EGFR, ALK, and subtyping in lung cancer

http://www.ncbi.nlm.nih.gov/pubmed/21233671

Pathology. 2011 Feb;43(2):103-15.
What's new in non-small cell lung cancer for pathologists: the importance of accurate subtyping, EGFR mutations and ALK rearrangements.
Cooper WA, O'toole S, Boyer M, Horvath L, Mahar A.

*Tissue Pathology and Diagnostic Oncology, Australia †Sydney Cancer Centre, Royal Prince Alfred Hospital, Sydney, Australia ‡Discipline of Pathology, School of Medicine, University of Western Sydney, Sydney, Australia §Garvan Institute of Medical Research, Darlinghurst, Australia ||Sydney Medical School, University of Sydney, Sydney, Australia ¶St Vincent's Clinical School, University of New South Wales, Sydney, Australia.
Abstract
In the past, the only critical point of distinction in the pathological diagnosis of lung cancer was between small cell and non-small cell lung cancer (NSCLC). The emergence of new targeted therapies and clinical trials demonstrating differing efficacy and toxicity of treatments according to specific histological subtypes of NSCLC, has resulted in an increasing need for improvements in pathological diagnosis. Accurate distinction between adenocarcinoma and squamous cell carcinoma is now critical as histological subtyping has the potential to influence clinical decision making and impact on patient outcome. While morphological criteria remain the most important feature to distinguish NSCLC subtypes, use of mucin and immunohistochemical stains (TTF-1, p63 and CK5/6) can be of assistance in difficult small biopsy cases. With the emergence of selective kinase inhibitors targeting epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK), there is a corresponding need to identify the subset of NSCLCs harbouring specific genetic mutations associated with sensitivity to these agents, almost all of which are found in adenocarcinomas. In this review, the importance of accurately subtyping NSCLC is discussed, along with a suggested approach for distinguishing histological subtypes in small biopsy specimens. The significance of EGFR and ALK mutations in NSCLC and the impact of these genotypes on pathology and clinical practice are also reviewed.

Lung tissue mechanics: More needs to be done on this

http://www.ncbi.nlm.nih.gov/pubmed/21212247

J Appl Physiol. 2011 Jan 6. [Epub ahead of print]
LUNG TISSUE MECHANICS AS AN EMERGENT PHENOMENON.
Suki B, Bates JH.

1Boston University.
Abstract
The mechanical properties of lung parenchymal tissue are both elastic and dissipative, as well as being highly nonlinear. These properties cannot be fully understood, however, in terms of the individual constituents of the tissue. Rather, the mechanical behavior of lung tissue emerges as a macroscopic phenomenon from the interactions of its microscopic components in a way that is neither intuitive nor easily understood. In this review, we first consider the quasi-static mechanical behavior of lung tissue and discuss computational models that show how smooth nonlinear stress-strain behavior can arise through a percolation-like process in which the sequential recruitment of collagen fibers with increasing strain causes them to progressively take over the load-bearing role from elastin. We also show how the concept of percolation can be used to link the pathologic progression of parenchymal disease at the micro scale to physiologic symptoms at the macro scale. We then examine the dynamic mechanical behavior of lung tissue, which invokes the notion of tissue resistance. Although usually modeled phenomenologically in terms of collections of springs and dashpots, lung tissue viscoelasticity again can be seen to reflect various types of complex dynamic interactions at the molecular level. Finally, we discuss the inevitability of why lung tissue mechanics needs to be complex.

Tianeptine and doctor shopping in France

http://www.ncbi.nlm.nih.gov/pubmed/21210844

Fundam Clin Pharmacol. 2011 Jan 7. doi: 10.1111/j.1472-8206.2010.00906.x. [Epub ahead of print]
Assessment of abuse of tianeptine from a reimbursement database using 'doctor-shopping' as an indicator.
Rouby F, Pradel V, Frauger E, Pauly V, Natali F, Reggio P, Thirion X, Micallef J.

CEIP-Addictovigilance PACA-Corse, Fédération de Pharmacologie et de Toxicologie, CHU Timone, Marseille, France Institut des Neurosciences Cognitives de la Méditerranée, Faculté de Médecine, Université de la Méditerranée-CNRS, UMR 6193, France CEIP-Addictovigilance PACA-Corse, Laboratoire de Santé Publique, Faculté de médecine, Marseille, France Direction Régionale du Service Médicale de la Région Provence-Alpes-Côte d'Azur et Corse (CNAMTS) 195 bd Chave 13392 Marseille Cedex 05, France.

Abstract
Doctor-shopping is a patient behaviour characterized by simultaneous consultations of several physicians during the same period. Some case reports have described an abuse of tianeptine, an atypical antidepressant. Our objective was to assess the extent of abuse of this drug with a method quantifying doctor-shopping in comparison with other antidepressants and benzodiazepines (BZD). All dispensations of antidepressants and BZD during the year 2005 in a French area of 4.5 million inhabitants were extracted from a reimbursement database. For each patient, two quantities were computed: quantity dispensed and obtained by doctor-shopping. Tianeptine and other drugs were compared using their doctor-shopping indicator (DSI), defined as the percentage of drug obtained by doctor-shopping among dispensed quantity; 410 525 patients received at least one antidepressant dispensation during the year 2005. Tianeptine was the sixth most dispensed antidepressant. The DSI of tianeptine was 2.0%, ranking it first among antidepressant (the second being mianserine with a DSI of 1%). Flunitrazepam has the highest DSI (30.2%), the DSI of the five following BZD (clonazepam, zolpidem, oxazepam, diazepam, bromazepam) range from 3.0% to 2.0%. Tianeptine is associated with higher DSI, compared with other antidepressants, suggesting that it may be subject to abuse in the population. Moreover, its DSI as a measure of diversion is similar to the DSI of diazepam or bromazepam.

"Trying to keep things normal"-parenting a child with Cystic Fibrosis

http://www.ncbi.nlm.nih.gov/pubmed/21212082

Clin Child Psychol Psychiatry. 2011 Jan 6. [Epub ahead of print]
Unravelling complexities involved in parenting a child with cystic fibrosis: An interpretative phenomenological analysis.
Glasscoe C, Smith JA.

