Motivated to Inspire: A cancer survivor's perspective

While the risk of prostate cancer does increase with age, there are still men in their 40s and 50s who are being diagnosed with the disease, many at an advanced stage

Alf Samuels shares his experience

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TNF-а, among other cytokines, initiates a wide spectrum of biological activities that help activate the host’s response to infection, and thus may play pathophysiologic roles in PPE. Odeh et al measured serum and pleural fluid TNF-а in 13 patients with UPPE and 8 patients with nonempyemic CPPE. At an optimal cutoff point of 10.7 pg/mL, discriminative properties for pleural TNF-а were as follows: sensitivity, 87.5%; specificity, 92.3%; and accuracy, 90.5% (AUC was not calculated). These statistics were all 100% for the P/S TNF-а ratio set at 3.0. By using a cutoff value of 80 pg/mL, we observed that the sensitivity of TNF-a (78%) to identify CPPE was double that of either pH (41%) or glucose (39%), whereas the specificity of the former (89%) was somewhat lower than those of the latter (94% and 97%, respectively). The combination of TNF-a and LDH increased the sensitivity to 91%, at the expense of a diminished specificity (77%).
Nevertheless, some degree of misclassification cost, ie, to place some unnecessary chest tubes, is acceptable from the clinical standpoint. Finally, unlike other research-ers who found a significant correlation between levels of pleural TNF-a and neutrophil counts in both UPPE (r = 0.44, p = 0.04) and CPPE (r = 0.57, p = 0.03), we did not observe such an association. This suggests that factors other than neutrophils account for the TNF-a concentrations in pleural fluid.
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