University of Torino Department of Thoracic Surgery Stage IV melanoma metastatic to the lung: patients characteristics (number: 26).
\\n\\n
More than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\\n\\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\\n\\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\\n\\nAdditionally, each book published by IntechOpen contains original content and research findings.
\\n\\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\\n\\n\\n\\n
\\n"}]',published:!0,mainMedia:null},components:[{type:"htmlEditorComponent",content:'
Simba Information has released its Open Access Book Publishing 2020 - 2024 report and has again identified IntechOpen as the world’s largest Open Access book publisher by title count.
\n\nSimba Information is a leading provider for market intelligence and forecasts in the media and publishing industry. The report, published every year, provides an overview and financial outlook for the global professional e-book publishing market.
\n\nIntechOpen, De Gruyter, and Frontiers are the largest OA book publishers by title count, with IntechOpen coming in at first place with 5,101 OA books published, a good 1,782 titles ahead of the nearest competitor.
\n\nSince the first Open Access Book Publishing report published in 2016, IntechOpen has held the top stop each year.
\n\n\n\nMore than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\n\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\n\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\n\nAdditionally, each book published by IntechOpen contains original content and research findings.
\n\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\n\n\n\n
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The results of electrical resistivity method to define 1D and 2D electrical models from two datasets acquired in dry and rainy seasons in Panama (Central America) were used to show the relationship between electrical resistivity and volumetric water content. Petrophysical analyses show good fits between resistivity and volumetric water content and known parameters for rocks and soils. The study on Earth planetary system noted that at all stages of the Earth?s formation, convective heat and mass transfer are the most important factors in the dynamics of the planet. 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\r\n\tThe history of neurosurgery is filled with descriptions of brave surgeons performing surgery against great odds in an attempt to improve outcomes in their patients. In the distant past, most neurosurgical procedures were limited to trephination, and this was sometimes performed for unclear reasons. Beginning in the Renaissance and accelerating through the middle and late 19th century, a greater understanding of cerebral localization, antisepsis, anesthesia, and hemostasis led to an era of great expansion in neurosurgical approaches and techniques.
\r\n\r\n\tThis book highlights the most important innovations and milestones in the history of neurosurgery through the ages that allowed the inauguration and establishment of neurosurgical techniques in the field of surgery.
\r\n\r\n\tThis book depicts world history of neurosurgery, including the prehistoric trepanation, advances of neurosurgery in developing countries and developed countries. The advances of spinal neurosurgery, function neurosurgery, endovascular neurosurgery, endoscopic neurosurgery, radiotherapeutic neurosurgery and peadiatric neurosurgery will also be included. Progress often depended on the technical advances of scientists coupled with the innovative ideas and courage of pioneering surgeons. A better understanding of this history provides insight into where we originated as a specialty and in what directions we may go in the future.
\r\n\r\n\tThis book will be very interesting. The text will be written in clear and concise English language. The text will also be original text and unique to this book.
",isbn:"978-1-83968-687-0",printIsbn:"978-1-83968-686-3",pdfIsbn:"978-1-83968-688-7",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,hash:"908c7edd9fcb3cbafbf42d30232db9a0",bookSignature:"Dr. Xianli Lv",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/10537.jpg",keywords:"Trepanation, Craniotomy, Neurosurgery, History, Development, Amygdalotomy, Brain Mapping, Ganglionectomy, Laminectomy, Neurolysis, Future, Neuroplastic Surgery",numberOfDownloads:65,numberOfWosCitations:0,numberOfCrossrefCitations:0,numberOfDimensionsCitations:0,numberOfTotalCitations:0,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"September 3rd 2020",dateEndSecondStepPublish:"October 1st 2020",dateEndThirdStepPublish:"November 30th 2020",dateEndFourthStepPublish:"February 18th 2021",dateEndFifthStepPublish:"April 19th 2021",remainingDaysToSecondStep:"5 months",secondStepPassed:!0,currentStepOfPublishingProcess:5,editedByType:null,kuFlag:!1,biosketch:"Xianli Lv M.D. is an editorial member of the Journal of Interventional Neuroradiology, Stroke and Vascular Neurology, Journal of Neuroradiology, and the Neuroradiology Journal. At present, he is working at the Neurosurgery Department, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University. His area of interest is in the Endovascular Neurosurgery of Intracranial Aneurysm, Cerebral AVM, Intracranial dural arteriovenous fistula, Spinal AVM, Pediatric cerebrospinal AVMs.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"153155",title:"Dr.",name:"Xianli",middleName:null,surname:"Lv",slug:"xianli-lv",fullName:"Xianli Lv",profilePictureURL:"https://mts.intechopen.com/storage/users/153155/images/system/153155.png",biography:"Xianli Lv M.D. \nMale \nBirth date: 10-May-1980\nNeurosurgery Department, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.\nAreas of Interest\nEndovascular Neurosurgery of Intracranial Aneurysm, Cerebral AVM, Intracranial dural arteriovenous fistula, Spinal AVM, Pediatric cerebrospinal AVMs. \nHobbies\nTravel, Reading\nContact information\nCell phone number: 13811519390\nEmail: lvxianli000@163.com\nPostal Address: Changping, Litanglu168, Beijing, 102218, China.\nWorking position\n2019.12- Beijing Tsinghua Changgeng Hospital of Tsinghua University, Associate professor\n2018.1-2019.11 Beijing Tsinghua Changgeng Hospital of Tsinghua University, Attending doctor\n2016.11-2017.12 Beijing Tiantan Hospital of Capital Medical University, Attentidng doctor\n2014.11-2016.11 Beijing Tiantan Hospital of Capital Medical University, Attending doctor\n2009.9-2014.10 Beijing Tiantan Hospital of Capital Medical University, Resident\n2006.9-2009.6 Beijing Institute of Neurosurgery, Capital Medical University, M.D.\n2003.9-2006.6 First Clinical Hospital of Jilin University, Medical Master\n1998.9-2003.6 Clinical Medicine, Medical College of Beihua University, Medical Bachelor\nSocial Part-time Jobs:\n2020.1 Editorial member of The Neuroradiology Journal \n2019.12 Member of stroke rehabilitation society of Chinese Medical Association \n2019.8 Member of the Standing Committee of interventional medicine branch of Beijing Medical Association\n2019.3 Member of Neurosurgery Popular Science Committee, Chinese Medical Association\n2018.10 Editorial Board of Journal of Neurological Intervention Information(Chinese)\n2018.6 Member of Neurological Intervention Specialist Branch of Beijing Medical Association\n2018.3 Reviewer for Journal of Neuroradiology\n2018.3 Reviewer for Journal of the Neurological Sciences\n2018.3 Editorial Board Member of Stroke and vascular neurology\n2017.12 Editorial Board Member for Interventional Neuroradiology\n2017.11 Reviewer of American Journal of Neuroradiology\n2017.1 Reviewer for Journal of NeuroInterventional Surgery\n2013.9 Member of world federation of interventional therapy neuradiology(WFITN)\nOral Presentation on International Conferences:\n2019.6 2019LINNC Seminar, China Edition. The role flow-control technique in endovascular treatment of complex cerebral arteriovenous shunts. Shanghai, China. \n2019.1 ABC Win seminar, France, Valdisere, Transarterial embolization of AVM \n2018.11 Second Sino-Japanese Union of Neurosurgery Conference, A systematic review of pipeline embolization device for giant intracranial aneurysms, Japan\n2018.6 13th Annual Meeting of Neurosurgery Doctors of Chinese Medical Association, The role of transcatheter arterial embolization in the treatment of cerebral AVMs, China\n2018.3 AAFITN Growth and rupture of Giant Intracranial aneurysms after Pipeline Embolization Device Treatment, Malaysia\n2017.10 The fourth WFITN\tCurative and adjunctive AVM embolization through choroidal arteries \n2015.11The thirteenth WFITN \tPre-existing, incidental and hemorrhagic AVMs in pregnancy and postpartum: gestational age, morbidity and mortality, management and risk for fetus.