University of Liverpool, UK.
Abstract
We conducted a qualitative study with caregivers for a contemporary understanding of the challenge of caring for a child with cystic fibrosis (CF). A single case is presented that details one woman's experience from her unique perspective of both, 'mother to a child with CF' and 'CF healthcare provider' using an interpretative phenomenological analysis. Emergent themes include: 'trying to keep things normal,' which includes different types of normality and routine management of treatment; 'when things become difficult,' which includes dealing with symptoms and battling with CF related decline; and, 'the complexity of decision making.' The discussion section expands on how, for this mother contrasting modes of managing CF (everyday life/full-on alert) co-existed and were further complicated by (i) role discrepancies (mother/nurse), and (ii) a dialectic between affect and reason. The CF parenting challenge increasingly involves responsibility for complex healthcare interventions and this study suggests a need for further enquiry into how caregivers are involved in the treatment plan and decision-making about treatment. Practice implications are proposed.

Med mal reforms-possible new approaches

http://www.ncbi.nlm.nih.gov/pubmed/21209291

Psychiatr Serv. 2011 Jan;62(1):6-8.
Law & psychiatry: reforming malpractice: the prospects for change.
Appelbaum PS.

Abstract
Previous efforts to change the U.S. medical malpractice system have involved such initiatives as time limits on filing claims, caps on noneconomic damages, and limiting attorneys' fees. This column briefly reviews such past efforts and describes several new approaches. They include programs that encourage prompt disclosure of errors and offers of compensation, efforts to mediate complaints outside the courts, and use of administrative processes to adjudicate claims. "No-fault" systems, such as those in New Zealand, Sweden, and Denmark, may be most likely to satisfy the interests of both patients and physicians but may not be politically acceptable in the United States.

Radon and lung cancer

http://www.ncbi.nlm.nih.gov/pubmed/21212062

Cancer Epidemiol Biomarkers Prev. 2011 Jan 6. [Epub ahead of print]
Radon and Lung Cancer in the American Cancer Society Cohort.
Turner MC, Krewski D, Chen Y, Pope CA 3rd, Gapstur SM, Thun MJ.

1McLaughlin Centre for Population Health Risk Asseessment, Institute of Population Health, University of Ottawa.
Abstract
BACKGROUND: Case-control studies conducted in North America, Europe, and Asia provided evidence of increased lung cancer risk due to radon in homes. Here, the association between residential radon and lung cancer mortality was examined in a large-scale cohort study.

METHODS: Nearly 1.2 million Cancer Prevention Study-II participants were recruited in 1982. Mean county-level residential radon concentrations were linked to study participants according to ZIP code information at enrollment (mean (SD) = 53.5 Bq/m3 (38.0)). Cox proportional hazards regression models were used to obtain adjusted hazard ratios and 95% confidence intervals (CI) for lung cancer mortality associated with radon. Potential effect modification by cigarette smoking, ambient sulfate concentrations, and other risk factors was assessed on both the additive and multiplicative scales.

RESULTS: Through 1988, 3,493 lung cancer deaths were observed among 811,961 participants included in the analysis. A significant positive linear trend was observed between categories of radon concentrations and lung cancer mortality (p = 0.02). A 15% (95% CI 1 - 31%) increase in the risk of lung cancer mortality was observed per each 100 Bq/m3 increase in radon. Participants with mean radon concentrations above the EPA guideline value (148 Bq/m3) experienced a 34% (95% CI 7 - 68%) increase in risk for lung cancer mortality relative to those below the guideline value.

CONCLUSIONS: This large prospective study showed a positive association between an ecological indicator of residential radon and lung cancer. Impact:These results further support efforts to reduce radon concentrations in homes to the lowest possible level.

From Yale-Education level and diabetes

http://www.ncbi.nlm.nih.gov/pubmed/21213044

Int J Health Care Finance Econ. 2011 Jan 7. [Epub ahead of print]
Education and health: evidence on adults with diabetes.
Ayyagari P, Grossman D, Sloan F.

Yale School of Public Health, Yale University, 60 College Street, P.O. Box 208034, New Haven, CT, 06520-8034, USA, Padmaja.ayyagari@yale.edu.
Abstract
Although the education-health relationship is well documented, pathways through which education influences health are not well understood. This study uses data from a 2003-2004 cross sectional supplemental survey of respondents to the longitudinal Health and Retirement Study (HRS) who had been diagnosed with diabetes mellitus to assess effects of education on health and mechanisms underlying the relationship. The supplemental survey provides rich detail on use of personal health care services (e.g., adherence to guidelines for diabetes care) and personal attributes which are plausibly largely time invariant and systematically related to years of schooling completed, including time preference, self-control, and self-confidence. Educational attainment, as measured by years of schooling completed, is systematically and positively related to time to onset of diabetes, and conditional on having been diagnosed with this disease on health outcomes, variables related to efficiency in health production, as well as use of diabetes specialists. However, the marginal effects of increasing educational attainment by a year are uniformly small. Accounting for other factors, including child health and child socioeconomic status which could affect years of schooling completed and adult health, adult cognition, income, and health insurance, and personal attributes from the supplemental survey, marginal effects of educational attainment tend to be lower than when these other factors are not included in the analysis, but they tend to remain statistically significant at conventional levels.

From JNCI-The question is "does", not "how"

http://www.ncbi.nlm.nih.gov/pubmed/21212382

J Natl Cancer Inst. 2011 Jan 6. [Epub ahead of print]
How Research Influences Policy Makers: Still Hazy After All These Years.
Lewis S.

Affiliations of author: Access Consulting Ltd, Saskatoon, Saskatchewan, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.

From Lopez-Terrada and Igbokwe: Molecular testing of solid tumors

http://www.ncbi.nlm.nih.gov/pubmed/21204713

Arch Pathol Lab Med. 2011 Jan;135(1):67-82.
Molecular testing of solid tumors.
Igbokwe A, Lopez-Terrada DH.

Abstract
Abstract Context-Molecular testing of solid tumors is steadily becoming a vital component of the contemporary anatomic pathologist's armamentarium. These sensitive and specific ancillary tools are useful for confirming ambiguous diagnoses suspected by light microscopy and for guiding therapeutic decisions, assessing prognosis, and monitoring patients for residual neoplastic disease after therapy. Objective-To review current molecular biomarkers and tumor-specific assays most useful in solid tumor testing, specifically of breast, colon, lung, thyroid, and soft tissue tumors, malignant melanoma, and tumors of unknown origin. A few upcoming molecular diagnostic assays that may become standard of care in the near future will also be discussed. Data Sources-Original research articles, review articles, and the authors' personal practice experience. Conclusions-Molecular testing in anatomic pathology is firmly established and will continue to gain ground as the need for more specific diagnoses and new targeted therapies evolve. Knowledge of the more common and clinically relevant molecular tests available for solid tumor diagnosis and management, and their indications and limitations, is necessary if anatomic pathologists are to optimally use these tests and act as consultants for fellow clinicians directly involved in patient care.

