In early-stage nonmyasthenic thymoma patients, thymomectomy without thymectomy through thoracotomy or VATS was associated with lower morbidity and shorter hospitalization, than thymomectomy with extended thymectomy. Postoperative myasthenia gravis did not develop in any of the patients enrolled in our study during the 57-month median follow-up period. Overall tumor recurrence rates were not significantly different between these two patient groups. On the basis of our results, we conclude that thymomectomy without thymectomy through thoracotomy or VATS is justified for early-stage nonmyasthenic thymoma patients, and longer follow-up is needed to investigate the necessity of thymectomy in this group.

Aging is a global problem. According to the World Health Organization's report about global health and aging, the number of people aged ≥ 65 will increase to approximately 1.6 billion in 2050 and comprise 16% of the world's population [1]. Aging is associated with health-related problems and substantial medical cost. Disease patterns among the elderly also shift to chronic non-communicable diseases such as cardiovascular disease, hypertension, diabetes, cancer, and dementia [1]. In the US, England, and Europe, approximately

These results suggest that there might be an immune interaction between pleural effusion tumor cells and macrophages. The low intensity of PD-L1 expression in immune cells is associated with the poor survival of patients with lung cancer with malignant pleural effusion.

Pemetrexed-based combination chemotherapy is preferred before a more efficient treatment strategy is found.

Background and objectivesThymoma has a variable long-term oncological outcome after surgical resection. Survival and tumor recurrence were analyzed to determine the predisposing factors for tumor recurrence.MethodsA total of 235 patients who underwent surgery for thymoma or thymic carcinoma from December 1997 to March 2013 were analyzed using Masaoka staging system and World Health Organization (WHO) histological classification. Surgical intervention included extended thymothymectomy via median sternotomy and thymomectomy via thoracotomy/ video-assisted thoracoscopic surgery (VATS).ResultsThe median duration of follow-up was 105 months (12–198 months). Among these 235 patients, recurrence was observed in 25 patients (10.7%). according to Masaoka stage I, IIA, IIB, III, IVA, IVB, recurrence rates were 1/65(1.5%), 8/106(7.5%), 1/32(3.1%), 6/20(30.0%), 8/10(80.0%), 1/1(100.0%), respectively. Disease or treatment-related mortality was observed in 13 patients. Overall survival rate was 94.4%. After univariate analysis, predisposing factors for tumor recurrence included Masaoka stage, WHO histologic type, tumor size, adjuvant therapy and margin status.ConclusionsDue to the indolent behavior of thymoma, tumor recurrence appears to be a better assessment of oncological outcome rather than survival. Factors associated with tumor recurrence include Masaoka stage, WHO histologic type, tumor size, adjuvant therapy and margin status.

Atrial fibrillation (AF) is one of the most frequent arrhythmias in clinical practice. Previous studies have reported the influence of AF on patients with heart failure (HF). The effect of AF on the non-HF critically ill patients in a medical intensive care unit (ICU) remains largely unclear. The study aimed to investigate the impact of AF presenting on ICU admission on the weaning outcome of non-HF mechanically ventilated patients in a medical ICU.A retrospective observational case–control study was conducted over a 1-year period in a medical ICU at Taipei Veterans General Hospital, a tertiary medical center in north Taiwan. Non-HF mechanically ventilated patients who were successful in their spontaneous breathing trial and underwent ventilator discontinuation were enrolled. The primary outcome measure was the ventilator status after the first episode of ventilator discontinuation.A total of 285 non-HF patients enrolled were divided into AF (n = 62) and non-AF (n = 223) groups. Compared with the non-AF patients, the AF patients were significantly associated with old age (P = 0.002), a higher rate of acute respiratory distress syndrome causing respiratory failure (P = 0.015), a higher percentage of sepsis before liberation from mechanical ventilation (MV) (P = 0.004), and a higher serum level of blood urea nitrogen on the day of liberation from MV (P = 0.003). Multivariate logistic regression analysis demonstrated that AF independently increased the risk of weaning failure [adjusted odds ratio (AOR), 3.268; 95% confidence interval (CI), 1.254–8.517; P = 0.015]. Furthermore, the AF patients were found to be independently associated with a high rate of ventilator dependence (log rank test, P = 0.026), prolonged total ventilator use (AOR, 1.979; 95% CI, 1.032–3.794; P = 0.040), increased length of ICU stay (AOR, 2.256; 95% CI, 1.049–4.849; P = 0.037), increased length of hospital stay (AOR, 2.921; 95% CI, 1.363–6.260; P = 0.006), and increased ICU mortality (AOR, 4.143; 95% CI, 1.381–12.424; P = 0.011).AF on ICU admission is an independent risk factor for weaning failure and significantly associated with poor hospital outcome in non-HF mechanically ventilated patients in a medical ICU.

Background. Lung cancer is frequently a disease of elderly patients. However, these patients are often treated less actively owing to a higher comorbidity rate and poor performance status. The efficacy of different treatments in elderly patients with epidermal growth factor receptor (EGFR)-mutated lung cancer is still unknown. Materials and Methods. We retrospectively reviewed the records of our pulmonary adenocarcinoma patients treated between 2010 and 2013. Data on patient age, type of tumor EGFR mutation, response to first-line EGFR-tyrosine kinase inhibitor (TKI) treatment, type of salvage chemotherapy, and efficacy of EGFR-TKI and salvage chemotherapy were collected. Results. In all, 473 of 1,230 stage IV adenocarcinoma patients had an EGFR mutation, and 330 of them received first-line TKI treatment. Of the 330 patients, 160 were $70 years old (elderly group) and 170 were ,70 years old (younger group).

Thymomas are enigmatic tumors for which surgical resection is the mainstay of treatment. However, there are still many debates about resected thymomas with pleural recurrence. Repetitive operations for thymomas involving pleural recurrence are still the treatment of choice. Herein, we present a case with a suitable performance status for re-operation with a new application for argon beam coagulation. Both our experience and the currently available evidence suggest that surgical resection could be considered for patients with advanced thymomas, even for patients with locally advanced or Masaoka-Koga stage IV thymomas. Multimodality or multimodal, treatments resulted in better oncological outcomes for these patients. In this case, we proved that the new application of argon beam coagulation for a thymoma patient with pleural recurrence is safe and feasible. Additional evidence should be collected, and patients should be followed to assess long-term benefits.