\n2012.9 East Asia Neurointervention Meeting\tFetal-type posterior cerebral artery could be prone to develop vascular insufficiency in parent vessel occlusion treatment of distal posterior cerebral artery aneurysms\t\n2010.10 The sixteenth neuroradiology forum\tThe incidence of trigeminocardiac reflex in endovascular treatment of dural arteriovenous fistula with Onyx\t\n2010.10 The sixteenth neuroradiology forum\tEndovascular treatment of complex intracranial aneurysms: technical review\t\n2007.9 The ninth WFITN Complications associated with transarterial embolization of intracranial dural arteriovenous fistulas with Onyx-18\t\nPublications between 2007 and 2019:\nFirst author publications\nBook chapters: \nChapter2. Lv X, Li Y, Jiang C. Percutaneous Transvenous Embolization of Intracranial Dural Arteriovenous Fistulas with Detachable Coils and/or in Combination with Onyx. In: Tjoumakaris SI, Ed. Arteriovenous fistulas-diagnosis and management. Rijeka: InTech Press 2013; pp. 25-41. ISBN: 978-953-51-1178-8\nChapter11. Lv X, Li Y, Jiang C. Traumatic middle meningeal artery and fistula formation with the cavernous sinus and a review of the literature on endovascular management of traumatic carotid cavernous fistulas. In: Tjoumakaris SI, Ed. Arteriovenous fistulas-diagnosis and management. Rijeka: InTech Press 2013; pp. 167-175. ISBN: 978-953-51-1178-8\nFirst author and corresponding author*\n2019\n1.Sun Y, Li X, Xiong J, Yu J, Lv X*. Transarterial Onyx embolization of residual AVM after surgical resection. World Neurosurg. 2019 Jun;126:e1242-e1245.\n2.Lv X, Jiang C, Liang S, Wang J*. The variant with the absence of the superior petrosal venous and sinus: A potential pitfall of transvenous balloon-assisted embolisation of Borden type II transverse-sigmoid dural arteriovenous fistula. Interv Neuroradiol. 2019 Aug;25(4):474-477. doi: 10.1177/1591019919841929.\n3.Lv X, Wang G*. Cilio-retinal Artery Occlusion after Extrusion Onyx Embolization for Ethmoidal Dural Arteriovenous Fistula via the Ophthalmic Artery. Arch Clin Case Rep. 2019;2(2): 06-11.\n4.Lv XL*. Accessory Meningeal Artery: Emphasis on Its Intracranial Distribution. Journal of Cerebrovascular Disease 2019; 2(1): 1-3.\n5. Lv X*. Hemorrhagic Factors of Moyamoya Disease. AJNR Am J Neuroradiol. 2019 Oct;40(10):1672-1673.\n6. Guo L, Liu T, Lv X*. Endovascular embolization of dural arteriovenous fistula in a child presented with slight conjunctival hyperemia. Childs Nerv Syst. 2019 Dec;35(12):2435-2437.\n7.Tian Jian, Li Yingqiang, Wang Lei, Xiong Jianing, Gong Cuiling, Lv Xianli*. Endovascular treatmentof multiple intracranial aneurysms with severe coronary heart disease: one case report. Chin J Neuromed. 2019;18(11):1161-1163.[Chinese]\n8.Lv X, Chen Z, Liu L, Jiang C, Wang G, Wang J*. Rupture of Intradural Giant Aneurysms: The Mode of Treatment, Anatomical, and Mechanical Factors. Neurol India. 2019; 67(5): 1194—1199. \n9. Sun J, Lv X*. Why does large venous pouch thrombose after cerebral arteriovenous shunts embolization?. Ann of Indian Acad Neurol. 2019, DOI: 10.4103/aian.AIAN_448_19\n10.Xiong J, Wang L, Tian J, Li Y, Gong C, Lv X*. Stent‑Assisted Coiling of Brain Aneurysms Under Conscious Sedation and Simultaneous Coronary Heart Disease Stenting: A New Concept. Ann of Indian Acad Neurol. 2019, DOI: 10.4103/aian.AIAN_471_19\n11. Lv X*, Jiang C, Wu Z, Jiang W, Wang G. Complex cerebral aneurysms: intra-luminal reconstruction using Pipeline flow-diverting stent and the obliteration mechanism. Neuroradiol J. 2019;1971400919894879. doi:10.1177/1971400919894879\n2018\n1.Lv X, Li W, Ge H, Jin H, He H, Jiang C, Li Y. Parent artery sacrifice for ruptured aneurysms in acute and chronic phases: A systematic review. Neurol India. 2018 May-Jun;66(3):695-699. \n2. Lv X, Li W, Li Y. Training residents and fellows in the procedure of diagnostic cervicocerebral angiography: Techniques to avoid complications. Neurol India. 2018 May-Jun;66(3):652-656.\n3. Lv X, Wang G. Review of de novo cerebral arteriovenous malformation: haemorrhage risk, treatment approaches and outcomes. Neuroradiol J. 2018 Jun;31(3):224-229. \n4. Lv X, Wu Z. The philosophy of 'unity of knowledge and action' in interventional neuroradiology teaching. Neuroradiol J. 2018 Jun;31(3):330-332.\n5. Lv X, Zhang Y, Jiang W. Systematic Review of Woven EndoBridge for Wide-Necked Bifurcation Aneurysms: Complications, Adequate Occlusion Rate, Morbidity, and Mortality. World Neurosurg. 2018 Feb;110:20-25. \n2017\n1.Lv X, Ge H, He H, Jiang C, Li Y*. A systematic review of pipeline embolization device for giant intracranial aneurysms. Neurology India. 2017;65:35-38.\n2.Lv X, Li W, Liu A, Lv M, Jiang C. Endovascular treatment evolution for pure intraorbital arteriovenous fistula: Three case reports and literature review. Neuroradiol J. 2017 Apr;30(2):151-159.\n3. Lv X, Hu X, Li W, He H, Jiang C*, Li Y. Curative and adjunctive AVM Onyx embolization of AVMs through the choroidal arteries. Interv Neuroradiol. 2017;23:392-398.\n4.Lv X, Li W, He H, Jiang C, Li Y*. Known and unknown cerebral arteriovenous malformations in pregnancies: Hemorrhage risk and influence on obstetrical management. Neuroradiol J. 2017 Oct;30(5):437-441.\n5.Lv X, Song C, He H, Jiang C, Li Y. Transvenous retrograde AVM embolization: Indications, techniques, complications and outcomes. Interv Neuroradiol. 2017 Oct;23(5):504-509\n6.Lv X. Letter: Comparison of N-butyl Cyanoacrylate and Onyx for the Embolization of Intracranial Arteriovenous Malformations—Analysis of Fluoroscopy and Procedure Times. Operative Neurosurgery. 2017;13(6):E37-38.\n2016\n1.Lv X, Hu X, Liu J, He H, Li Y*. The influence of age and the initial clinical presentations of patients with an arteriovenous malformation on the risk of hemorrhage. Neurology India. 2016;64:87-94. 2.Lv X, Yang H, Liu P, Li Y. Flow-diverter devices in treatment of intracranial aneurysms: A Meta-analysis and systematic review. Neuroradiol J. 2016;29(1):66-71. 3.Lv X, Liu P, Li Y*. Pre-existing, Incidental and Hemorrhagic AVMs in Pregnancy and Postpartum: Gestational Age, Morbidity and Mortality, Management and Risk for fetus. Interv Neuroradiol. 2016;22(2):206-211. \n4.Lv X, Wu Z, He H, Ge H, Li Y*. Proposal of classification of aneurysms coexisting with AVM and possible treatment strategies. Turkish Neurosurgery 2016; 26: 229-233. \n5.Lv X, Ge H, Jin H, He H, Jiang C, Li Y*. Endovascular treatment of unruptured posterior circulation intracranial aneurysms. Ann Indian Acad Neurol 2016;19:302-6.\n6.Liu P1, Lv XL1, Liu AH, Chen C, Ge HJ, Jin HW, Feng X, Lv M, Li YX, Duan L*. Intracranial aneurysms associated with moyamoya disease in children: clinical features and long-term surgical outcome. World Neurosurg. 2016 Oct;94:513-520.\n7. Ge H, Jin H, Li Y, Lv X*. Extraction of a migrated coil from the Enterprise stent strut using a Solitaire AB stent. Neuroradiol J. 2016 Dec;29(6):470-472.\n8.Lv X, Ge H, He H, Jiang C, Li Y*. Anterior inferior cerebellar artery aneurysms: Segments and results of surgical and endovascular managements. Interv Neuroradiol. 2016 Dec;22(6):643-648. Epub 2016 Aug 2.\n9. Lv X, Chen X, Ge H, He H, Jiang C, Li Y*. Adjunct to Embolize the High-Flow Fistula Part of Arteriovenous Malformation Using a Double-Lumen Balloon Catheter. World Neurosurg. 2016 Dec;96:370-374.\n2015\n1. Lv X, Li Y. Progress in diagnosis and treatment of subarachnoid hemorrhage during pregnancy and childbirth. Chinese Journal of Neurosurgery,2015,31(1):95-98.\n2. Lv X, Liu P, Li Y. The clinical characteristics and treatment of cerebral AVM in pregnancy. Neuroradiol J. 2015 Jun;28(3):234-7.\n3. Lv X, Liu J, Hu X, Li Y*. Patient age, hemorrhage patterns and AVM outcomes. World Neurosurg. 2015; ;84(4):1039-44.\n4.Lv X, Wu Z*. Anatomic Variations of Internal Jugular Vein, Inferior Petrosal Sinus and Its Confluence Pattern: Implications in Inferior Petrosal Sinus Catheterization. Interv Neuroradiol. 2015;21(6):769-773.\n5. Lv X, He H, Wu Z*. China's Medical Education and Interventional Neuroradiology Training. World Neurosurg. 2015 Nov;84(5):1462-5.\n2014\n1.Zhang Z, Lv X*, Wu Z*, Li Y, Yang X, Jiang C, Xu R, Shen C. Clinical and angiographic outcome of endovascular and conservative treatment for giant cavernous carotid artery aneurysms. Interv Neuroradiol. 2014;20: 29-36. \n2.Lv X, Wu Z, Li Y*. Innervation of Cerebral Dura Mater. Neuroradiolog J. 2014 Jun;27(3):293-298.\n3.Lv X, Wu Z, Li Y*. Effect of electromagnetic radiation on the coils used in aneurysm embolization. Neuroradiolog J. 2014 Jun;27(3):350-355.\n4.Zhongxue Wu. Angel under X-ray. Translated by Xianli Lv. Interventional Neuroradiology 2014;20: 454. \n2013\n1.Jiang C, Lv X, Li Y, Wu Z, Shi J*. Surgical access on the superior ophthalmic vein to the cavernous sinus dural fistula for embolization. J Neurointerv Surg. 2013;5(3):e13. \n2.Lv X, Li Y, Yang X, Jiang C, Wu Z*. Characteristics of brain arteriovenous malformations in patients presenting with nonhemorrhagic neurologic deficits. World Neurosurg. 2013;79(3-4): 484–488\n3.Lv X, Wu Z*. Robot-assisted Gait Rehabilitation after Stroke. Journal of Rehabilitation Robotics. 2013;1:3-8. \n4.Lv X, Wu Z, Li Y*. Arteriovenous Malformation in the Brain: a Theoretical Study Explaining the Behavior of Liquid Embolic Agents during Endovascular Treatment. Neuroradiol J. 2013;26:661-668\n5.Lv X, Li Z, Li Y*. Prehistoric Skull Trepanation in China. World Neurosurg. 2013;80(6):897-9. \n2012\n1.Lv X, Li Y, Yang X, Jiang C, Wu Z*. Endovascular embolization for symptomatic perimedullary AVF and intramedullary AVM: a series and literature review. Neuroradiology. 2012;54:349-359\n2.Lv X, Wu Z*, Li Y, Yang X, Jiang C, Sun Y, Zhang N. Endovascular treatment of cerebral aneurysms associated with arteriovenous malformations. Eur J Radiol. 