Monday, May 9, 2011

GM-CSF in the lung protects against lethal influenza infection in mice

Am J Respir Crit Care Med. 2011 Apr 7. [Epub ahead of print]
GM-CSF in the Lung Protects Against Lethal Influenza Infection.
Huang FF, Barnes PF, Feng Y, Donis R, Chroneos ZC, Idell S, Allen T, Perez DR, Whitsett JA, Dunussi-Joannopoulos K, Shams H.
Center for Pulmonary and Infectious Disease Control, University of Texas Health Science Center at Tyler, Tyler, Texas, United States.
Alveolar macrophages contribute to host defenses against influenza in animal models. Enhancing alveolar macrophage function may contribute to protection against influenza

To determine if increased expression of granulocyte-macrophage colony stimulating factor in the lung increases resistance to influenza

Wild-type mice and transgenic mice that expressed granulocyte macrophage-colony stimulating factor in the lung were infected with influenza virus, and lung pathology, weight loss and mortality were measured. We also administered granulocyte-macrophage colony stimulating factor to the lungs of wild-type mice that were infected with influenza virus.

Wild-type mice all died after infection with different strains of influenza virus, but all transgenic mice expressing granulocyte-macrophage colony stimulating factor in the lungs survived. The latter also had greatly reduced weight loss and lung injury, and showed histologic evidence of a rapid host inflammatory response that controlled infection. The resistance of transgenic mice to influenza was abrogated by elimination of alveolar phagocytes, but not by depletion of T-cells, B-cells or neutrophils. Transgenic mice had far more alveolar macrophages than wild-type mice, and they were more resistant to influenza-induced apoptosis. Delivery of intranasal granulocyte macrophage-colony stimulating factor to wild-type mice also conferred resistance to influenza.

Granulocyte-macrophage colony stimulating factor confers resistance to influenza by enhancing innate immune mechanisms that depend on alveolar macrophages. Pulmonary delivery of this cytokine has the potential to reduce the morbidity and mortality due to influenza virus.

Revolution in lung cancer: New challenges for the surgical pathologist

Arch Pathol Lab Med. 2011 Jan;135(1):110-6.
Revolution in lung cancer: new challenges for the surgical pathologist.
Cagle PT, Allen TC, Dacic S, Beasley MB, Borczuk AC, Chirieac LR, Laucirica R, Ro JY, Kerr KM.
Department of Pathology and Laboratory Medicine, 6565 Fannin Street, The Methodist Hospital, Houston, Texas 77030, USA.
Traditionally, lung cancer has been viewed as an aggressive, relentlessly progressive disease with few treatment options and poor survival. The traditional role of the pathologist has been primarily to differentiate small cell carcinoma from non-small cell carcinoma on biopsy and cytology specimens and to stage non-small cell carcinomas that underwent resection. In recent years, our concepts of lung cancer have undergone a revolution, including (1) the advent of successful, new, molecular-targeted therapies for lung cancer, many of which are associated with specific histologic cell types and subtypes; (2) new observations on the natural history of lung cancer derived from ongoing high-resolution computed tomography screening studies and recent histologic findings; and (3) proposals to revise the classification of lung cancers, particularly adenocarcinomas, in part because of the first 2 developments.

To summarize the important, new developments in lung cancer, emphasizing the role of the surgical pathologist in personalized care for patients with lung cancer.

Information about the new developments in lung cancer was obtained from the peer-review medical literature and the authors' experiences.

For decades, we have perceived lung cancer as a relentlessly aggressive and mostly incurable disease for which the surgical pathologist had a limited role. Today, surgical pathologists have an important and expanding role in the diagnosis and treatment of lung cancer, and it is essential to keep informed of new advances.

High cholesterol and cancer? More research, please

Ann Oncol. 2011 May 4. [Epub ahead of print]
Dietary cholesterol intake and cancer.
Hu J, La Vecchia C, de Groh M, Negri E, Morrison H, Mery L; the Canadian Cancer Registries Epidemiology Research Group.
Science Integration Division, Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, Ottawa, Canada.
This study assesses the association between dietary cholesterol intake and the risk of various cancers.