HER2 and breast cancer

http://www.ncbi.nlm.nih.gov/pubmed/21204711

Arch Pathol Lab Med. 2011 Jan;135(1):55-62.
HER2: Biology, Detection, and Clinical Implications.
Gutierrez C, Schiff R.

Abstract
Abstract Context-HER2 is a membrane tyrosine kinase and oncogene that is overexpressed and gene amplified in about 20% of breast cancers. When activated it provides the cell with potent proliferative and antiapoptosis signals and it is the major driver of tumor development and progression for this subset of breast cancer. When shown to be overexpressed or amplified by appropriate methods, HER2 is a valuable treatment target. Objectives-To review the basic biology of the HER2 signaling network, to discuss various approved methods for its detection in clinical specimens, and to describe the impressive results of therapies targeting HER2. Data Sources-Selected literature searchable on PubMed as well as older studies revealed by the literature review were reviewed. Conclusion-HER2 is an important member of a complex signaling network and when gene amplified, it results in an aggressive subtype of breast cancer. Patients with tumors found to overexpress HER2 protein or to be amplified for the gene are candidates for therapy that significantly reduces mortality.

NYT: The Texas Omen

http://www.nytimes.com/2011/01/07/opinion/07krugman.html?_r=2&hp

Verbing. I'm with the First American here.

http://moreintelligentlife.com/content/ideas/anthony-gardner/youve-been-verbed

From Richard Epstein: Medical innovation occurs despite, not because of, government regulators

http://www.law.uchicago.edu/news/epstein-argues-medical-innovation-occurs-spite-not-because-government-regulators

Cancer screening 2011

http://www.ncbi.nlm.nih.gov/pubmed/21205832

CA Cancer J Clin. 2011 Jan 4. [Epub ahead of print]
Cancer screening in the United States, 2011: A Review of Current American Cancer Society Guidelines and Issues in Cancer Screening.
Smith RA, Cokkinides V, Brooks D, Saslow D, Shah M, Brawley OW.

Director of Cancer Screening, Cancer Control Science Department, American Cancer Society, Atlanta, GA.
Abstract
Each year the American Cancer Society (ACS) publishes a summary of its recommendations for early cancer detection, a report on data and trends in cancer screening rates, and select issues related to cancer screening. This article summarizes the current ACS guidelines, describes the anticipated impact of new health care reform legislation on cancer screening, and discusses recent public debates over the comparative effectiveness of different colorectal cancer screening tests. The latest data on the utilization of cancer screening from the National Health Interview Survey is described, as well as several recent reports on the role of health care professionals in adult utilization of cancer screening.

More patients, less payment--what is a hospital to do?

http://www.ncbi.nlm.nih.gov/pubmed/21209441

Health Aff (Millwood). 2011 Jan;30(1):76-80.
More patients, less payment: increasing hospital efficiency in the aftermath of health reform.
Litvak E, Bisognano M.

Abstract
A major issue for the US health care system will be accommodating the needs of the estimated thirty-two million Americans who will gain insurance coverage under the Affordable Care Act by 2019. For hospitals, a traditional response to this increased demand might be to add resources, such as more staff and beds. We argue that such actions would be unaffordable and unnecessary. Research has demonstrated that large gains in efficiency can be made through streamlining patient flow and redesigning care processes. We argue that once managed efficiently, US hospitals, on average, could achieve at least an 80-90 percent bed occupancy rate-at least 15 percent higher than the current level-without adding beds at capital costs of approximately $1 million per bed. This article outlines a plan for hospitals to accommodate more patients without increasing beds or staff, and for policy makers to require hospitals to make these changes or provide incentives for them to do so.

NEJM: Sebelius on health care reform

http://www.ncbi.nlm.nih.gov/pubmed/21208103

N Engl J Med. 2011 Jan 5. [Epub ahead of print]
Implementing Health Care Reform - An Interview with HHS Secretary Kathleen Sebelius.
Iglehart JK.

Abstract
After having served as a Democratic state legislator, insurance commissioner, and governor of the traditionally Republican state of Kansas, Kathleen Sebelius was sworn in as Secretary of Health and Human Services (HHS) on April 28, 2009. A sprawling agency that administers Medicare and Medicaid and oversees the Food and Drug Administration, the National Institutes of Health, and other agencies, HHS spends about 25% of the federal budget. Sebelius took charge of the department during a tumultuous period, as Congress debated the sweeping health care reform bill that HHS must now administer. Sebelius shared her opinions in an interview conducted by . . .

ACOs: HMOs with a new paint job? We'll see...

http://www.ncbi.nlm.nih.gov/pubmed/21209435

Health Aff (Millwood). 2011 Jan;30(1):32-40.
Accountable care organizations: the case for flexible partnerships between health plans and providers.
Goldsmith J.

Abstract
Under the Affordable Care Act, the new Center for Medicare and Medicaid Innovation will guide a number of experimental programs in health care payment and delivery. Among the most ambitious of the reform models is the accountable care organization (ACO), which will offer providers economic rewards if they can reduce Medicare's cost growth in their communities. However, the dismal history of provider-led attempts to manage costs suggests that this program is unlikely to accomplish its objectives. What's more, if ACOs foster more market concentration among providers, they have the potential to shift costs onto private insurers. This paper proposes a more flexible payment model for providers and private insurers that would divide health care services into three categories: long-term, low-intensity primary care; unscheduled care, including unscheduled emergency services; and major clinical interventions that usually involve hospitalization or organized outpatient care. Each category of care would be paid for differently, with each containing different elements of financial risk for the providers. Health plans would then be encouraged to provide logistical and analytic support to providers in managing health costs in these categories.

