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The Impact of Superior Mediastinal Lymph Node Metastases on Prognosis in Non-small Cell Lung Cancer Located in the Right Middle Lobe.

We aimed to assess hilar and mediastinal lymph node involvement and its impact on prognosis in patients with right middle lobe lung cancer.

METHODS:: The records of 170 patients undergoing surgery for right middle lobe non-small cell lung cancer from 1980 to December 2007 were retrospectively examined. There were 45 patients found to have hilar or mediastinal lymph nodes metastases. This subgroup included 31 N2 patients and 14 N1 patients, and included 23 women and 22 men, whose ages ranged from 32 to 83 years (median = 61 years). The status of mediastinal, hilar, and interlobar lymph nodes was assessed according to the seventh edition of the TNM classification for lung cancer. Patient records were examined for age, gender, preoperative nodal status, surgical procedure, metastatic status of lymph nodes (distribution and numbers), tumor size, and histologic features (cell type and differentiation degree). Survival duration was defined as the interval between surgery and death from the tumor or the most recent follow-up.

RESULTS:: For N1 cases (n = 14), the most frequent metastatic site was #12m (lymph nodes adjacent to the middle lobe bronchus), which occurred in 11 cases; there was one case with metastases in #11s (lymph nodes between the upper lobe bronchus and bronchus intermedius), and no case with #11i metastases (lymph nodes between the right middle and lower lobe bronchi). The most frequent metastatic mediastinal zone was the subcarinal zone (25/31), and the superior mediastinal zone also had a high incidence of metastases (22/31). Sixteen cases had metastases to both the superior and subcarinal zones, and six cases had metastasis to superior mediastinal zone without subcarinal zone metastasis. When #11s or #11i was involved, eight of nine or five of five, respectively, were N2 cases. Univariate analyses revealed that tumor diameter, cN, status of lymph node metastases, and operative procedure (pneumonectomy) were significant prognostic factors in N2 cases. Regarding status of lymph node metastases, superior mediastinal zone metastases, both superior and inferior (subcarinal) zone metastases, and #11i were significant prognostic factors. Because #11i metastases and superior mediastinal lymph nodes metastases were highly correlated with each other (p = 0.02), two separate models were used in multivariate analyses. Superior mediastinal metastases (p = 0.03) and #11i metastases (p = 0.015) were revealed to be significant independent prognostic factors, whereas multiple-zone metastases only tended toward significance as an adverse prognostic factor (p = 0.054).

CONCLUSIONS:: Superior mediastinal lymph node metastases and #11i metastases were significant adverse prognostic factors in patients with middle lobe lung cancer, and they were associated with each other.

[Pleural metastases from bronchial carcinoma: Is a cure possible?]

The 2009 TNM classification of lung cancer reclassified patients with pleural invasion from stage IIIB (T4) to stage IV (M+). However, the 2009 TNM separates patients with pleural metastases (M1a) from patients with others visceral metastases (M1b), the patients with stage M1a having the better prognosis.

CASE REPORTS: Two cases are reported of patients with non-small cell lung cancer (NSCLC) metastatic to the pleura, having a long disease free survival (50 and 34 months).

CONCLUSIONS: Patients with pleural metastases from NSCLC seem to have a better prognosis than other patients with stage IV disease, maybe because of a subgroup of patients with long survival. This long survival is probably related to specific biological characteristics of certain pleural disorders that need to be identified. This would allow a more aggressive treatment of this subgroup of patients regarded today as incurable.

Noninvasive Ventilation for Respiratory Distress Syndrome: A Randomized Controlled Trial

This study suggests that NIPPV, as an intial respiratory support for preterm infants with RDS, is feasible and safe and may have beneficial effects, when compared with NCPAP.

Inhalational Lung Injury Associated With Humidifier "White Dust"

We report here the case of a young infant with significant accidental inhalational lung injury related to dispersal of mineral dust from an ultrasonic home-use humidifier. The clinical consequences included prolonged hypoxemia, tachypnea, and failure to thrive. Radiography revealed pneumonitis, and pulmonary-function testing showed a nonreversible mild obstructive ventilatory defect.

Because of persistent symptoms, evolution of failure to thrive, and nonresponse to inhaled and short courses of systemic glucocorticoids, an aggressive management approach was successfully pursued with high-dose pulse steroid therapy, which could be a potential therapeutic approach for similar patients. In addition, this case raises important questions about the safety of exposing infants and young children to...

Dermatophagoides pteronyssinus 2 regulates nerve growth factor release to induce airway inflammation via a reactive oxygen species-dependent pathway

Group 2 allergen of Dermatophagoides pteronyssinus 2 (Der p2) induces airway inflammation without protease activity, and elevated nerve growth factor (NGF) levels are also found in this inflammation. How the allergen Der p2 regulates NGF release via reactive oxygen species (ROS) to induce inflammation remains unclear.

In the present study, intratracheal administration of Der p2 to mice led to inflammatory cell infiltration, mucus gland hyperplasia, and NGF upregulation in the bronchial epithelium, as well as elevated ROS and NGF production in bronchoalveolar lavage fluids. In addition, Der p2 caused fibrocyte accumulation and mild fibrosis. p38 mitogen-activated protein kinase (MAPK) and c-Jun N-terminal kinase (JNK) inhibitors inhibited Der p2-induced NGF release in LA4 lung epithelial ce...

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