Mailed questionnaires were completed between 1994 and 1997 in eight Canadian provinces by 1182 incident histologically confirmed cases of the stomach, 1727 of the colon, 1447 of the rectum, 628 of the pancreas, 3341 of the lung, 2362 of the breast, 442 of the ovary, 1799 of the prostate, 686 of the testis, 1345 of the kidney, 1029 of the bladder, 1009 of the brain, 1666 non-Hodgkin's lymphomas (NHL), 1069 leukemia and 5039 population controls. Information on dietary habits and nutrition intake were obtained using a food frequency questionnaire, which provided data on eating habits 2 years before the study. Odds ratios (ORs) were derived by unconditional logistic regression to adjust for total energy intake and other potential confounding factors.

Dietary cholesterol was positively associated with the risk of cancers of the stomach, colon, rectum, pancreas, lung, breast (mainly postmenopausal), kidney, bladder and NHL: the ORs for the highest versus the lowest quartile ranged from 1.4 to 1.7. In contrast, cholesterol intake was inversely associated with prostate cancer.

Our findings add to the evidence that high cholesterol intake is linked to increased risk of various cancers. A diet low in cholesterol may play a role in the prevention of several cancers.

From Duke: Lung cancer and genomic signatures

Proc Am Thorac Soc. 2011 May;8(2):180-2.
Pathway-based classification of lung cancer: a strategy to guide therapeutic selection.
Nevins JR.
Duke Institute for Genome Sciences and Policy, Duke University Medical Center, Durham, NC, 27708.
The critical challenge in virtually all cancer research is heterogeneity: "Breast cancer" and "lung cancer" are actually collections of disease with distinct molecular mechanisms and clinical characteristics. The challenge is evident in the complexity of most cancers with multiple mutations and alterations generating the cancer phenotype, requiring therapeutic strategies that can match the complexity with equally complex combination regimens. Substantial progress in treatment requires major advances in methods to define refined, "common mechanism" subgroups to allow development of combination therapeutics that target these individual mechanisms. Our work is on the use of genomic signatures of oncogenic signaling pathways that provide an opportunity to dissect the complexity of lung cancer and to serve as tools to direct the use of targeted therapeutic agents.

Hookah smoking. Just say no.

Asian Pac J Cancer Prev. 2011;12(2):519-24.
Hookah smoking and lung cancer in the kashmir valley of the Indian subcontinent.
Koul PA, Hajni MR, Sheikh MA, Khan UH, Shah A, Khan Y, Ahangar AG, Tasleem RA.
Internal and Pulmonary Medicine, SheriKashmir Institute of Medical Sciences, Srinagar, India E-mail :
Background: The literature about the causal relationship between lung cancer and tobacco smoking mostly concerns cigarettes. Hookah smoking is popular in the Kashmir valley of the Indian subcontinent, and is generally believed to be innocuous because of the passage of the smoke through water before inhalation. Objective: To determine the relationship of hookah smoking to lung cancer in Kashmir. Materials and Methods: In a case-control design, 251 cases of lung cancer and 500 age-matched controls were studied. A predefined questionnaire was administered through a personal interview regarding various smoking and dietary patterns and the results compared through statistical analyses. Results: There were 194 (178 current) ever-smokers amongst the cases and 223 (134 current) amongst controls. Smokers had a 4.2 times risk of lung cancer compared to non smokers (OR 4.23, 95% CI 3.0-5.96, p< 0.0001). There were 120 hookah smokers amongst the cases and 100 amongst the controls and hookah smokers were nearly six times at risk for lung cancer as compared to nonsmokers (OR 5.83, (95% CI 3.95-8.60, p<0.0001). Cigarette smokers were commoner amongst cases (46 vs 64 in controls; OR 3.49, 95% CI 2.18-5.60, p=0.000). The severity of smoking was associated with a higher risk of lung cancer (Chi-square 72.1, p 0.000).The practice of changing water of the hookah after each session proved non-existent. Conclusion: Hookah smoking is associated with a significantly higher risk for lung cancer in Kashmiri population, with about 6 fold elevated risk as compared to non-smoking controls.