Pneumonia: Hospital readmission within 30 days of discharge

http://www.ncbi.nlm.nih.gov/pubmed/21210415

J Hosp Med. 2011 Jan 5. [Epub ahead of print]
Development, validation, and results of a measure of 30-day readmission following hospitalization for pneumonia.
Lindenauer PK, Normand SL, Drye EE, Lin Z, Goodrich K, Desai MM, Bratzler DW, O'Donnell WJ, Metersky ML, Krumholz HM.

Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts.
Abstract
BACKGROUND: Readmission following hospital discharge has become an important target of quality improvement.

OBJECTIVE: To describe the development, validation, and results of a risk-standardized measure of hospital readmission rates among elderly patients with pneumonia employed in federal quality measurement and efficiency initiatives.

DESIGN: A retrospective cohort study using hospital and outpatient Medicare claims from 2005 and 2006.

SETTING: A total of 4675 hospitals in the United States.

PATIENTS: Medicare beneficiaries aged >65 years with a principal discharge diagnosis of pneumonia.

INTERVENTION: None.

MEASUREMENTS: Hospital-specific, risk-standardized 30-day readmission rates calculated as the ratio of predicted-to-expected readmissions, multiplied by the national unadjusted rate. Comparison of the areas under the receiver operating curve (ROC) and measurement of correlation coefficient in development and validation samples.

RESULTS: The development sample consisted of 226,545 hospitalizations at 4675 hospitals, with an overall unadjusted 30-day readmission rate of 17.4%. The median risk-standardized hospital readmission rate was 17.3%, and the odds of readmission for a hospital one standard deviation above average was 1.4 times that of a hospital one standard deviation below average. Performance of the medical record and administrative models was similar (areas under the ROC curve 0.59 and 0.63, respectively) and the correlation coefficient of estimated state-specific standardized readmission rates from the administrative and medical record models was 0.96.

CONCLUSIONS: Rehospitalization within 30 days of treatment for pneumonia is common, and rates vary across hospitals. A risk-standardized measure of hospital readmission rates derived from administrative claims has similar performance characteristics to one based on medical record. review

From Amsterdam: More about diabetes and depression

http://www.ncbi.nlm.nih.gov/pubmed/21210541

Diabet Med. 2011 Jan;28(1):86-9.
More co-morbid depression in patients with Type 2 diabetes with multiple complications. An observational study at a specialized outpatient clinic.
van Steenbergen-Weijenburg KM, van Puffelen AL, Horn EK, Nuyen J, van Dam PS, van Benthem TB, Beekman AT, Rutten FF, Hakkaart-van Roijen L, van der Feltz-Cornelis CM.

Department of Psychiatry and Medical Psychology, Onze Lieve Vrouwe Gasthuis, VU University Medical Centre, Amsterdam, the Netherlands. Ksteenbergen@trimbos.nl
Abstract
AIMS: The impact of depression on patients with chronic medical illnesses such as diabetes is well documented. Depression is relatively common in diabetes patients with diabetes-related complications and they are more likely to be referred to specialized outpatient facilities. Only a few studies have addressed the association between depression and multiple diabetes-related complications at these specialized outpatient facilities. The aim of this study was to determine the association between diabetes with multiple complications and depression in patients with Type 2 diabetes at a specialized outpatient clinic.

METHODS: After giving informed consent, 1194 patients were screened for depression using the Patient Health Questionnaire (PHQ-9). Additional data on the type of diabetes and complications were taken from the medical records. Logistic regression analysis was conducted, with complications as the predictor variable and the probability of depression as the dependent variable.

RESULTS: A total of 596 (63%) patients with Type 2 diabetes participated in the study. The presence of two or more complications (OR 2.23, 95% CI 1.02–2.94) was significantly associated with depression. Neuropathy (OR 1.7, 95% CI 1.10–2.77) and nephropathy (OR 1.68, 95% CI 1.00–2.48) were especially related to depression.

CONCLUSIONS: Patients with Type 2 diabetes with two or more complications, especially neuropathy or nephropathy, are at high risk of depression. Knowing this can help clinicians identify patients at risk for depression and facilitate timely and adequate treatment.

Old news

http://www.ncbi.nlm.nih.gov/pubmed/21209060

BMJ. 2011 Jan 5;342:c7452. doi: 10.1136/bmj.c7452.
Wakefield's article linking MMR vaccine and autism was fraudulent.
Godlee F, Smith J, Marcovitch H.

BMJ, London, UK.

Cystic fibrosis in the young: acceptance and well-being

http://www.ncbi.nlm.nih.gov/pubmed/21208979

J Pediatr Psychol. 2011 Jan 5. [Epub ahead of print]
Acceptance and Well-Being in Adolescents and Young Adults with Cystic Fibrosis: A Prospective Study.
Casier A, Goubert L, Theunis M, Huse D, De Baets F, Matthys D, Crombez G.

Department of Experimental-Clinical and Health Psychology, Ghent University, Research Institute for Psychology and Health, Utrecht, University Hospital Ghent, Cystic Fibrosis Centre, Belgian Cystic Fibrosis Association, Brussels and Department of Pediatrics, University Hospital Ghent.
Abstract
OBJECTIVE: To prospectively investigate the role of acceptance in well-being in adolescents and young adults with cystic fibrosis (CF).

METHOD: A total of 40 adolescents and young adults with CF (ages 14-22 years) completed questionnaires assessing acceptance, anxiety and depressive symptoms, physical functioning, role functioning, emotional functioning, and social functioning. After 6 months, 28 of them completed the questionnaires on anxiety and depressive symptoms, physical functioning, role functioning, emotional functioning, and social functioning a second time.

RESULTS: More acceptance (Time 1) was related to less depressive symptoms (Time 1 and 2), and to better role, emotional, and social functioning (Time 1).

CONCLUSIONS: Results indicate that accepting the limitations imposed by chronic disease and readjusting life goals may have a positive effect upon well-being in adolescents and young adults with CF. Further research is needed to clarify whether acceptance-based interventions are useful in promoting well-being in adolescents and young adults with CF.

From Denmark: Cost effectiveness of preop PET in lung cancer patients

http://www.ncbi.nlm.nih.gov/pubmed/21210111

Eur J Nucl Med Mol Imaging. 2011 Jan 6. [Epub ahead of print]
Preoperative staging of lung cancer with PET/CT: cost-effectiveness evaluation alongside a randomized controlled trial.
Søgaard R, Fischer BM, Mortensen J, Højgaard L, Lassen U.

