death is a crucial process during embryogenesis and for the maintenance of homeostasis throughout life. Deregulation of apoptosis has been implicated in abnormal lung development in the fetus and disease progression in adults. Caspases, are proteases which belong to the family of cysteine aspartic acid proteases and are the key components for the downstream amplification of intra-cellular apoptotic signals. Of the 14 caspases known, caspase-3 is the key executioner of apoptosis. Fetal rat lung fibroblasts but not PDL viability is reduced by exposure to CSE. In addition Caspase 3 activity is elevated after CSE exposure in fetal lung fibroblasts but not in PDLs. Expression of caspase 3 is induced in CSE exposed lung fibroblasts but not in PDLs. Caspase 3 was localized to the cytoplasm in both cell types.

Secondhand Tobacco Smoke Exposure and Lung Adenocarcinoma In Situ/Minimally Invasive Adenocarcinoma (AIS/MIA).

Science.gov (United States)

Kim, Claire H; Lee, Yuan-Chin Amy; Hung, Rayjean J; Boffetta, Paolo; Xie, Dong; Wampfler, Jason A; Cote, Michele L; Chang, Shen-Chih; Ugolini, Donatella; Neri, Monica; Le Marchand, Loic; Schwartz, Ann G; Morgenstern, Hal; Christiani, David C; Yang, Ping; Zhang, Zuo-Feng

2015-12-01

The aim of this study was to estimate the effect of exposure to secondhand tobacco smoke on the incidence of lung adenocarcinoma in situ/minimally invasive adenocarcinoma (AIS/MIA). Data from seven case-control studies participating in the International Lung Cancer Consortium (ILCCO) were pooled, resulting in 625 cases of AIS/MIA and 7,403 controls, of whom 170 cases and 3,035 controls were never smokers. Unconditional logistic regression was used to estimate adjusted ORs (ORadj) and 95% confidence intervals (CI), controlling for age, sex, race, smoking status (ever/never), and pack-years of smoking. Study center was included in the models as a random-effects intercept term. Ever versus never exposure to secondhand tobacco smoke was positively associated with AIS/MIA incidence in all subjects (ORadj = 1.48; 95% CI, 1.14-1.93) and in never smokers (ORadj = 1.45; 95% CI, 1.00-2.12). There was, however, appreciable heterogeneity of ORadj across studies (P = 0.01), and the pooled estimates were largely influenced by one large study (40% of all cases and 30% of all controls). These findings provide weak evidence for an effect of secondhand tobacco smoke exposure on AIS/MIA incidence. Further studies are needed to assess the impact of secondhand tobacco smoke exposure using the newly recommended classification of subtypes of lung adenocarcinoma. ©2015 American Association for Cancer Research.

SARS – Lung Pathology

Indian Academy of Sciences (India)

Dry nonproductive cough – may show minimal lung infiltration. Recovery; * Lungs get fluid in bronchi- droplets infective and +ve for virus in culture and PCR. May also have co-infection with chlamydia/metapneumoviruses. Recovery; * Lung tissue destroyed due to ? immunological/cytokine mediated damage-Recovery ...

Physical and biological predictors of radiation-induced whole lung injury: early results of a prospective study

International Nuclear Information System (INIS)

Marks, L.B.; Munley, M.; Bentel, G.; Hollis, D.; Zhou, S.; Jirtle, R.; Kong, F.M.; Scarfone, C.; Antoine, P.; Chew, M.; Tapson, V.; Spencer, D.; Jaszczak, R.; Coleman, E.; Anscher, M.

1996-01-01

Purpose: To develop methods of predicting the pulmonary consequences of thoracic irradiation (RT) by prospectively studying changes in pulmonary function following RT. Methods: 105 patients receiving incidental partial lung irradiation during treatment of tumors in/around the thorax (lung-70, breast-18, lymphoma-4, misc-3) had whole lung function assessed (symptoms and pulmonary function tests [PFTs: FEV1-forced expiratory volume 1 sec; DLCO-diffusion capacity]) before and repeatedly 6-48 months following RT. All had computed tomography-based 3-dimensional (3D) dose calculations with lung density heterogeneity corrections for dose-volume histogram (DVH) and NTCP (normal tissue complication probability) calculations. Functional DVHs (DVfH) based on SPECT (single photon emission computed tomography) lung perfusion scans, and serial transforming growth factor-beta (TGF-β) levels were available in 50 and 30 patients, respectively. The incidence and severity of changes in whole lung function were correlated with clinical, physical and biological factors outlined in the results. Exploratory statistical analyses were preformed using chi-square, logistic regression, and multiple linear regression. Mean pt age=57, range 21-87; sex: 63 F, 42 M; 29 had chemotherapy (CT) before/with RT; Follow-up 6-48 months (mean 15, median 12). Results RT-induced symptoms developed in 26 patients (7-grade I-no intervention; 16 grade II-steroids; 3 grade III-oxygen and steroids). A mixed model based on pre-RT DLCO and CT-based NTCP was strongly predictive for the development of symptoms (p 30 Gy. In patients with 'good' pre-RT PFTs, there may be a relationship between the % reduction in PFT and % lung volume receiving >30 Gy (figure). Conclusion: Whole lung injury (symptoms or PFT changes) appears to be related to a variety of physical, biological and clinical factors. The data suggest that no one variable is likely to be an adequate predictor and that multi-faceted predictive models will be