From UCSF: Racial differences in smoking and carcinogen exposure

Racial Differences in the Relationship Between Number of Cigarettes Smoked and Nicotine and Carcinogen Exposure.
Benowitz NL, Dains KM, Dempsey D, Wilson M, Jacob P.
Corresponding Author: Neal L. Benowitz, M.D., Division of Clinical Pharmacology and Experimental Therapeutics, University of California, San Francisco, P.O. Box 1220, San Francisco, CA 94143-1220, USA. Telephone: 415-206-8324; Fax: 415-206-4956; E-mail:
Black smokers are reported to have higher lung cancer rates and greater tobacco dependence at lower levels of cigarette consumption compared to non-Hispanic White smokers. We studied the relationship between cigarettes per day (CPD) and biomarkers of nicotine and carcinogen exposure in Black and White smokers.

In 128 Black and White smokers, we measured plasma nicotine and its main proximate metabolite cotinine, urine nicotine equivalents, 4-(methylnitrosamino)-1-(3)pyridyl-1-butanol (NNAL), and polycyclic aromatic hydrocarbon (PAH) metabolites.

The dose-response between CPD and nicotine equivalents, and NNAL and PAH was flat for Black but positive for White smokers (Race × CPD interaction, all ps < .05). Regression estimates for the Race × CPD interactions were 0.042 (95% CI 0.013-0.070), 0.054 (0.023-0.086), and 0.028 (0.004-0.052) for urine nicotine equivalents, NNAL, and PAHs, respectively. In contrast there was a strong correlation between nicotine equivalents and NNAL and PAH independent of race. Nicotine and carcinogen exposure per individual cigarette was inversely related to CPD. This inverse correlation was stronger in Black compared to White smokers and stronger in menthol compared to regular cigarette smokers (not mutually adjusted). Conclusions: Our data indicate that Blacks on average smoke cigarettes differently than White smokers such that CPD predicts smoke intake more poorly in Black than in White smokers.

Abandoned on Bataan

Friday, May 6, 2011

Status of health care in Slovakia

Health Syst Transit. 2011 Feb;13(2):1-174.
Slovakia health system review.
Szalay T, Pazitny P, Szalayova A, Frisova S, Morvay K, Petrovic M, van Ginneken E.
Health Policy Institute, Slovakia; Berlin University of Technology.
The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services, and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. The Slovak health system is a system in progress. Major health reform in the period 2002 to 2006 introduced a new approach based on managed competition. Although large improvements have been made since the 1990s (for example in life expectancy and infant mortality), health outcomes are generally still substantially worse than the average for the EU15 but close to the other Visegrad Four countries. Per capita health spending (in purchasing power parity [PPP]) was around half the EU15 average. A large share of these resources was absorbed by pharmaceutical spending (28% in 2008, compared to 16% in OECD countries). Some important utilization indicators signal plenty of resources in the system but may also indicate excess bed capacity and overutilization. The number of physicians and nurses per capita has been actively reduced since 2001 but remains above the average of the EU12 (i.e. the 12 countries that joined the EU in 2004 and 2007). An ageing workforce and professional migration may reinforce a shortage of health care workers. People have free choice of general practitioner (GP) and specialist. Their services are provided without cost-sharing from patients, with the notable exception of dental procedures. Inpatient care and specialized ambulatory care are provided in general hospitals and specialized hospitals. Pharmaceutical expenditure per capita accounts for one-third of public expenditure on health care. Long-term care is provided by health care facilities and social care facilities. Slovakia has a progressive system of financing health care. However, the health reforms of 2002 to 2006 led to an increase in the number of households that contributed more from their income and the distributive impacts were not equitable. This was mainly caused by the introduction of a reference pricing scheme for pharmaceuticals. Some key challenges remain: improving the health status of the population and the quality of care while securing the future financial sustainability of the system.

