Thursday, December 30, 2010

Health care reform: Do the Dutch have it figured out?

J Health Serv Res Policy. 2011 Jan;16(1):3-4.
Health care reform in the Netherlands: the fairest of all?
Schut F, van de Ven W.

Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands

Frozen Section Library-Appendix, Colon, and Anus

Frozen Section Library-Pleura

Frozen Section Library-Genitourinary Tract

Frozen Section Library-Lung

Risk factors for death in France

"Independent determinants of mortality were living area (Northern France), older age, male gender, no high-school completion, smoking, systolic blood pressure ≥ 160 mmHg, LDL-cholesterol ≥ 5.2 mmol/l, and diabetes."

Eur J Epidemiol. 2010 Dec 28. [Epub ahead of print]
Ten-year risk of all-cause mortality: assessment of a risk prediction algorithm in a French general population.
Bérard E, Bongard V, Arveiler D, Amouyel P, Wagner A, Dallongeville J, Haas B, Cottel D, Ruidavets JB, Ferrières J.

Department of Epidemiology, Health Economics and Public Health, UMR 558 INSERM, Université de Toulouse, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
While assessment of global cardiovascular risk is uniformly recommended for risk factor management, prediction of all-cause death has seldom been considered in available charts. We established an updated algorithm to predict absolute 10-year risk of all-cause mortality in apparently healthy subjects living in France, a country with high life expectancy. Analyses were based on the Third French MONICA Survey on cardiovascular risk factors (1995-1996) carried out in 3,208 participants from the general population aged 35-64. Vital status was obtained 10 years after inclusion and assessment of determinants of mortality was based on multivariable Cox modelling. One-hundred-fifty-six deaths were recorded. Independent determinants of mortality were living area (Northern France), older age, male gender, no high-school completion, smoking, systolic blood pressure ≥ 160 mmHg, LDL-cholesterol ≥ 5.2 mmol/l, and diabetes. Score sheets were developed to easily estimate 10-year risk of death. For example, a non diabetic, heavy smoker, 46-year old man, living in South-Western France, who did not complete high-school, with LDL-cholesterol ≥ 5.2 mmol/l and systolic blood pressure < 160 mmHg, has a 17% probability of death in the ten coming years. The C-statistic of the prediction model was 0.76 [95% CI: 0.72-0.80] with a degree of overoptimism estimated at 0.0058 in a bootstrap sample. Calibration was satisfying: P value for Hosmer-Lemeshow χ(2) test was 0.483. This prediction algorithm is a simple tool for guiding practitioners towards a more or less aggressive management of risk factors in apparently healthy subjects.

Oncology nurses and cancer patient survival

Oncol Nurs Forum. 2011 Jan 1;38(1):E11-9.
Oncology nurses' perspectives on the state of cancer survivorship care: current practice and barriers to implementation.
Irwin M, Klemp JR, Glennon C, Frazier LM.

Research Department, Oncology Nursing Society (ONS), Pittsburgh, PA.
Purpose/Objectives: To describe current survivorship care from the perspectives of oncology nurses.Design: Descriptive.Setting: E-mail invitation to Web-based survey.Sample: 399 Oncology Nursing Society members providing care for patients initially treated more than one year previously.Methods: An online survey was used to evaluate current aspects of survivorship care.Main Research Variables: Practice settings, services provided, and barriers to delivering survivorship care.Findings: Few nurses (27%) worked in settings with a formal survivorship program. Several program components were provided significantly more often in outpatient settings, pediatric facilities, and workplaces with a formal survivorship program. At the transition from acute to follow-up care, the survivorship nursing care provided most often was scheduling for ongoing monitoring (71%) and the least likely was assistance for employment or legal issues (16%). The greatest barriers to providing survivorship care were lack of time and funding (46%). Among nurses new to oncology (fewer than five years), 49% indicated they lacked sufficient knowledge compared to 36% of nurses with more than five years of oncology experience.Conclusions: Findings describe current aspects of survivorship care across practice settings. Nurses reported that the greatest barriers are lack of time, funding, and lack of knowledge about survivorship issues.Implications for Nursing: A need exists for education to enhance knowledge and skills of nurses who will provide survivorship care. Research is warranted to develop empirically supported guidelines and care-delivery models that address the barriers to providing survivorship services.

Congratulations to Sanja Dacic, MD, PhD, U Pitt, new Deputy Editor-in-Chief of the Archives of Pathology and Laboratory Medicine

Non-US healthcare-primary problem long wait times?

AJR Am J Roentgenol. 2011 Jan;196(1):W30-6.
Health care systems of developed non-u.s. Nations: strengths, weaknesses, and recommendations for the United States--observations from internationally recognized imaging specialists.
Brubaker LM, Picano E, Breen DJ, Marti-Bonmati L, Semelka RC.

Department of Radiology, University of North Carolina at Chapel Hill, CB#7510, 101 Manning Dr., Chapel Hill, NC 27599-7510.
OBJECTIVE: The purpose of this article is to survey imaging experts from developed nations on their impression of their own health care system and recommendations for the U.S. health care system as it seeks to enact health care reform.

MATERIALS AND METHODS: A survey was sent to individual imaging experts from developed nations requesting information on their health care systems (type of system, strengths, and weaknesses) and their recommendations for the United States.

RESULTS: Eighteen respondents from 17 developed nations completed the survey. All respondents reported universal health care coverage: four with government-operated health care, one with mixed government and private insurance-operated health care, 10 with predominantly government run with private insurance supplementation health care, and one with predominantly private insurance with government-operated supplementation health care. The most commonly cited strength was universal health care coverage for all citizens. The most commonly cited weakness was prolonged wait times. Notably absent was concern by the respondent physicians about malpractice litigation. The most commonly cited recommendation was the implementation of a universal health care coverage program.

CONCLUSION: In our survey of 18 imaging experts from 17 nations outside the United States, most respondents thought that their nations offered adequate universal health care coverage for their citizens, with the primary drawback of long wait times.

Pseudomonas virulence and OprF

Infect Immun. 2010 Dec 28. [Epub ahead of print]
Full virulence of Pseudomonas aeruginosa requires OprF.
Fito-Boncompte L, Chapalain A, Bouffartigues E, Chaker H, Lesouhaitier O, Gicquel G, Bazire A, Madi A, Connil N, Véron W, Taupin L, Toussaint B, Cornelis P, Wei Q, Shioya K, Déziel E, Feuilloley MG, Orange N, Dufour A, Chevalier S.

Laboratoire de Microbiologie du Froid, Signaux et Micro-environnement. EA 4312. Normandie Sécurité Sanitaire. Université de Rouen (France); Laboratoire de Biotechnologie et Chimie Marines. EA 3884. Université de Bretagne Sud, UEB, Lorient (France); Laboratory of Microbial interactions, Department of Molecular and Cellular Interactions, Flanders Institute of Biotechnology (VIB), Vrije Universiteit Brussel (Belgium); INRS-Institut Armand-Frappier, Laval, Québec (Canada); TIMC-IMAG, TheREx, Thérapeutiques recombinantes expérimentales, UMR5525 CNRS-Université Joseph Fourier, Grenoble (France).
OprF is a general outer membrane porin of Pseudomonas aeruginosa, a well known human opportunistic pathogen associated with severe hospital-acquired sepsis and chronic lung infections of cystic fibrosis patients. A multiphenotypic approach, based on the comparative study of a wildtype strain of P. aeruginosa, its isogenic mutant oprF and the oprF complemented strain, showed that OprF is required for P. aeruginosa virulence. The absence of OprF results in impaired adhesion to animal cells, secretion of ExoT and ExoS toxins through the type III secretion system (T3SS), and production of the quorum sensing-dependent virulence factors pyocyanin, elastase, lectin PA-1L and exotoxin A. Accordingly, in the oprF mutant, production of the signal molecules N-(3-oxododecanoyl)-L-homoserine lactone and N-butanoyl-L-homoserine lactone was found to be reduced or delayed, respectively. The Pseudomonas Quinolone Signal (PQS) production was decreased while its precursor the 4-hydroxy-2-heptylquinoline (HHQ) accumulated in the cells. Taken together, these results show the involvement of OprF in P. aeruginosa virulence, at least partly through modulation of the quorum sensing network. This is the first study showing a link between OprF, PQS synthesis, T3SS and virulence factor production, providing novel insights on virulence expression.

Be careful with those mock trials.

Radiology. 2010 Dec;257(3):836-45.
Mock trial at 2009 RSNA annual meeting: Jury exonerates radiologist for failure to communicate abnormal finding--but....
Berlin L.

Rush Medical College Chicago, Ill, USA.
Comment in:

Radiology. 2010 Dec;257(3):609-11.
On the morning of Sunday November 29, 2009, hundreds of radiologist-attendees at the Radiological Society of North America's Scientific Assembly and Annual Meeting took their seats in a simulated courtroom at McCormick Place, Chicago, Ill, to witness a mock trial of a radiologist who had been accused of medical malpractice for failing to communicate to a referring physician a possibly important abnormal radiologic finding. This report is a summary of the lawsuit. Supplemental material:

Spain: "bad or very bad personal experience in 98.8%". The other 1.2% must have misunderstood the concept...

Rev Clin Esp. 2010 Dec 21. [Epub ahead of print]
[Consequences of lawsuits on affected doctors.]
[Article in Spanish]

Perea-Pérez B, Santiago-Sáez A, Labajo-González E, Albarrán-Juan ME, Sánchez-Sánchez JA.

Departamento de Toxicología y Legislación Sanitaria, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España.
OBJECTIVES: To determine the consequences of a judicial claim on the private life and professional practice of affected doctors.

MATERIAL AND METHODS: A cross-sectional, descriptive study was performed on the basis of 169 surveys filled out by physicians subjected to a lawsuit in Spain in the period including 2002-2005.

RESULTS: The claim produced a bad or very bad personal experience in 98.8%. A total of 85.1% admitted repercussions on family life, 84% made some change in the way they worked, and 57.4% admitted effects on their vocation. There was an unfavorable court ruling in 6%.

CONCLUSIONS: There were important repercussions on doctors after a lawsuit, both on their private and family life, as well as the way they approach medical practice.

Vicarious learning networks! and smoking...

Health Educ Behav. 2010 Dec 28. [Epub ahead of print]
Social Norms and the Relationship Between Cigarette Use and Religiosity Among Adolescents in the United States.
Gryczynski J, Ward BW.