in Heterogeneous Media

Directory of Open Access Journals (Sweden)

Saeed Balouchi

2013-01-01

Full Text Available Fractured reservoirs contain about 85 and 90 percent of oil and gas resources respectively in Iran. A comprehensive study and investigation of fractures as the main factor affecting fluid flow or perhaps barrier seems necessary for reservoir development studies. High degrees of heterogeneity and sparseness of data have incapacitated conventional deterministic methods in fracture network modeling. Recently, simulated annealing (SA has been applied to generate stochastic realizations of spatially correlated fracture networks by assuming that the elastic energy of fractures follows Boltzmann distribution. Although SA honors local variability, the objective function of geometrical fracture modeling is defined for homogeneous conditions. In this study, after the introduction of SA and the derivation of the energy function, a novel technique is presented to adjust the model with highly heterogeneous data for a fractured field from the southwest of Iran. To this end, the regular object-based model is combined with a grid-based technique to cover the heterogeneity of reservoir properties. The original SA algorithm is also modified by being constrained in different directions and weighting the energy function to make it appropriate for heterogeneous conditions. The simulation results of the presented approach are in good agreement with the observed field data.

EMPREENDEDORISMO E VALORES HUMANOS: UM ESTUDO CONCEITUAL

Directory of Open Access Journals (Sweden)

Luciano Vignochi

2013-09-01

Full Text Available O objetivo principal deste artigo foi identificar conceitos de valores humanos em publicações científicas sobre empreendedorismo. Não há um único conceito de valores humanos, gerando diversas abordagens e aplicações do termo em estudos sobre empreendedorismo. Para identificar diferenças conceituais e aplicações práticas, optou-se por realizar uma análise de conteúdo em um portfólio de artigos selecionados em bases de dados. O principal critério de seleção das publicações foi aderência ao tema. Os resultados mostram que valores podem ser definidos como: critérios de julgamento da realidade; aspectos abstratos, cognitivos e afetivos ou características determinantes da personalidade e do comportamento de empreendedores. Valores influenciam a sobrevivência do indivíduo, o crescimento do empreendimento e podem nivelar a congruência do empreendedor e seu propósito de empreendimento com os critérios de convivência social. Ainda foram discriminados resultados de estudos aplicados com vistas a destacar evidências de contribuições práticas de pesquisas sobre valores humanos em empreendedorismo. Futuras investigações para aprofundar e replicar as análises realizadas neste estudo podem contribuir com a formação de empreendedores, a realização de diagnóstico empresarial e com avanços para a consolidação um modelo de desenvolvimento de empresas baseado em valores humanos.

Optimal Control of Heterogeneous Systems with Endogenous Domain of Heterogeneity

International Nuclear Information System (INIS)

Belyakov, Anton O.; Tsachev, Tsvetomir; Veliov, Vladimir M.

2011-01-01

The paper deals with optimal control of heterogeneous systems, that is, families of controlled ODEs parameterized by a parameter running over a domain called domain of heterogeneity. The main novelty in the paper is that the domain of heterogeneity is endogenous: it may depend on the control and on the state of the system. This extension is crucial for several economic applications and turns out to rise interesting mathematical problems. A necessary optimality condition is derived, where one of the adjoint variables satisfies a differential inclusion (instead of equation) and the maximization of the Hamiltonian takes the form of “min-max”. As a consequence, a Pontryagin-type maximum principle is obtained under certain regularity conditions for the optimal control. A formula for the derivative of the objective function with respect to the control from L ∞ is presented together with a sufficient condition for its existence. A stylized economic example is investigated analytically and numerically.

Bird diversity and environmental heterogeneity in North America: A test of the area-heterogeneity trade-off

Science.gov (United States)

Rachel Chocron; Curtis H. Flather; Ronen Kadmon

2015-01-01

Aim: Deterministic niche theory predicts that increasing environmental heterogeneity increases species richness. In contrast, a recent stochastic model suggests that heterogeneity has a unimodal effect on species richness since high levels of heterogeneity reduce the effective area available per species, thereby increasing the likelihood of stochastic...

How to optimize the lung donor.