World Health Organization 2011, on behalf of the European Observatory on health systems and Policies.

From Johns Hopkins: More about the patient-centered medical home

Am J Prev Med. 2011 May;40(5 Suppl 2):S225-33.
Patient-centered medical home cyberinfrastructure current and future landscape.
Finkelstein J, Barr MS, Kothari PP, Nace DK, Quinn M.
Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, Maryland.
The patient-centered medical home (PCMH) is an approach that evolved from the understanding that a well-organized, proactive clinical team working in a tandem with well-informed patients is better able to address the preventive and disease management needs in a guideline-concordant manner. This approach represents a fundamental shift from episodic acute care models and has become an integral part of health reform supported on a federal level. The major aspects of PCMH, especially pertinent to its information infrastructure, have been discussed by an expert panel organized by the Agency for Healthcare Research and Quality at the Informatics for Consumer Health Summit. The goal of this article is to summarize the panel discussions along the four major domains presented at the summit: (1) PCMH as an Evolving Model of Healthcare Delivery; (2) Health Information Technology (HIT) Applications to Support the PCMH; (3) Current HIT Landscape of PCMH: Challenges and Opportunities; and (4) Future HIT Landscape of PCMH: Federal Initiatives on Health Informatics, Legislation, and Standardization.

Health care policy and congressional gridlock

J Health Polit Policy Law. 2011 Apr;36(2):227-64.
Breaking gridlock: the determinants of health policy change in congress.
Volden C, Wiseman AE.
Ohio State University.
Prior to the 2010 health care reforms, scholars often commented that health policy making in Congress was mired in political gridlock, that reforms were far more likely to fail than to succeed, and that the path forward was unclear. In light of recent events, new narratives are being advanced. In formulating these assessments, scholars of health politics tend to analyze individual major reform proposals to determine why they succeeded or failed and what lessons could be drawn for the future. Taking a different approach, we examine all health policies proposed in the U.S. House of Representatives between 1973 and 2002. We analyze these bills' fates and the effectiveness of their sponsors in guiding these proposals through Congress. Setting these proposed policies against a baseline of policy advancements in other areas, we demonstrate that health policy making has indeed been far more gridlocked than policy making in most other areas. We then isolate some of the causes of this gridlock, as well as some of the conditions that have helped to bring about health policy change.

From UNC-Chapel Hill: Online reporting of nursing home medication errors

J Patient Saf. 2011 Apr 19. [Epub ahead of print]
Online Medication Error Graphic Reports: A Pilot in North Carolina Nursing Homes.
Greene SB, Williams CE, Pierson S, Hansen RA, Carey TS.
From the *Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and †Harrison School of Pharmacy, Auburn University, Auburn, Alabama.
Since 2003, North Carolina nursing homes have been required by state law to report all medication errors, but the nursing homes have not had usable and timely access to their own error data. We created and pilot tested a new online graphic reporting feature to give homes practical and timely reports on their own reported errors for use in improving medication processes.

The new graphic reports feature was added to the existing online reporting system and provides immediate access to a set of tables and graphs on all submitted errors. Fifteen nursing homes were recruited to participate in a pilot test of the graphic reports. Key informant interviews were conducted to gather in-depth qualitative information on the use of the reports.

The reports were used primarily for providing information to members of the quality assurance committee and for staff training. Sites had very few technical problems accessing or printing the reports and were able to view them on existing computer systems. Sites with significant numbers of submitted errors in the system reported greater usefulness of the graphics than sites with few errors. Staff turnover at the director of nursing position was the most common reason for low participation at some sites.

The online graphic reports are a positive, user-friendly next step in providing information to the nursing homes to use in improving patient safety. The information is deemed by the users to be the right content, professional in appearance, and accessible to the nursing home.

