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Existing devices detect main breathing data and none is aimed to monitor biomechanics of ventilation motions with small wearable device.The used device has been designed for noninvasive wearing to detect main motion parameters of a rib during ventilation in an experimental campaign with 218 subjects. Experimental activity is carried out by testing in vivo with human volunteers for an experimental characterization of ventilation motions as related to normal breathing, maximal breathing and coughing.Findings can be summarized from a numerical analysis of experimental results in terms of statistical values of ventilation motion parameters in rotation and acceleration as function of age and sex of the tested subjects. The discussed campaign reporting results on healthy patients was carried out with the aim to build a reference database of normal conditions against which the status of patients with both thoracic and ventilation problems can then be judged. Females showed significantly larger lateral-to-lateral movements during basal breathing and lateral-to-lateral Z-axis movements during maximal breathing and cough. Males demonstrated wider antero-posterior Y-axis and cranio-caudal X-axis movements during maximal breathing, while antero-posterior movements prevailed during cough. Older participants demonstrated larger lateral-to-lateral Z-axis and antero-posterior Y-axis movements during basal breathing. Young participants showed more significant increments along antero-posterior Y-axis from basal to maximal breathing and basal to cough, demonstrating a more efficient muscular activity.The ventilation motion during ventilation act is useful to detect the status of ventilation and can give indications for diagnostics and medical solutions even in thoracic surgery.

SummaryPlatelet activation, commonly found in lung cancer patients, may cause the release of angiogenic factors, such as vascular endothelial growth factor (VEGF-A). The present study was designed to investigate whether plasma VEGF-A levels were associated to different stages of non-small cell lung cancer (NSCLC). Moreover, sP-selectin, prothrombin fragment 1+2 (F1+2),thrombin-antithrombin III complex (TATc) and D-dimer levels were measured to test the hypothesis of an involvement of platelet and coagulation activation in tumor angiogenesis. VEGF-A, sP-selectin, F1+2, TATc and D-dimer levels were elevated in 65 patients with NSCLC, particularly in metastatic patients. sP-selectin (p

In this work urea-formaldehyde microcapsules containing an epoxy resin are prepared by in situ polymerization of monomers in an oil-in-water emulsion. Scanning electronic microscopy (SEM) was performed to investigate on microcapsule size and surface morphology. Calorimetric and spectroscopic analyses were carried out with the aim of evaluate the encapsulation yield and the shell features. Factors determining the microencapsulability of the core material were described. In particular, our interest was devoted to a better understanding of the influence of the reaction parameters on the microcapsule properties. It was found that the encapsulation yield as well as the extent of urea-formaldehyde polymerization depends on the reaction temperature and the stirring speed.

To assess the long-term results and health-related quality of life in patients undergoing surgery for oesophageal achalasia.Thirty-nine patients with achalasia (25 males, mean age 42+/-13 years) underwent open-Heller myotomy and Dor fundoplication by the same surgeon. Long-term results were assessed by imaging, endoscopy, manometry, pH-metry, and Short Form 36 and Nottingham Health Profile questionnaires whenever applicable. Six patients were at radiological stage I, 20 were at stage II, 2 at stage III and 11 at stage IV. Dysphagia and regurgitation were scored according to the four-grade classification (1=no symptoms; 4=persistent symptoms). Pulmonary symptoms were present in six patients. Lower oesophageal pressure was 30+/-34 mmHg. Six patients had undergone previous pneumatodilation.No procedure related mortality was recorded. Mean follow-up was 107+/-30 months (54-177). Preoperative to 5-year postoperative mean decrement in lower oesophageal sphincter pressure was 12.3+/-8.3 mmHg (P0.001) in oesophageal width was 11.5+/-7.1 mm (P0.001) in dysphagia 1.8+/-0.8 (P0.001) and regurgitation 1.4+/-0.7 (P0.001) Four patients presented relapse dysphagia and two of those were re-operated upon. Three patients developed acid reflux, which was satisfactorily treated with proton-pump inhibitors. Preoperative to 4-year postoperative quality of life scores were available for 20 patients. Questionnaires showed a significant improvement (P0.001) especially in all psychosocial domains, which were correlated with postoperative dysphagia score and lower oesophageal sphincter pressure.Heller myotomy and Dor fundoplication is a safe and effective procedure that improves symptoms, functional status and especially psychosocial aspect of quality of life in the long term in oesophageal achalasia.