This study investigated the social dynamics that underlie the negative association between religiosity and cigarette use among U.S. adolescents. Using data from the 2007 National Survey on Drug Use and Health, the authors used a theory-based conceptual model (vicarious learning networks [VLN]) to examine the role that key reference group norms play in the religiosity-smoking relationship. This relationship is partially mediated by parents' and close friends' perceived disapproval for smoking. However, religiosity maintains a strong negative association with smoking. Consistent with the VLN model, cigarette use varied substantively based on reference group normative configurations. To the extent that the protective effects of religiosity arise from its influence in structuring the social milieu, some of religiosity's benefits could potentially be leveraged through interventions that promote healthy norms among reference groups within the social network. The VLN model may be a useful tool for conceptualizing the transmission of health behavior through social learning processes.

EGFR, KRAS, and advanced lung adenocarcinoma

Anticancer Res. 2010 Dec;30(12):5121-8.
Prognostic and Predictive Implications of EGFR Mutations, EGFR Copy Number and KRAS Mutations in Advanced Stage Lung Adenocarcinoma.
Bonanno L, Schiavon M, Nardo G, Bertorelle R, Bonaldi L, Galligioni A, Indraccolo S, Pasello G, Rea F, Favaretto A.

Medical Oncology 2, Istituto Oncologico Veneto-IRCCS, Via Gattamelata, 64, 35128 Padua, Italy.
Background/Aim: Gefitinib and erlotinib were shown to be particularly effective in a clinically selected subpopulation of non-small cell lung cancer patients (NSCLC): adenocarcinoma histology, non-smoking status, Asian origin and female gender have been associated with improved clinical benefit compared to the unselected NSCLC population. The aim of the present study was to investigate the prognostic and predictive role of EGFR and KRAS analysis in advanced lung adenocarcinomas, selected according to clinical features associated to better response to EGFR tyrosine kinase inhibitors (TKIs), namely female gender and non-smoker or former light smoker status.

PATIENTS AND METHODS: EGFR and KRAS mutations and EGFR FISH status were assessed in 67 surgical samples.

RESULTS: EGFR and KRAS mutations were found in 16 (26.7%) and 12 (17.9%) patients, respectively. FISH analysis was positive in 34 (56.7%) patients. EGFR-mutated patients showed significantly longer survival when treated with EGFR TKIs (p=0.002, hazard ratio (HR)=0.036, 95% confidence interval (CI): 0.004 -0.303). KRAS mutations was found to be an independent negative prognostic factor in multivariate analysis (p=0.008, HR=3.52, 95%CI: 1.39-8.9). The prognostic value of EGFR FISH status was not confirmed in multivariate analysis (p=0.048, HR=0.47, 95%CI: 0.22-0.99).

CONCLUSION: In a group of clinically selected patients, EGFR and KRAS analysis was able to define distinct molecular subsets of lung adenocarcinoma.

TGF, P17, and pulmonary fibrosis

Cytokine. 2010 Dec 22. [Epub ahead of print]
Therapeutic effect of a peptide inhibitor of TGF-β on pulmonary fibrosis.
Arribillaga L, Dotor J, Basagoiti M, Riezu-Boj JI, Borrás-Cuesta F, Lasarte JJ, Sarobe P, Cornet ME, Feijoó E.

DIGNA Biotech, Madrid, Spain.
Pulmonary fibrosis encompasses several respiratory diseases characterized by epithelial cell injury, inflammation and fibrosis. Transforming growth factor (TGF)-β1 is one of the main profibrogenic cytokines involved in the pathogenesis of lung fibrosis. It induces fibroblast differentiation into myofibroblasts, which produce high levels of collagen and concomitantly loss of lung elasticity and reduction of the respiratory function. In the present study, we have investigated the effects of P17 (a TGF-β inhibitor peptide) on IMR-90 lung fibroblast differentiation in vitro, as well as on the inhibition of the development of bleomycin-induced pulmonary fibrosis in mice. It was found that in IMR-90 cells, P17 inhibited TGF-β1-induced expression of connective tissue growth factor and α-smooth muscle actin. In vivo, treatment of mice with P17 2days after bleomycin administration decreased lung fibrosis, areas of myofibroblast-like cells and lymphocyte infiltrate. P17 also reduced mRNA expression of collagen type I, fibronectin and the fibronectin splice isoform EDA in the lung, and increased the expression of IFN-γ mRNA. Finally, therapeutic treatment with P17 in mice with already established fibrosis was able to significantly attenuate the progression of lung fibrosis. These results suggest that P17 may be useful in the treatment of pulmonary fibrosis.

Copyright © 2010 Elsevier Ltd. All rights reserved.

Wednesday, December 29, 2010

Transbronchial and Endobronchial Biopsies

Respiratory symptoms in World Trade Center responders

J Occup Environ Med. 2010 Dec 23. [Epub ahead of print]
Respiratory Symptoms Were Associated With Lower Spirometry Results During the First Examination of WTC Responders.
Udasin I, Schechter C, Crowley L, Sotolongo A, Gochfeld M, Luft B, Moline J, Harrison D, Enright P.

From the University of Medicine and Dentistry of New Jersey,- Robert Wood Johnson Medical School, Piscataway, New Jersey (Drs Udasin, Sotolongo, and Gochfeld), Family and Social Medicine, Albert Einstein School of Medicine, Bronx (Dr Schechter), Community and Preventive Medicine, Mount Sinai School of Medicine (Drs Crowley and Moline), Department of Medicine, State University of New York at Stony Brook, Port Jefferson (Dr Luft), Division of Pulmonary and Critical Care Medicine, Department of Medicine, New York University School of Medicine (Dr Harrison), College of Public Health, The University of Arizona, Tucson, Arizona (Dr Enright).
OBJECTIVE: Determine if World Trade Center (WTC) disaster responders had lower lung function and higher bronchodilator responsiveness than those with respiratory symptoms and conditions.

METHODS: We evaluated cardinal respiratory symptoms (dyspnea, wheezing, dry cough, productive cough) and determined the difference in FEV1, FVC, and bronchodilator responsiveness.

RESULTS: All respiratory symptoms were associated with a lower FEV1 and FVC, and a larger bronchodilator response. Responders reporting chronic productive cough, starting during WTC work and persisting, had a mean FEV1 109 mL lower than those without chronic persistent cough; their odds of having abnormally low FEV1 was 1.40 times higher; and they were 1.65 times as likely to demonstrate bronchodilator responsiveness.

CONCLUSIONS: Responders reporting chronic persistent cough, wheezing or dyspnea at first medical examination were more likely to have lower lung function and bronchodilator responsiveness.

The CSI effect!

J Forensic Sci. 2010 Dec 13. doi: 10.1111/j.1556-4029.2010.01621.x. [Epub ahead of print]
The CSI Effect and the Canadian and the Australian Jury*(,†).
Holmgren JA, Fordham J.

Department of Justice Studies, Mount Royal University, 4825 Mount Royal Gate, SW Calgary, AB T3H 5S6, Canada. Jury Research Unit, Centre for Forensic Science, University of Western Australia, M420, Stirling Highway, Crawley 6009, Australia.
  Television shows, such as CBS's CSI and its spin-offs CSI: Miami; CSI: Las Vegas; and CSI: New York, have sparked the imagination of thousands of viewers who want to become forensic scientists. The shows' fictional portrayals of crime scene investigations have prompted fears that jurors will demand DNA and other forensic evidence before they will convict, and have unrealistic expectations of that evidence. This has been dubbed the "CSI effect." This phenomenon was explored using results from a Canadian study based on 605 surveys of Canadian college students who would be considered jury-eligible and Australian quantitative and qualitative findings from a study that surveyed and interviewed real posttrial jurors. Information about the way jurors deal with forensic evidence in the context of other evidence and feedback about the way in which understanding such evidence could be increased were gained from both these studies. The comparison provides insights into the knowledge base of jurors, permitting adaptation of methods of presenting forensic information by lawyers and experts in court, based on evidence rather than folklore. While the Canadian juror data showed statistically significant findings that jurors are clearly influenced in their treatment of some forensic evidence by their television-viewing habits, reassuringly, no support was found in either study for the operation of a detrimental CSI effect as defined above. In the Australian study, in fact, support was found for the proposition that jurors assess forensic evidence in a balanced and thoughtful manner.

EGFR and mesothelioma

Cancer Treat Rev. 2010 Dec 21. [Epub ahead of print]
Targeted epidermal growth factor receptor therapy in malignant pleural mesothelioma: Where do we stand?
Agarwal V, Lind MJ, Cawkwell L.

Cancer Biology Proteomics Group, Postgraduate Medical Institute of the University of Hull and Hull York Medical School, Hull, UK; Queens Centre for Oncology and Haematology, Hull and East Yorkshire NHS Trust, Hull, UK.
The median survival for patients with malignant pleural mesothelioma remains extremely poor and there is a need for the development of more effective treatment modalities. The epidermal growth factor receptor is frequently over-expressed in malignant pleural mesothelioma samples and therefore may be a potential therapeutic target. Targeted EGFR therapy has been successful in non-small cell lung cancer using small molecule tyrosine kinase inhibitors and in colorectal cancer using monoclonal anti-EGFR antibodies. However, phase II clinical trials based on EGFR tyrosine kinase inhibitor therapy have so far not shown promise in mesothelioma. This review includes a background to targeted EGFR treatment strategies, explores putative therapy resistance mechanisms, including the role of predictive biomarkers, and describes the current status of targeted EGFR therapeutic strategies for mesothelioma patients.

Is lung cancer risk from smoking increasing?

Cancer Causes Control. 2010 Dec 25. [Epub ahead of print]
Has the lung cancer risk from smoking increased over the last fifty years?
Burns DM, Anderson CM, Gray N.

UCSD School of Medicine, 1120 Solana Dr, Del Mar, San Diego, CA, USA,
BACKGROUND: We examine whether the lung cancer risk due to smoking has increased over time.

METHODS: Lung cancer risk equations based on prospective mortality data collected from 1960 to 1972 were applied to 5-year birth-cohort-specific estimates of smoking behaviors among white males to estimate lung cancer mortality rates for U.S. white males from 1960 to 2000. These estimated rates were compared to U.S. white male mortality rates for the same birth cohorts.

RESULTS: Observed birth-cohort-specific U.S. lung cancer mortality rates are substantially higher than those expected from changes in smoking behaviors, and the proportional difference increases with advancing calendar year. This trend persisted even when the duration term was increased in the risk equation. However, adjusting for changes in cigarette design over time by adding a term for the duration of smoking after 1972 resulted in the predicted rates closely approximating the observed U.S. mortality rates.

CONCLUSION: Lung cancer risk estimates observed during the 1960s under predict current lung cancer mortality rates in U.S. white males. Adjustment for the duration of smoking after 1972 results in estimates that reasonably approximate the observed U.S. lung cancer mortality, suggesting that lung cancer risks from smoking are increasing in the United States coincident with changes in cigarette design.