Thursday, May 5, 2011

The complication rate for colonoscopy reportedly is low

Eur J Gastroenterol Hepatol. 2011 Jun;23(6):492-8.
Complications in colonoscopy: analysis of 7-year physician-reported adverse events.
Niv Y, Gershtansky Y, Kenett RS, Tal Y, Birkenfeld S.
aDepartment of Gastroenterology, Rabin Medical Center, Tel Aviv University bMedical Risk Management, The Madanes Group cThe KPA Group, University of Torino, Italy dClalit Health Services, Tel Aviv District, Israel.
The number of malpractice claims against physicians and health institutes in Israel is increasing continuously, as in the rest of the Western world. This trend became a serious financial burden.

In this study we analyzed reports of gastroenterologists on colonoscopy adverse events to the medical malpractice insurer, as well as complaint/demand for compensation from patients represented by lawyers, between 1 January 2000 and 31 December 2006.

All the reports of physicians associated with colonoscopy adverse events from health institutes covered by Madanes Insurance Group were analyzed and summarized using a specially designed questionnaire. Clinical and epidemiological details about the patients, procedures, and adverse events were coded into an excel sheet, discussed, and evaluated.

One hundred and two cases of colonoscopy adverse events were reported. There were 48 cases of men (47.1%) and the average age was 69.9±12.90 years. In this period of time 252 064 colonoscopies were performed by the institutes in the sampling frame, and the number of adverse events was on average 4.0 (between 2.8 and 6.2) for 10 000 colonoscopies. The difference between the years was not statistically significant. Perforation occurred in one of 2864 procedures, bleeding in one of 29 007 procedures, and respiratory complications in one of 50 412 procedures.

This is the first study in Israel based on physicians' reports of colonoscopic adverse events. The picture is optimistic, as the rate of complications is low, and the data encourage early detection and reporting.

Is it time to reconsider using specialty courts for med mal?

J Perinat Neonatal Nurs. 2011 Apr-Jun;25(2):99-102.
Health courts: an alternative to traditional tort law.
Miller LA.
President, Perinatal Risk Management and Education Services, Portland, Oregon.
The current adversarial tort-based system of adjudicating malpractice claims is flawed. Alternate methods of compensation for birth injuries related to oxygen deprivation or mechanical injury are being utilized in Virginia and Florida. Although utilization of both of these schemes is limited, and they are not without problems in application, both have been successful in reducing the number of malpractice claims in the tort system and in reducing malpractice premiums. While the Florida and Virginia programs are primarily focused on compensation, other models outside the US focus include compensation as well as enhanced dispute resolution and potential for clinical practice change through peer review. Experts in the fields of law and public policy in the United States have evaluated a variety of approaches and have proposed models for administrative health courts that would provide both compensation and dispute resolution for medical and nursing malpractice claims. These alternative models are based on transparency and disclosure, with just compensation for injuries, and opportunities for improvements in patient safety.

PMID: 21540680 [PubMed - in process]

From MIT: Will health care reform make health insurance affordable?

Issue Brief (Commonw Fund). 2011 Apr;2:1-15.
Realizing health reform's potential: will the Affordable Care Act make health insurance affordable?
Gruber J, Perry I.
Massachusetts Institute of Technology and Health Care Program, National Bureau of Economic Research, USA.
Using a budget-based approach to measuring affordability, this issue brief explores whether the subsidies available through the Affordable Care Act are enough to make health insurance affordable for low-income families. Drawing from the Consumer Expenditure Survey, the authors assess how much "room" people have in their budget, after paying for other necessities, to pay for health care needs. The results show that an overwhelming majority of households have room in their budgets for the necessities, health insurance premiums, and moderate levels of out-of-pocket costs established by the Affordable Care Act. Fewer than 10 percent of families above the federal poverty level do not have the resources to pay for premiums and typical out-of-pocket costs, even with the subsidies provided by the health reform law. Affordability remains a concern for some families with high out-of-pocket spending, suggesting that this is the major risk to insurance affordability.