Centre for Health Service Research and Technology Assessment, University of Southern Denmark, Copenhagen, Denmark, ris@cast.sdu.dk.
Abstract
PURPOSE: Positron emission tomography (PET)/CT has become a widely used technology for preoperative staging of non-small cell lung cancer (NSCLC). Two recent randomized controlled trials (RCT) have established its efficacy over conventional staging, but no studies have assessed its cost-effectiveness. The objective of this study was to assess the cost-effectiveness of PET/CT as an adjunct to conventional workup for preoperative staging of NSCLC.

METHODS: The study was conducted alongside an RCT in which 189 patients were allocated to conventional staging (n = 91) or conventional staging + PET/CT (n = 98) and followed for 1 year after which the numbers of futile thoracotomies in each group were monitored. A full health care sector perspective was adapted for costing resource use. The outcome parameter was defined as the number needed to treat (NNT)-here number of PET/CT scans needed-to avoid one futile thoracotomy. All monetary estimates were inflated to 2010 .

RESULTS: The incremental cost of the PET/CT-based regimen was estimated at 3,927 [95% confidence interval (CI) -3,331; 10,586] and the NNT at 4.92 (95% CI 3.00; 13.62). These resulted in an average incremental cost-effectiveness ratio of 19,314 , which would be cost-effective at a probability of 0.90 given a willingness to pay of 50,000 per avoided futile thoracotomy. When costs of comorbidity-related hospital services were excluded, the PET/CT regimen appeared dominant.

CONCLUSION: Applying a full health care sector perspective, the cost-effectiveness of PET/CT for staging NSCLC seems to depend on the willingness to pay in order to avoid a futile thoracotomy. However, given that four outliers in terms of extreme comorbidity were all randomized to the PET/CT arm, there is uncertainty about the conclusion. When hospital costs of comorbidity were excluded, the PET/CT regimen was found to be both more accurate and cost saving.

Surgical safety checklists could cut malpractice suits by nearly 1/3!

http://www.ncbi.nlm.nih.gov/pubmed/21209590

Ann Surg. 2011 Jan 4. [Epub ahead of print]
Prevention of Surgical Malpractice Claims by a Surgical Safety Checklist.
de Vries EN, Eikens-Jansen MP, Hamersma AM, Smorenburg SM, Gouma DJ, Boermeester MA.

*Department of Surgery, Academic Medical Centre, Amsterdam †MediRisk, Utrecht ‡Department of Quality and Process Innovation, Academic Medical Centre, Amsterdam, the Netherlands.
Abstract
OBJECTIVE: To assess what proportion of surgical malpractice claims might be prevented by the use of a surgical safety checklist.

BACKGROUND: Surgical disciplines are overrepresented in the distribution of adverse events. The recently described multidisciplinary SURgical PAtient Safety System (SURPASS) checklist covers the entire surgical pathway from admission to discharge and is being validated in various ways. Malpractice claims constitute an important source of information on adverse events. In this study, surgical malpractice claims were evaluated in detail to assess the proportion and nature of claims that might have been prevented if the SURPASS checklist had been used.

METHODS: A retrospective claim record review was performed using the database of the largest Dutch insurance company for medical liability. All accepted or settled closed surgical malpractice claims filed as a consequence of an incident that occurred between January 1, 2004 and December 31, 2005 were included. Data on the type and outcome of the incident and contributing factors were extracted. All contributing factors were compared to the SURPASS checklist to assess which incidents the checklist might have prevented.

RESULTS: We included 294 claims. Failure in diagnosis and peroperative damage were the most common types of incident; cognitive contributing factors were present in two-thirds of claims. Of a total of 412 contributing factors, 29% might have been intercepted by the SURPASS checklist. The checklist might have prevented 40% of deaths and 29% of incidents leading to permanent damage.

CONCLUSION: Nearly one-third of all contributing factors in accepted surgical malpractice claims of patients that had undergone surgery might have been intercepted by using a comprehensive surgical safety checklist. A considerable amount of damage, both physical and financial, is likely to be prevented by using the SURPASS checklist.

Mesothelioma: antiangiogenic therapy

http://www.ncbi.nlm.nih.gov/pubmed/21196199

Front Biosci. 2011 Jan 1;16:740-8.
Antiangiogenic therapies for malignant pleural mesothelioma.
Yano S, Li Q, Wang W, Yamada T, Takeuchi S, Nakataki E, Ogino H, Goto H, Nishioka Y, Sone S.

Division of Medical Oncology, Cancer Research Institute, Kanazawa University. Kanazawa, Ishikawa 920-0934.
Abstract
Malignant pleural mesothelioma (MPM), arises from the mesothelial cells, is difficult to be diagnosed at an early stage, and is refractory to conventional chemotherapy and radiotherapy. Therefore, the establishment of novel effective therapies is necessary to improve the prognosis for many patients with this disease. Recent studies have demonstrated that angiogenesis plays a significant role in MPM progression, suggesting the importance of tumor vessels as therapeutic targets. To explore molecular pathogenesis and evaluate the efficacy of vascular targeting therapy in MPM, we developed orthotopic implantation SCID mouse models of MPM. We found that selective VEGF inhibitors were effective only in the treatment of high-VEGF-producing MPM models. On the other hand, multiple kinase inhibitor E7080, with inhibitory activity against various angiogenic cytokine receptors, suppressed the progression and prolonged survival of both high-VEGF-producing and low-VEGF-producing MPM models. Further understanding of the functional characteristics of tumor angiogenesis may be essential to improve targeting therapies in MPM. In this review, we introduce current status of clinical strategies and novel therapeutic approaches against angiogenesis in MPM.

Cancer in HIV+ patients in France

http://www.ncbi.nlm.nih.gov/pubmed/21207370

Int J Cancer. 2011 Jan 4. [Epub ahead of print]
The spectrum of malignancies in HIV-infected patients in 2006 in France: The ONCOVIH study.
Lanoy E, Spano JP, Bonnet F, Guiguet M, Boué F, Cadranel J, Carcelain G, Couderc LJ, Frange P, Girard PM, Oksenhendler E, Poizot-Martin I, Semaille C, Agut H, Katlama C, Costagliola D; the ONCOVIH study group.