Lung cancer screening has potential, but the issue is complex

Ann Nucl Med. 2010 Dec 28. [Epub ahead of print]
Relationship of detection rate of PET cancer screening examinees and risk factors: analysis of background of examinees.
Shibata K, Arai M, Matsuura M, Uno K, Yoshida T, Momose T, Ohtomo K.

Nishidai Clinic Diagnostic Imaging Center, 1-83-8 Takashimadaira, Itabashi, Tokyo, Japan,
OBJECTIVE: PET cancer screening is performed widely in Japan as opportunistic screening, but no study has focused on the correlation with various cancer risk factors and the seeking bias of examinees and cancer detection rate. Analyzing our large series of PET cancer screening data, correlations with cancer detection rates according to general cancer risk factors and PET detection survey were reviewed, and the selection bias of the medical examinees was determined.

METHODS: 19189 examinees who underwent PET cancer screening were enrolled. Using logistic-regression analysis, we analyzed correlations between smoking history/drinking history/cancer family history and detection rates of thyroid cancer/breast cancer/colorectal cancer/lung cancer, which are the main malignancies detected in PET cancer screening. In addition, we evaluated seeking bias of examinees, analyzing correlations between the presence of cancer risk factors and prior screening checkups at other institutions to our PET cancer screening using a matched case-control study.

RESULTS: Cancer detection rates by FDG-PET were 1.17% (224/19189), being much higher than those of standard cancer mass screenings. In males, statistically significant correlations were seen between lung cancer and smoking, and between prostate cancer and a family history of prostate cancer, but not between the detection rates of three other types of cancer (thyroid cancer/lung cancer/colorectal cancer) and other cancer risk factors. In females, detection rates of four types of cancer (thyroid cancer/lung cancer/colorectal cancer/breast cancer) were significantly higher in the examinees without cancer risks, and subgroup analysis according to types of cancer did not indicate significant correlations either. The matched case-control study evaluating seeking bias indicated that a significant proportion of the examinees with cancer risks had undergone prior cancer screening at other institutions.

CONCLUSIONS: Our study indicated that there was significant seeking bias for prior screening of examinees, with this accounting for the fact that this study did not find a significant correlation between cancer risks and cancer detection rates. The results of our study indicated that PET cancer screening can provide high cancer detection rates.

Friday, December 24, 2010

From Mayo Clinic: Safe aggressive diabetes care

Mayo Clin Proc. 2010 Dec;85(12 Suppl):S15-26. Epub 2010 Nov 24.
Glycemic control and weight reduction without causing hypoglycemia: the case for continued safe aggressive care of patients with type 2 diabetes mellitus and avoidance of therapeutic inertia.
Schwartz SS, Kohl BA.

Penn Presbyterian Medical Center, Second Floor, Philadelphia Heart Institute, 51 N 39th St, Philadelphia, PA 19104, USA.
Diabetes mellitus (DM) is a major and growing concern in the United States, in large part because of an epidemic of obesity in America and its relation to type 2 DM. In affected patients, postprandial glucose may be an early indicator of glucose intolerance or a prediabetes condition, which may be a better predictor of cardiovascular risk than impaired fasting glucose level. Treating patients who have early signs of hyperglycemia, including elevated postprandial glucose level, with intensive glucose control that does not lead to weight gain, and ideally may be associated with weight reduction, may be vital to preventing or reducing later cardiovascular morbidity and mortality. Because hypoglycemia is an important complication of current DM treatments and may cause acute secondary adverse cardiovascular outcomes, not causing hypoglycemia is mandatory. Given that weight loss can significantly lower cardiovascular risk and improve other cardiovascular risk factors in patients with type 2 DM and that medications are available that can result in weight reduction without leading to hypoglycemia, the successful treatment of patients with type 2 DM should be individualized and should address the complete pathophysiologic process. This review is a hypothesis article that presents arguments against general approaches to the treatment of type 2 DM. An algorithm is presented in which the goal for managing patients with type 2 DM is to lower the blood glucose level as much as possible for as long as possible without causing hypoglycemia. In addition, body weight should ideally be improved, reducing cardiovascular risk factors and avoiding therapeutic inertia.

Diabetes and genomics

N Engl J Med. 2010 Dec 9;363(24):2339-50.
Genomics, type 2 diabetes, and obesity.
McCarthy MI.

Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Oxford OX3 7LJ, United Kingdom.

How best to get information to cancer patients?

Health (London). 2010 Dec 22. [Epub ahead of print]
Exploring patients' experience of receiving information about cancer: A comparison of interview and questionnaire methods of data collection.
Pollock K, Moghaddam N, Cox K, Wilson E, Howard P.

School of Nursing, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2HA, UK.
Patient information is widely regarded both as a resource and an entitlement: a means of 'empowering' patients to behave as 'consumers' of health care. Patient 'satisfaction' has come to be regarded as an important outcome of care. This article presents qualitative interview data regarding the experience of patient information provision and the results of a self-completed Information Satisfaction Questionnaire (ISQ) among patients and relatives affected by cancer. It considers the implications of the differences between these for service evaluation and current policy implementation promoting patients as informed and expert consumers of health care. The study findings contribute to growing evidence that the high rate of patients' expressed satisfaction with different aspects of service provision as indicated by structured questionnaire responses is largely an artefact of the method of data collection. Accounts of negative experiences were common, but did not translate into expressed criticism or overt dissatisfaction. It is important that the limitations of such surveys are contextualized in relation to qualitative findings such as those of the present study. Especially in the face of serious and life-threatening illness, professional constructs such as 'information delivery', 'satisfaction' and 'shared decision making' have little resonance for many patients, who prefer to trust in professional expertise and to eschew the acquisition of specialist knowledge and active involvement in decisions about health care.

Inhaled antibiotics for cystic fibrosis patients--more research on this is needed

Sci Transl Med. 2010 Dec 22;2(63):63mr4.
Development of the First Inhaled Antibiotic for the Treatment of Cystic Fibrosis.
Rose LM, Neale R.

Cystic Fibrosis Therapeutics Development Network Coordinating Center, Seattle Children's Research Institute, Seattle, WA 98101, USA.
Tobramycin Inhalation Solution USP (TOBI), a therapy developed to treat lung infections associated with cystic fibrosis (CF), was presented as a demonstration case for collaborative pharmaceutical development at a Clinical and Translational Science Awards Industry Forum on "Promoting Efficient and Effective Collaborations Among Academia, Government, and Industry" held in February 2010. TOBI was developed by PathoGenesis Corporation (Seattle, WA) in collaboration with the academic inventors, the National Institutes of Health, the U.S. Food and Drug Administration, and the CF Foundation. The presenters, representing the academic, industry, and foundation partners, each reviewed the program from their perspectives and identified challenges that existed during the discovery, development, and commercialization of TOBI. The attendees were asked to consider other collaborative opportunities that might have further improved TOBI development, including the optimal roles of the academic researchers, foundations, and other agencies when industry drives development and commercialization decisions.

More on flying and COPD

Respir Med. 2011 Jan;105(1):50-6. Epub 2010 Oct 25.
High prevalence of respiratory symptoms during air travel in patients with COPD.
Edvardsen A, Akerø A, Hardie JA, Ryg M, Eagan TM, Skjønsberg OH, Bakke PS.

Department of Respiratory Physiology, Glittreklinikken AS, Pb 104 Åneby, 1485 Hakadal, Norway.
OBJECTIVE: The reduced pressure in aircraft cabins may cause severe hypoxemia and respiratory distress in patients with chronic obstructive pulmonary disease (COPD). The primary objective of this study was to determine the prevalence of in-flight symptoms in COPD patients and non-COPD subjects, and evaluate associations between these symptoms and pre-flight variables.

METHODS: In a cross-sectional study of 391 COPD patients and 184 non-COPD subjects, we recorded lung function, blood gas values, exercise capacity, air travel habits and in-flight symptoms.

RESULTS: Fifty-four percent of the COPD patients had travelled by air the last two years. Hypoxia-related symptoms during air travel were experienced in 25% of the COPD patients and 9% of the non-COPD subjects (p < 0.001). After adjusting for smoking status, age and gender, the odds ratio for COPD patients to experience dyspnea or air hunger was 6.6 (95% CI 2.5-17.3, p < 0.001) compared to non-COPD subjects. In the COPD patients, in-flight dyspnea or air hunger was strongly associated with pre-flight score on the Medical Research Council (MRC) Dyspnea scale (p < 0.001).

CONCLUSION: COPD patients had significantly increased risk of in-flight dyspnea or air hunger compared to non-COPD subjects. In COPD patients these symptoms were strongly associated with pre-flight MRC Dyspnea score.

From Mayo: GPC5 and lung cancer

J Thorac Oncol. 2011 Jan;6(1):2-5.
GPC5 Gene and Its Related Pathways in Lung Cancer.
Li Y, Yang P.

Department of Health Sciences Research, Mayo Clinic, College of Medicine, Rochester, Minnesota.

More challenging than ever: Getting adequate lung cancer tissue for histologic and molecular analysis using finer and finer biopsy methods

J Thorac Oncol. 2011 Jan;6(1):203-206.
How I Do It-Optimal Methodology for Multidirectional Analysis of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration Samples.
Nakajima T, Yasufuku K.

Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
BACKGROUND: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive modality with a high diagnostic yield for mediastinal lymph node staging of patients with lung cancer. Although limited to the use of needle aspiration during EBUS-TBNA, aspirates has been shown to be useful for molecular analysis. However, the ideal methodology of the specimen handling during EBUS-TBNA has not been described.

METHODS: Based on our institutional experience and review of the literature, we describe the optimal methodology for multidirectional analysis of EBUS-TBNA samples.

RESULTS: EBUS-TBNA specimens can be used for molecular analysis such as epidermal growth factor receptor (EGFR), Anaplastic lymphoma kinase (ALK) and V-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog (KRAS) mutations when processed properly. Rapid on-site cytology is invaluable during the assessment of the aspirated during EBUS-TBNA.

DISCUSSION: Obtaining adequate samples through a non-surgical biopsy technique for pathologic diagnosis as well as molecular analysis will be of immediate importance for personalized management of lung cancer. EBUS-TBNA is an ideal approach that allows combined pathological and molecular analysis of metastatic lymph nodes.

More and more, KRAS and lung cancer...

J Thorac Oncol. 2011 Jan;6(1):220-222.
KRAS Mutation Analysis Helps to Differentiate Between Pulmonary Metastasis from Colon Adenocarcinoma In Situ and Primary Lung Adenocarcinoma.
Ortiz TM, Cohen DW, Kent MS, Jänne PA, Costa DB.

*Division of Medical Oncology, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Harvard Medical School; and †Departments of Surgery, Pathology, and Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.