Rigid-rod vinyl ester resins represent an interesting family of materials. They can be synthesized starting from the corresponding epoxy resin. Due to their composition, they exhibit outstanding properties, such as heat and chemical resistance, high impact and corrosion resistance. These features, combined with the ease of curing, make vinyl ester resins good candidates for several industrial applications, such as glass fiber composites, adhesives, corrosion-resistant coatings, electrical encapsulation, and radiation-curable inks. In the first part of this study, a new liquid crystalline methacrylated monomer has been prepared and tested as adhesive. The synthesis has been carried out by reacting methacrylic acid with a rigid-rod epoxy monomer derived from the reaction between p-(2,3-epoxypropoxy)-Ą-methylstilbene (DOMS, diglycidyloxy Ą-methylstilbene) and aniline in a molar ratio of 3 to 2. The monomer was named md3a2 (methacrylated derivative of doms-aniline epoxy compound). Md3a2 is liquid crystalline in a wide range of temperature, as shown by DSC and optical microscopy. In a second part of the work, the adhesion properties of the novel liquid crystalline resin have been tested and compared to those exhibited by conventional (non-liquid crystalline) adhesive, the methacrylated derivative of an epoxy compound synthesized from a 3 to 2 molar ratio of Epon 825㵠(which is a commercial epoxy) and aniline. This monomer was named mep3a2 (methacrylated derivative of Epon 825-aniline epoxy compound). The adhesion of the two resins on a pre-treated aluminum substrates has been evaluated using mechanical tests (single-lap joint test, according to ASTM standard D1002-72) and scanning electron microscopy (SEM).

Evaluation of mediastinal lymph nodes in patients with lung cancer is fundamental for their treatment and prognosis. Chest computed tomography (CT) is presently the most utilized diagnostic modality. In recent years endoscopic ultrasound (EUS) is being employed for this purpose. We retrospectively compared the results of CT and EUS staging of 35 selected patients with postsurgical stage. A total of 175 lymph node sites were examined. Results CT vs EUS were as follows: specificity 92% vs 98%, sensitivity 88% vs 84%, positive predicted accuracy 80% vs 96%, negative predicted accuracy 95% vs 94%, overall accuracy 92% vs 95%. The region most accessible by EUS evaluation were the paraesophageal lymph nodes; the most difficult were the right superior mediastinal nodes which cannot be imaged for anatomic reasons. EUS not only allows one to arrive at correct diagnosis with less false positive results, but also permits evaluation of lymph nodes which are not enlarged. We think that EUS, in combination with CT, is an appropriate modality for staging of mediastinal lymph nodes in patients with lung cancer.

Defects in the apoptotic pathway represent a critical element in the progression of neoplastic disease and may also concur to determine treatment efficacy at the cellular level. Fas (Apo-1/CD95) is a cell-surface receptor involved in cell death signaling. In this study we analyzed, by immunohistochemistry, the expression of Fas protein in a group of 68 NSCLC (non-small cell lung cancer) specimens. Statistical analyses did not show any significant relationship between Fas immunohistochemical expression and clinical parameters of lung cancer patients, except for nodal status. Our data do not support the use of Fas as a molecular prognostic role in NSCLC. On the other hand, considering the role of the Fas-pathway in chemotherapy-induced apoptosis, further studies are required to analyze the potential value of Fas expression in predicting the response of NSCLC patients to chemotherapy.