2012;81:1296-1298\n3. Lv X, Li Y, Xinjian Y, Jiang C, Wu Z*. Results of endovascular treatment for intracranial wide-necked saccular and dissecting aneurysms using the Enterprise stent: A single center experience. Eur J Radiol. 2012;81:1179-1183\n4.Zhang J, Lv X,* Yang J, Wu Z. Stent-assisted coil embolization of intracranial aneurysms using Solitaire stent. Neurology India 2012; 60:278-282\n5.Lv X, Wu Z*, Li Y, Yang X, Jiang C. Hemorrhage risk after partial endovascular NBCA and ONYX embolization for brain arteriovenous malformation. Neurol Res. 2012;34:552-6. \n6.Lv X, Li Y, Yang X, Jiang C, Wu Z*. Potential proneness of fetal-type posterior cerebral artery to vascular insufficiency in parentvessel occlusion of distal posterior cerebral artery aneurysms. J Neurosurg. 2012;117:284-7.\n7.Lv X, Wu Z, Qu RB*, Jin H*. Endovascular Treatment of Cerebral Aneurysms During Acute (<72 Hours) Subarachnoid Hemorrhage. Journal of Neurological Sciences [Turkish] 2012;29:535-541\n8.Li T, Lv X*, Wu Z. Endovascular treatment of hemifacial spasm associated with a petrosal DAVF using transarterial Onyx embolization: case report. Interv Neuroradiol. 2012;18:69-73\n2011\n1.Lv X, Jiang C, Li Y, Liu L, Liu J, Wu Z*. The laterocavernous sinus system: venous inflows, venous outflows and clinical significance. World Neurosurgery 2011;75:90-93\n2.Lv X, Feng W, Li Y, Yang X, Jiang C, Liu L, Liu J, Sun J, Wu Z*. Cavernous region dural fistulas with the venous drainage of laterocavernous sinus. Neurol India 2011;59:190-194\n3.Lv X, Jiang C, Li Y, Yang X, Wu Z*. Endovascular treatment for cerebral perforating artery aneurysms. Neurol Res. 2011;33:553-557.\n4.Lv X, Wu Z*, Jiang C, Yang X, Li Y, Sun Y, Zhang N. Angioarchitectural characteristics of brain arteriovenous malformations presenting with and without hemorrhage. World Neurosurgery 2011; 76:95-99\n5.Lv X, Li Y, Jiang C, Yang X, Wu Z*. Potential advantages and limitations of the Leo stent in endovascular treatment of complex cerebral aneurysms. Eur J Radiol. 2011;79:317-322\n6.Lv X, Li Y, Yang X, Jiang C, Wu Z*. Characteristics of arteriovenous malformations associated with cerebral aneurysms. World Neurosurg. 2011;76(3-4):288-91.\n7. Lv X, Jiang C, Li Y, Liu L, Liu J, Wu Z*. The limitations and risks of transarterial Onyx injections in the treatment of grade I and II DAVFs. Eur J Radiol. 2011;80:e385-e388\n8.Lv X, Wu Z*, Jiang C, Li Y, Yang X, Zhang Y, Zhang N. Complication risk of endovascular embolization for cerebral arteriovenous malformation. Eur J Radiol. 2011;80:776-779\n9. Lv X, Wu Z*, Li Y, Jiang C, Yang X, Zhang J. Cerebral arteriovenous malformations associated with flow-related and circle of Willis aneurysms. World Neurosurgery 2011; 76: 455-458\n10.Lv X, Yang X, Li Y, Jiang C, Wu Z*. Dural arteriovenous fistula with spinal perimedullary venous drainage. Neurology India. 2011;59:899-902\n11.Lv X, Wu Z*, Jiang C, Li Y. Illustrative case: A patient with cerebral proliferative angiopathy. Eur J Radiol Extra. 2011;78:e67-e70\n12. Lv X, Lv M, Li Y, Yang X, Jiang C, Wu Z*. Endovascular treatment of ruptured and unruptured vertebral artery aneurysms. Digital-Neuroradiol J. 2011;1(17):797-806\n2010\n1.Lv X, Jiang C, Li Y, Wu Z*. Embolization of intracranial dural arteriovenous fistulas with Onyx-18. Eur J Radiol. 2010;73:664-671\n2.Lv X, Jiang C, Li Y, Yang X, Wu Z*. Isolated oculomotor nerve palsy in interventional neuroradiology. Eur J Radiol 2010;74:441-444\n3.Lv X, Jiang C, Li Y, Yang X, Wu Z*. Recovery of opthalmoplegia associated with cavernous sinus dural arteriovenous fistulas after transvenous cavernous sinus packing. Eur J Radiol 2010 ;75 :139-142\n4.Lv X, Jiang C, Li Y, Lv M, Wu Z*. Endovascular treatment of dural fistulas with the venous outflow of laterocavernous sinus. Eur J Radiol. 2010;75:e129-e134\n5.Lv X, Jiang C, Li Y, Wu Z*. Clinical outcomes of ruptured and unruptured vertebral artery-posterior inferior cerebellar artery complex dissecting aneurysms after endovascular embolization. AJNR Am J Neuroradiol. 2010;31:1232-1235\n6.Lv X, Jiang C, Li Y, Yang X, Wu Z*. Clinical outcomes of endovascular treatment for intracranial pial arteriovenous fistulas. World Neurosurgery 2010; 73:385-390\n7.Lv X, Jiang C, Li Y, Liu L, Liu J, Wu Z*. Transverse-sigmoid sinus dural arteriovenous fistulae. World Neurosurgery 2010;74:297-305\n8.Lv X, Li Y, Jiang C, Yang X, Wu Z*. Endovascular treatment using stents for vertebral artery fusiform aneurysms. Neurol Res 2010;32:792-795\n9.Lv X, Jiang C, Li Y, Wu Z*. Clinical outcomes of lower cranial nerve palsies caused by vertebral artery–posteroinferior cerebellar artery aneurysms after endovascular embolization. Neurol Res 2010;32:796-800\n10.Lv X, Wu Z*, Jiang C, Li Y, Yang X, Zhang Y, Lv M, Zhang N. Endovascular treatment accounts for a change in brain arteriovenous malformation natural history risk. Interv Neuroradiol 2010;16:127-132\n11.Lv X, Li Y, Jiang C, Wu Z*. The incidence of trigeminocardiac reflex in endovascular treatment of dural arteriovenous fistula with Onyx. Interv Neuroradiol 2010;16(1):59-63\n12.Lv X, Li Y, Jiang C, Yang X, Wu Z*. Brain arteriovenous malformation and endovascular treatment: effect on seizures. Interv Neuroradiol 2010;16(1):39-45\n2009\n1.Lv X, Li Y*, Jiang C, Wu Z. Endovascular treatment of brain arteriovenous fistulas. Am. J. Neuroradiol 2009;30:851-856\n2.Lv X, Jiang C*, Zhang J, Li Y, Wu Z. Complications related to percutaneous transarterial embolization of intracranial dural arteriovenous fistulas in 40 patients. Am. J. Neuroradiol.2009; 30: 462 - 468.\n3.Lv X, Jiang C, Li Y,Yang X, Wu Z*. Endovascular treatment for pediatric intracranial aneurysms. Neuroradiology 2009;51:749-754\n4.Lv X, Jiang C*, Li Y, Wu Z*. Percutaneous transvenous packing of cavernous sinus with Onyx for cavernous dural arteriovenous fistula. Eur J Radiol. 2009;71:356-362\n5.Lv X, Li Y, Jiang C, Yang X, Wu Z*. Parent vessel occlusion for P2 dissecting aneurysms of the posterior cerebral artery. Surg Neurol. 2009;71(3):319-25. \n6.Lv X, Jiang C, Li Y, Wu Z*. A promising adjuvant to detachable coils for cavernous packing-Onyx. Interv Neuroradiol 2009;15:145-152\n7. Lv X, Jiang C, Li Y, Yang X, Wu Z*. Treatment of giant intracranial aneurysms. Interv Neuroradiol 2009;15:135-144\n8.Lv X, Jiang C, Li Y, Yang X, Wu Z*. Intraarterial and intravenous treatment of transverse/sigmoid sinus dural arteriovenous fistulas. Interv Neuroradiol 2009;15:291-300 \n9.Lv X, Li Y, Jiang C, Wu Z*. Endovascular management for P2 aneurysms of the posterior cerebral artery: experience on proximal occlusion of P2 segment. Interv Neuroradiol 2009;15:341-348\n2008\n1.Lv XL, Li YX, Liu AH, Lv M, Jiang P, Zhang JB, Wu ZX*. A complex cavernous sinus dural arteriovenous fistula secondary to covered stent placement for a traumatic carotid artery-cavernous sinus fistula. J Neurosurg. 2008;108(3):588-90. \n2.Lv X, Jiang C*, Li Y, Wu Z. Results and complications of transarterial embolization of intracranial dural arteriovenous fistulas using Onyx-18. J Neurosurg 2008;109:1083-1090\n3.Lv X, Li Y, Wu Z*. Endovascular treatment of the anterior cranial fossa dural arteriovenous fistulas. Neuroradiology 2008;50:433-437\n4.Lv X, Li Y, Liu A, Lv M, Jiang C*, Wu Z. Endovascular embolization of dural arteriovenous fistulas of the anterior cranial fossa: three case reports. Neurol Res, 2008;30(8):852-9.\n5.Lv X, Jiang C, Li Y, Lv M, Zhang J, Wu Z*. Intracranial pseudoaneurysms, dissections and carotid-cavernous fistulas: repair with percutaneous implantation of endovascular covered stents. Interv Neuroradiol 2008;14:435-440\n6.Lv X, Jiang C, Li Y, Yang X, Wu Z*. Percutaneous transvenous embolization of intracranial dural arteriovenous fistulae with detachable coils and/or in combination with Onyx. Interv Neuroradiol 2008;14:415-427\n7.Lv X, Li Y*, Lv M, Liu A, Wu Z*. Successful endovascular treatment of a deep cerebral arteriovenous fistula with unusual venous drainage. Eur J Radiol Extra 2008;68:e53-58\n8.Lv X*, Li Y, Liu A, Wu Z. Endovascular management of multiple cerebral aneurysms in acute subarachnoid hemorrhage associated with fenestrated basilar artery: a case report and review of the literature. Neuroradiol J. 2008;21:137-142\n9.Lv X, Li Y, Liu A, Zhang J, Wu Z*. Parent artery occlusion for peripheral anterior inferior cerebellar artery aneurysm: case report and review of the literature. Neuroradiol J. 2008;21:261-265\n10.Lv X, Li Y, Wu Z*. Endovascular management for bilateral ophthalmic segment “kissing aneurysms” presenting with nasal bleeding: case report. Neuroradiol J. 2008;21:266-269\n11.Lv X, Jiang C*, Li Y, Yang X, Wu Z. Transarterial embolization of tentorial dural arteriovenous fistulas with Onyx-18. Neuroradiol J. 2008;21:406-414\n12.Lv X, Zhong J, Li Y, Jiang C, Wu Z*. Dural arteriovenous fistula involving the transverse sigmoid sinus presenting as chemosis: a case report. Neuroradiol J. 2008;21:428-432\n13.Lv X, Li Y, Jiang C, Zhang J, Wu Z*. Venous infarction associated with a sigmoid sinus dural arteriovenous fistula: case report. Neuroradiol J. 2008;21:579-583\n2007 \n1.Lv X, Li Y, Lv M, Liu A, Zhang J, Wu Z*. Trigemino-cardiac reflex in embolization of intracranial dural arteriovenous fistula. Am J Neuroradiol 2007;(28):1769-1770\n2.Lv X, Li Y, Liu A, Jiang P, Lv M, Wu Z*. Endovascular treatment of intracranial giant serpentine aneurysms. Neuroradiol J. 2007;20(2):237-241\n3.Lv X, Li Y, Liu A, Jiang C, Wu Z*. Transarterial embolization of dural arteriovenous fistulas of the anterior cranial fossa Onyx-18: Case report. Neuroradiol J. 2007;20(3):53-59\nNon-first author\n2017\n1.Ge H, Lv X, Jin H, Tian Z, Li Y*, He H. The role of endovascular treatment in unruptured basilar tip aneurysms. Interv Neuroradiol. 