Inserm, U943; UPMC Univ Paris 06, UMR S943, Paris, F-75013 France.
Abstract
Since no large descriptive studies of incident cancers in HIV-infected patients are available in France, the nationwide cross-sectional ONCOVIH study aimed to prospectively report new malignancies diagnosed in HIV-infected patients in cancer centers and HIV/AIDS centers. We estimated the number of cancers in France for the year 2006 using the capture-recapture methods with two sources: ONCOVIH and the FHDH ANRS-CO4 cohort, as well as the completeness of the sources. Incidence and relative risks (RR) to the general population were estimated.In 2006, 672 new malignancies in 668 patients were reported in ONCOVIH; the most common were non Hodgkin's lymphoma (NHL, 21.5%), Kaposi's sarcoma (KS, 16.0%), lung cancer (9.4%), anal cancer (8.2%), Hodgkin's lymphoma (7.6%), skin cancers excluding melanoma (6.8%) and liver cancer (5.6%). Based on the capture-recapture approach, the estimated number of malignancies was 1320 and non AIDS-defining malignancies (NADM) represented 68% of cases. The overall ascertainement of malignancies were 53%, and 59%, in the ONCOVIH study, and the FHDH ANRS-CO4 cohort, respectively. The estimated incidence of cancer among HIV-infected patients was 14 per 1000 person-years. Compared with the general population, the estimated RR in HIV-infected patients was 3.5 (95%CI 3.3-3.8) in men and 3.6 (95%CI 3.2-4.0) in women, and was particularly elevated in younger patients.Even in the era of combined antiretroviral therapy, the incidence of cancer is higher in HIV-infected persons than in the general population. A large variety of malignancies were diagnosed, and the majority were NADM.

The medical malpractice muddle

http://www.ncbi.nlm.nih.gov/pubmed/21134946

Health Aff (Millwood). 2010 Dec;29(12):2355.
The medical malpractice muddle.
Green JB.

Comment on:

Health Aff (Millwood). 2010 Sep;29(9):1569-77.

Drug therapy for prediabetic metabolic syndrome patients?

http://www.ncbi.nlm.nih.gov/pubmed/21207204

Curr Diab Rep. 2011 Jan 5. [Epub ahead of print]
Should the Metabolic Syndrome Patient with Prediabetes Be Offered Pharmacotherapy?
Sullivan SD, Ratner RE.

Department of Endocrinology, Washington Hospital Center, 110 Irving Street, NW, Suite 2A-72, Washington, DC, 20010, USA, Shannon.d.sullivan@medstar.net.
Abstract
Impaired fasting glucose and impaired glucose tolerance reflect perturbations in glucose metabolism and define a prediabetic state in which risk for type 2 diabetes mellitus (T2DM) is increased. There is overlap between prediabetes and the metabolic syndrome, which itself increases the risk for T2DM and cardiovascular disease. The utility of medical interventions to prevent progression to diabetes in prediabetic individuals, many of whom also manifest metabolic syndrome, has been examined in several large clinical trials. Intensive lifestyle intervention consistently results in drastic reductions in the incidence of T2DM and reversal of metabolic syndrome. Additionally, pharmacotherapies-including metformin, acarbose, thiazolidinediones, glucagon-like peptide 1 receptor agonists, and renin-angiotensin inhibitors-also reduce diabetes incidence with variable effects on metabolic syndrome components. Taken together, we recommend that prediabetic patients undergo intensive lifestyle intervention, with the addition of pharmacotherapy based on the presence of specific features of the metabolic syndrome, for diabetes prevention.

Lung cancer--potential biomarkers

http://www.ncbi.nlm.nih.gov/pubmed/21206385

J Thorac Oncol. 2011 Jan 4. [Epub ahead of print]
Pharmacogenetic and Germline Prognostic Markers of Lung Cancer.
Horgan AM, Yang B, Azad AK, Amir E, John T, Cescon DW, Wheatley-Price P, Hung RJ, Shepherd FA, Liu G.

Department of Medical Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada.
Abstract
INTRODUCTION: Lung cancer is the leading global cause of cancer-related mortality. Interindividual variability in treatment response and cancer outcomes has focused attention on genetic polymorphisms as prognostic markers. We evaluated the overall contribution of candidate polymorphism association studies to our current understanding of the genetic predictors of lung cancer outcomes.

METHODS: We examined the results of 90 studies that evaluated associations between genetic polymorphisms and lung cancer outcomes published between January 1990 and May 2009.

RESULTS: A total of 170 genetic variations in 90 studies were identified. Overall survival was a primary outcome in 81% of the studies and toxicity in 19%. Candidate polymorphisms in the DNA repair/synthesis pathway were the most frequently studied. Strong evidence in large-scale confirmatory studies of any single polymorphism was lacking. Polymorphisms of EGFR, XRCC1, and ERCC1 were associated with pharmacogenetic outcomes, whereas polymorphisms of MDM2, p53, and GSTM1 were associated with prognostic outcomes. All remaining polymorphisms had results lacking or failing replication testing. Heterogeneity in study populations, incomplete reporting of important population or study characteristics, inadequate power, and inconsistencies in methodology were common.

CONCLUSIONS: Although the quality of existing studies involving the candidate polymorphism approach is highly variable, a small set of candidate polymorphisms was identified as potential biomarkers of clinical or pharmacogenetic outcome and would benefit from further replication testing. Newer approaches including haplotype tagging, pathway, genome-wide association, and combination methods with validative approaches may facilitate a more accurate prediction of lung cancer outcomes by genetic variation.

Norwegian sailors experience a healthy soldier effect

http://www.ncbi.nlm.nih.gov/pubmed/21206964

Scand J Work Environ Health. 2011 Jan 5. [Epub ahead of print]
Cause-specific mortality and cancer incidence among 28 300 Royal Norwegian Navy servicemen followed for more than 50 years.
Strand LA, Martinsen JI, Koefoed VF, Sommerfelt-Pettersen J, Grimsrud TK.

Leif Aage Strand, Cancer Registry of Norway, N-0304 Oslo, Norway. leif.age.strand@kreftregisteret.no.
Abstract
OBJECTIVES: The aim of this study was to examine mortality and cancer incidence in a cohort of 28 300 military servicemen known, from personnel files, to have served in the Royal Norwegian Navy during 1950-2004.

METHODS: The cohort was followed from 1951-2007 for mortality and from 1953-2008 for cancer. Standardized mortality ratios (SMR) and incidence ratios (SIR) for cancer were calculated from national rates. Internal comparisons [rate ratios (RR)] were made using Poisson regression.