From Birmingham UK: Lung cancer at 26?

J Thorac Oncol. 2011 Jan;6(1):218-219.
Small Cell Lung Cancer in a 26-Year-Old Man with Significant Cannabis Exposure.
Graef S, Choo CG, Warfield A, Cullen M, Woolhouse I.

Departments of *Respiratory Medicine, †Histopathology, and ‡Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.

Lung cancer: the ASCO annual meeting presentations

J Thorac Oncol. 2011 Jan;6(1):227-232.
Summary of Presentations from the 46th Annual Meeting of the American Society of Clinical Oncology: Focus on Non-small Cell Lung Cancer (2010).
Stinchcombe TE, Baggstrom MQ, Somaiah N, Simon GR, Govindan R.

*Lineberger Comprehensive Cancer Center at the University of North Carolina, Chapel Hill, North Carolina; †Washington University School of Medicine and Alvin J. Siteman Cancer Center, St. Louis, Missouri; ‡Fox Chase Cancer Center, Philadelphia, Pennsylvania; and §Medical University of South Carolina, Charleston, South Carolina.
The promising results of crizotinib in molecularly selected patients with advanced non-small cell lung cancer (NSCLC) whose tumor cells had a novel fusion protein involving anaplastic lymphoma kinase presented at the 2010 American Society of Clinical Oncology reinforce once again the importance of understanding molecular heterogeneity of lung cancer and careful patient selection. Several other important issues were the subject of presentations related to lung cancer at the recently concluded American Society of Clinical Oncology annual meeting. The articles covered a wide variety of topics including optimal staging techniques to detect mediastinal nodal involvement, the role of platinum-based doublet chemotherapy in the management of elderly patients with advanced NSCLC, use of maintenance therapy with gemcitabine, and the impact of early introduction of organized palliative care in improving the quality of life of patients with advanced NSCLC. This report provides a brief overview of the presentations related to lung cancer that are relevant to clinical practice and future research.

From Harvard: ERCC2/XPD polymorphisms and lung cancer risk

J Thorac Oncol. 2011 Jan;6(1):233.
ERCC2/XPD Polymorphisms and Lung Cancer Risk.
Christiani DC.

Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Harvard School of Public Health, Boston, Massachusetts.

From UT Southwestern: Nuclear receptor expression as possible lung cancer biomarkers

PLoS Med. 2010 Dec 14;7(12):e1000378.
Nuclear Receptor Expression Defines a Set of Prognostic Biomarkers for Lung Cancer.
Jeong Y, Xie Y, Xiao G, Behrens C, Girard L, Wistuba II, Minna JD, Mangelsdorf DJ.

Department of Pharmacology, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America.
BACKGROUND: The identification of prognostic tumor biomarkers that also would have potential as therapeutic targets, particularly in patients with early stage disease, has been a long sought-after goal in the management and treatment of lung cancer. The nuclear receptor (NR) superfamily, which is composed of 48 transcription factors that govern complex physiologic and pathophysiologic processes, could represent a unique subset of these biomarkers. In fact, many members of this family are the targets of already identified selective receptor modulators, providing a direct link between individual tumor NR quantitation and selection of therapy. The goal of this study, which begins this overall strategy, was to investigate the association between mRNA expression of the NR superfamily and the clinical outcome for patients with lung cancer, and to test whether a tumor NR gene signature provided useful information (over available clinical data) for patients with lung cancer.

METHODS AND FINDINGS: Using quantitative real-time PCR to study NR expression in 30 microdissected non-small-cell lung cancers (NSCLCs) and their pair-matched normal lung epithelium, we found great variability in NR expression among patients' tumor and non-involved lung epithelium, found a strong association between NR expression and clinical outcome, and identified an NR gene signature from both normal and tumor tissues that predicted patient survival time and disease recurrence. The NR signature derived from the initial 30 NSCLC samples was validated in two independent microarray datasets derived from 442 and 117 resected lung adenocarcinomas. The NR gene signature was also validated in 130 squamous cell carcinomas. The prognostic signature in tumors could be distilled to expression of two NRs, short heterodimer partner and progesterone receptor, as single gene predictors of NSCLC patient survival time, including for patients with stage I disease. Of equal interest, the studies of microdissected histologically normal epithelium and matched tumors identified expression in normal (but not tumor) epithelium of NGFIB3 and mineralocorticoid receptor as single gene predictors of good prognosis.

CONCLUSIONS: NR expression is strongly associated with clinical outcomes for patients with lung cancer, and this expression profile provides a unique prognostic signature for lung cancer patient survival time, particularly for those with early stage disease. This study highlights the potential use of NRs as a rational set of therapeutically tractable genes as theragnostic biomarkers, and specifically identifies short heterodimer partner and progesterone receptor in tumors, and NGFIB3 and MR in non-neoplastic lung epithelium, for future detailed translational study in lung cancer.

The politics of assisted reproduction

Bioethics. 2011 Feb;25(2):92-101. doi: 10.1111/j.1467-8519.2010.01869.x.
Donchin A.

Indiana University.
This paper interprets the British legislative process that initiated the first comprehensive national regulation of embryo research and fertility services and examines subsequent efforts to restrain the assisted reproduction industry. After describing and evaluating British regulatory measures, I consider successive failures to control the assisted reproduction industry in the US. I discuss disparities between UK and US regulatory initiatives and their bearing on regulation in other countries. Then I turn to the political and social structures in which the assisted reproduction industry is embedded. I argue that regulatory bodies are seldom neutral arbiters. They tend to respond most readily to special interests and neglect strategies that could more effectively meet the health needs of the people they represent. Neither national nor international bodies have aggressively pursued policies to harness the industry, reduce infertility rates, or meet the needs of people whose fertility is threatened by substandard healthcare and environmental neglect. In conclusion, I consider recent initiatives by activist groups to mount an alternative response to the industry's current practices and build a transnational reproductive justice movement.

Universal asbestos ban? Let's see the evidence based pros and cons, please

Int J Occup Med Environ Health. 2010;23(2):201-7.
Asbestos is still with us: repeat call for a universal ban.
Collegium Ramazzini.

General Secretariat, Castello di Bentivoglio, 40010 Bentivoglio, Bologna, Italy.
All forms of asbestos are proven human carcinogens. All forms of asbestos cause malignant mesothelioma, lung, and laryngeal cancers, and may cause ovarian, gastrointestinal and other cancers. No exposure to asbestos is without risk, and there is no safe threshold of exposure to asbestos. Asbestos cancer victims die painful lingering deaths. These deaths are almost entirely preventable. When evidence of the carcinogenicity of asbestos became incontrovertible, the concerned parties, including the Collegium Ramazzini, called for a universal ban on the mining, manufacture and use of asbestos in all countries around the world. Asbestos is now banned in 52 countries, and safer products have replaced many materials that once were made with asbestos. Nonetheless, a large number of countries still use, import, and export asbestos and asbestos-containing products. And in many countries that have banned other forms of asbestos, the so-called "controlled use" of chrysotile asbestos continues to be permitted, an exemption that has no basis in medical science but rather reflects the political and economic influence of the asbestos mining and manufacturing industry. To protect the health of all people in the world--industrial workers, construction workers, women and children, now and in future generations--the Collegium Ramazzini calls again today on all countries of the world, as we have repeatedly in the past, to join in the international endeavor to ban all forms of asbestos. An international ban on asbestos is urgently needed.

Thursday, December 23, 2010

Nanocytology and lung cancer

Future Oncol. 2011 Jan;7(1):1-3.
Nanocytology for field carcinogenesis detection: novel paradigm for lung cancer risk stratification.
Roy HK, Hensing T, Backman V.

Department of Medicine, NorthShore University Health Systems, Evanston IL 60201, USA.

VEGF and diagnosis in pleural fluid--More work needs to be done on this

Interact Cardiovasc Thorac Surg. 2010 Dec 20. [Epub ahead of print]
Vascular endothelial growth factor in pleural fluid for differential diagnosis of benign and malignant origin and its clinical applications.
Fiorelli A, Vicidomini G, Di Domenico M, Napolitano F, Messina G, Morgillo F, Ciardiello F, Santini M.

Thoracic Surgery Unit, Second University of Naples, Naples, Italy.
Our goal was to determine the role of vascular endothelial growth factor (VEGF) in diagnosing of pleural effusion (PE) in order to select patients deserving of more aggressive procedures. Seventy-nine consecutive patients with undiagnosed unilateral PE were enrolled. Pleural VEGF levels, measured using enzyme-linked immunosorbent assay (ELISA), were correlated to etiology of PEs and other markers (protein, lactic dehydrogenase, amylase, glucose). The median level of VEGF in exudates (n=65) was significantly higher than that in transudates (P=0.0001) and among exudates, it was significantly higher in malignant (n=49) than that in benign exudates (P=0.005). No significant differences were observed between malignant effusions due to lung cancer (n=11) and other malignant effusions wmesothelioma (n=13) andyor extra-thoracic cancerx. Among all variables valuated, logistic regression found that only VEGF was significantly correlated with the presence of malignant disease (P=0.002). Analysis of the receiver operating characterists (ROC) curves showed that the areas under the curve of VEGF were significantly larger than that of amylase (P=0.02), glucose (P=0.01), lactic dehydrogenase (P=0.001) and protein (P=0.01). VEGF increased the diagnostic rate of cytological examination by 24%. VEGF may represent a helpful adjunct to conventional diagnostic tools in ruling out malignancy as a probable diagnosis, thus guiding the selection of patients who might benefit from further invasive procedures.

Advances in Surgical Pathology: Lung Cancer

Electromagnetic navigation bronchoscopy!

Future Oncol. 2011 Jan;7(1):31-36.
Electromagnetic navigation bronchoscopy.
Bechara R, Parks C, Ernst A.
Emory University School of Medicine, Atlanta, GA, USA.

Social transformation of physicians. Good article, but may I suggest "patients" rather than "clients"?

J Health Soc Behav. 2010;51 Suppl:S94-106.
The continued social transformation of the medical profession.
Timmermans S, Oh H.

UCLA, Los Angeles, CA 90095-1551, USA.
A pressing concern in contemporary health policy is whether the medical profession's mandate to take care of clients has been undermined by the influx of money into health care. We examine the medical profession's transformation over the past decades. First, we review how sociologists have viewed the medical profession over the past half-century as one stakeholder among other stakeholders vying for market share and power in the health care field. We then examine three recent challenges to the profession that exemplify the tension between self-interest and collective altruism to act in the best interest of patients: (1) the rise of patient consumerism, (2) the advent of evidence-based medicine, and (3) the increasing power of the pharmaceutical industry. We show the resilience of the medical profession as it adapts and transforms in response to these challenges. We conclude with implications to help inform policy makers' assessments of how the medical profession will react to policy initiatives.