2017 Feb;23(1):8-13.\n2016\n1. Jin H, Lv X, Li Y. Transarterial Onyx embolization of jugular foramen dural arteriovenous fistula with spinal venous drainage manifesting as myelopathy-a case report and review of the literature. Interv Neuroradiol. 2016 Oct;22(5):579-83.\n2. Yu J, Shi L, Lv X, Wu Z, Yang H. Intracranial non-galenic pial arteriovenous fistula: A review of the literature. Interv Neuroradiol. 2016 Oct;22(5):557-68. \n3. Liu P, Qi H, Liu A, Lv X, Jiang Y, Zhao X, Li R, Lu B, Lv M, Chen H, Li Y. Relationship between aneurysm wall enhancement and conventional risk factors in patients with unruptured intracranial aneurysms: A black-blood MRI study. Interv Neuroradiol. 2016 Oct;22(5):501-5. \n4.Liu P, Xu Y, Lv X, Ge H, Lv M, Li Y. Progression of unilateral moyamoya disease resulted in spontaneous occlusion of ipsilateral cavernous dural arteriovenous fistula: Case report. Interv Neuroradiol. 2016 Jun;22(3):362-4. \n5. Yu J, Lv X, Li Y, Wu Z. Therapeutic progress in pediatric intracranial dural arteriovenous shunts: A review. Interv Neuroradiol. 2016 Oct;22(5):548-56.\n2015\n1.Yang H, Sun Y, Jiang Y, Lv X, Zhao Y, Li Y*, Liu A. Comparison Of Stent-Assisted Coiling Vs Coiling Alone In 563 Intracranial Aneurysms: Safety And Efficacy At A High-Volume Center. Neurosurgery. 2015; 77: 241-247. \n2.Yang H, Li Y*, Jiang Y, Lv X. Thromboelastography for monitoring platelet function in unruptured intracranial aneurysm patients undergoing stent placement. Interv Neuroradiol. 2015;21(1):61-68. \n3.Huo X, Jiang Y, Lv X, Yang H, Zhao Y, Li X*. Targeted embolization reduces hemorrhage complications in partially embolized cerebral AVM combined with gamma knife surgery. Interv Neuroradiol. 2015;21(1):80-87. \n4.Zhang Z, Lv X, Yang X, Shiqing MU, Wu Z*, Shen C, Xu R. Endovascular management of giant aneurysms: An introspection. Neurol India. 2015 Mar-Apr;63(2):184-9. doi: 10.4103/0028-3886.156278.\n5. Huo X, Jiang Y, Lv X, Yang H, Zhao Y, Li Y*. Gamma Knife surgical treatment for partially embolized cerebral arteriovenous malformations. J Neurosurg. 2015 Aug 7:1-10. \n6. Liu P, Lv X, Li Y, Lv M*. Onyx embolization of a ruptured rotundum foreman artery aneurysm in a patient with moyamoya disease: case report. World Neurosurg. 2015; 84(4):1178.e1-3. \n7. Liu P, Lv X, Li Y, Lv M*. Endovascular management of intracranial aneurysms during pregnancy in three cases and review of the literature. Interv Neuroradiol. 2015 Dec;21(6):654-8.\n2014\n1.Shen X, Liu J, Lv X, Li Y*. Risk of Rupture and Risks of Endovascular Management of Unruptured Brain Arteriovenous Malformations. Interventional Neuroradiology 2014;20: 495-501. \n2.Liu J, Lv M, Lv X, He H, Liu A, Qian Z, Li Y*. Curative Glubran 2 Embolization of Cerebral Arteriovenous Malformations: Patient Selection and Initial Results. Interventional Neuroradiology 2014;20: 722-728. \n2012\n1.Jiang P, Lv X, Wu Z*, Li Y. Dural arteriovenous fistula of crianiocervical junction. Neurology India. 2012;60:94-95\n2.Lou J, Lv X, Wu Z, Jiang C*. Brain AVM characteristics and age. Eur J Radiol. 2012;81:780-783\n3.Sun Y, Lv X, Li Y, Li A*. Complications caused by cerebral arteriovenous malformation embolization. Neuroradiol J. 2012;25(5):541-7.\n4.Jia J, Lv X, Liu A, Wu Z*, Li Y. Enterprise Stent-Assisted Coiling of Wide-Necked Intracranial Aneurysms: Clinical and Angiographic Follow-up. Interv Neuroradiol. 2012;18(4):426-31.\n5. Wu Z, Li Y, Yang X, Jiang C, Lv M, Lv X. Intracranial vascular treatment of multiple aneurysms. Chinese Journal of Neurosurgery.2012; 28(11): 1113-1115.\n2011\n1.Liu L, He H, Jiang C*, Lv X, Li Y. Deliberate parent artery occlusion for non-saccular posterior cerebral artery aneurysms. Interv Neuroradiol. 2011;17:159-68\n2.Jiang C, Lv X, Li Y, Wu Z*. Transarterial Onyx packing of the transverse–sigmoid sinus for dural arteriovenous fistulas. Eur J Radiol. 2011;80:767-770\n3.Sun Y, Li Y, Li AM*. Endovascular treatment of paraclinoid aneurysms. Interv Neuroradiol. 2011;17:425-430\n4.Jiang P, Lv X, Wu Z*, Li Y, Jiang C, Yang X, Zhang Y. Characteristics of brain arteriovenous malformations presenting with seizures without acute or remote hemorrhage. Digital- Neuroradiol J. 2011;1:1051-1053\n2010\n1.Zhang J, Lv X*, Jiang C, Li Y, Yang X, Wu Z. Endovascular treatment of cerebral aneurysms with the use of stents in small cerebral vessels. Neurol Res. 2010;32(2):119-122\n2.Yang T, Liu S, Lv X*, Wu Z. Balloon kyphoplasty for acute osteoporotic compression fractures. Interv Neuroradiol 2010;16(1):65-70\n3.Zhang J, Lv X, Li Y, Wu Z*.Superior cerebellar artery infarction in endovascular treatment for tentorial dural arteriovenous fistulas. Eur J Radiol. 2010;74:e33-e37\n4.Yu B*, Wu Z, Lv X, Liu Y, Sang M. Endovascular treatment of A1 segment aneurysms of the anterior cerebral artery. Neurol India 2010;58:446-448 \n5.Luo J, Lv X, Jiang C*, Wu Z. Preliminary use of Leo stent in endovascular treatment of wide-necked cerebral aneurysms. World Neurosurgery 2010;73:379-384\n6.Sun Y, Lv X, Li Y, Jiang C, Wu Z, Li AM*. Endovascular embolization for deep basal ganglia arteriovenous malformations. Neuroradiol J. 2010;23:359-362\n7.Zhang J, Lv X, Jiang C, Li Y, Yang X, Wu Z*. Transarterial and transvenous embolization for cavernous sinus dural arteriovenous fistulae. Interv Neuroradiol 2010;16:269-277\n8.Zhang J, Zhang R, Wu Z*, Lv X, Liu B. Results of endovascular management for mid-basilar artery aneurysms. Interv Neuroradiol 2010;16:249-254\n9.Wu Z*, Lv X, Li Y, Jiang C, Yang X. Endovascular treatment for complex intracranial aneurysms: lessons learnt in five patients. Neuroradiol J. 2010;23:459-466\n10.Zhang J, Lv M, Lv X, Jiang C, Li Y, Wu Z*. Endovascular treatment using stents for cerebral aneurysms. Neuroradiol J. 2010;23:730-736\n11.Lv M, Lv X, Jiang C, Wu Z*. A P1 aneurysm and diabetes insipidus caused by traumatic brain injury. Neuroradiol J. 2010;23:724-729\n12.Zhang J, Lv M, Lv X, Jiang C, Li Y, Wu Z*. Endovascular treatment using stents for cerebral aneurysms. Neuroradiol J. 2010;23:730-736\n13.Lv M, Lv X, Jiang C, Wu Z*. A P1 aneurysm and diabetes insipidus caused by traumatic brain injury. Neuroradiol J. 2010;23:724-729\n14. Sun Y, Li A, Li Y, Chen J, Shi H, Jiang P, Lv X, Jiang Y, Zhang N. Endovascular treatment of giant intracranial aneurysms. Journal of Clinical Neurosurgery. 2010;7(1):36-39.\n15. Zhang J, Zhang R, Wu Z, Lv X, Liu B. Results of Endovascular Management for Mid-Basilar Artery Aneurysms. Interv Neuroradiol. 2010; 16(3): 249–254.\n2009\n1.Jiang C, Lv X, Li Y, Zhang J, Wu Z*. Endovascular treatment of high-risk tentorial dural arteriovenous fistulas: clinical outcomes. Neuroradiology. 2009;51(2):103-11.\n2.Jiang C, Lv X, Wu Z*. Clinical-pathology review: Supratentorial cerebral arteriovenous fistula. Eur J Radiol Extra 2009 ;72 :e97-e102\n3.Wu Z*, Lv X, Yang X, He H. Ruptured vertebro-inferoposterior cerebellar artery dissecting aneurysm treated with the Neuroform stent deployment and vertebral artery occlusion. Eur J Radiol Extra. 2009; 70:e100-e103\n4.Lv M, Lv X*, Li Y, Yang X, Wu Z. Vertebral dissecting aneurysm treated with the Wingspan stent deployment and detachable coils: Technical note. Interv Neuroradiol 2009;15:113-116\n5.Lv M, Lv X*, Li Y, Jiang C, Jiang P, Wu Z. Dissecting aneurysm at proximal anterior cerebral artery treated by parent artery occlusion. Interv Neuroradiol 2009;15:123-126\n6.Wang H, Lv X, Jiang C, Li Y, Wu Z, Xu K*. Onyx migration in endovascular management of intracranial dural arteriovenous fistulas. Interv Neuroradiol 2009;15:301-308\n7.Liu L, Lv X, Jiang C*, Wu Z. Transvenous embolization of cavernous sinus dural arteriovenous fistulae. Zhong hua shen jing wai ke za zhi 2009;25:695-698\n2008\n1.Li Y, Lv X, Jiang C, Liu A, Wu Z*. Endovascular treatment of posterior cerebral artery aneurysms. Neuroradiol J. 2008;21:128-136\n2. Liu A, Lv X*, Li Y, Lv M, Wu Z. Traumatic middle meningeal artery and fistula formation with the cavernous sinus: case report. Surg Neurol 2008;70:660-663\n3.He HW*, Jiang CH, Wu ZX, Li YX, Lü XL, Wang ZC. Transvenous embolization with a combination of detachable coils and onyx for a complicated cavernous dural arteriovenous fistula. Chin Med J (Engl) 2008; 121:1651–1655\n4.Jiang C, Lv X, Li Y, Wu Z*. Transvenous treatment of cavernous dural arteriovenous fistulae with Onyx and coils. Neuroradiol. J. 2008;21:415-422\n2007\n1.Jiang C, Lv X, Li Y, Wu Z*. Transarterial and transvenous embolization for tentorial dural arteriovenous fistula: case report. Neuroradiol J. 2007;20(6):726-729\n2.Jiang C, Lv X, Li Y, Liu A, Wu Z*. Transvenous embolization with Onyx for dural arteriovenous fistula of cavernous sinus: a report of two case reports. Neuroradiol J. 2007;20(6):718-725\n3.Jiang C, Lv X,Li Y, Liu A, Lv M, Jiang P, Wu Z*. Transvenous embolization of cavernous sinus dural arteriovenous fistula with Onyx-18 and plentinum coils: Technical Note. 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It has been estimated that more than 55,000 Americans developed MM in 2004, and that about 8,000 ultimately died of it (1).
