Pack‐years of cigarette smoking as a prognostic factor in patients with stage IIIB/IV nonsmall cell lung cancer

BACKGROUND:

This study was undertaken to characterize the relation between the survival of patients with stage IIIB/IV nonsmall cell lung cancer (NSCLC) and pack‐years of cigarette smoking (graded according to the American Joint Committee on Cancer staging system).

METHODS:

Data were analyzed from patients with stage IIIB/IV NSCLC who had completed a prospective smoking questionnaire. The impact of pack‐years of cigarette smoking, age, sex, Karnofsky performance status (KPS), and the presence of weight loss >5% was evaluated on overall survival using univariate and multivariate analyses.

RESULTS:

Smoking history and clinical data were available for 2010 patients with stage IIIB/IV NSCLC (1004 women and 1006 men). Approximately 70% of patients (1409 patients) had smoked >15 pack‐years, 13% (270) were former and current smokers who had smoked ≤15 pack‐years, and 16% (331) were never‐smokers (<100 lifetime cigarettes). Never‐smokers had a longer median survival compared with former or current smokers (17.8 months vs 11.3 months; log?rank P < .001). Among smokers, patients with a ≤15 pack‐year history of smoking had a longer median survival than patients who had smoked >15 pack‐years (14.6 months vs 10.8 months; log?rank P = .03). As the number of pack‐years increased, the median overall survival decreased (log?rank P < .001). Multivariate analysis indicated that a history of smoking was an independent prognostic factor (hazard ratio, 1.36; P < .001).

CONCLUSIONS:

More cigarette smoking, measured in pack‐years, was associated with decreased survival after a diagnosis of stage IIIB/IV NSCLC. Trials assessing survival in patients with stage IIIB/IV NSCLC should report a detailed cigarette smoking history for all patients. Cancer 2010. © 2009 American Cancer Society.     

Internal hernia--a rare cause of intestinal obstruction

Internal hernia is rare its frequency ranging between 0.6 and 5.8%. It results from the protrusion of one or more abdominal viscera (usually small bowel) through an intraperitoneal opening. The opening can be normal (e.g. Winslow foramen), congenital (paraduodenal fossa, ileocecal fossa), or abnormal anatomical entities (after trauma or surgery). The clinical diagnosis of internal hernia is difficult because of the lack of specific signs and symptoms. There is a 63.6% lifetime risk of strangulation and bowel ischemia. In such cases, computed tomography is essential in the preoperative diagnosis because of the high mortality rate (20%) (which justifies its costs).     

Effect of the Looseness of the Beam End Connection Used for the Pallet Racking Storage Systems,on the Mechanical Behavior of the Bearing Beams

The worldwide use of pallet racking storage systems leads to the necessity for research regarding the effects of the clearance between the metallic tabs of the connector and upright slots (looseness effect) on the performance of load-bearing beams. Firstly, the looseness angle and the rotational stiffness were experimentally obtained for three types of beam-to-upright connections. A theoretical approach is used to investigate the magnitude of the looseness effects that occurred on the performances of the bearing beam of the pallet storage systems in terms of the bending moment developed at the midpoint of the beam and maximum deflection. Calculation corrections were evaluated for the connections involved in the experimental part, for the case which considers the looseness effects with respect to the case which does not consider the looseness effect. In order to evaluate the effects of the parameters of the connections on calculus corrections, the theoretical model was used for other types of beam-to-upright connections. It is shown that the maximum corrections are 2.99% and 5.16% for the bending moment developed at the midpoint of the beam and for the maximum deflection, respectively. It is proved that the connector type affects the size of the correction.     

A multiple imputation approach for MNAR mechanisms compatible with Heckman's model

Standard implementations of multiple imputation (MI) approaches provide unbiased inferences based on an assumption of underlying missing at random (MAR) mechanisms. However, in the presence of missing data generated by missing not at random (MNAR) mechanisms, MI is not satisfactory. Originating in an econometric statistical context, Heckman's model, also called the sample selection method, deals with selected samples using two joined linear equations, termed the selection equation and the outcome equation. It has been successfully applied to MNAR outcomes. Nevertheless, such a method only addresses missing outcomes, and this is a strong limitation in clinical epidemiology settings, where covariates are also often missing. We propose to extend the validity of MI to some MNAR mechanisms through the use of the Heckman's model as imputation model and a two‐step estimation process. This approach will provide a solution that can be used in an MI by chained equation framework to impute missing (either outcomes or covariates) data resulting either from a MAR or an MNAR mechanism when the MNAR mechanism is compatible with a Heckman's model. The approach is illustrated on a real dataset from a randomised trial in patients with seasonal influenza. Copyright © 2016 John Wiley & Sons, Ltd.     

Different phenotypes generated by changes in bcl-2 and p53 expression in breast cancer

We have identified by immunohistochemistry/ immunocytochemistry the expression of bcl-2 molecule in 55 primary breast carcinomas and in 30 corresponding axillary lymph nodes metastases, together with a set of molecules known as prognostic factors: estrogen receptors, progesterone receptors, and p53 protein. Our results demonstrated a significant correlation (p < 0.05) between bcl-2 and hormonal receptors expression in tumors, but not in axillary metastases (p < 0.1), a significant inverse correlation between bcl-2 and p53 expression in primary tumors (p < 0.02), but a significant direct correlation in axillary metastases (p < 0.02). The bcl-2+/p53- phenotype, associated with normal breast epithelium, is present in 79.17% primary tumors, but only in 15.38% axillary lymph nodes metastases. A larger number of lymph nodes metastases expressed a bcl-2+/ p53+ more aggressive phenotype compared with primary tumors (58.82% versus 48.39%). This shows that changes in the expression of bcl-2, p53, estrogen and progesterone receptors can lead to an increased cellular aggressiveness and thus to an increased tumoral invasive and metastasizing potential.     

Distinct Immune Cell Populations Define Response to Anti-PD-1 Monotherapy and Anti-PD-1/Anti-CTLA-4 Combined Therapy

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Evaluation of Dried Blood Spot Testing for SARS-CoV-2 Serology Using a Quantitative Commercial Assay

Dried blood spots (DBS) are commonly used for serologic testing for viruses and provide an alternative collection method when phlebotomy and/or conventional laboratory testing are not readily available. DBS collection could be used to facilitate widespread testing for SARS-CoV-2 antibodies to document past infection, vaccination, and potentially immunity. We investigated the characteristics of Roche’s Anti-SARS-CoV-2 (S) assay, a quantitative commercial assay for antibodies against the spike glycoprotein. Antibody levels were reduced relative to plasma following elution from DBS. Quantitative results from DBS samples were highly correlated with values from plasma (r² = 0.98), allowing for extrapolation using DBS results to accurately estimate plasma antibody levels. High concordance between plasma and fingerpick DBS was observed in PCR-confirmed COVID-19 patients tested 90 days or more after the diagnosis (45/46 matched; 1/46 mismatched plasma vs. DBS). The assessment of antibody responses to SARS-CoV-2 using DBS may be feasible using a quantitative anti-S assay, although false negatives may rarely occur in those with very low antibody levels.