NCI study: what makes Americans over- or underrate their health care?

J Health Commun. 2010;15 Suppl 3:147-56.
Factors associated with americans' ratings of health care quality: what do they tell us about the raters and the health care system?
Chou WY, Wang LC, Finney Rutten LJ, Moser RP, Hesse BW.

Health Communication and Informatics Research Branch, National Cancer Institute, Bethesda, Maryland, USA.
Consumer satisfaction ratings of health care quality represent a commonly used measure of health care performance. Identifying factors associated with ratings will help us understand the relative influence of individuals' sociodemographic and health characteristics on satisfaction level, thus informing policy making and clinical practice. Existing research has yielded mixed results on key predictors of consumer ratings. Using nationally representative data, this study aims to identify factors associated with Americans' ratings of health care quality. Data from 2008 Health Information National Trends Survey (HINTS) were analyzed using weighted multinomial logistic regressions to estimate consumer ratings. Predictor variables included demographics, health status, care access, and attitude and perceptions about health. Overall ratings were positively skewed; 70% of respondents rated care as "excellent" or "very good." Minority race, psychological distress, not having had cancer, not having a regular health care provider, not having health insurance, lacking confidence in self-care, and avoidance of doctors were significantly associated with lower ratings. The study identifies the psychosocial characteristics associated with lower consumer ratings. The results highlight the importance of using multiple approaches to assess quality of care, including considering patient characteristics, and contribute to the evidence base for evaluating overall quality of care at the dawn of health care reform.

Communication during surgery. A Harvard study.

Ann Surg. 2010 Dec 17. [Epub ahead of print]
A Policy-based Intervention for the Reduction of Communication Breakdowns in Inpatient Surgical Care: Results From a Harvard Surgical Safety Collaborative.
Arriaga AF, Elbardissi AW, Regenbogen SE, Greenberg CC, Berry WR, Lipsitz S, Moorman D, Kasser J, Warshaw AL, Zinner MJ, Gawande AA.

*Department of Health Policy and Management, Harvard School of Public Health †Department of Surgery, Brigham and Women's Hospital ‡Department of Surgery, Massachusetts General Hospital §Department of Surgery, Beth Israel Deaconess Medical Center ¶Department of Surgery, Children's Hospital Boston, Boston, Massachusetts.
OBJECTIVE: To develop and evaluate an intervention to reduce breakdowns in communication during inpatient surgical care.

BACKGROUND: Communication breakdowns are the second most common cause of avoidable surgical adverse events after technical errors.

METHODS: In a pre- and postintervention study, a random selection of patients on the surgical services of 4 teaching hospitals were observed according to 3 measures: (1) resident-attending communication of critical patient events (eg, transfer into the intensive care unit, unplanned intubation, cardiac arrest); (2) resident-attending notification regarding routine weekend patient status; and (3) frequency of weekend patient visits by an attending. All departments then developed and adopted a set of policy and education initiatives designed to increase prompt and consistent resident-attending communication (especially in critical events) and to improve regular attending visits with surgical patients. Specific reinforcement of the policies included a pocket information card for residents, as well as periodic reminders. Repeat audits of the surgical services were then conducted.

RESULTS: We reviewed information for 211 critical events and 1360 patients for the nature of resident and attending communication practices. After the intervention, the proportion of critical events not conveyed to an attending decreased from 33% (26/80) to 2% (1/47), and gaps in the frequency of attending notification of patient status on weekends were virtually eliminated (P < 0.0001); the proportion of weekend patients not visited by an attending for greater than 24 hours decreased by half (from 61% to 33%; P = 0.0002). Contact resulted in attending-led changes in patient management in one-third of cases.

CONCLUSIONS: An intervention to improve surgical communication practices at 4 teaching hospitals led to significant reductions in potentially harmful communication breakdowns during inpatient care; significant alterations in patient management were noted in one-third of cases in which there was an adherence to recommended communication practices.

Wednesday, December 22, 2010

8.8 months: Mean mesothelioma survival

Ind Health. 2010 Dec 16. [Epub ahead of print]
Malignant Mesothelioma: A Clinical Study of 238 Cases.
Haber SE, Haber JM.
Texas Occupational Medicine Institute.
Malignant mesothelioma is a diffuse tumor arising in the pleura, peritoneum, or other serosal surface and is closely associated with asbestos exposure. An estimated 2,500 to 3,000 cases are diagnosed each year in the United States. Although there are individual case reports and small series detailing the clinical aspects of mesothelioma, few studies examine a large series of patients with malignant mesothelioma from the clinical perspective. This study reports on the findings of 238 cases of malignant mesothelioma from a private consultative medical practice. Most cases had a history of occupational asbestos exposure. The mean latency was 48.5 yr, with women having a longer latency than men. The mean age at diagnosis was 70. Survival overall was poor (mean 8.8 months), but treatment was beneficial (mean 11.3 versus 6.4 months). Epithelioid histology conferred a survival advantage over sarcomatoid and responded better to treatment. Our data support an inverse relationship between asbestos dose and latency.

Physicians: Looking to lawyers to learn patient advocacy?

J Am Acad Psychiatry Law. 2010;38(4):590-1.
Commentary: on doctors and lawyers.
Kapoor R.

Yale University School of Medicine, 34 Park Street, New Haven, CT 06519.
Psychiatrists and attorneys often find collaboration difficult, even when working toward mutually beneficial goals. In this commentary, a young psychiatrist reflects upon the mismatch between physicians and attorneys. Differences in medical and legal training, as well as different personality styles and approaches to problem solving, may contribute to conflict. However, psychiatrists can benefit and learn from the attorneys' approach and apply it to situations in which advocacy for good patient care and the fundamental values of medicine is necessary.

Sanja Dacic and colleagues: ER and PR and lung cancer prognosis

Clin Cancer Res. 2010 Nov 9. [Epub ahead of print]
Combined analysis of estrogen receptor {beta}-1 and progesterone receptor expression identifies lung cancer patients with poor outcome.
Stabile LP, Dacic S, Land SR, Lenzner DE, Dhir R, Aquafondata M, Landreneau RJ, Grandis JR, Siegfried JM.

Department of Pharmacology, University of Pittsburgh.
PURPOSE: Steroid hormones and growth factors affect lung cancer, and it is possible they act in concert to influence patient outcome.

EXPERIMENTAL DESIGN: Primary lung tumors and normal lung tissue were analyzed for expression and localization of estrogen receptor α and β-1 (ERα and ERβ), aromatase, progesterone receptor (PR), and epidermal growth factor receptor (EGFR).

RESULTS: Tumors expressed higher levels of ERβ compared to matched normal lung, while the reverse was true of PR. High cytoplasmic ERβ expression was identified as an independent negative prognostic predictor of overall survival (OS) (HR=1.67), and low total PR was identified as an independent negative predictor of time to progression (TTP) (HR=1.59). After adjusting for stage, age, sex and smoking, combined high cytoplasmic ERβ and low total PR showed enhanced effects on OS (HR=2.64) and on TTP (HR=6.02). Further effects on OS were observed when EGFR expression was included (HR=5.32). Patients with low cytoplasmic ERβ, low aromatase, low EGFR and high total PR had shorter OS than patients with the opposite pattern (HR= 6.60). Contribution of these markers to survival showed no significant sex differences in a multivariable model. ERα was elevated in tumors but was not predictive of survival, and appears to represent a variant ERα protein that is only recognized by a C-terminal antibody.

CONCLUSIONS: Hormonal and EGFR pathways together may contribute to lung cancer prognosis. Lung tumors with high ERβ-1/low PR may define patients with aggressive biology. A validation study is necessary to fully assess the predictive value of these markers.

Assessing quality in humanitarian aid

Eval Program Plann. 2010 Nov 10. [Epub ahead of print]
Humanitarian action in developing countries: Who evaluates who?
Pérouse de Montclos MA.

CEPED (Centre Population & Développement), UMR 196 Paris Descartes - INED - IRD, 19 rue Jacob, 75006 Paris, France.

Humanitarian NGOs and intergovernmental organisations are usually assessed by their funders, not their beneficiaries. In most cases, their evaluation relies on interviews with "professionals", neglects field surveys, does not use opinion polls and seldom tries to assess the socioeconomic impact of relief. Moreover, it is commissioned by stakeholders at the risk of being judge and party. Such a system brings several conflicts of interest: (1) it needs to be approved by those who are evaluated and so does not deal with "bad eggs" that refuse to be investigated; (2) it produces biased analysis, does not name names and passes over fundamental issues; (3) it is very formal and technocratic, if not meaningless; (4) it does not help to learn from past mistakes. Hence this article proposes a framework to develop third party evaluations. It is suggested that, to be really independent, evaluation should neither be paid or commissioned by stakeholders, i.e. NGOs and institutional funders. To facilitate learning, its methodology and its results must also be available to the general public. To be accepted by those who are evaluated, finally, it should highlight the difficulties, explain the political context, acknowledge its subjectivity, recognize its limits, focus on processes more than results and develop qualitative analysis out of quantitative indicators.

From the CDC: Disability and public health

Disabil Health J. 2011 Jan;4(1):12-8.
Evolving views of disability and public health: The roles of advocacy and public health.
Krahn G, Campbell VA.

Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA 30333, USA.
Promoting health, quality of life, and participation of persons with disabilities is a relatively recent development in public health. Its brief history reflects three distinct public health perspectives toward disability-a traditional approach that focuses on preventing disability, a contemporary approach that regards disability as a minority group experiencing disparities relative to people without disabilities, and an emerging perspective where disability status is considered one of multiple determinants of health. The field of disability and health has been influenced by the interaction of disability advocacy with the public health process of surveillance, epidemiology research, and intervention. Advocacy draws on political and legal arguments to press for action on issues such as health care access, control of services, and choice of residence. Public health uses surveillance to document magnitude of problems; epidemiology to identify specific groups, develop measures, and apply rigorous research methods; and intervention to improve health behaviors and health outcomes. The field of disability and public health, however, has lagged in addressing the role of environmental factors in the disabling process, in moving to societal participation as an outcome, and in implementing population scale interventions.

Things that go bump on the right

Psychon Bull Rev. 2010 Dec;17(6):910-4.
Feeling socially powerless makes you more prone to bumping into things on the right and induces leftward line bisection error.
Wilkinson D, Guinote A, Weick M, Molinari R, Graham K.