\n\t\t\tMore than one third of patients operated for MM develop tumor recurrence; melanoma patients’ annual risk of death in Stage IV of the American Joint Committee on Cancer (AJCC) has been estimated to be about 20% during the first 3 years (2). The site of relapse is a very important predictor of survival. Regional lymph node recurrences in fact, may be surgically resected and 5-year survival rate have been reported to be between 20% and 50% (3-4). Distant metastases (MTS), both in visceral and non-visceral sites, reported a 5-year survival of approximately 5% (5-7); for these patients surgery is not often feasible and systemic treatment (chemotherapy, immunotherapy, radiotherapy) is sometimes the curative option.
\n\t\t\tLung is the second most common site for metastatic MM spread (8). The annual probability of developing lung MTS progressively increases from 10% at 5 years to 17% at 15 years after the resection of the primary tumor (9). Lung MTS are usually asymptomatic, sometimes multiple, occasionally detected with radiological imaging during patient follow-up.
\n\t\t\tOnce lung MTS has developed, the possible surgical treatment remains controversial. Even if a clear clinical advantage in overall survival (OS) after resection of pulmonary MTS from osteogenic sarcoma, soft tissue sarcoma, non-seminomatous testicular neoplasms, colorectal and renal cell carcinoma has been demonstrated, 5-year survival rates in melanoma patients were lower, ranging between 5% and 31% (10-12). These ranges indicate how a preoperative patient selection is mandatory. In fact, only 10-35% of all metastatic melanoma patients are suitable for a complete surgical resection (13).
\n\t\t\tSystemic treatments including chemotherapy, radiotherapy, immunotherapy and more recently molecular target agents, demonstrated a partial clinical response only, with severe adverse effect and a dramatic impact on patient’s quality of life (QOL), providing little, if any, attested survival benefit. Chemotherapy regimens may include: dacarbazine, cisplatin and carmusine, alone or in combination with a variety of immunotherapies, including cytokines, monoclonal antibodies and vaccination strategies with synthetic peptides, naked DNA, dendritic cells and recombinant viruses (14-17). Unfortunately, results are presently discouraging: <20% of patients treated with such therapeutic options present with a partial response rate and very few are long-term survivors.
\n\t\t\tDue to these reasons, surgery remains the treatment of choice to improve OS in Stage IV melanoma patients; anyway, surgery cannot be offered to all of metastatic patients. The need for a correct patient preoperative clinical assessment, in order to avoid incomplete surgical resections, has been demonstrated by many studies.
\n\t\t\tThe aim of this paper is to underline the prognostic factors which influence survival in melanoma patients with pulmonary metastases undergoing surgical resection. The first part regards the experience of the Thoracic Surgery Department of the University of Torino; lastly we discuss our results at the light of those of the most important series published in Literature.
\n\t\tIn 2010 our group, a dedicated high-volume thoracic surgical team with long time experience in the management of pulmonary metastases, published its experience on the surgical treatment of pulmonary metastases from MM (18). Twenty-six patients were operated between January 2000 and December 2008. Table 1 shows patients clinical characteristics.
\n\t\t\t\t\n\t\t\t\t\t\t\t\t | \n\t\t\t\t\t\t
University of Torino Department of Thoracic Surgery Stage IV melanoma metastatic to the lung: patients characteristics (number: 26).
Our patients’ inclusion criteria were: 1) complete resection of the primary tumor; 2) no evidence of any other extrapulmonary MTSs; 3) resectable lung MTS; 4) predicted post-resection lung volumes compatible with the anticipated pulmonary resection.
\n\t\t\t\tIn all cases lung MTSs were discovered with a routine chest X-ray during the follow-up program. The lesion/s was/were confirmed by a thoracic CT scan; since 2003, PET scan was available in our centre and routinely used.
\n\t\t\t\tLung represented the first metastatic site in the majority of our patients (17; 65%); in 9 patients, lung MTS developed after metastatic spread in other viscera. A single pulmonary nodule was observed in 14 cases; 5 patients had 2 nodules and multiple nodules were observed in the remaining 7.
\n\t\t\t\tAll patients received adjuvant or neoadjuvant systemic therapy (either chemotherapy or immunotherapy). The mean disease-free interval (DFI) was of 36 months.
\n\t\t\t\tLung wedge resection was the commonest surgical procedure performed (23 cases) whereas lobectomy was necessary in 3 patients. A complete surgical resection was accomplished in all patients and it was confirmed by the histological examination. There was no postoperative mortality.
\n\t\t\t\tOne, 3 and 5-year survival rates were 72%, 36% and 23% respectively.
\n\t\t\t\tThe Cox regression analysis identified the female gender (p=0.05) as the only independent prognostic factor related to patients survival. This result can be attributed to the limited number of our patients and to their preoperative selection: these factors may explain why the number of pulmonary MTS and/or the DFI did not reach a statistical significance in our analysis (18).
\n\t\t\t\tA formal search in literature results in several small and out of date series, and many case reports regarding unusual clinical manifestations of pulmonary MTS from MM.
\n\t\t\t\tIn order to analyze the results and to recognize possible prognostic factors we summarize the most interesting ones, comparing them to our data.
\n\t\t\t\n\t\t\t\t\tTafra et al. (12) reviewed the John Wayne Cancer Institute’s melanoma series: among 6129 patients treated from 1971 to 1993, 2167 had distant MTS and 984 presented with pulmonary nodules. Of these, only 106 (11%) were submitted to a surgical resection and received an overall of 117 procedures. All operations were performed through thoracotomy.
\n\t\t\t\tWedge resection was performed in 71 cases (61%), lobectomy in 25 and pneumonectomy in 6. Fifteen patients received an extrapulmonary intrathoracic resection (not otherwise clarified).
\n\t\t\t\tMore than half of patients (56/106) had a single pulmonary MTS; 23 had 2 or 3 nodules and 28 more than 3. In 41 patients (38.7%) an incomplete resection was performed.
\n\t\t\t\tAuthors concluded that patients with complete resection survived longer than those with an incomplete one, even if this data did not reach statistical significance.
\n\t\t\t\tThere was a trend towards a better survival in patients receiving a lobectomy when compared to those submitted to a wedge and for those with a single pulmonary lesion, but also these results were not statistically significant.
\n\t\t\t\n\t\t\t\t\tOlilla et al. (15) reconsidered the John Wayne Cancer Institute series of metastatic melanoma patients between 1971 and 1994 (129 cases) and pointed out the importance of the Tumor Doubling Time (TDT). TDT was calculated for each patient comparing successive chest radiographs in order to measure the changing diameters of each pulmonary nodule. When a patient presented with more than a nodule, TDT was calculated by measuring the fastest-growing one. Forty-five patients had at least two preoperative chest X-rays to compare, and only those were included in the study. Again, most of patients had a solitary nodule (33,73%). A complete resection was accomplished in 38 cases (84.4%): wedge resection was the commonest surgical procedure (32, 71.1%), followed by lobectomy (11, 24.4%). The median TDT for these 45 patients was 66.9 days (range: 13.7-287.4 days). Sixty days was the TDT cut-off value decided by Authors.
\n\t\t\t\tA radical surgical resection (p=0.04) and a TDT≥60 days (p=0.01) were the two statistically positive prognostic factors. In particular, for patients with a TDT≥60 days, the median survival was 29.2 months with 20.7% 5-year survival rate.
\n\t\t\t\n\t\t\t\t\tLeo et al. (19) reconsidered 328 patients with pulmonary MTS from MM, previously collected by Pastorino et al., including them into the International Registry of Lung Metastases which gathered data from 18 mayor Thoracic Surgical centres from Europe, USA and North America (20).
\n\t\t\t\tThoracotomic surgical approach was the commonest proposed in Leo’s series (247 patients); sternotomy was performed in 74 and video-assisted thoracic surgery (VATS) in 7, only. Bilateral interventions were proposed in 74 patients. Wedge resection was the most common surgical procedure (230), followed by lobectomy (4) and pneumonectomy (14). An extrapulmonary resection (chest wall, pleura, diaphragm, liver, mediastinal structures) was required in 50 cases (15.2%). A complete surgical resection (R0) was accomplished in 282 patients (85.9%).
\n\t\t\t\tPatients receiving a R0 resection survived longer than others in whom an incomplete one (R1-2) was performed (22% 5-year and 16% 10-year survival rates for R0 patients; 0% 5-year survival for R1-2 ones, p<0.01). Considering R0 patients only, a DFI>36 months (30% 5-year, 22% 5-year, p<0.01) and a single lesion (25% 5-year and 22% 10-year, p=0.03) statistically influenced patients survival.
\n\t\t\t\t\n\t\t\t\t\tLeo proposed four prognostic groups of patients, according to his multivariate analysis results, which were: 1) R0 metastasectomy and no adverse factor (only 1 lesion and DFI>36 months); 2) R0 metastasectomy and 1 unfavourable factor (more than 1 pulmonary nodule or DFI<36 months); 3) R0 metastasectomy and 2 unvavourable factors; 4) R1-2 metastasectomy.
\n\t\t\t\tIt was thus demonstrated that differences in survival among these groups were statistically highly significant: 29% 5-year survival rate and 26% 10 year for Group 1; 20% 5-year and 10% 10 year for Group 2; 7% 5-year and 0% 10 year for Group 3; no 5 year survivors in Group 4.
\n\t\t\t\t\n\t\t\t\t\tLeo concluded that a complete surgical resection and a DFI>36 months were the most important positive prognostic factors.
\n\t\t\t\n\t\t\t\t\tAndrews and Coll. (21) reported Lee Moffitt Cancer Center’s experience of patients with pulmonary MTS from MM between 1988 and 2005. An overall of 86 cases (64 men) were enrolled in this study. Preoperative patient assessment included thoracic CT scan and brain magnetic resonance imaging (MRI) to confirm the number and location of pulmonary nodules seen at the chest radiograph, and also to exclude possible extrathoracic malignancies. PET scan was used in 27 patients. A complete resection was achieved in all cases. Wedge resection (35, 22 of which through VATS procedures) was the most frequent surgical procedure performed. Ten were the segmental resections and 9 the lobectomies, all of these performed with a thoracotomy.
\n\t\t\t\tThe estimated 5-year survival rate was 33%.
\n\t\t\t\tWhile a long DFI did not statistically affect survival, only the number of pulmonary lesions (1 vs 2-4) was a statistical prognostic factor (41 months vs. 21, p=0.05).
\n\t\t\t\n\t\t\t\t\tNeumann and Coll. (22) studied 122 pulmonary MTS treated at the Memorial Sloan-Kettering Cancer Center (MSKCC). Of these, only 26 patients (21%) received a surgical resection while others were treated with systemic therapy (82) or did not receive any sort of treatment (14); a complete resection was accomplished in all operated patients (a wedge resection, most frequently). Metastasectomy was associated with improved survival (median 40 months vs 11 months in non-operated patients); in operated patients, Authors pointed out an estimated 29% 5-year survival rate.
\n\t\t\t\tAt the Cox regression analysis, a solitary metastasis (HR 1.9, 95%CI 1.1-3.2, p<0.0005) and the absence of extrathoracic disease (HR 1.9, 95% CI 1.2-3.1, p=0.01) were strong positive predictors of long-term survival. The lung resection itself was an independent factor predictive of survival (HR 0.42, 95%CI 0.21-0.87, p=0.02).