Lung cancer is never smokers

Int J Clin Oncol. 2011 May 3. [Epub ahead of print]
Primary lung cancer in never smokers.
Maehara Y.
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, 812-8582, Japan,

MicroRNAs, chemotherapy resistance, and lung cancer

J Biomed Biotechnol. 2011;2011:474632. Epub 2011 Mar 31.
MicroRNA Gene Dosage Alterations and Drug Response in Lung Cancer.
Enfield KS, Stewart GL, Pikor LA, Alvarez CE, Lam S, Lam WL, Chari R.
British Columbia Cancer Research Centre, 675 West 10th Avenue, Vancouver, BC, Canada V5Z 1L3.
Chemotherapy resistance is a key contributor to the dismal prognoses for lung cancer patients. While the majority of studies have focused on sequence mutations and expression changes in protein-coding genes, recent reports have suggested that microRNA (miRNA) expression changes also play an influential role in chemotherapy response. However, the role of genetic alterations at miRNA loci in the context of chemotherapy response has yet to be investigated. In this study, we demonstrate the application of an integrative, multidimensional approach in order to identify miRNAs that are associated with chemotherapeutic resistance and sensitivity utilizing publicly available drug response, miRNA loci copy number, miRNA expression, and mRNA expression data from independent resources. By instigating a logical stepwise strategy, we have identified specific miRNAs that are associated with resistance to several chemotherapeutic agents and provide a proof of principle demonstration of how these various databases may be exploited to derive relevant pharmacogenomic results.

From NCI: Increased waist circumference is an independent measure of risk of death

PLoS One. 2011 Apr 26;6(4):e18582.
Waist circumference as compared with body-mass index in predicting mortality from specific causes.
Leitzmann MF, Moore SC, Koster A, Harris TB, Park Y, Hollenbeck A, Schatzkin A.
Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, United States of America.
Whether waist circumference provides clinically meaningful information not delivered by body-mass index regarding prediction of cause-specific death is uncertain.

We prospectively examined waist circumference (WC) and body-mass index (BMI) in relation to cause-specific death in 225,712 U.S. women and men. Cox regression was used to estimate relative risks and 95% confidence intervals (CI). Statistical analyses were conducted using SAS version 9.1.

During follow-up from 1996 through 2005, we documented 20,977 deaths. Increased WC consistently predicted risk of death due to any cause as well as major causes of death, including deaths from cancer, cardiovascular disease, and non-cancer/non-cardiovascular diseases, independent of BMI, age, sex, race/ethnicity, smoking status, and alcohol intake. When WC and BMI were mutually adjusted in a model, WC was related to 1.37 fold increased risk of death from any cancer and 1.82 fold increase risk of death from cardiovascular disease, comparing the highest versus lowest WC categories. Importantly, WC, but not BMI showed statistically significant positive associations with deaths from lung cancer and chronic respiratory disease. Participants in the highest versus lowest WC category had a relative risk of death from lung cancer of 1.77 (95% CI, 1.41 to 2.23) and of death from chronic respiratory disease of 2.77 (95% CI, 1.95 to 3.95). In contrast, subjects in the highest versus lowest BMI category had a relative risk of death from lung cancer of 0.94 (95% CI, 0.75 to 1.17) and of death from chronic respiratory disease of 1.18 (95% CI, 0.89 to 1.56).

Increased abdominal fat measured by WC was related to a higher risk of deaths from major specific causes, including deaths from lung cancer and chronic respiratory disease, independent of BMI.

