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1.  Surgery in 2013 and beyond 
Journal of Thoracic Disease  2013;5(Suppl 5):S593-S606.
Lung cancer is a leading cause of cancer related mortality. The role of surgery continues to evolve and in the last ten years there have been a number of significant changes in the surgical management of lung cancer. These changes extend across the entire surgical spectrum of lung cancer management including diagnosis, staging, treatment and pathology.
Positron Emission Tomography (PET) scanning and ultrasound (EBUS) have redefined traditional staging paradigms, and surgical techniques, including video-assisted thoracoscopy (VATS), robotic surgery and uniportal surgery, are now accepted as standard of care in many centers. The changing pathology of lung cancer, with more peripheral tumours and an increase in adenocarcinomas has important implications for the Thoracic surgeon. Screening, using Low-Dose CT scanning, is having an impact, with not only a higher percentage of lower stage cancers detected, but also redefining the role of sublobar resection. The incidence of pneumonectomy has reduced as have the rates of “exploratory thoracotomy”. In general, lung resection is considered for stage I and II patients with a selected role in more advanced stage disease as part of a multimodality approach.
This paper will look at these issues and how they impact on Thoracic Surgical practice in 2013 and beyond.
doi:10.3978/j.issn.2072-1439.2013.07.39
PMCID: PMC3804869  PMID: 24163751
Lung cancer; surgery
2.  Full myocardial revascularization with bilateral internal mammary artery Y grafts 
Annals of Cardiothoracic Surgery  2013;2(4):444-452.
Background
Bilateral internal mammary artery (BIMA) grafting in coronary artery surgery provides better long term outcomes than single internal mammary artery and saphenous vein grafting but the optimum configuration of BIMAs has not been established. This study analyzed perioperative and late outcomes of patients who underwent BIMA grafting with a composite Y configuration.
Methods
Patients (n=922) who underwent BIMA Y grafting were identified from a cardiac surgical database and then cross matched against hospital and cardiology databases and the state death register to identify episodes of repeat coronary angiography, cardiac surgical re-intervention and death. Analysis of repeat angiography was performed after retrieval of the angiogram reports.
Results
In 95% of patients, full myocardial revascularization was achieved with BIMAs alone, using a composite Y configuration with an average of 4.1 IMA to coronary artery anastomoses per patient. The perioperative mortality was 1.5% and the 5-, 10- and 15-year survival estimates were 95%, 87% and 77% respectively. Analysis of 166 symptom-driven post-discharge coronary angiograms showed grafts to the left anterior descending artery and increasing severity of coronary artery stenosis at preoperative angiography as predictors of anastomotic patency.
Conclusions
Full myocardial revascularization can be achieved with reasonable safety in most patients with triple vessel disease and good left ventricular function, and provides good late survival.
doi:10.3978/j.issn.2225-319X.2013.07.07
PMCID: PMC3741876  PMID: 23977621
Coronary artery bypass; internal mammary artery (IMA); myocardial revascularization
3.  Phenotypes and Karyotypes of Human Malignant Mesothelioma Cell Lines 
PLoS ONE  2013;8(3):e58132.
Background
Malignant mesothelioma is an aggressive tumour of serosal surfaces most commonly pleura. Characterised cell lines represent a valuable tool to study the biology of mesothelioma. The aim of this study was to develop and biologically characterise six malignant mesothelioma cell lines to evaluate their potential as models of human malignant mesothelioma.
Methods
Five lines were initiated from pleural biopsies, and one from pleural effusion of patients with histologically proven malignant mesothelioma. Mesothelial origin was assessed by standard morphology, Transmission Electron Microscopy (TEM) and immunocytochemistry. Growth characteristics were assayed using population doubling times. Spectral karyotyping was performed to assess chromosomal abnormalities. Authentication of donor specific derivation was undertaken by DNA fingerprinting using a panel of SNPs.
Results
Most of cell lines exhibited spindle cell shape, with some retaining stellate shapes. At passage 2 to 6 all lines stained positively for calretinin and cytokeratin 19, and demonstrated capacity for anchorage-independent growth. At passage 4 to 16, doubling times ranged from 30–72 hours, and on spectral karyotyping all lines exhibited numerical chromosomal abnormalities ranging from 41 to 113. Monosomy of chromosomes 8, 14, 22 or 17 was observed in three lines. One line displayed four different karyotypes at passage 8, but only one karyotype at passage 42, and another displayed polyploidy at passage 40 which was not present at early passages. At passages 5–17, TEM showed characteristic features of mesothelioma ultrastructure in all lines including microvilli and tight intercellular junctions.
Conclusion
These six cell lines exhibit varying cell morphology, a range of doubling times, and show diverse passage-dependent structural chromosomal changes observed in malignant tumours. However they retain characteristic immunocytochemical protein expression profiles of mesothelioma during maintenance in artificial culture systems. These characteristics support their potential as in vitro model systems for studying cellular, molecular and genetic aspects of mesothelioma.
doi:10.1371/journal.pone.0058132
PMCID: PMC3597627  PMID: 23516439
4.  Pleural fluid cell-free DNA integrity index to identify cytologically negative malignant pleural effusions including mesotheliomas 
BMC Cancer  2012;12:428.
Background
The diagnosis of malignant pleural effusions (MPE) is often clinically challenging, especially if the cytology is negative for malignancy. DNA integrity index has been reported to be a marker of malignancy. The aim of this study was to evaluate the utility of pleural fluid DNA integrity index in the diagnosis of MPE.
Methods
We studied 75 pleural fluid and matched serum samples from consecutive subjects. Pleural fluid and serum ALU DNA repeats [115bp, 247bp and 247bp/115bp ratio (DNA integrity index)] were assessed by real-time quantitative PCR. Pleural fluid and serum mesothelin levels were quantified using ELISA.
Results
Based on clinico-pathological evaluation, 52 subjects had MPE (including 16 mesotheliomas) and 23 had benign effusions. Pleural fluid DNA integrity index was higher in MPE compared with benign effusions (1.2 vs. 0.8; p<0.001). Cytology had a sensitivity of 55% in diagnosing MPE. If cytology and pleural fluid DNA integrity index were considered together, they exhibited 81% sensitivity and 87% specificity in distinguishing benign and malignant effusions. In cytology-negative pleural effusions (35 MPE and 28 benign effusions), elevated pleural fluid DNA integrity index had an 81% positive predictive value in detecting MPEs. In the detection of mesothelioma, at a specificity of 90%, pleural fluid DNA integrity index had similar sensitivity to pleural fluid and serum mesothelin (75% each respectively).
Conclusion
Pleural fluid DNA integrity index is a promising diagnostic biomarker for identification of MPEs, including mesothelioma. This biomarker may be particularly useful in cases of MPE where pleural aspirate cytology is negative, and could guide the decision to undertake more invasive definitive testing. A prospective validation study is being undertaken to validate our findings and test the clinical utility of this biomarker for altering clinical practice.
doi:10.1186/1471-2407-12-428
PMCID: PMC3495778  PMID: 23009708
Malignant pleural effusions; Mesothelioma; Lung cancer; DNA integrity index; Mesothelin

Results 1-4 (4)