\n\t\t\tFinally, Petersen et al. (23) retrospectively reviewed the experience with lung MTS from MM patients treated in the Duke Comprehensive Cancer Center between years 1970 and 2004. An overall of 1720 patients were recorded: those submitted to surgery were only 318 (18.5%) while others received a systemic treatment. Two hundred forty-nine (78%) of operated patients received a radical resection; those receiving an incomplete resection were more likely to have multiple pulmonary lesions. Patients receiving curative resections had 19 months median survival and 21% 5-year survival rate, compared to 11 months and 13% of those with an incomplete one (p<0.0001).
\n\t\t\t\tThe univariate analysis highlighted that lymph nodes metastases (p=0.001), 2 or more pulmonary MTS (p<0.001), a short DFI (p<0.001) and the presence of extrathoracic MTS (p<0.001) were significant negative prognostic factors.
\n\t\t\t\tThe number of pulmonary MTS (p=0.012), a short DFI (p<0.001) and the presence of extrathoracic MTS (p<0.001) were found to be independent predictors of survival at the multivariate analysis. Table 2 and 3 summarize the series results and their prognostic factors, respectively.
\n\t\t\t\t\n\t\t\t\t\t\t\t\t | \n\t\t\t\t\t\t
Survival after complete resection of pulmonary MTS.
\n\t\t\t\t\t\t\t\t | \n\t\t\t\t\t\t
Prognostic factors in the cited series.
One may observe, by means of a formal search in literature of surgical series of resected pulmonary MTS from MM, that only few papers have been published in a long interval of time; the most recent series were taken into consideration in order to obtain the most comparable results as possible.
\n\t\t\tPreoperative patient assessment in the oldest series (Tafra, Olilla and Leo) presented some limitations, especially due to the lack of new generation radiological imaging which are mandatory to avoid the risk of incomplete/non-radical resections. Percentages of reported non curative procedures were 38.7% (41/106) in Tafra, 15.6% (7/45) in Olilla and 14% (46/328) in Leo.
\n\t\t\tA preoperative patient assessment is fundamental: thoracic and abdominal CT scan, brain MRI and whole body PET scan should be proposed in all. In those patients with lung MTS and concomitant extrathoracic lesions, surgery is contraindicated: those patients should receive systemic therapy alone.
\n\t\t\tWhen prognostic factors are evaluated, the importance of the number of lung MTS has been emphasized by many Authors. In almost all series, a higher survival rate of patients with 1 lesion was observed. The role and the importance of the type of surgical procedure (wedge resection vs lobectomy) was not important; generally when the MTS is peripherally located, it can be easily removed with a wedge resection or a segmentectomy (Fig. 1). Instead, lobectomy is reserved to those deeply located lesions within the lung parenchyma, in which the risk of non-free resection margins of tumoral tissue may be high if a non-anatomic resection is performed. Also, the procedure used to perform the limited resection (thoracotomy or a VATS) did not influence the survival rate. With the development of mini-invasive thoracic procedures and of the technologies to it dedicated, the role of VATS (and of robotics in the next future) is rapidly growing. Patients operated in such manner face a limited surgical impact, less pain and may have a shorter postoperative course, which can also reduce the overall recovery health costs. Furthermore, if a limited pulmonary resection is performed, patients’ postoperative respiratory function is conserved: this leads to a better tolerated adjuvant systemic therapy and the chance to propose a redo-surgery in case of possible tumor relapse, which unfortunately is not infrequent.
\n\t\t\tThe importance of a strict follow-up is brought to evidence by the majority of Authors. The common follow-up should include a chest X-ray; thoracic CT scan should be performed
\n\t\t\tPreoperative radiological and intraoperative images of resected pulmonary MTS from malignant melanoma.
whenever a nodule is detected. In case of its positivity at the PET scanning, surgery should be proposed immediately. We suggest to avoid repeated radiological controls of the nodule due to the high risk of possible tumor spreading.
\n\t\t\tPrognostic factors are almost the same: limited number of pulmonary MTS, a short DFI, absence of extrathoracic MTS, completeness of surgical resection (Table 3).
\n\t\t\tThe role of the lymphadenectomy is not always put in evidence. We believe that lymph node sampling should be performed in all cases; many Author statistically demonstrated the significance of lymph node MTS as a prognostic factor: it’s evident that patients with metastatic nodes have lower survival rate when compared to N0 patients. This data itself may suggest the role and importance of lymphadenectomy.
\n\t\t\tIn conclusion, even if patients with pulmonary MTS from melanoma have a poor prognosis, those in whom a surgical resection can be proposed present a longer life expectancy than others treated with systemic therapy alone. In order to avoid incomplete surgical resections (in whom the survival is similar to chemotherapy) a selective preoperative patient assessment is mandatory. Surgical resection (wedge/segmentectomy) should be limited whenever possible and lymph nodal sampling should be routinely performed. Postoperative adjuvant therapy (chemotherapy, immunotherapy, radiotherapy) must always be proposed and a strict follow-up scheduled; in case of new pulmonary lesions developing, surgery should be planned, if feasible.
\n\t\tAyer’s [1] logical positivism had tried to ground all authentic knowing in the rational or empirically observable and/or measurable. Other than the “truths” contained in mathematics and logic, all other truth or assured knowledge claims were to be restricted to what could be empirically verified according to the so-called “Verification Principle” emanating from an eminent group of European philosophers known as the Vienna Circle [2]. The Verification Principle and its spawning in logical positivism were effectively outgrowths of nineteenth-century thinking resulting largely from conceptions of scientific method and supposedly assured scientific knowing held at the time.
\nDuring the nineteenth century and persisting well into the twentieth and even twenty-first centuries, scientific knowledge was believed to rest entirely on empirical methodology and so all human pursuits interested in knowledge were to follow suit. Among the human science disciplines, psychology and sociology developed in this way and, especially granted their influence on education, it was predictable that it would reflect these beliefs as well. Hence, as a highly influential influence, we find Tyler [3] generating a virtual empirical science around assessment regimes which, in the spirit of “teaching to the test,” inevitably determined the direction of pedagogy. Bloom and associates [4, 5] built further on such thinking in the form of the taxonomies of educational objectives and their appropriate assessment regimes; these taxonomies drove generations of educational thinking, in turn also influencing the ways in which the principles and practice of pedagogy were enacted in schools. Thus, the foundations for instrumentalism in education were being well set in place, with associated pedagogical assumptions and practice unrelenting regardless of masses of evidence of the damage that can be done by them to efficacious learning, not to mention that their own foundations in scientific thinking have come under increasing scrutiny. These claims will be substantiated in what follows and the terms of a values pedagogical alternative will be outlined and justified by reference to international research, especially in the data and findings of the Australian Values Education Program.
\nWittgenstein [6], in his famous work, Philosophical Investigations, refers to “reality” and the “facts” thereof as part of what he calls “language games.” The gist is that the locus of human knowing is contained in language rather than empirically verifiable data. It was a subtle yet fundamental under-cutting of the basis of logical positivism and nineteenth century thinking about empiricism as the basis of all knowing. Ferre [7], in this regard, bespeaks a clear Wittgensteinian perspective in declaring that “facts are never given in isolation from the minds that receive them” (p. 761). Ferre implied that the things we call “facts” or verifiable data are really theories in the minds of the subjects who perceive them, and hence are less observable or least of all measurable than in the ways that logical positivists held to be determinative.
\nSuch rejoinders were further reinforced by Lakatos [8] and Kuhn [9] who coined the notions of “touchstone” and “paradigm” respectively to connote the true basis of claims to “know.” According to their theories, knowing is not merely a linear conforming of perception and reality, as the logical positivist would have it. It is not objective in the simple observable or measurable sense because it is infused with the subjectivity of the person doing the knowing. Quine [10] went on to show just how subjective were the assertions of those empiricists claiming to be objective: indeed, the Verification Principle itself defied the very rules which formed it in that it belonged to neither category of mathematics and logic nor of the empirically verifiable. Feyerabend [11] launched highly critical attacks on the ways in which education systems had applied logical positivist and/or simple empirical assumptions to curriculum and pedagogy, especially in the ways they had prioritized certain forms of knowledge over others, on the purported basis that they offered surer knowing (read the empirically verifiable knowing of science and technology mainly), while other forms of knowledge were relegated to the margins if not right out of education. See also Apple [12] on “high status knowledge” and the damage that such conceptions have done to the balanced curriculum and holistic learning.
\nThe “certain forms of knowledge” to which Feyerabend refers is further enlightened in Habermas’s [13, 14] “ways of knowing” theory. Habermas’s explanation for apparently different forms of knowledge derives from his belief that knowing is impelled by a series of “cognitive interests,” three interests which are effectively part of the way the human mind works. First, there is an interest in technical control which impels an “empirical-analytic” way of knowing. This is useful knowledge for performing fairly basic tasks of being able to put something together, find a place on a map, operate a machine, or for competence in the fundamentals of literacy and numeracy. Second, the interest in understanding meanings gives rise to an “historical-hermeneutic” way of knowing, the knowing that results largely from engagement, interrelationship and dialogue with others. This is a knowing that wants to get behind basic knowing to interpret what it might mean, for example, to understand the importance of what is being put together, the significance of the place on the map, the ramifications and potential impact of the machine’s operations, and the full effects of literacy and numeracy, including their cultural significance and differences. While empirical-analytic knowing does not require human interaction nor much in the way of imagination, historical-hermeneutic knowing requires both.
\nThird, there is an interest in being emancipated, a free agent as it were, which issues in a “critical” or “self-reflectivity” way of knowing, the knowledge that comes ultimately from knowing oneself. This is the knowing that causes us to reflect critically on our subject matter, our sources and ultimately ourselves as agents of knowing. Such agency impels us to go to any lengths to be assured that what we know is, as far as is possible, the unfettered truth, free of cultural bias and partial interpretation, including as those might function in ourselves. For Habermas, this way of knowing provides for the only truly assured, totally comprehensive and authentic human knowing. It is a deeply moral knowing in that it drives fearlessly beyond the politically correct or skewed, the safe, and the partisan interested, including as these blind spots play out in oneself. It requires profound forms of human encounter and ultimately of self-knowledge. It also requires much in the way of imagination. Habermasian literature, primary and secondary, is replete with the notion of imagination as a prerequisite for knowing of the fullest kind. Indeed, against both modernism’s and especially post-modernism’s unimaginative conceptions of the Enlightenment project, he proffers that what they have robbed us of is “… the spontaneous powers of imagination, of self-experience and of emotionality.” ([15], p. 13) For Habermas, this is an aberration of what the Enlightenment project was intended to do [16, 17].
\nIn this work, Habermas illustrates well, among other things, the limitations of logical positivism’s conception of knowing and all it has led to, the limitations being set essentially around a knowing of basics, a knowing he describes as empirical-analytic, useful for certain basic knowledge and skills but a long way from the full reaches of knowing. It is an especially long way from the more sophisticated knowing related to interpretations and meanings, and the more moral knowing that entails deep human encounters and, finally, a ruthless self-knowing, all of which require deep levels of imagination and emotionality. Seeing it this way helps to understand why Feyerabend was so critical of education that prioritized more basic knowing to the exclusion of holistic knowing.