RESULTS: Mortality for all Navy personnel was lower than expected for all causes combined (SMR 0.84) and for most disease groups and violent causes, but not for cancer mortality (SMR 1.02). Vessel crews had consistently higher SMR than land-based personnel, still with rates lower than - or close to - national ones. The relative risk between the two subgroups was in the same direction for mortality from alcohol abuse and non-malignant alcohol-related diseases (RR 1.56) and for the incidence of alcohol-related cancers (RR 1.58) and lung cancer (RR 1.65). An overall small excess in the incidence of all cancers combined for the entire cohort (SIR 1.06) was caused by prostate cancer, malignant melanoma, and non-melanoma skin cancer. An excess of bladder cancer was observed among submariners (SIR 1.53).

CONCLUSION: The low all-cause mortality was in line with a "healthy soldier effect". Navy personnel had a lower-than-expected mortality from accidents and suicide. Alcohol-related diseases were more frequent among vessel crews than among land-based personnel, but largely comparable to the rates among all Norwegian men.

Advances in Surgical Pathology: Gastric Cancer

http://www.amazon.com/s/ref=nb_sb_noss?url=search-alias%3Dstripbooks&field-keywords=tan+lauwers&x=0&y=0

Revolution in Lung Cancer

http://www.ncbi.nlm.nih.gov/pubmed/21204716

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.

Abstract
Abstract Context-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. Objective-To summarize the important, new developments in lung cancer, emphasizing the role of the surgical pathologist in personalized care for patients with lung cancer. Data Sources-Information about the new developments in lung cancer was obtained from the peer-review medical literature and the authors' experiences. Conclusions-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.

Revolution in lung cancer

http://www.archivesofpathology.org/doi/pdf/10.1043/2010-0567-RA.1

Revolution in Lung Cancer: New Challenges for the Surgical Pathologist
Philip T. Cagle, MD, Timothy C. Allen, MD, JD, Sanja Dacic, MD, PhD, Mary Beth Beasley, MD, Alain C. Borczuk, MD, Lucian R. Chirieac, MD, Rodolfo Laucirica, MD, Jae Y. Ro, MD, PhD, and Keith M. Kerr, MD

Abstract
Context—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.

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

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

Conclusions—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.

From the Department of Pathology and Laboratory Medicine, The Methodist Hospital, Houston, Texas (Drs Cagle and Ro); the Department of Pathology and Laboratory Medicine, Weill Medical College of Cornell University, New York, New York (Dr Cagle and Ro); the Department of Pathology, The University of Texas Health Science Center at Tyler, Texas (Dr Allen); the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, Mount Sinai Medical Center, New York (Dr Beasley); the Department of Pathology, Columbia University Medical Center, New York (Dr Borczuk); the Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (Dr Chirieac); the Department of Pathology, Baylor College of Medicine, Houston (Dr Laucirica); the Department of Pathology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland (Dr Kerr); and the School of Medical Sciences, University of Aberdeen (Dr Kerr).

The stigma of lung cancer

http://www.ncbi.nlm.nih.gov/pubmed/21186151

Oncol Nurs Forum. 2011 Jan 1;38(1):E46-54.
Measuring stigma in people with lung cancer: psychometric testing of the cataldo lung cancer stigma scale.
Cataldo JK, Slaughter R, Jahan TM, Pongquan VL, Hwang WJ.

Department of Physiological Nursing-Gerontology, University of California, San Francisco.
Abstract
Purpose/Objectives: To develop an instrument to measure the stigma perceived by people with lung cancer based on the HIV Stigma Scale.Design: Psychometric analysis.Setting: Online survey.Sample: 186 patients with lung cancer.Methods: An exploratory factor analysis with a common factor model using alpha factor extraction.Main Research Variables: Lung cancer stigma, depression, and quality of life.
Findings: Four factors emerged: stigma and shame, social isolation, discrimination, and smoking. Inspection of unrotated first-factor loadings showed support for a general stigma factor. Construct validity was supported by relationships with related constructs: self-esteem, depression, social support, and social conflict. Coefficient alphas ranging from 0.75-0.97 for the subscales (0.96 for stigma and shame, 0.97 for social isolation, 0.9 for discrimination, and 0.75 for smoking) and 0.98 for the 43-item Cataldo Lung Cancer Stigma Scale (CLCSS) provided evidence of reliability. The final version of the CLCSS was 31 items. Coefficient alpha was recalculated for the total stigma scale (0.96) and the four subscales (0.97 for stigma and shame, 0.96 for social isolation, 0.92 for discrimination, and 0.75 for smoking).Conclusions: The CLCSS is a reliable and valid measure of health-related stigma in this sample of people with lung cancer.
Implications for Nursing: The CLCSS can be used to identify the presence and impact of lung cancer stigma and allow for the development of effective stigma interventions for patients with lung cancer.

Health care reform-effects on the self insured

http://www.ncbi.nlm.nih.gov/pubmed/21192488

Issue Brief Natl Health Policy Forum. 2010 Dec 21;(840):1-14.
Self-insurance and the potential effects of health reform on the small-group market.
Linehan K.

Abstract
The Patient Protection and Affordable Care Act (PPACA) as amended by the Health Care Education Reconciliation Act of 2010 makes landmark changes to health insurance markets. Individual and small-group insurance plans and markets will see the biggest changes, but PPACA also affects large employer and self-insured plans by imposing rules for benefit design and health plan practices. Over half of workers--most often those in very large firms--are covered by self-insured health plans in which employers (or employee groups) bear all or some of the risk of providing insurance coverage to a defined population of workers and their dependents. As PPACA provisions become effective, some have argued that smaller firms that offer insurance may opt to self-insure their health benefits because of new small-group market rules. Such a shift could affect risk pooling in the small-group market. This paper examines the definition and prevalence of self-insured health plans, the application of PPACA provisions to these plans, and the possible effects on the broader health insurance market, should many more employers decide to self-insure.

COPD exacerbation and GOLD stage

http://www.ncbi.nlm.nih.gov/pubmed/21191438

Int J Chron Obstruct Pulmon Dis. 2010 Dec 9;5:435-44.
Association between lung function and exacerbation frequency in patients with COPD.
Hoogendoorn M, Feenstra TL, Hoogenveen RT, Al M, Mölken MR.