University of Kent, Canterbury, England.
Social power affects the manner in which people view themselves and act toward others, a finding that has attracted broad interest from the social and political sciences. However, there has been little interest from those within cognitive neuroscience. Here, we demonstrate that the effects of power extend beyond social interaction and invoke elementary spatial biases in behavior consistent with preferential hemispheric activation. In particular, participants who felt relatively powerless, compared with those who felt more powerful, were more likely to bisect horizontal lines to the left of center, and bump into the right-hand (as opposed to the left-hand) side when walking through a narrow passage. These results suggest that power induces hemispheric differences in visuomotor behavior, indicating that this ubiquitous phenomenon affects not only how we interact with one another, but also how we interact with the physical world.

From Mark Wick and colleagues: Full disclosure in industry-sponsored medical research. Very important.

Clin Chem. 2010 Dec 20. [Epub ahead of print]
Full Disclosure in Industry-Sponsored Laboratory Medicine Research Studies: Statement by the Consortium of Laboratory Medicine Journal Editors.
Rifai N, Plebani M, Wu A, Brugnara C, Delvin E, Lamb EJ, Ness PM, Wick MR, Berg JP.

From Kevin Leslie and colleagues: Distinguishing lung adenocarcinoma from squamous cell carcinoma

Am J Surg Pathol. 2010 Dec;34(12):1805-11.
Optimal immunohistochemical markers for distinguishing lung adenocarcinomas from squamous cell carcinomas in small tumor samples.
Terry J, Leung S, Laskin J, Leslie KO, Gown AM, Ionescu DN.

Department of Pathology, BC Cancer Agency, Vancouver, British Columbia, Canada.
The histologic subtype of non-small cell lung carcinoma is important in selecting appropriate chemotherapy for patients with advanced disease. As many of these patients are not operative candidates, they are treated medically after biopsy for diagnosis. Inherent limitations of small biopsy samples can make distinguishing poorly differentiated lung adenocarcinoma (ADC) from squamous cell carcinoma (SCC) difficult. The value of histochemical and immunohistochemical markers to help separate poorly differentiated ADC from SCC in resection specimens is well established; however, the optimal use of markers in small tissue samples has only recently been examined and the correlation of marker expression in small tissue samples with histologic subtype determined on resection specimens has not been well documented. We address this issue by examining the expression of 9 markers (p63, TTF1, CK5/6, CK7, 34βE12, Napsin A, mucicarmine, NTRK1, and NTRK2) on 200 cases of ADC and 225 cases of SCC in tissue microarray format to mimic small tissue specimens. The single best marker to separate ADC from SCC is p63 (for SCC: sensitivity 84%, specificity 85%). Logistic regression analysis identifies p63, TTF1, CK5/6, CK7, Napsin A, and mucicarmine as the optimal panel to separate ADC from SCC. Reduction of the panel to p63, TTF1, CK5/6, and CK7 is marginally less effective but may be the best compromise when tissue is limited. We present an algorithm for the stepwise application of p63, TTF1, CK5/6, CK7, Napsin A, and mucicarmine in situations in which separation of ADC from SCC in small specimens cannot be accomplished by morphology alone.

Kerr, Wells, Nicholson, Gibbs et al: PAP with HP!

Respirology. 2010 Nov;15(8):1197-202. doi: 10.1111/j.1440-1843.2010.01848.x.
Alveolar proteinosis with hypersensitivity pneumonitis: a new clinical phenotype.
Verma H, Nicholson AG, Kerr KM, Dempsey OJ, Gibbs AR, Campbell I, Black F, Rassl D, Rice AJ, Renzoni EA, Wells AU, Hansell DM.

Department of Radiology, Royal Marsden Hospital, London, UK.
BACKGROUND AND OBJECTIVE: The aim of the present study was to report the features of five patients with concurrent histopathological features of pulmonary alveolar proteinosis (PAP) and hypersensitivity pneumonitis (HP) and their high-resolution CT (HRCT) appearances.

METHODS: Patients with histopathological features of both HP and PAP on surgical lung biopsy referred for tertiary review were retrospectively identified. The pathology and HRCT images were semi-quantitatively scored to evaluate the relative contribution to HP and PAP.

RESULTS: Five patients had histopathological features of HP and PAP but had varied HRCT appearances. All had imaging features of PAP to a varying degree with two patients also showing characteristics of HP but three patients had ill-defined thickened interlobular septa, not typical of either disease.

London: "Radical" lung cancer treatment guidelines

Thorax. 2010 Oct;65 Suppl 3:iii1-27.
Guidelines on the radical management of patients with lung cancer.
Lim E, Baldwin D, Beckles M, Duffy J, Entwisle J, Faivre-Finn C, Kerr K, Macfie A, McGuigan J, Padley S, Popat S, Screaton N, Snee M, Waller D, Warburton C, Win T; British Thoracic Society; Society for Cardiothoracic Surgery in Great Britain and Ireland.

Academic Division of Thoracic Surgery, Royal Brompton Hospital, London, UK.
A joint initiative by the British Thoracic Society and the Society for Cardiothoracic Surgery in Great Britain and Ireland was undertaken to update the 2001 guidelines for the selection and assessment of patients with lung cancer who can potentially be managed by radical treatment.

From Michigan State U: Lung cancer patients and dealing with death

Death Stud. 2010 Nov;34(10):931-946.
Death Concerns Among Individuals Newly Diagnosed with Lung Cancer.
Lehto R, Therrien B.

Michigan State University College of Nursing, East Lansing, MI.
Confronting the reality of death is an important challenge for individuals facing life-threatening illness such as lung cancer, the leading cause of cancer death. Few studies, however, document the nature of death-related concerns in individuals newly diagnosed with lung cancer. The aims of this exploratory study were to examine unsolicited death-related concerns among newly diagnosed individuals, and to determine if age, gender, marital status, stage of disease, type of treatment, presence of co-morbid conditions, and Veteran status were related to extent of death concerns. A mixed method approach was used to examine death concerns in 73 individuals newly diagnosed with non-small cell lung cancer. Seven categories related to death were identified: psychological preparation; time left; impact; behavioral preparation; acceptance; cancer death experiences; and post-death. Stage of disease and Veteran status were factors that were related to increased numbers of death-related content. Findings demonstrate that death concerns are varied, primarily negative, and are relevant to the person facing a new lung cancer diagnosis, thus highlighting the importance for health care providers to assess, discuss, and listen for death concerns in the acute care setting.

Delay in breast cancer diagnosis: work needs to be done now

"The proportion of women experiencing diagnostic delays was high, with more African American women experiencing delays than white women (34% versus 17%, respectively)."

Women Health. 2010 Dec;50(8):705-18.
Factors associated with delays to diagnosis and treatment of breast cancer in women in a louisiana urban safety net hospital.
Williams DL, Tortu S, Thomson J.

Louisiana State University Health Sciences Center, School of Public Health, New Orleans, Louisiana, USA.
Only lung cancer surpasses breast cancer as a cause of death from cancer. However, the burden of cancer is not borne equally across racial and ethnic groups. In the United States, African American women have significantly higher mortality rates from breast cancer than white women. Delayed follow-up of breast abnormalities and delays from diagnosis to treatment may contribute to higher mortality. This study examined factors associated with delays to diagnosis and treatment of breast cancer in a group of white and African American women. Identified from tumor registry records were 247 women with pathology-confirmed first primary in situ and invasive breast carcinomas with no known previous cancer diagnosis. Factors associated with delays from provider recognition of abnormality to breast cancer diagnosis (diagnostic delays) and from diagnosis to treatment (treatment delays) were determined using chi-square tests and logistic regression. Factors that were considered included age, race, stage of disease at diagnosis, tumor size, type of abnormality, type of medical service at presentation, and prior mammogram within the past two years. The proportion of women experiencing diagnostic delays was high, with more African American women experiencing delays than white women (34% versus 17%, respectively). African American and white women did not differ in distribution of stage of cancer at diagnosis. Significantly smaller tumor sizes were found in women experiencing diagnostic delays compared to those not experiencing delays. Conversely, women experiencing treatment delays were significantly older and had larger tumor sizes compared to those not experiencing delays. More African American women experienced delays in diagnosis; however these delays did not appear to affect outcomes. Older age as a significant factor in treatment delays suggests that comorbidities as well as other possible barriers to treatment warrant further investigation in older women. The reasons for racial disparities in breast cancer outcomes remain and call for further study.

Reduced lung cancer risk in people with schizophrenia?

"When lung cancer is adjusted for smoking rates, there appears to be a lower risk of lung cancer than expected providing some basis to support an inherently reduced risk of cancer."

Can J Psychiatry. 2010 Dec;55(12):761-7.
Schizophrenia and cancer: in 2010 do we understand the connection?
Bushe CJ, Hodgson R.

Senior Clinical Research Physician, Eli Lilly and Company Ltd, Basingstoke, England.
Objective: In recent years, there has been a plethora of cancer mortality and incidence data reported in schizophrenia. Despite this, there has been little focus on cancer in schizophrenia guidelines. Additionally, there have been suggestions that schizophrenia may provide inherent protection against cancer. The goal of this review is to establish, using recent data, the incidence and mortality rates for cancer in schizophrenia. Method: We identified systematic reviews and meta-analyses and undertook a search using the Medical Subject Headings' entry terms schizophrenia and neoplasm. Results: Incidence and mortality rates for cancer in schizophrenia are increased, compared with relevant general populations. Data are not uniformly reported and cohort ages tend to be young for expected cancer incidence. Despite the young cohort ages, the incidence of the major cancers-lung and breast-are substantially increased. Confounders are often not measured in the epidemiologic databases. When lung cancer is adjusted for smoking rates, there appears to be a lower risk of lung cancer than expected providing some basis to support an inherently reduced risk of cancer. There may also be a dissonance between incidence and mortality rates that suggest a prejudice against either diagnosis or treatment of these vulnerable patients. Conclusion: A single definitive study of schizophrenia and cancer is unfeasible, and future research will lean heavily on systematic review and meta-analysis. Researchers should report cancer data to include age and follow-up data and cohort overlap. Cancer accounts for almost an equivalent mortality as cardiovascular disease.

Tumor-infiltrating immune cells and Lung Cancer

J Thorac Oncol. 2010 Dec 17. [Epub ahead of print]
The Role of Tumor-Infiltrating Immune Cells and Chronic Inflammation at the Tumor Site on Cancer Development, Progression, and Prognosis: Emphasis on Non-small Cell Lung Cancer.
Bremnes RM, Al-Shibli K, Donnem T, Sirera R, Al-Saad S, Andersen S, Stenvold H, Camps C, Busund LT.

