No abstract

BackgroundThe presence of multiple metastatic pulmonary nodules is a predictor of poor survival after pulmonary metastasectomy. However, there is a paucity of data addressing the exact number of pulmonary metastases over which prognosis becomes grave. The aim of our study is to investigate the prognosis of pulmonary metastasectomy from colorectal cancer (CRC) depending on the number of pulmonary metastases.MethodsPatients who had undergone pulmonary metastasectomy for CRC between November 1994 and December 2013 were included. Survival and recurrence patterns were analyzed with regard to the number of pulmonary metastases. Patients were divided into three groups depending on the number of pulmonary metastases that were detected by the final pathologic report: group I—single metastasis; group II—2–3 metastases; and group III—4+ metastases.ResultsA total of 615 patients who had undergone pulmonary metastasectomy from colorectal cancer were included. The median follow-up period was 31 months (range 2–211 months). The median disease-free interval (DFI) from the time of the primary operation for colorectal cancer was 20 months (range 0–209 months). There were 414 patients in group I (single metastasis), 159 in group II (2–3 metastases), and 42 in group III (4+ metastases). The overall 5-year survival rate was 64.2 %. The 5-year survival rates in groups I, II, and III were 70.0, 56.2, and 33.7 %, respectively (group I vs. II, p < 0.001; group II vs. III, p = 0.012). The 5-year recurrence-free rates were 39.5, 30.6, and 8.5 % in groups I, II, and III, respectively (group I vs. II, p < 0.001; group II vs. III, p = 0.056). Multivariable analysis revealed that age, multiple pulmonary nodules, thoracic lymph node metastasis, and adjuvant chemotherapy are independent predictors of survival.ConclusionsThe overall survival and recurrence after pulmonary metastasectomy for CRC is dependent on the number of metastases. Surgical treatment can be offered to patients with three or fewer pulmonary metastases. However, more meticulous patient selection is required to decide whether a surgical approach is feasible in patients with four or more pulmonary metastases.

This study examined the transportation choices of individuals in a large campus setting at the Ohio State University, Columbus. A web-based survey was conducted to understand the travel patterns of the campus community and to inform recommendations to reduce single-occupancy vehicle travel there. Mode choice and the most important factors that affected it were the focus of the survey. The survey included questions about respondent attitudes toward auto use and the factors that would encourage them to carpool and take transit to campus. Discrete choice models were estimated to analyze commuter mode choices to travel to campus. The results showed that proximity to bicycle lanes and trails and bus stops increased the propensity to choose these modes. Students were more likely to travel by alternative modes than faculty and staff members. Individuals concerned about travel time, flexibility of departure time, safety, and the ability to stop on the way to and from campus were more likely to drive alone to campus. Strategies to increase the modal share of alternative modes are presented in the paper on the basis of the descriptive findings and the model results. This study's findings may be used by practitioners and campus transportation planners to understand better the factors that cause people not to choose alternative transportation modes and to evaluate transportation improvements to be considered for implementation.

This study asks if there is gender-specific spatial heterogeneity in local obesity. By using the 2015 Korea Community Health Survey and employing spatial analyses, this study found that there is considerable gender-specific spatial heterogeneity in local obesity rates. More specifically, we found that: (1) local obesity rates are more spatially dependent for women than for men; (2) environmental factors, in general, have stronger effects on local obesity rates for women than for men; (3) environmental factors have more spatially varying effects on local obesity rates for women than for men. Based on these findings, we suggest that policies for obesity prevention should not be based on the assumption of spatial homogeneity and gender indifference, but rather should be refined based on gender-specific spatial heterogeneity in local obesity.