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Melanoma as a very aggressive type of cancer is still in urgent need of improved treatment. Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) and arginine deiminase (ADI-PEG20) are two of many suggested drugs for treating melanoma. Both have shown anti-tumor activities without harming normal cells. However, resistance to both drugs has also been noted. Studies on the mechanism of action of and resistance to these drugs provide multiple targets that can be utilized to increase the efficacy and overcome the resistance. As a result, combination strategies have been proposed for these drug candidates with various other agents, and achieved enhanced or synergistic anti-tumor effect. The combination of TRAIL and ADI-PEG20 as one example can greatly enhance the cytotoxicity to melanoma cells including those resistant to the single component of this combination. It is found that combination treatment generally can alter the expression of the components of cell signaling in melanoma cells to favor cell death. In this paper, the signaling of TRAIL and ADI-PEG20-induced arginine deprivation including the main mechanism of resistance to these drugs and exemplary combination strategies is discussed. Finally, factors hampering the clinical application of both drugs, current and future development to overcome these hurdles are briefly discussed.

BACKGROUNDThe phenomenon of academic procrastination affects nearly 95% of post-secondary students within academia with its association seen in reduced academic performance. Amidst the onset of COVID-19, this systematic review aims to provide insight towards potential virtual interventions to support personal management of academic procrastination for young adults. METHODSThe selection procedure followed the Preferred Reporting Items for Systematic Review and MetaAnalyses (PRISMA) guidelines. The protocol was registered with PROSPERO (record ID: CRD42021234243). Studies were reviewed based on a pre-determined and piloted screening tool with study screening and extraction performed independently among two authors. After reconciliation, disagreements were settled by a third author. Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT) in duplicate. Heterogeneity in study designs, outcomes, and measurements precluded meta and statistical analyses; thus, a qualitative analysis of studies was provided. RESULTSA total of 49 studies were included with identification of two primary web-based interventions for reducing academic procrastination in a mobile app setting. The first intervention involves emotional management through increasing tolerance and modifying negative emotions which determines the activity with the highest likelihood of procrastination each day, and the subject's resilience or the subject's commitment should be emphasized. The second intervention involves mental imagery for subjects to feel an affinity for his/her future self, and thus decrease procrastination behaviours. CONCLUSIONTwo main virtual interventions were determined from the systematic review: (1) an intervention for managing personal emotions, and (2) an intervention that involves creating a mental image of one's future self.

Radiostrontium isotopes (Sr, Sr, and Sr) are major fission by-products in nuclear reactors, in radiological events, and in environmental radioactive contamination. A method to analyze Sr and Sr in water has been developed using gradient elution with dilute hydrochloric acid and cation exchange resin, followed by carbonate precipitation. Counting was done on a gas proportional counter. The sample was recounted a second time after 2 to 3 wk to permit Y, a progeny of Sr, to achieve secular equilibrium and to allow Sr and Sr to be determined. This method was found to be simple, exhibiting high recovery, reduced use of hazardous chemicals, and lower cost compared to other current methods. An extensive comparison of the performance of the cation exchange method vs. a method using strong nitric acid (US Environmental Protection Agency Method 905.0) and a method using a specific strontium resin was conducted on performance test samples containing Sr (in a number of matrices) from the US Department of Energy's Mixed Analyte Performance Evaluation Program and mixed Sr- and Sr-containing water samples from the Environmental Resource Associates quality assurance program. The method described here is shown to yield comparable results to others.