To analyze the behavior of circulating von Willebrand factor antigen (vWf:Ag) in patients with non-small cell lung cancer (NSCLC).Pre-surgical vWf:Ag levels were measured in 64 patients with histologically diagnosed NSCLC compared to 64 patients with benign pulmonary diseases, as well as 64 age- and sex-matched controls.Patients with NSCLC had mean vWf:Ag concentrations lower than either controls or benign patients (p =0.001). CEA was the only variable predictive of low vWf:Ag levels (p0.01). Five of the 64 NSCLC patients had abnormally low vWf:Ag concentrations (36 IU/dL). When these patients were excluded from the analysis, the vWf:Ag levels of NSCLC patients did not differ from those of controls (p=0.19).The vWf antigen levels of NSCLC patients are not substantially altered. A small subset of these patients will have a depletion of circulating vWf:Ag, probably because of a paraneoplastic process associated with an advanced stage of disease.

The purpose of this study was to investigate whether hydrotalcite is able to intercalate diclofenac, a nonsteroidal anti-inflammatory drug, and release it in a controlled manner. Layered Mg−Al hydrotalcite in the chloride form was used as a host, and the intercalation compound was prepared by Cl−/diclofenac anionic exchange. Drug release from the intercalation compound was performed in vitro in simulated intestinal fluid at pH 7.5 according to USP 24 and in a pH 7.0 solution designed to mimic the ionic conditions of the small intestine. Results from the intercalation process show that hydrotalcite is able to intercalate diclofenac with a simple procedure and with a good drug loading (55% wt/wt). The in vitro drug release was remarkably lower than that from the corresponding physical mixture at both pH 7.5 and pH 7.0. In the latter case, the release was not complete at 24 hours. The kinetic analysis shows the importance of the diffusion through the particle in controlling the drug release rate. The obtained results show that hydrotalcite may be used to prepare modified release formulations.

Background: The purpose of this study was to examine the prognostic impact of occult disease after extrapleural pneumonectomy for malignant mesothelioma. Methods: We reviewed the resection margin and node specimens from 41 consecutive patients undergoing extrapleural pneumonectomy for malignant pleural mesothelioma in different institutions between 1985 and 2004. The specimens were reassessed by immunohistochemical staining with anticalretinin and antimesothelin monoclonal antibodies, and results were used to draw Kaplan-Meier survival curves and perform Cox regression analyses. Results: Histologic examination showed 34 epithelioid, 4 biphasic, and 3 sarcomatoid subtypes. Results of postoperative TNM staging were that 14 patients were in stage I, 6 were in stage II, and 21 were in stage III. One patient died during the early postoperative period. Median survival was 13 months. Survival was affected by nonepithelial histologic type (p = 0.001), TNM stage (p = 0.007), positive resection margins (p = 0.002), and N disease (p = 0.01). Immunohistochemistry revealed occult positive resection margins in 6 patients, not correlated with T stage. Microscopic N disease was discovered in 5 patients, of whom 2 had their nodes retrieved through cervical mediastinoscopy. No correlation with nodal diameter was found. In all patients microscopic N disease could have been accessible through mediastinoscopy. Overall, the presence of occult disease was diagnosed in 5 new patients and influenced survival more than any other variable, both at univariate (p < 0.001) and multivariate Cox regression analysis (p < 0.0001; odds ratio, 5.4; 95% confidence interval, 3 to 15). Conclusions: In malignant pleural mesothelioma, the presence of occult disease in resection margins and lymph nodes can be identified by immunohistochemistry and significantly influences the prognosis. Cervical mediastinoscopy is useful in all patients considered for radical resection, but all specimens should be processed with immunohistochemical staining. © 2008 The Society of Thoracic Surgeons.