*Institute of Clinical Medicine, University of Tromsø, Tromsø; †Department of Oncology, University Hospital of Northern Norway, Tromsø; ‡Institute of Medical Biology, University of Tromsø, Tromsø; §Department of Pathology, Nordland Central Hospital, Bodø, Norway; ∥Department of Biotechnology, Universidad Politécnica de Valencia, Spain; ¶Department of Pathology, University Hospital of Northern Norway, Tromsø, Norway; and #Department of Oncology, Hospital General Universitario de Valencia, Spain.
In addition to malignant neoplastic cells, cancer tissues also include immune cells, fibroblasts, and endothelial cells, including an abundant collection of growth factors, proangiogenic mediators, cytokines, chemokines, and components of the extracellular matrix. The main physiological function of the immune cells is to monitor tissue homeostasis, to protect against invading pathogens, and to eliminate transformed or damaged cells. Between immune cells and malignant cells in the tumor stroma, there is in fact a complex interaction which has significant prognostic relevance as the immune system has both tumor-promoting and -inhibiting roles. In non-small cell lung cancer (NSCLC), there is a marked infiltration of different types of immune cells, and the distribution, tissue localization, and cell types are significantly associated with progression and survival. Cancer immunotherapy has seen a significant progress during the last decade. An increased understanding of the mechanisms by which lung cancer cells escape the immune system, and the recognition of the key tumor antigens and immune system components in tumor ignorance have led to the development of several lung cancer vaccines. As the NSCLC prognosis in general is dismal, one may hope that future immunotherapy may be an effective adjunct to standard therapy, reversing immunologic tolerance in the tumor microenvironment. This review reports on the tumor stroma and in particular tumor-suppressing and -promoting roles of the immune system. Furthermore, it presents recent literature on relevant immune cell-related research in NSCLC.

From Moffitt: Stigma of lung cancer and depression

Psychooncology. 2010 Dec 20. [Epub ahead of print]
Depression in lung cancer patients: the role of perceived stigma.
Gonzalez BD, Jacobsen PB.

Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, University of South Florida, FL, USA.
Objective: Previous research has shown that lung cancer patients are at an increased risk for depressive symptomatology; however, little is known about the factors contributing to depression in these patients. This study focused on the possible association between perceived stigma related to a lung cancer diagnosis and depressive symptomatology. It was hypothesized that greater perceived stigma would be related to greater depressive symptomatology and that perceived stigma would account for variance in depressive symptomatology above and beyond that accounted for by relevant clinical, demographic, and psychosocial variables.Method: A sample of 95 participants receiving chemotherapy for stage II-IV non-small cell lung cancer was recruited during routine outpatient chemotherapy visits. Participants completed a demographic questionnaire and self-report measures assessing perceived stigma, depressive symptomatology, and other psychosocial variables. A medical chart review was conducted to assess clinical factors.Results: As hypothesized, there was a positive association between perceived stigma and depressive symptomatology, r = 0.46, p<0.001. Perceived stigma also accounted for significant unique variance in depressive symptomatology above and beyond that accounted for by relevant demographic, clinical, and psychosocial factors, β = 0.19, p<0.05.Conclusions: Future research should aim to replicate and extend these findings in longitudinal studies and explore whether lung cancer patients' depressive symptomatology can be ameliorated by targeting perceived stigma. Copyright © 2010 John Wiley & Sons, Ltd.

Sunday, December 12, 2010

Balancing life with a chronic disease

Aust J Prim Health. 2010;16(1):66-74.
Achieving a balanced life in the face of chronic illness.
Jeon YH, Jowsey T, Yen L, Glasgow NJ, Essue B, Kljakovic M, Pearce-Brown C, Mirzaei M, Usherwood T, Jan S, Kraus SG, Aspin C.

Australian Primary Health Care Research Institute, Menzies Centre for Health Policy, The Australian National University, Building 62, Mills Road, Acton, ACT 0200, Australia.

The increasing prevalence of chronic disease is a driver of health system reform in most economically advanced nations. A consistent theme within these reforms is building greater patient-centredness into the health care delivery. This study aims to develop an in-depth understanding of the experience of patients and family carers affected by chronic illness that will be the basis on which to propose policy and health system interventions that are patient-centred. Participants struggled with the ongoing tasks of balancing their lives with the increasing demands and intrusion of chronic illness. Their attempts to achieve a balance were seriously hampered by fragmented services, complexity in navigating health services, relationships with health professionals and others, and co-morbidity. Future policy directions include designing models of care and infrastructure that enable patients and their family carers to balance life and illness, and aligning patient-centred care not only within health services but also with community and social support services.

Health care reform: Don't forget quality!

Am J Med Qual. 2010 Dec 7. [Epub ahead of print]
Focus on Quality: An Opportunity to Execute Health Care Reform.
Mathews SC, Pronovost PJ, Herzlinger RE.

Johns Hopkins University, Baltimore, MD.

From Bryan Liang and colleague: Getting it right in OR

J Clin Anesth. 2008 Mar;20(2):150-3.
Trust but verify: cooperation cannot mean abdication in the operating room.
Liang BA, Tran KM.

Institute of Health Law Studies, California Western School of Law, San Diego, CA

Saturday, December 11, 2010


Eur J Cardiothorac Surg. 2010 Nov 26. [Epub ahead of print]
Imaging of thoracic textiloma.
Ridene I, Hantous-Zannad S, Zidi A, Smati B, Baccouche I, Kilani T, Ben Miled-M'rad K.

Department of Radiology, Abderrahmane Mami Hospital, 2080 Ariana, Tunisia.
Objective: Intrathoracic textiloma or gossypiboma, a retained surgical sponge in the thoracic cavity, is an exceptional but serious complication following thoracic or abdominal surgery. The purpose of this work is to highlight the topographic features of thoracic textiloma and to describe imaging aspects, and, particularly, computed tomography (CT) features. Methods: Eight patients have been operated in our thoracic surgery department for thoracic gossypiboma. In the past, three patients had undergone hepatic surgery and the five others had a history of thoracic surgery. All the patients had a chest radiograph, five of them had a thoracic ultrasonography, all had a chest CT, and one patient had a chest magnetic resonance imaging (MRI). Results: In patients with a history of abdominal surgery, the foreign body was located in the parenchyma of the right lower lobe. In the other patients, the foreign body was either intrapleural or mediastinal. Ultrasonography suggested the diagnosis of textiloma in three of the five patients by demonstrating a non-calcified hyperechoic mass with acoustic shadow. At CT, the gossypiboma was a low-attenuating mass containing trapped gas lucencies in six patients and it was a high-attenuating mass in two patients. MRI showed a diaphragmatic defect in one patient with an intrapulmonary gossypiboma that migrated from the abdomen. Conclusions: The CT aspect of thoracic gossypiboma may be different according to pleural or parenchymal location. The spongiform appearance, characteristic in abdominal gossypiboma, is not the only CT presentation of thoracic gossypiboma. The confrontation of the surgical history with the CT signs helps to have a preoperative diagnosis.

Pemetrexed as mesothelioma treatment?

Asia Pac J Clin Oncol. 2010 Dec;6(4):248-50. doi: 10.1111/j.1743-7563.2010.01362.x.
Pemetrexed for malignant pleural mesothelioma: Is it a standard second-line therapy?
Tamura K, Fujiwara Y.

Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan.

Videothoracoscopy for pleural empyema

Eur J Cardiothorac Surg. 2010 Dec 4. [Epub ahead of print]
The role of videothoracoscopy in chronic pleural empyema.
Divisi D, Imbriglio G, De Vico A, Crisci R.

Department of Thoracic Surgery, 'G. Mazzini' Hospital, Teramo, Italy.

Finding lung cancer with post-aneurysm CT

J Vasc Surg. 2010 Dec 1. [Epub ahead of print]
The incidence of pulmonary neoplasms discovered by serial computed tomography scanning after endovascular abdominal aortic aneurysm repair.
Harthun NL, Lau CL.

Department of Surgery, Division of Vascular Surgery, Johns Hopkins Medical Institutions, Baltimore, Md.
OBJECTIVES: Serial computed tomography (CT) scanning is routinely used to follow up endovascular exclusion of abdominal aortic aneurysms (AAAs). Nonvascular diseases can be identified, and these exams include images of the lung bases, which can provide information that leads to the diagnosis of pulmonary neoplasms. This study was conducted to determine the rate and type of pulmonary-based oncologic diseases identified by serial CT scanning of patients with endovascular repair of AAAs.

METHODS: A retrospective review of 138 consecutive patients receiving endovascular AAA exclusion during an 8-year period was performed. Length of follow-up and number of CT scans performed was recorded. CT characteristics of the lesion (size, character, and suspicion of malignancy), type of biopsy procedure performed, and final pathologic diagnosis were collected. Oncologic treatments and survival length were also evaluated.

RESULTS: Pulmonary lesions were found in 25 patients (18%), of whom 5 (4%) died during follow-up, and 13 (9%) had stable, subcentimeter lesions and continue to have surveillance from vascular specialists only. Seven patients (5%) with pulmonary lesions were referred for evaluation by thoracic surgeons. Six patients (4%) underwent biopsy of the lesion and were diagnosed with cancer. One patient refused a biopsy and is being monitored with serial CT scans. Four lung cancers (1 small cell and 3 non-small cell), one primary pulmonary carcinoid tumor, and one B-cell lymphoma were discovered. No changes were noted in the lesions in the patient receiving CT surveillance. More than half of the cancers were diagnosed in stage I, with a mean lesion diameter of 11 mm at biopsy. Of 25 patients with pulmonary nodules, 24 were men. The patients diagnosed with cancer are all still alive, with a mean survival length of 2.5 years (range, 0.5-6 years) after oncologic treatment.

CONCLUSIONS: Serial CT scans may reveal a high rate of pulmonary malignancies in a population with AAAs. Attention to the incidental finding of pulmonary nodules on CT scans and arrangement of appropriate follow-up by the vascular surgeon is important for patients undergoing surveillance after endovascular AAA repair. These results indicate that aggressive management of these lesions (early thoracic surgery consultation and biopsy) is appropriate in this high-risk population and may offer early diagnosis and improved long-term survival.

Helping lung cancer patients with their symptoms

J Pain Symptom Manage. 2010 Dec 3. [Epub ahead of print]
Managing Symptoms in Patients with Advanced Lung Cancer during Radiotherapy: Results of a Psychoeducational Randomized Controlled Trial.
Chan CW, Richardson A, Richardson J.

The Nethersole School of Nursing (C.W.H.C.), The Chinese University of Hong Kong, Hong Kong, SAR; School of Health Sciences (A.R.), University of Southampton, Southampton, United Kingdom; and Faculty of Health (J.R.), University of Plymouth, Plymouth, United Kingdom.
CONTEXT: Breathlessness, fatigue, and anxiety are distressing symptoms for patients with advanced lung cancer. Usually managed as isolated symptoms, they often can occur simultaneously. Previous research often has addressed management of discrete symptoms rather than considering them as a cluster, which, in reality, is the situation faced by patients.

