Patients with N2 nonsmall cell lung cancer (N2-NSCLC) represent heterogeneous groups. Survivin is a member of the inhibitor of apoptosis family. If N2-NSCLC patients could be stratified, based on survivin expression and/or its relation to cell cycle proteins, into homogeneous subgroups, certain therapies could be selected for those patients.Survivin expression in 78 surgically resected primary pathological N2-NSCLC tumours was evaluated using immunohistochemistry. Relationships of survivin expression to overall survival, clinical features and expression of six cell cycle-related proteins (pRb, cyclin D1, p16 INK4A , p53, p21 Waf1 and Ki-67) were analysed.Nuclear survivin and the number of mediastinal lymph node (LN) stations were independent prognostic factors. The patient group with combined negative survivin/single mediastinal LN station were the most favourable prognostic group, and was related to the clinical nodal factor. Indeed, patients with negative survivin/low Ki-67 labelling indices had the best survival, especially in nonsquamous histopathology.The current authors conclude that nuclear survivin is strongly related to lymph node metastasis and proliferative potentials in pathological N2 nonsmall cell lung cancer patients. Pre-operative N2 nonsmall cell lung cancer patients with combined negative nuclear survivin and a single mediastinal lymph node station, or low proliferative indices, particularly in clinical N0-1 disease and nonsquamous histopathology, respectively, are expected to have a favourable post-operative prognosis and may be candidates for primary resection.

Background:Care of the patient with shock is one of the most challenging issues in emergency medicine and critical care. Use of thoracic ultrasonography has gained a wider ground in emergency medicine and intensive care. So, lung ultrasound is being a basic application, allowing the assessment of urgent diagnoses and therapeutic decisions. Aim of the work:This Study aimed to assess the value of chest ultrasound in differentiation between different types of shock for proper treatment. Materials and Methods:Our prospective study was conducted on 68 shocked patients, 39 were males(58%)and 29 were females (41%) their age ranged from 20 to 85years with mean age 58 years .All patients were admitted to the Respiratory Intensive Care Unit (RICU) of Chest Department at Assuit University Hospital during the period from November 2016 to April 2017 and were evaluated for the cause of shock.We performed early bed-side chest sonographic examination. Results:68 shocked patients were included in the study. 30 patients were septic shock, 19 patients were obstructive shock, 11 patients were cardiogenic shock,4 patients were hypovolemic shock,2 patients were mixed type of the shock, and 2 patients were not defined the causes of the shock. The study shows that there was a significant relationship between different types of shock and chest ultrasound finding (P= 0.04). 14 cases (46.7%) with septic shock had consolidation.14 cases (46.7%) with septic shock had pleural effusion and it was Para pneumonic. Also, we found 9 cases with pleural effusion (47.3%) in obstructive shock due to pulmonary embolism. We found B-lines in 45.5% in cardiogenic shocked patients.Also, there was a significant relationship between PH and PaCO2 different types of shock (P=0.04& 0.01 respectively). We found that combined respiratory Acidosis and metabolic alkalosis was more in patients with septic shock.Also, we found that patients with cardiogenic shock had both acidosis and alkalosis disorders in equal. Conclusion:We highlight the role of integrating chest ultrasound techniques in the physician resuscitation pathways to diagnose shock etiology, augment their clinical evaluation and guide resuscitation.

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Spirometry is the most widely used lung function test both in the diagnosis and stratification of severity of lung disease. The Forced Expiratory Flow between 25 and 75% of the FVC (FEF25_75) is one of the most commonly cited measures of small airways pathology. This study aimed at evaluation of early effect of smoking on small airways. It included: 50 asymptomatic smokers (Group 1) and 50 non smokers (Group 2) as a control. The result revealed: The subjects age was ranged from 18 to 75 years with mean age 43.12 ± 13.231SD in smokers, and range from 15-62 with mean age 41.74 years with ± 14.512SD in nonsmokers. 62 % of the a symptomatic smokers were Manual workers which are the majority of the smokers, and 38 % for Mental worker while the majority of non-smokers were Mental worker 64 %, with 36 % for Manual worker. Smoking cigarette was most common (54 %), then marijuana (46 %). The mean values of all the pulmonary function tests are significantly reduced in smokers compared to non smokers, although, they are within the normal range. The association of impaired PFTs in smokers was found to be statistically highly significant to FEF 25-75 (small airway). Otherwise; there were no significance to other values applying unpaired T test. The most affected age group in significant FEF25-75 reduction was found in 36-55years old, females were more affected than males. The duration of smoking was the most independent risk factor that affects the small airways, than the type of smoking and number of cigarettes or stones per day.

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