Biodegradable polymer composites reinforced with agri-food lignocellulosic biowaste represent cost-effective and sustainable materials potentially able to replace traditional composites for structural, household, and packaging applications. Herein, the preparation of polylactic acid (PLA)/pecan (Carya illinoinensis) nutshell (PNS) biocomposites at high filler loading (50 wt%) is reported, alongside the effect of two environmentally friendly physical treatments, namely ball-milling of the filler and thermal annealing on biocomposites. PNS enhanced the thermal stability, the viscoelastic response, and the crystallinity of the polymer. Furthermore, filler ball-milling also increased the melt fluidity of the biocomposites, potentially improving melt processing. Finally, the presence of PNS remarkably enhanced the effect of thermal annealing in the compounds. In particular, heat deflection temperature of the biocomposites dramatically increased, up to 60 °C with respect to the non-annealed samples. Overall, these results emphasize the potential of combining natural fillers and environmentally benign physical treatments to tailor the properties of PLA biocomposites, especially for those applications which require a stiff and lightweight material with low deformability.

Liquid crystalline epoxy networks (LCENs) are a class of materials that combine the useful benefits of both liquid crystals and epoxy networks exhibiting fascinating thermal, mechanical, and stimuli-responsive properties. They have emerged as a new platform for developing functional materials suitable for various applications, such as sensors, actuators, smart coatings and adhesives, tunable optical systems, and soft robotics. This article provides an overview of LCENs and their composites as functional materials, including their synthesis and characterisation, focusing on structure-processing–property relationships. We provide objective analyses on how materials engineers can use these relationships to develop LCENs with desired functionalities for targeted applications. Emerging areas, including advanced manufacturing and multi-functional design of LCENs are covered to show the overall progress in this field. We also survey the forward-looking status of LCEN research in designing novel materials for future technologies.

Microplastics released from textiles during the washing process represent the most prevalent type of microparticles found in different environmental compartments and ecosystems around the world. Release of microfibres during the washing process of synthetic textiles is due to the mechanical and chemical stresses that clothes undergo in washing machines. Several washing process parameters, conditions, formulations of laundering additives have been correlated to microfibre release and some of them have been identified to affect microfibre release during washing process, while no correlation has been evaluated between microfibre release and washing load. In the present study, microfibre release was evaluated as function of the washing load in a real washing process, indicating a progressive decrease of microfibre release with increasing washing load. The quantity of released microfibres increased by around 5 times by decreasing the washing load due to a synergistic effect between water-volume to fabric ratio and mechanical stress during washing. Moreover, the higher mechanical stress to which the fabric is subjected in the case of a low washing load, hinders the discrimination of the effect on the release of other washing parameters like the type of detergent and laundry additives used.

Clinical manifestations of leishmaniasis range from self-healing, cutaneous lesions to fatal infections of the viscera. With no preventative Leishmania vaccine available, the frontline option against leishmaniasis is chemotherapy. Unfortunately, currently available anti-Leishmania drugs face several obstacles, including toxicity that limits dosing and emergent drug resistant strains in endemic regions. It is, therefore, imperative that more effective drug formulations with decreased toxicity profiles are developed. Previous studies had shown that 2-(((5-Methyl-2-thienyl)methylene)amino)-N-phenylbenzamide (also called Retro-2) has efficacy against Leishmania infections. Structure–activity relationship (SAR) analogs of Retro-2, using the dihydroquinazolinone (DHQZ) base structure, were subsequently described that are more efficacious than Retro-2. However, considering the hydrophobic nature of these compounds that limits their solubility and uptake, the current studies were initiated to determine whether the solubility of Retro-2 and its SAR analogs could be enhanced through encapsulation in amphiphilic polymer nanoparticles. We evaluated encapsulation of these compounds in the amphiphilic, thermoresponsive oligo(ethylene glycol) methacrylate-co-pentafluorostyrene (PFG30) copolymer that forms nanoparticle aggregates upon heating past temperatures of 30°C. The hydrophobic tracer, coumarin 6, was used to evaluate uptake of a hydrophobic molecule into PFG30 aggregates. Mass spectrometry analysis showed considerably greater delivery of encapsulated DHQZ analogs into infected cells and more rapid shrinkage of L. amazonensis communal vacuoles. Moreover, encapsulation in PFG30 augmented the efficacy of Retro-2 and its SAR analogs to clear both L. amazonensis and L. donovani infections. These studies demonstrate that encapsulation of compounds in PFG30 is a viable approach to dramatically increase bioavailability and efficacy of anti-Leishmania compounds.