\nEven as the terms of nineteenth century positivism were being laid, such as bespoken in the Verification Principle, so the critique was underway, a critique that, from Habermas’s point of view, has not been taken seriously and from Feyerabend’s view, has impacted negatively on education. For Habermas, knowing required a fortified hermeneutic dimension which ultimately could lead to the more sophisticated knowing connoted in being an agent of knowing, in his sense. Habermas [15] is quite explicit that, for him, his thinking here owes much to Husserlian philosophy. Husserl [18] was a nineteenth century empiricist who saw even then the limitations of the narrower assumptions and functioning of a simple understanding of empiricism, ones that emanated from the Verification Principle and became the basis of logical positivism. He described this kind of empiricism as “descriptive science,” fundamentally the same conception as to be found in Habermas’s empirical-analytic knowing, the knowing of basic facts and figures, purely descriptive knowing.
\nWhile a useful foundation for scientific knowing, for Husserl, it lacked the more important and essential human knowing that was the product of what he referred to as “eidetic science,” the knowing and understanding of meanings, of different perceptions that can only be unraveled by human beings interacting and by deep forms of reflective learning. Eidetic science was heavily subjective and that was the very thing that was being in a sense forbidden by the obsession with descriptive science, creating in turn an inherent obstacle to deeper forms of learning. For Husserl, human sciences had to include a human element and yet that was being denied to them by the scientific assumptions of the day. The irony herein was that knowledge of the deeper kind was being blocked in the name of a science purporting to be the means of all knowing. The same irony is reflected in both Habermasian epistemology and Feyerabend’s and Apple’s reflections on what was ensuing in education. In the name of sound education, sound education was being denied. So what are the assumptions that led to this anomaly and how can they be broken down and re-formed in the interests of truly sound education? Well, the path and history of science itself, the very discipline that is purported to lie at the foundations of the assumptions, are instructive in this regard. The two exemplars by which I choose to make that point are the sciences of astrophysics and neuroscience.
\nFor Husserl, truth was best understood as ever elusive, rather than easily grasped in the way of simple empiricism, and so the truth seeker had to proceed with caution. Good science was a humble rather than arrogant methodology around alleged “certainties” that the tenets of descriptive science had led to. Good science was replete with imagination. Husserl’s caution about science is interestingly prophetic when one considers the far greater caution detected in much modern science, such as astrophysics, for instance. Against all the alleged certainties premised by earlier empirically bound method, we find find de Grasse Tyson [19] referring to dark energy and dark matter as a “mysterious presence,” constituting 96% or so of the known universe, responsible for maintaining it the way it is, yet about which we are “clueless.” He describes dark matter as our “frenemy,” part friend, part enemy: “We have no clue what it is. It is kind of annoying. But we desperately need it in our calculations to arrive at an accurate description of the universe.” (p. 62).
\nDe Grasse Tyson speaks frequently about the need for high levels of cognitive imagination for modern astrophysics to proceed. He underlines this point by reference to Albert Einstein, fairly unarguably the greatest scientist to ever live, yet one not given at all to simple empiricism or to being limited by Husserl’s notion of descriptive science. He says of Einstein that he “… hardly ever set foot in the laboratory; he did not test phenomena or use elaborate equipment. He was a theorist who perfected the “thought experiment,” in which you engage nature through your imagination” (p. 62). De Grasse Tyson refers to the book, titled, 100 scientists against Einstein [20] showing how these mainly simple empiricists (Husserl’s descriptive scientists) were wrong and Einstein’s imaginative methods (Husserl’s archetypal eidetic scientist) were ultimately proved correct. As examples of the limitations of their simple empiricism, some of Einstein’s critics described as “fantasy” the notion of the so-called “cosmic constant,” the central tenet in his theory of relativity. In fact, the “cosmic constant” was finally ratified with a measure of empirical evidence in 1998 [21], something further demonstrated by the famous 2016 gravitational wave detected by the Hadron Collider [22] and to an extent ratified even further by the famous and ground-breaking picture of the black hole in 2019 [23].
\nEinstein’s knowing was finally endorsed by highly sophisticated forms of empiricism but the basis and impulsion of his knowing came not from empirical method but from what I refer to as imaginative method. On the other hand, the reliance on a simple empiricism on the part of the 100 adversarial scientists blinded them, while Einstein’s on imagination released him to speculate on realities that were quite beyond empirical verification of the kind most scientists of the day were relying on. In Husserlian terms, it illustrates the reliance for holistic knowing purposes on descriptive and eidetic sciences intersecting and interacting. In Habermasian terms, the 100 scientists’ cognitive interest was in control, where Einstein’s was in imaginative exploration of the kind that characterizes the true agent of knowing. He wanted to know the truth and to get there he had to go beyond the bounds of controlled knowing. There is a lesson here for all learning ventures, including school-based pedagogy. Over-controlling of the knowledge process in the form of endless measuring of outcomes, accountability and assorted forms of instrumentalism can actually create blind spots and retard knowing of the most important kinds. On the other hand, releasing and nurturing the imagination might well be the most useful thing that schools can do.
\nUpdated neuroscience is another science that, in many ways, takes us to the same place. Damasio [24] and Immordino-Yang [25] refer to the enriched cognitive functioning, especially around imagination that ensues when discourse of any kind takes account of emotionality and sociality. In reference specifically to school-based discourse, Damasio and Immordino-Yang [26] have this to say:
\nModern biology reveals humans to be fundamentally emotional and social creatures. And yet those of us in the field of education often fail to consider that the high-level cognitive skills taught in schools, including reasoning, decision making, and processes related to language, reading, and mathematics, do not function as rational, disembodied systems, somehow influenced by but detached from emotion and the body. (p. 3)
\nNarvaez [27, 28, 29, 30] builds on these ideas, both as a neuropsychologist and educator, in the ways she positions imagination as the confidence-builder and architect of the mindset essential to what she refers to as “efficacious learning.” She ties imagination, emotion and cognition together in suggesting that it is imagination that unlocks the emotions that are needed for sound reasoning. In a word, reasoning is both rational and emotional. The mind thinks both logically and emotionally.
\nNarvaez focusses much on the ways in which human knowing has worked over the millennia of human existence, a process that in a sense is repeated each time a new life comes into the world. Among her specialities is early childhood education where imagination is the key or, if not stimulated, it is the death of efficacious learning. Yet, in the face of any amount of evidence, including in the different ways in which the scientific base of instrumentalist pedagogy is changing, instrumentalism in pedagogy and education generally seems to be the standard modus operandi of educational systems. The desire for accountability, invariably motivated by political agendas, including of control, rather than inspired by educational theory, drives systems towards the most easily measurable, invariably the basics, Habermas’s empirical-analytic knowing, Husserl’s descriptive science, Damasio’s and Immordino-Yang’s disembodied systems. When this drive becomes an obsession, affecting individual schools’ reputations, the key performance indicators of school administrators, the political slogans of governments and oppositions, the “be all and end all” of ranking in international testing, then the casualty is imaginative pedagogy and its associated efficacious learning. Let me offer one example of this, an example from Australia.
\nNAPLAN (National Assessment Program Literacy and Numeracy) was established by the Australian Government in 2008. It is a national literacy and numeracy testing mechanism administered at four levels across primary and secondary education. It is mandatory for any school wishing to maintain government registration. Its results are inserted into a software program called “My School” (comprising a large data set about each school’s numbers, demographics and, once imported, NAPLAN test results). This import was designed to show which schools were doing well in literacy and numeracy and which were not. It quickly became a ready-reference for parents in their school selection, a serious reputational issue for schools and a crucial KPI (key performance indicator) for school administrators.
\nNAPLAN had two main stated purposes: first, it was to strengthen literacy and numeracy levels of Australia’s young people; second, it was to improve Australia’s standing in the OECD international testing mechanism, PISA (Program for International Student Assessment). Evidence suggested, after 10 years, that there was no indication that either objective had been achieved in any substantial way. According to one study that typified the national result, literacy and numeracy levels had not improved, at least according to the limited NAPLAN device itself [31]. Additionally, Australia’s standing in PISA was demonstrably worse than before NAPLAN began [32].
\nAt the time of writing, there is a strong push coming from powerful education entities, bureaucracies, teacher unions and teachers themselves that NAPLAN has so skewed the imperatives of education that it constitutes a menace to efficacious learning. Furthermore, research evaluations of the mechanism testify that it has “… a narrow focus on a limited set of skills rather than developing capacity…” The same research identified the following problems:
the NAPLAN tests added little to teachers’ understanding of students’ literacy levels;
the assessment was a poor measure of student achievement;
the tests had little relation to students’ lives, or to their future job prospects;
pressure to prepare students for NAPLAN detracted from other learning opportunities;
stress around the inflated importance of the test negatively impacted some students’ wellbeing;
pressure to “teach to the test” frustrated many teachers, reducing their sense of professional autonomy [33].
Meanwhile, an international testing expert declared NAPLAN to be “bizarre” in its inappropriateness. It is directed at all the wrong kind of learning and actually encourages bad writing [34]. Most recently, the federal government’s own national policy and practice entity, the Gonski Institute for Education, called for its “ditching” [35]. In a word, NAPLAN has become synonymous with bad teaching and incompetent, negligent and damaging education. It is not simply that NAPLAN has achieved nothing worthwhile. The more damaging finding from evaluation is that it has become a threat to the business of sound education and has malevolently influenced school-based pedagogy.
\nNAPLAN created a stressful, needlessly competitive and, in that sense, unsafe environment for learning. Furthermore, it failed to impact positively on the very academic learning that was its principal target. It is a prime example of a pedagogical approach driven by the linear assumptions of logical positivism and ignoring the wisdom to be found in the philosophical and scientific perspectives outlined above. I now wish to summarize briefly the very different effects of a values pedagogy, drawing on evidence principally from the Australian Values Education Program. In contrast with instrumentalist pedagogy, it emanated in what I describe as imaginative pedagogy, a pedagogy that elicited the imaginative capacities essential to the most effective forms of learning.
\nNarvaez [27, 28, 29] makes the point that imaginative pedagogy is not always the result of spontaneous impulses. It requires both the safe environment and the guiding hand of craftily planned pedagogy. It is another way of talking about the two-sided coin of values pedagogy, the implicit side being the safe, values-filled learning environment and the explicit being the values-focused pedagogy.
\nBy implicit is meant that the learning environment must be values-filled, characterized by care, trust, respect and encouragement. There is any amount of research that has demonstrated the importance of the values-filled “ambience,” as Newmann [36] described it. Newmann’s work was in the area of “authentic pedagogy,” the pedagogy most associated with teaching that works best. Findings from his research were factor analyzed into five “pedagogical dynamics,” five features or characteristics that seemed to sum up the things most obviously associated with teaching that was working, achieving its goals, including academic achievement. The last and most important was the “ambience of care and trust.” The ambience of care and trust is the starting point, or sine qua non, of values pedagogy. The learning environment must be characterized by care and trust, positive relationships and safety and security [37, 38, 39].