Our Enhanced Recovery After Thoracic Surgery protocol was implemented on February 1, 2018, and firmly established 7 months later. We instituted protocol modifications on January 1, 2020, aiming to further reduce postoperative opioid consumption. We sought to evaluate the influence of such efforts on clinical outcomes and the use of both schedule II and schedule IV opioids following robotic thoracoscopic procedures.A retrospective study of patients undergoing elective robotic procedures between September 1, 2018, and December 31, 2020, was conducted. Essential components of pain management in the original protocol included nonopioid analgesics, intercostal nerve blocks with long-acting liposomal bupivacaine diluted with normal saline, and opioids (ie, scheduled tramadol administration and as-needed schedule II narcotics). Protocol optimization included replacing saline diluent with 0.25% bupivacaine and switching tramadol to as needed, keeping other aspects unchanged. Demographic characteristics, type of robotic procedures, postoperative outcomes, and in-hospital and postdischarge opioids prescribed (ie, milligrams of morphine equivalent [MME]) were extracted from electronic medical records.Three hundred twenty-four patients met the inclusion criteria (159 in the original and 183 in the optimized protocol). There was no difference in postoperative outcomes or acute postoperative pain; there was a significant reduction of in-hospital and postdischarge opioid requirements in the optimized cohort. For anatomic resections: mean, 60.0 MME (range, 0-60.0 MME) versus mean, 105.0 MME (range, 60.0-150.0 MME), and other procedures: mean, 0 MME (range, 0-60 MME) versus mean, 140.0 (range, 60.0-150.0 MME) (Small modifications to our protocol for pain management strategies are safe and associated with significant decrease of opioid requirements, particularly schedule II narcotics, during the postoperative period without influencing acute pain levels.

Objective The use of segmentectomy for peripheral T ≤2 cm, N0 non-small cell lung cancer (NSCLC) has increased in the last decade. We sought to compare clinical outcomes and overall survival between robotic, video-assisted thoracoscopic surgery (VATS), and open segmentectomy. Methods The National Cancer Database was queried for patients with clinical T ≤2 cm, N0 NSCLC who underwent segmentectomy via robotic, thoracoscopic (VATS), and open approaches (2010 to 2015). Univariate and Cox regression analyses were used to compare surgical approaches and to evaluate predictors of overall survival. Statistical analyses were done using SPSS Version 21.0. Results Segmentectomy was performed in 3,888 patients during the study period with 406 robotic, 1,837 VATS, and 1,645 open patients. VATS and robotic segmentectomy were performed more often at academic or comprehensive community cancer programs as compared to community programs ( P < 0.05). Conversion to open thoracotomy was similar between robotic and VATS groups when stratified by hospital volume. Lymph node yield was significantly higher for robotic (median = 6), compared to VATS (median = 5) or open (median = 4; P < 0.001). Length of stay was decreased for robotic versus open ( P < 0.01). No differences in 30-day readmissions ( P = 0.12) were observed among the 3 modalities. Overall survival was similar among groups ( P = 0.18). Conclusions Robotic segmentectomy provides similar clinical outcomes compared to other standardized approaches for clinical T ≤2 cm, N0 NSCLC. A higher lymph node yield in robotic segmentectomy was not associated with improved survival in this study population.

We present a rare case pulmonary metastasis of an early stage endometrial cancer nearly 20 years after curative surgical resection. Our patient had a remote history of hysterectomy for endometrial cancer in 1998 and later had Stage 1B right upper lobe lung cancer treated with lobectomy and adjuvant chemotherapy in 2014. She was found to have an enlarging nodule in the left upper lobe in 2018, which was thought to be another primary lung cancer. She underwent left upper lobe segmentectomy for an intraoperative diagnosis of adenocarcinoma by diagnostic wedge resection of the lung nodule. Final pathologic examination of the resected tumor demonstrated an endometrial adenocarcinoma. It is important for thoracic surgeons to remain vigilant, keeping secondary lung cancer in the differential diagnosis for patients with complex oncologic histories.