Washing processes of synthetic clothes are considered the main source of microplastic pollution in the oceans, as during washing, microfibres are released and cannot be completely blocked by wastewater treatments plants, thus reaching the marine ecosystems. The development of mitigation approaches is strongly needed to prevent the impact of microplastics on marine environments. With the aim to protect the fabrics during the washing processes and then reduce the release of microfibres, in this work, new finishing treatments of polyamide fabrics were performed by an ElectroFluidoDynamic (EFD) method. This approach was used to obtain homogeneous coatings of biodegradable polymers, namely poly (lactic acid) and poly (butylene succinate-co-butylene adipate), on polyamide surface, without affecting the fabric hand and wettability. The treatments were very effective, able to significantly reduce the amount of microfibres released during washing tests, proving to be a promising application to mitigate micro plastic pollution. (C) 2019 Elsevier Ltd. All rights reserved.

Hypothesis In the last years, several cost-effective technologies have been investigated to functionalize textile substrates for large scale applications and industrial production. However, several limitations of currently used technologies still restrict the capability to form functional coatings finely controlling the textile surface properties and topographic structure of the coatings at sub-micrometric scale. Experiments Herein, we introduced a new non-conventional electrofluidodynamic technology – based on the use of electrostatic forces to polymer/composite solutions – for the application onto textile fabrics of functional coatings. With respect to particle/fibrous coatings usually applied through conventional electrospraying/electrospinning processes, the proposed approach is able to realize homogeneous and continuous coatings by a one-step process, imparting tailored functionalities to the textiles surfaces through the use of customized experimental setups. Findings We proved that this process can be successfully used to realize functional coatings based on a bioderived polymer, namely polylactic acid (PLA), on commercial woven polyamide (PA) fabrics. In addition, due to the usage of graphene derivatives or photochromic dyes in combination with PLA, the applied coatings are able to confer peculiar functionalities (i.e., electrical conductivity, photochromic properties, etc.) to polyamide fabrics, as proved by SEM, conductivity and UV irradiation measurements, for innovative applications in smart textiles, e-health and wearable electronics.

Energy preservation is one of the serious concerns in recent years to reduce fossil fuels consumption and greenhouse gases. Magnetic microcapsules based on n-hexadecane/Fe3O4 core and poly methyl methacrylate (PMMA) shell were designed as an innovative type of dual-functional phase change materials. Fe3O4 nanoparticles were first synthesized by co-precipitation method and then modified with oleic acid. Then, they were incorporated into suspension polymerization in the presence of MMA and n-hexadecane. FTIR and SEM analyses confirmed the presence of all components in the magnetic microcapsules with a wrinkled morphology and uniform size in averagely 180 µm. They revealed reasonable thermal storage properties and high thermal cycling performance according to DSC thermograms. The encapsulation efficiency and thermal storage ability were calculated by the extracted data from DSC analysis for all the samples and their thermal conductivities were measured too. Magnetometry studies approved superparamagnetic properties of the obtained microcapsules with low remanence and coercivity. With such a dual-functional feature, the introduced magnetic microcapsules could show potential applications in some high-tech fields with providing both thermal regulating and magnetic responsive properties.