\nThe explicit side of the coin is seen in the orientation of the learning discourse being around values, the values inherent in curriculum content, rather than merely the “facts and figures” or most easily measurable features of the content. One of the many misconceptions about values pedagogy is that it means doing something additional to the standard curriculum. In fact, it does not require separation from the curriculum; rather, it determines the direction of the curriculum through becoming the pedagogy.
\nThe content of any curriculum area tends to focus on the facts and figures (what Habermas calls the “empirical/analytic”) relevant to the area in question. Why? Because that is the most easily measured. When employed judiciously and seen as first step or means to a greater end, this can assist in the foundations of sound pedagogy. On the other hand, when it is seen as the entire step or end in itself, it becomes a malevolent force against sound pedagogy, instead settling for what I am describing as instrumentalist pedagogy. As most teachers know well, the more education that follows this kind of instrumentalism, the more boring it risks becoming, the more skewed in favor of those with retentive memories and the more unfair and potentially damaging it becomes to those many people who learn better in other ways. Additionally, the case being made above by the likes of Habermas and Narvaez is that, important as the facts and figures might be, the less we stimulate the interpretive, critical and imaginative ways of knowing, the more we stifle efficacious learning, and indeed the more we risk atrophying cognitive powers generally. In that sense, instrumentalist forms of pedagogy risk “de-educating” and stifling learning potential, rather than the opposite that is intended.
\nSo, in the values pedagogy work as it functioned in the Australian program, all extant content was derived from the set syllabuses but instead of settling for the standard objectives, largely the easily measurable ones, the values inherent in the content became the focus, thereby stretching rather than limiting the cognitive powers being called on. In other words, instead of simply rolling out the content because it was there in the syllabus and because a measurable outcome for reporting was demanded by the system, lessons were begun with questions like “what value is in this content? What value for students’ important knowledge, vital understanding of the world into which they are moving, crucial skills and competencies for future work, important insights for their wellbeing and the wellbeing of those with whom they will form relationships? What value is it to their future personal and social development? What value is it for the world in general? What vital lessons about humanity and the Cosmos, if any, might be contained in this content?”
\nEvidence suggests that when these kinds of values questions were stimulating and determining the pedagogical direction, then the easily measurable content knowledge fell out anyway and, in all irony, students were actually more likely to remember the facts and figures at the center of such content knowledge, far beyond the measuring device, because of the contextual stimulation that was being applied. In Habermasian terms, interpretive, critical, self-reflective and imaginative knowing was being impelled. Data from the projects testifying to these claims include the following:
\nThe pedagogies engage students in real-life learning, offer opportunity for real practice, provide safe structures for taking risks, and encourage personal reflection and action ([40], p. 9).
\n(Values pedagogy) …requires students to scrutinise questions that are difficult to resolve or answer, and focus on listening, thinking, challenging and changing viewpoints within a guided and safe environment ([40], p. 28).
\nThe structured discussion and agreed values that govern the engagement provide safety and support for students as well as an expectation that correction and revision are part of the debating process. It promotes critical thinking and encourages an obligation to respect one’s fellow inquirers. It attempts to produce better thinkers and more caring members of society, who accept differences and, at the same time, submit conflicts to reasonable scrutiny ([40], p. 28).
\nThe justification of such findings against Habermasian theory was summarized in the following way:
\nThe frame of reference emanates from Habermas’s ‘Ways of Knowing’ and ‘Communicative Action’ theories. In a word, it is the one who knows not only empirically analytically and historically hermeneutically, but self-reflectively who is capable of the just and empowering relationships implied in the notion of communicative action. In a sense, one finally comes truly to know when one knows oneself, and authentic knowing of self can only come through action for others, the practical action for change and betterment implied by praxis. Habermas provides the conceptual foundation for a values education that transforms educational practice, its actors in students and teachers, and the role of the school towards holistic social agency, the school that is not merely a disjoined receptacle for isolated academic activity, but one whose purpose is to serve and enrich the lives not only of its immediate inhabitants but of its community. ([39], p. 220)
\nIn the projects that ran as part of the program, there were what were described as predictable, less predictable and quite unpredictable results. The predictable results were that students’ accrual of important personal and social values was strengthened and affirmed. These were predictable in the sense that any curriculum intervention inputs a particular discourse, words, phrases, terms and concepts even in the setting up phase. One then will find that discourse coming through in the implementation and assessment phases; it would be a fundamental sign of failure if that were not the case. Hence, the inspirational document, the so-called National Framework for Values Education in Australian Schools [41, 43], contained much explicit values discourse and predictably then there was a lot of similar discourse to be found in the evaluation phase, be it coming from teachers, university researcher participants, parents or the students themselves:
\nEveryone in the classroom exchange, teachers and students alike, became more conscious of trying to be respectful, trying to do their best, and trying to give others a fair go. We also found that by creating an environment where these values were constantly shaping classroom activity, student learning was improving, teachers and students were happier, and school was calmer. ([42], p. 120)
\nMoreover, there were less predictable results in the form of a plethora of discourse about improvements in student behavior and teacher and student wellbeing. Such discourse was less predictable in the sense that behavior change and wellbeing were not explicit target outcomes for the projects. Nonetheless, this discourse was commonly to be found at the evaluation phase:
\n… the documented behaviour of students has improved significantly, evidenced in vastly reduced incidents and discipline reports and suspensions. The school is … a “much better place to be”. Children are “well behaved”, demonstrate improved self-control, relate better to each other and, most significantly, share with teachers a common language of expectations … Other evidence of this change in the social environment of the school is the significant rise in parental satisfaction. ([42], p. 41)
\nThen there was the unpredictable category of discourse around academic attention (what we eventually described as academic diligence). There was no discourse whatever in the set up about academic improvement yet it began appearing very early on in the feedback process and then continued as a persistent feature of evaluation. It was initially referred to as a “surprise effect” [44] and impelled much of the searching out of the literature (Habermas, Narvaez, etc.) noted above in order to try and explain it. As they show, be it from a philosophical or neuroscientific perspective, a pedagogy that provides a caring, positive relational and safe learning environment (the implicit side of the coin), along with an approach to content that challenges interpretive, critical, self-reflective and imaginative pedagogy is likely to result in, as Narvaez would put it, the kinds of emotions that make for sound reasoning. In this sense, the surprise is not such a surprise. The surprise is, rather, that we so easily forget such fundamentals.
\nThe issue of the unpredictable academic diligence being enhanced was one that required especial attention when the results were being finally evaluated and all claims were subject to their own testing and measuring in the project titled, Project to Test and Measure the Impact of Values Education on Student Effects and School Ambience [45]. The Executive Summary of this project summarizes the findings around academic diligence as an improvement factor in the following paragraph:
\nThus, there was substantial quantitative and qualitative evidence suggesting that there were observable and measurable improvements in students’ academic diligence, including increased attentiveness, a greater capacity to work independently as well as more cooperatively, greater care and effort being invested in schoolwork and students assuming more responsibility for their own learning as well as classroom “chores.” ([45], p. 6)
\nFull and complete details of how this project functioned methodologically can be found in Lovat and Dally [46].
\nThe great Muslim scholar of the Middle Ages, Abu al-Ghazali had much to say about educational wisdom [47, 48]. Amidst the wisdom are words about the imperative for good learning to be prefaced by the instilling of imagination and the eliciting of wonder. These are the foundations of enduring learning, or what we might refer to as lifelong learning. A pedagogy focused too much on prescriptive teaching and persistent testing will retard progressive learning, while one centered on imagination and wonder can facilitate the desire to continue on the learning path. In many ways, Ghazali was an educational neuroscientist well before his time. His perspective also underlines why it is that values pedagogy contains a potential to lay the foundations for lifelong learning.
\nIndeed, there is a literature that deals precisely with the connection between values pedagogy and lifelong learning [49], including higher learning. As described, values pedagogy has potential to inflame the cognitive interests that impel those higher forms of learning that are essential to the kinds of critique that an informed populace requires of its citizenry, including the original and innovative thought associated with doctoral learning, as an example drawn from the parameters of higher education [50, 51]. This underlines the importance of such a pedagogy not only for maximizing learning breadth and depth in schools but also for the kind of learning that leads to the highest forms of intellectual achievement such as are crucial to individual wholeness and to a successful, moral and harmonious citizenry.
\nGhazali’s de facto motto was to ask many questions and allow the answers to come from the learner rather than the teacher. Above all, not to provide answers to questions that had not even been asked by the learner. Yet, of course, much education at all levels does precisely what he advised not to do. This is at the heart of instrumentalist pedagogy and it explains why it can do such damage to learning potential, especially in the long term. It can offer the kind of short term learning required for immediate tasks and satisfying testing requirements but it offers little to lifelong and/or higher learning and, furthermore, can work against it. The effects of such are multiple, ranging from a narrowing of the kinds of critique necessary to overturn age-old prejudices that lead invariably to dysfunctional societies and a fractious world through to a surfeit of doctoral candidates in universities who are less equipped than they should be in independent learning strategies. In this sense, instrumentalist pedagogies are formulas for retarded learning, while values pedagogy has the potential to lay the foundations for progressive learning.
\nThe challenge for educational institutions at all levels is to take heed of the multiplicity of research that underpins the claims being made here. We live in an era that is blessed with the scientific understanding of learning that Ghazali did not possess. Yet, the irony would seem to be that he might well have understood intuitively how efficacious learning should proceed, regardless of the lack of evidence. On the other hand, many modern educational regimes have the evidence before them but ignore it and establish regimes of learning that are actually hostile to efficacious learning. The Australian NAPLAN example above is just one of any number of examples from school and higher education regimes that could be cited of negligent and damaging practice underpinned by an instrumentalist set of assumptions leading to instrumentalist pedagogies and a narrowing of the scope of learning.
\nEspecially as education becomes more of a mass industry and resources become invariably lean, the temptation to establish perfunctory goals at the lowest level of what Habermas calls empirical-analytic knowing becomes particularly coercive. This is especially the case because the output of such knowing is the most easily measured. School and higher education regimes can therefore easily fool themselves, through the record of measurements, into thinking that good outcomes have been achieved and good learning has been facilitated, where in fact the foundations of lifelong and higher learning have been damaged and retarded. This is a challenge indeed for the modern education setting, wherever and at whatever level. Granted these challenges, research around values pedagogy presents as a viable, inexpensive way forward.
\nThe chapter has set out to debunk the kinds of instrumentalist pedagogies that abound in educational systems both for their conceptual weaknesses and failure to keep pace with the very scientific understandings on which they rest and for the demonstrable damage they do to young people’s learning potential. It furthermore proposes a values pedagogy as an approach with potential for obverse effects, one that ensures the right environment for learning as well as the kind of intellectual stimulation required for the imagination that spurs the emotions that impel sound reasoning. In a word, instrumentalist pedagogy survives as a tool of political agendas and populist media, whereas values pedagogy rests on the firmest evidence from philosophical and neuroscientific research about how the mind works, the brain functions and how efficacious learning is therefore best effected.
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