Chrysovalantis V. Papageorgiou

Role of quantitative CT in predicting postoperative FEV1 and chronic dyspnea in patients undergoing lung resection

Lung resection is the mainstay of treatment in patients with early stage non-small cell lung cancer. However, lung cancer patients often suffer from comorbidities and the respiratory reserve should be carefully evaluated preoperatively in order to avoid postoperative complications. Forced expiratory volume in 1 second (FEV1) is considered to be an index that depicts the patients respiratory efficacy and its prediction has a key role in the preoperative evaluation of lung cancer patients with impaired lung function. Prediction of postoperative FEV1 is currently possible with the use of perfusion radionuclide lung scanning.Quantitative CT is the analysis of data acquired during normal chest CT scan using the systems software. By applying a dual threshold of -500 to -910 Hounsfield Units, functional lung volumes are estimated and postoperative FEV1 can be predicted by reducing the preoperative measurement by the fraction of the part to be resected.Studies have shown that preoperative predictions correlate well with the actual postoperative measurements. Additionally, quantitative CT results are in good agreement with perfusion scintigraphy predictions. Newer radiological techniques such as perfusion MRI and co-registered SPECT/CT have also been used in the preoperative evaluation with similar results.In conclusion, chest CT which is obligatory for staging, can be used for quantitative analysis of the already available data. It is technically simple, providing an accurate prediction of postoperative FEV1. Thus, quantitative CT appears to be a useful tool in the preoperative evaluation of lung cancer patients undergoing lung resection.RiassuntoLa resezione polmonare è il trattamento di prima scelta per i pazienti con tumore polmonare non a piccole cellule in stadio iniziale. Tuttavia i pazienti con tumore polmonare presentano spesso comorbilità, quindi la riserva respiratoria dovrebbe essere valutata attentamente in sede preoperatoria per evitare complicanze postoperatorie.Il volume espiratorio forzato in 1 secondo (FEV1) viene considerato come l’indice che più rispecchia l’efficienza respiratoria di un paziente, quindi predirne il valore postoperatorio riveste un ruolo chiave nella valutazione preoperatoria dei pazienti con tumore polmonare e funzionalità respiratoria alterata. Attualmente è possibile stimare il valore di FEV1 postoperatorio con una scintigrafia polmonare perfusoria.Viene definita TAC quantitativa un’analisi dei dati ottenuti durante una normale TAC toracica utilizzando un software dedicato. Applicando una duplice soglia da -500 a -910 Hounsfield Units si possono stimare i volumi polmonari e si può quindi prevedere il FEV1 postoperatorio sottreaendo al valore preoperatorio quello relativo alla quota da sottoporre a resezione.Alcuni studi hanno dimostrato che le stime preoperatorie correlavano bene con il valore effettivamente misurato dopo l’intervento. Inoltre i risultati della TAC quantitativa sono in accordo con quanto predetto dalla scintigrafia perfusoria. Tecniche radiologiche più recenti come la risonanza magnetica perfusoria e la registrazione contemporanea di TAC e SPECT sono state a loro volta utilizzate in sede preoperatoria con analoghi risultati.In conclusione la TAC del torace, che deve comunque essere eseguita per la stadiazione del tumore, può essere utilizzata per un’analisi quantitativa di dati che sono già disponibili. Tecnicamente è semplice ed assicura una stima accurata del FEV1 postoperatorio. La TAC quantitativa appare perciò come un mezzo utile nella valutazione preoperatoria dei pazienti con tumore polmonare candidabili all’intervento di resezione.

Association of 5-HTTLPR Polymorphism with the Nursing Diagnoses and the Achievement of Nursing Outcomes in Patients with Major Depression

ABSTRACT The aim of this study is to investigate whether a 44-base-pair insertion/deletion polymorphism in the upstream regulatory region of the serotonin transporter gene (5-HTTLPR) is associated with the nursing diagnoses and the achievement of the desired nursing outcomes in inpatients with major depression. Thirty five patients were evaluated. The nursing diagnoses of risk for suicide and imbalanced nutrition are reported less often in homozygotes of the high-expressing gene (LA). Carriers of the low-expressing genes (LG or S) have a worse response to interventions which aim to increase low self-esteem, indicating that they may need more intensive care in order to achieve the desired outcome. Genetics in psychiatric nursing could help refine personalized care, however further studies with large sample sizes and multiple gene evaluations are needed.

Intracellular ESAT‐6: A new biomarker for Mycobacterium tuberculosis infection

Early secreted antigenic target 6 (ESAT‐6) is a virulent factor of Mycobacterium tuberculosis (MTB). The identification of intracellular (i/c) ESAT‐6 in host cells would be a direct marker of MTB infection. We developed a method to detect i/cESAT‐6 by flow cytometry. The aim of this study is to investigate the expression of i/cESAT‐6 in the host cells of individuals with MTB infection.

Flow cytometry analysis of CD4+IFN-γ+ T-cells for the diagnosis of mycobacterium tuberculosis infection

CD4+ cells expressing Interferon‐γ (IFN‐γ), following stimulation with specific mycobacterial antigens, identified with flow cytometry (FCM‐CD4+IFN‐γ+), is a new method for the diagnosis of Mycobacterium tuberculosis (MTB) infection. The aim of this study is to investigate the performance of FCM‐CD4+IFN‐γ+ in comparison with tuberculin skin test (TST) and Quantiferon TB Gold In‐Tube (QFT‐G‐IT) in the diagnosis of latent MTB infection (LTBI), in close contacts and in patients with rheumatic diseases under treatment with anti‐TNFa and other biologic agents.

Prediction of Postoperative Lung Function in Patients With Lung Cancer: The Role of Quantitative CT Imaging

We thank Drs Myrianthefs and Baltopoulos for the data reported in their letter. They used the results of our recently published study in CHEST 1 to evaluate the different economic outcomes of patients in the ICU with ventilator-associated pneumonia (VAP) treated with IV colistin monotherapy or aerosolized plus IV (AS 1 IV) colistin therapy in a Greek hospital. They found that 7-day AS 1 IV colistin therapy is less expensive than 10-day IV colistin monotherapy. They also found that a considerable cost benefi t may occur as a result of fewer days under mechanical ventilation (MV) and shorter length of ICU stay. Of course, we agree with them that the use of AS 1 IV colistin therapy can be a costeffective strategy in patients with VAP, shortening the duration of therapy, MV, and ICU stay and achieving better clinical outcomes. Because our study was retrospective, a proper cost assessment was not completely reliable, especially in the absence of parameters whose prospective collection would have been important (ie, those related to nurse workload). Consequently, we preferred to not speculate on the cost-benefi t analysis. As the total length of hospitalization is the main cost driver, in our institution a considerable cost benefi t would also be expected as a result of fewer days under MV and shorter ICU length of stay. In conclusion, the cost-effectiveness of AS 1 IV colistin therapy for the management of VAP caused by multidrug-resistant gram-negative bacteria should be an important end point to be further investigated in multicenter prospective randomized clinical trials.