The efficiency of photomobile polymers (PMP) in the conversion of light into mechanical work plays a fundamental role in achieving cutting-edge innovation in the development of novel applications ranging from energy harvesting to sensor approaches. Because of their photochromic properties, azobenzene monomers have been shown to be an efficient material for the preparation of PMPs with appropriate photoresponsivity. Upon integration of the azobenzene molecules as moieties into a polymer, they act as an engine, allowing fast movements of up to 50 Hz. In this work we show a promising approach for integrating ZnO nanoparticles into a liquid crystalline polymer network. The addition of such nanoparticles allows the trapping of incoming light, which acts as diffusive points in the polymer matrix. We characterized the achieved nanocomposite material in terms of thermomechanical and optical properties and finally demonstrated that the doped PMP was better performing that the undoped PMP film.

International audience; The last two decades have witnessed a significant growth in using bioderived materials, driven by the necessity of replacing fossil-derived precursors, reducing the fossil fuel consumption, and lowering the global environmental impact. This is possible thanks to the availability of abundant resources from biomasses and the development of optimized technologies based on the principles of sustainability and circular economy. Herein, we report on the synthesis and characterization of new carbohydrate-derived epoxy resins. In particular, 2,5-bis[(oxiran-2-ylmethoxy)methyl]furan has been synthesized and cured with methyl nadic anhydride. The effect of different initiators was studied, in order to identify the most efficient curable formulations. A series of resins was then prepared varying the epoxide–anhydride ratios. The results gathered from physicochemical, mechanical, morphological analyses have demonstrated that the produced furan-based thermosets have the potential to be proposed as sustainable alternatives to the traditional, bisphenol A-containing epoxy resins.

In this work, free-standing shape-memory thermally triggered actuators are developed by laminating 'thiol-epoxy'-based glassy thermoset (GT) and stretched liquid-crystalline network (LCN) films. A sequential curing process was used to obtain GTs with tailored thermomechanical properties and network relaxation dynamics, and also to assemble the final actuator. The actuation extent, rate and time were studied by varying the GT and the heating rate in thermo-actuation with an experimental approach. The results demonstrate that it is possible to tailor the actuation rate and time by designing GT materials with a glass transition temperature close to that of the liquid-crystalline-to-isotropic phase transition of the LCN, thus making it possible to couple the two processes. Such coupling is also possible in rapid heating processes even when the glass transition temperature of the GT is clearly lower than the isotropization temperature of the LCN, depending on the network relaxation dynamics of the GT and the presence of thermal gradients within the actuators. Interestingly, varying the GT network relaxation dynamics does not affect the actuation extent. As predicted by the analytical model developed in our previous work, the modulus of the GT layer is mainly responsible for the actuation extent. Finally, to demonstrate the enhanced control of the actuation, specifically designed actuators were assembled in a three-dimensional actuating device able to make complex motions (including 'S-type' bending). This approach makes it possible to engineer advanced functional materials for application in self-adaptable structures and soft robotics.

Objective: Recurrent intrathoracic thymomas may have an unpredictable behavior. Cell-cycle protein expression has proven useful in predicting outcome in a variety of neoplasms. We investigated its potential prognostic importance in recurrent intrathoracic thymomas. Methods: We reviewed the case histories of 25 consecutive patients operated on between 1987 and 2004 for intrathoracic recurrence (7 mediastinal, 18 nonmediastinal) after radical thymomectomy. Complete resection was performed in 14 patients. In the other 11 patients incomplete resection was followed by chemotherapy and radiotherapy. Expression of cell-cycle proteins (p53, p21, and p27) was assessed by immunohistochemistry in specimens retrieved from both initial and recurrent thymomas. Univariate and multivariate analysis for prognostic factors present at the time of the recurrence was performed. Results: Eight of 14 patients who underwent complete resection had a second recurrence after a mean free interval of 20 ± 9 months, and a new complete resection was reperformed in 4. After incomplete resection, chemotherapy and radiotherapy allowed total remission in 4 subjects and only 1 of these had a second recurrence. Survival after surgery of the recurrence was negatively influenced by incomplete recurrence resection (P = .03), first disease-free interval less than 24 months (P = .03), high p53 (P = .04), low p21 (P = .02), low p27 (P = .003) expressions, and combination of these proteins (p53 high, p21 low, p27 low expression) (P = .0001). Multivariate analysis selected the triple combination of cell-cycle protein expression as the most significant prognostic variable (P = .02, odds ratio = 11.96, 95% confidence interval = 1.39-102.63). Conclusions: Cell-cycle protein expression, and namely the combination of high p53, low p21, and low p27 expression, may have a potential prognostic importance in recurrent intrathoracic thymomas. © 2009 The American Association for Thoracic Surgery.