Monday, May 2, 2011

Health care reform: medical residents' perspective

Otolaryngol Head Neck Surg. 2011 Apr 26. [Epub ahead of print]
Resident Physicians' Perspectives on Health Care Reform.
Frake PC, Cheng AY, Howell RJ, Patel NJ.
Division of Otolaryngology-Head & Neck Surgery, The George Washington University, Washington, DC, USA.
Objective. To investigate the perspectives of resident physicians, in otolaryngology and other specialties, with respect to various health care reform proposals. Also, to determine if these opinions vary between residents training to become general medical doctors versus surgeons and specialists and between those with various levels of educational debt. Study Design and Participants. Survey of resident physicians across the United States. Methods. Opinions of participants were measured on a 5-point Likert scale. Results. Of the 1576 respondents, the majority agreed that tort reform and electronic medical records would improve quality of care and help contain health care costs. However, few residents agreed that bundling of services (BOS), hospital-acquired conditions penalties (HACP), and quality-based reimbursement (QBR) would improve the quality of care. Specialists and surgeons, in comparison to generalists, were (1) less likely to agree that BOS, HACP, or QBR would improve the quality of care; (2) more likely to agree that tort reform would help contain health care costs; and (3) more likely to believe that BOS, HACP, or QBR would decrease physician compensation. Higher educational debt burden was also an independent predictor of increased skepticism about health care reforms effects on physician compensation. Conclusions. Residents in general medicine and surgery/specialty training programs agreed that tort reform and electronic medical records would help improve the quality of health care and help contain costs. However, both groups expressed strong concern that certain elements of the Patient Protection and Affordable Care Act would not achieve these goals.

ARDS and increased transcription factors

Arch Pathol Lab Med. 2011 May;135(5):647-54.
Increased Levels of Nuclear Factor κB and Fos-Related Antigen 1 in Lung Tissues From Patients With Acute Respiratory Distress Syndrome.
Fudala R, Allen TC, Krupa A, Cagle PT, Nash S, Gryczynski Z, Gryczynski I, Kurdowska AK.

Abstract Context.-Both nuclear factor κB and Fos-related antigen 1 have been implicated in the pathogenesis of inflammatory lung diseases, including acute lung injury/acute respiratory distress syndrome. Objective.-To evaluate lung tissues from patients with acute respiratory distress syndrome for presence of nuclear factor κB and Fos-related antigen 1. Design.-Lung tissue sections from 5 patients with acute respiratory distress syndrome and sections of normal lung tissues of 4 patients were stained with antibodies against epithelial cell marker (surfactant protein B) and nuclear factor κB or Fos-related antigen 1. Samples were analyzed using confocal laser microscopy. Results.-We have detected significantly increased levels of activated nuclear factor κB and Fos-related antigen 1 in lung tissues from patients with acute respiratory distress syndrome compared with control tissues, suggesting that these transcription factors undergo activation in lungs of patients suffering from acute respiratory distress syndrome. Conclusions.-Our data demonstrate that activated nuclear factor κB and Fos-related antigen 1 are elevated in epithelial cells in lung tissues of patients with acute respiratory distress syndrome.

Never-smoking Asian women and lung cancer

Chin J Cancer. 2011 May;30(5):287-92.
East meets West: ethnic differences in epidemiology and clinical behaviors of lung cancer between East Asians and Caucasians.
Zhou W, Christiani DC.
Molecular Epidemiology Research, Global Outcomes Research, Pfizer Oncology, Collegeville, PA 19426,

Lung cancer is the leading cause of cancer death worldwide, with large variation of the incidence and mortality across regions. Although the mortality of lung cancer has been decreasing, or steady in the US, it has been increasing in Asia for the past two decades. Smoking is the leading cause of lung cancer, and other risk factors such as indoor coal burning, cooking fumes, and infections may play important roles in the development of lung cancer among Asian never smoking women. The median age of diagnosis in Asian patients with lung cancer is generally younger than Caucasian patients, particularly among never-smokers. Asians and Caucasians may have different genetic susceptibilities to lung cancer, as evidenced from candidate polymorphisms and genome-wide association studies. Recent epidemiologic studies and clinical trials have shown consistently that Asian ethnicity is a favorable prognostic factor for overall survival in non-small cell lung cancer (NSCLC), independent of smoking status. Compared with Caucasian patients with NSCLC, East Asian patients have a much higher prevalence of epidermal growth factor receptor (EGFR) mutation (approximately 30% vs. 7%, predominantly among patients with adenocarcinoma and never-smokers), a lower prevalence of K-Ras mutation (less than 10% vs. 18%, predominantly among patients with adenocarcinoma and smokers), and higher proportion of patients who are responsive to EGFR tyrosine kinase inhibitors. The ethnic differences in epidemiology and clinical behaviors should be taken into account when conducting global clinical trials that include different ethnic populations.