OBJECTIVES: This study aimed to examine the effectiveness of a psychoeducational intervention (PEI) on the symptom cluster of anxiety, breathlessness, and fatigue, compared with usual care.

METHODS: A pretest/posttest, two-group, randomized, controlled trial was conducted. Education on symptom management and coaching in the use of progressive muscle relaxation were delivered to patients one week prior to commencing radiotherapy (RT), and repeated three weeks after beginning RT. Symptom data were collected at four time points: prior to the intervention, three weeks, six weeks, and 12 weeks postintervention.

RESULTS: One hundred forty lung cancer patients receiving palliative RT were recruited from a publicly funded hospital in Hong Kong. Doubly multivariate analysis of variance revealed a significant difference (time×group interaction effect, P=0.003) over time between the PEI and usual care control group on the pattern of change of the symptom cluster. Significant effects on the patterns of changes in breathlessness (P=0.002), fatigue (P=0.011), anxiety (P=0.001), and functional ability (P=0.000) also were found.

CONCLUSION: PEI was a promising treatment for relieving the symptom cluster and each of the individually assessed symptoms. More effort needs to be directed at studying impact of interventions on common symptom clusters.

From Cleveland Clinic: Eye complications after lung transplantation

Br J Ophthalmol. 2010 Dec 3. [Epub ahead of print]
Ocular complications in patients with lung transplants.
Tarabishy AB, Khatib OF, Nocero JR, Budev M, Kaiser PK.

Cleveland Clinic, Cleveland, Ohio, USA.
Aim To describe infectious and non-infectious ocular complications found in patients with lung transplants. Methods 545 patients underwent lung transplantation from January 1998 to September 2008 at the Cleveland Clinic. Patients who underwent ophthalmic examination at the Cole Eye Institute after lung transplantation were included in the study. Outcomes Diagnoses, treatments, surgeries, laboratory parameters of immune status and patient survival were examined. Results Of the 545 patients who received a lung transplant during the study period at the Cleveland Clinic, 46 (8.4%) patients underwent ophthalmology examination after a lung transplant. The most common ocular finding was posterior subcapsular cataract, found in 13/46 (28.3%) patients. Infectious ocular complications were present in 6/46 patients (13.0%) including fungal infections (rhino-orbital mucormycosis (n=1), disseminated Pseudallescheria boydii infection (n=2)), cytomegalovirus retinitis (n=1), varicella-zoster virus keratouveitis (n=1) and herpes zoster ophthalmicus (n=1). Five of six patients with infectious ocular complications died within 6 months of evaluation. Decreased absolute lymphocyte count was associated with infectious ocular complications (p=0.014). Conclusions Many ocular conditions can occur in patients with lung transplants. Ocular infectious complications were uncommon but may be associated with increased mortality.

HGF and lung fibrosis

Acta Pharmacol Sin. 2010 Dec 6. [Epub ahead of print]
Hepatocyte growth factor in lung repair and pulmonary fibrosis.
Panganiban RA, Day RM.

Department of Pharmacology, Uniformed Services University of the Health Sciences, Bethesda, MD 20852, USA.

Cannabis and lung disease: An article from Edinburgh, Scotland

J R Coll Physicians Edinb. 2010 Dec;40(4):328-34.
Cannabis and the lung.
Reid PT, Macleod J, Robertson JR.

General Hospital, Crewe Road, Edinburgh EH4 2XU, UK.
The use of cannabis is embedded within many societies, mostly used by the young and widely perceived to be safe. Increasing concern regarding the potential for cannabis to cause mental health effects has dominated cannabis research and the potential adverse respiratory effects have received relatively little attention. Studies on cannabis are challenging and subject to confounding by concomitant use of tobacco and other social factors, and while many of the studies referred to in this review are beset by the difficulties inherent in undertaking epidemiological research of the effects of cannabis, there is an emerging concern among many chest physicians who would suggest that habitual smoking of cannabis may contribute to the development of chronic obstructive pulmonary disease, pneumothorax and respiratory infections, including tuberculosis. Special attention should be given to the risk of lung cancer, particularly as biological plausibility may precede epidemiology.

Another person lost to lung cancer

Am Psychol. 2010 Dec;65(9):926.
Xiaojia ge (1954-2009).
Donnellan MB.

Michigan State University.

Cystic fibrosis and Pseudomonas biofilms

Future Microbiol. 2010 Nov;5:1663-74.
Pseudomonas aeruginosa biofilms in cystic fibrosis.
Høiby N, Ciofu O, Bjarnsholt T.

Department of Clinical Microbiology 9301, Rigshospitalet, University of Copenhagen, Juliane Maries Vej 22, 2200 Copenhagen, Denmark.

The use of male-only fresh frozen plasma to prevent transfusion-related acute lung injury

Transfusion. 2010 Dec 6. doi: 10.1111/j.1537-2995.2010.02969.x. [Epub ahead of print]
Male-only fresh-frozen plasma for transfusion-related acute lung injury prevention: before-and-after comparative cohort study.
Wiersum-Osselton JC, Middelburg RA, Beckers EA, Van Tilborgh AJ, Zijlker-Jansen PY, Brand A, Van Der Bom JG, Schipperus MR.

From the TRIP (Transfusion Reactions in Patients) Dutch National Hemovigilance Office, The Hague; the Department of Research and Development, Sanquin Blood Bank Southwest, Rotterdam; the Jon J. van Rood Center for Clinical Transfusion Research, Department of Clinical Epidemiology, Einthoven Laboratory, and the Department of Immunohaematology and Blood Transfusion, Leiden University Medical Center, Leiden; and the Department of Internal Medicine-Hematology, Maastricht University Medical Center, Maastricht, the Netherlands.

From Marc Ladanyi and colleagues at Memorial Sloan-Kettering: EGFR-TK resistance in lung cancer

Clin Cancer Res. 2010 Dec 6. [Epub ahead of print]
Acquired resistance to EGFR tyrosine kinase inhibitors in EGFR mutant lung cancer: Distinct natural history of patients with tumors harboring the T790M mutation.
Oxnard GR, Arcila ME, Sima C, Riely GJ, Chmielecki J, Kris MG, Pao W, Ladanyi M, Miller VA.

No. But 2011...

Chest. 2010 Dec;138(6):1287-8.
2010: the year of the lung.
Guntupalli KK, Gutterman D, Raoof S, Markowski PA.

ARDS: JAMA article by Pipeling and Fan at Johns Hopkins

JAMA. 2010 Dec 8;304(22):2521-7.
Therapies for refractory hypoxemia in acute respiratory distress syndrome.
Pipeling MR, Fan E.

Division of Pulmonary and Critical Care Medicine, Johns Hopkins Medical Institutions, Johns Hopkins University, Baltimore, Maryland, USA.
Acute respiratory distress syndrome (ARDS) is a common and severe form of acute lung injury, resulting from both direct (eg, pneumonia) and indirect (eg, sepsis) pulmonary insults. It is a common cause of admission to the intensive care unit due to hypoxemic respiratory failure requiring mechanical ventilation, and is associated with significant morbidity and mortality. In some patients, ARDS leads to the development of life-threatening refractory hypoxemia. In these patients, physicians may consider a number of therapies (eg, recruitment maneuvers, prone positioning, inhaled nitric oxide, high-frequency oscillatory ventilation, extracorporeal membrane oxygenation) to alleviate hypoxemia in patients unable to maintain reasonable oxygenation while being supported with conventional mechanical ventilation. Although these strategies have demonstrated improved oxygenation with their use, their impact on patient-important outcomes (eg, mortality) remains unproven. However, in the minority of patients with ARDS and refractory hypoxemia, institution of these therapies may be considered on a case-by-case basis. Future studies are needed to elucidate the efficacy of these therapies on outcomes in patients with severe ARDS and refractory hypoxemia.

Bird fancier's lung!

Intern Med. 2010;49(23):2605-8. Epub 2010 Dec 1.
Bird Fancier's Lung Which Developed in a Pigeon Breeder Presenting Organizing Pneumonia.
Ito T, Sugino K, Satoh D, Muramatsu Y, Sano G, Sato K, Sakaguchi S, Isobe K, Sakamoto S, Takai Y, Hata Y, Shibuya K, Uekusa T, Kurosaki A, Homma S.

Department of Respiratory Medicine, Toho University Omori Medical Center.

Nanoparticles. In the lung.

Nat Biotechnol. 2010 Dec;28(12):1275-6.
Nanoparticles in the lung.
Kreyling WG, Hirn S, Schleh C.

Wolfgang G. Kreyling, Stephanie Hirn and Carsten Schleh are at the Comprehensive Pneumology Center, Institute of Lung Biology and Disease, and Focus Network Nanoparticles and Health, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg/Munich, Germany.

Pulmonary alveolar microlithiasis: it's rare, but it exists.

Lung India. 2010 Oct;27(4):250-2.
Pulmonary alveolar microlithiasis with calcified pleural plaques.
Malhotra B, Sabharwal R, Singh M, Singh A.

Department of Chest and TB, Government Medical College Amritsar, India.

Lung cancer brain metastases and prophylactic brain irradiation

The bottom line: "Prophylactic cranial irradiation in stage III NSCLC significantly decreases the risk of brain metastases without improving 1-year overall survival. There were no significant differences in global cognitive function or quality of life after prophylactic cranial irradiation, but there was a significant decline in memory at 1 year."

J Clin Oncol. 2010 Dec 6. [Epub ahead of print]
Phase III Trial of Prophylactic Cranial Irradiation Compared With Observation in Patients With Locally Advanced Non-Small-Cell Lung Cancer: Neurocognitive and Quality-of-Life Analysis.
Sun A, Bae K, Gore EM, Movsas B, Wong SJ, Meyers CA, Bonner JA, Schild SE, Gaspar LE, Bogart JA, Werner-Wasik M, Choy H.

Princess Margaret Hospital-University Health Network, University of Toronto, Toronto, Ontario, Canada; Radiation Therapy Oncology Group; Thomas Jefferson University Hospital, Philadelphia, PA; Henry Ford Health System; Medical College of Wisconsin, Milwaukee, WI; MD Anderson Cancer Center, Houston; University of Texas Southwestern Medical Center, Dallas, TX; University of Alabama at Birmingham, Birmingham, AL; Mayo Clinic Arizona, Scottsdale, AZ; University of Colorado Cancer Center, Aurora, CO; and the State University of New York Health Science Center at Syracuse, Syracuse, NY.

MicroRNAs and avoiding lung cancer overdiagnosis

J Cell Physiol. 2010 Dec 6. [Epub ahead of print]
Reducing the risk of overdiagnosis in lung cancer: A support from molecular biology.
Barba M, Felsani A, Rinaldi M, Giunta S, Malorni W, Paggi MG.