Purpose: Although survival of encapsulated thymomas is usually good, some patients present a higher incidence rate of recurrence and a shorter long-term survival. Abnormalities in the components of cell cycle checkpoints are extremely common among virtually all neoplasms. In this study, three components of the cell cycle machinery (i.e., p21, p27 and p53) were examined in a series of well-characterized encapsulated thymoma specimens to analyze coregulation and influence on recurrence and survival. Experimental Design: Sixty-eight consecutive patients with thymoma were operated in our center from 1987 to 2000. Expression of p53, p21, and p27 was studied in specimens from 25 encapsulated thymomas using immunohistochemistry. Generic factors and gene expression influencing the probability of recurrence were studied. Positive expression was dichotomized defining positive when present in more than 5% of tumor cells. Mean follow up was 85.9 months; clinical data about recurrence were recorded. Results: Univariate analysis suggests that positive p53 (P < 0.05), negative p21 (P = 0.01), and especially negative p27 expressions (P = 0.001) significantly correlate with poor prognosis for disease-free survival. Multivariate Cox regression analysis suggests that negative p27 immunohistology is the only significant variable for poor prognosis (P = 0.03; odds ratio, 0.08; 95% confidence interval, 0.01-0.88). Conclusions: These results show that loss of control of cell cycle checkpoints is a common occurrence in thymomas and support the idea that functional cooperation between different cell cycle inhibitor proteins constitutes another level of regulation in cell growth control and tumor suppression.

BACKGROUND Despite radical surgical resection, thymomas often recur. The objective of the current retrospective study was to investigate the prognostic relevance of the expression of cell-cycle proteins in these neoplasms to formulate a possible therapeutic surveillance strategy for the prevention of recurrence. METHODS The authors retrospectively reviewed the main clinicopathologic factors, including the World Health Organization (WHO) classification, of patients with thymoma who had undergone radical surgical resection. Specimens were studied using immunohistochemistry and the expression of cell-cycle proteins (i.e., p21, p27, and p53) was assessed. Univariate and multivariate analysis of predicting survival prognostic factors were performed. RESULTS The authors analyzed 88 patients with thymoma who underwent radical surgical resection at the study institution. According to the Masaoka staging system, 41 patients had Stage I disease, 31 patients had Stage II disease, and 16 patients had Stage III disease. There were 24 tumor recurrences (27.3%), 4 of which were local, 16 of which were distant intrathoracic, and 4 of which were extrathoracic. The second radical resection provided a disease-free survival rate that was similar to the first. Only Masaoka stage (P = 0.001), WHO classification (P=0.001), high expression of p53 (P=0.03), and low expression of p21 (P=0.02) and p27 (P=0.001) were found to be correlated with a reduced disease-free survival. Low p27 expression was found to be the most significant predictive factor of a short disease-free survival (P=0.001), especially when associated with low p21 expression and high p53 expression (P=0.0001). CONCLUSIONS Long-term disease-free survival in thymoma patients treated with radical surgical resection was found to be correlated with Masaoka stage, WHO classification, and expression of cell-cycle proteins, with the latter found to be the most significant predictive factor. Functional cooperation between cell-cycle proteins might constitute another level of regulation in tumor growth. More careful surveillance should be adopted whenever there is negative cell-cycle protein expression. Cancer 2005. © 2005 American Cancer Society.