Supplemental material, Supplementary Material, for Comparative Analysis of Robotic Segmentectomy For Non-Small Cell Lung Cancer: A National Cancer Database Study by Karishma Kodia, Syed S. Razi, Ahmed Alnajar, Dao M. Nguyen, and Nestor Villamizar in Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery

Item does not contain fulltext MediaEval 2020 Workshop

Internet of Things and its applications are becoming commonplace with more devices, but always at risk of network security. It is therefore crucial for an IoT network design to identify attackers accurately, quickly and promptly. Many solutions have been proposed, mainly concerning secure IoT architectures and classification algorithms, but none of them have paid enough attention to reducing the complexity. Our proposal in this paper is an edge cloud architecture that fulfills the detection task right at the edge layer, near the source of the attacks for quick response, versatility, as well as reducing the workload of the cloud. We also propose a multi attack detection mechanism called LocKedge Low Complexity Cyberattack Detection in IoT Edge Computing, which has low complexity for deployment at the edge zone while still maintaining high accuracy. LocKedge is implemented in two manners: centralized and federated learning manners in order to verify the performance of the architecture from different perspectives. The performance of our proposed mechanism is compared with that of other machine learning and deep learning methods using the most updated BoT IoT data set. The results show that LocKedge outperforms other algorithms such as NN, CNN, RNN, KNN, SVM, KNN, RF and Decision Tree in terms of accuracy and NN in terms of complexity., 13 pages, 20 figures, submitted to IEEE Access

Critical airway stenosis presents a challenge for surgeons and anesthesiologists alike in securing a reliable airway for adequate ventilation. The use of veno-venous (VV) extra-corporeal membrane oxygenation (ECMO) has been described as a strategy to provide adequate gas exchange in such instances. We present a case of a young female with a complex paratracheal mass significantly compressing the trachea in whom a planned intra-operative VV ECMO was instituted to allow safe oro-tracheal intubation of a double lumen endotracheal tube for lung isolation and tumor resection.

This program director survey attempts to determine how coronavirus 2019 (COVID-19) pandemic is impacting current training in cardiothoracic surgery. A transition to virtual didactic sessions may prove beneficial with increasing attendance. On the other hand, decreasing live simulation and case volumes may jeopardize achieving competency in surgical skills.

Mediastinal paragangliomas are very uncommon neuroendocrine neoplasms. Due to their tissue of origin (sympathetic ganglia of the great vessels), they tend to arise deep within pericardial space and, more importantly, intimately attached to great vessels, which makes surgical resection, even with cardiopulmonary bypass, very challenging. This commentary accompanies the case report describing complex surgical management of a paraganglioma located in the anterior mediastinum that was initially thought to be a thymoma.

Stereotactic body radiation therapy (SBRT) is increasingly being offered for early stage non-small cell lung cancer (NSCLC). We sought to evaluate long-term survival outcomes after lobectomy and SBRT in patients aged 80 years or more with stage I NSCLC.The National Cancer Database was queried for patients with clinical stage IA and IB (size 40 mm or smaller) NSCLC who underwent SBRT or lobectomy. Only patients with no comorbidities were selected. Number of lymph nodes (LN) examined was used to stratify lobectomy patients into 0 LN, 1 to 6 LN, and 7 or more LN. Propensity score analysis was used to adjust treatment groups. Kaplan-Meier and multivariate Cox regression analysis were used for survival analysis.A total of 8964 patients with stage I NSCLC treated with lobectomy were compared with 286 patients who received SBRT. Using propensity matched pairs, lobectomy (7 LN or more) had significantly improved survival as compared with SBRT (median 74 vs 53.2 months, P.05); however, no survival differences were observed when 0 LN were sampled (median 53.8 vs 52.3 months, P = .88). In multivariate analysis, lobectomy was associated with significantly improved survival (hazard ratio 0.726; 95% confidence interval; 0.580 to 0.910; P = .005). In addition, age, sex, high grade, and tumor size were independent predictors of survival.Among healthy octogenarians with clinical stage I NSCLC who are good surgical candidates, lobectomy offers better survival than SBRT. Adequate LN dissection allows true nodal staging and opportunity for adjuvant treatment when unsuspected nodal metastases are found.