Institute for Medical Technology Assessment, Erasmus University, Rotterdam;
Abstract
PURPOSE: To quantify the relationship between severity of chronic obstructive pulmonary disease (COPD) as expressed by Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage and the annual exacerbation frequency in patients with COPD.

METHODS: We performed a systematic literature review to identify randomized controlled trials and cohort studies reporting the exacerbation frequency in COPD patients receiving usual care or placebo. Annual frequencies were determined for total exacerbations defined by an increased use of health care (event-based), total exacerbations defined by an increase of symptoms, and severe exacerbations defined by a hospitalization. The association between the mean forced expiratory volume in one second (FEV(1))% predicted of study populations and the exacerbation frequencies was estimated using weighted log linear regression with random effects. The regression equations were applied to the mean FEV(1)% predicted for each GOLD stage to estimate the frequency per stage.

RESULTS: Thirty-seven relevant studies were found, with 43 reports of total exacerbation frequency (event-based, n = 19; symptom-based, n = 24) and 14 reports of frequency of severe exacerbations. Annual event-based exacerbation frequencies per GOLD stage were estimated at 0.82 (95% confidence interval 0.46-1.49) for mild, 1.17 (0.93-1.50) for moderate, 1.61 (1.51-1.74) for severe, and 2.10 (1.51-2.94) for very severe COPD. Annual symptom-based frequencies were 1.15 (95% confidence interval 0.67-2.07), 1.44 (1.14-1.87), 1.76 (1.70-1.88), and 2.09 (1.57-2.82), respectively. For severe exacerbations, annual frequencies were 0.11 (95% confidence interval 0.02-0.56), 0.16 (0.07-0.33), 0.22 (0.20-0.23), and 0.28 (0.14-0.63), respectively. Study duration or type of study (cohort versus trial) did not significantly affect the outcomes.

CONCLUSION: This study provides an estimate of the exacerbation frequency per GOLD stage, which can be used for health economic and modeling purposes.

Pulmonary metastectomy for colorectal cancer metastases

http://www.ncbi.nlm.nih.gov/pubmed/21191691

Surg Today. 2011 Jan;41(1):54-9. Epub 2010 Dec 30.
Results of a pulmonary metastasectomy in patients with colorectal cancer.
Suemitsu R, Takeo S, Kusumoto E, Hamatake M, Ikejiri K, Saitsu H.

Department of Thoracic Surgery, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan.
Abstract
PURPOSE: The lung is one of the key sites of hematogenous metastasis in patients with colorectal cancer. A metastasectomy of the lung is reported to improve the prognosis of colorectal cancer. We reviewed our experience in evaluating the surgical outcomes in colorectal cancer patients who have undergone a pulmonary metastasectomy.

METHODS: A single-center retrospective evaluation of clinical prognostic factors (1996-2008) related to a pulmonary metastasectomy of patients with colorectal cancer was conducted. Fifty-seven consecutive patients in our hospital who had undergone a resection of pulmonary metastasis from colorectal cancer were retrospectively investigated.

RESULTS: The mean age of the patients who underwent an initial pulmonary metastasectomy was 63.8 years. The average number of pulmonary metastases was 3.8. Pulmonary metastasectomy was performed an average of 1.6 times per head. A total of 32 patients had undergone a liver metastasectomy, and the 5-year survival of these 32 patients was 43.1%. The 5-year survival of the time from first pulmonary metastasectomy was 53.9%. There were no statistical differences with regard to the disease-free interval, interval from primary resection, or the number of pulmonary metastasectomies.

CONCLUSIONS: A pulmonary resection for colorectal pulmonary metastases is therefore considered to be a favorable treatment for long-term survival even in the presence of liver metastases. Thoracic surgeons should therefore aggressively perform a pulmonary metastasectomy of colorectal cancer.

More about lung cancer screening

http://www.ncbi.nlm.nih.gov/pubmed/21191112

J Natl Cancer Inst. 2010 Dec 29. [Epub ahead of print]
Lung Cancer Screening: Ready for Prime Time?
Peres J.

Blast injury to the lung

http://www.ncbi.nlm.nih.gov/pubmed/21149364

Philos Trans R Soc Lond B Biol Sci. 2011 Jan 27;366(1562):286-90.
Characterization of the response to primary blast injury.
Kirkman E, Watts S.

Biomedical Sciences, Dstl Porton Down, Salisbury SP4 0JQ, UK.
Abstract
Lung injuries, predominantly arising from blast exposure, are a clinical problem in a significant minority of current military casualties. This special feature consists of a series of articles on lung injury. This first article examines the mechanism of the response to blast lung (primary blast injury to the lung). Subsequent articles examine the incidence of blast lung, clinical consequences and current concepts of treatment, computer (in silico) modelling of lung injury and finally chemical injuries to the lungs. Blast lung is caused by a shock wave generated by an explosion causing widespread damage in the lungs, leading to intrapulmonary haemorrhage. This, and the ensuing inflammatory response in the lung, leads to a compromise in pulmonary gas exchange and hypoxia that can worsen over several hours. There is also a characteristic cardio-respiratory effect mediated via an autonomic reflex causing apnoea (or rapid shallow breathing), bradycardia and hypotension (the latter possibly also due to the release of nitric oxide). An understanding of this response, and the way it modifies other reflexes, can help the development of new treatment strategies for this condition and for the way it influences the patient's response to concomitant injuries.

Cystic peritoneal mesothelioma-very rare lesion but generally carrying a good prognosis

http://www.ncbi.nlm.nih.gov/pubmed/21191708

Surg Today. 2011 Jan;41(1):141-6. Epub 2010 Dec 30.
Cystic peritoneal mesothelioma: Report of a case.
Cavallaro A, Berretta M, Lo Menzo E, Cavallaro V, Zanghì A, Di Vita M, Cappellani A.

Department of Surgery, University of Catania, Catania, Italy.
Abstract
Benign multicystic peritoneal mesothelioma (BMPM) is a rare disease with good short-term prognosis and rare malignant transformation. However, its biological significance remains unexplained. A neoplastic origin is considered by many authors to require a surgical excision, based on the high recurrence and progressive growth rate of the tumors. However, alternative or integrative treatment options have also been proposed. A 45-year-old woman presented to our unit with a history of occasional discomfort and pain in the left hip. On physical examination, we noticed a tough-elastic, fixed mass located in the iliac fossa. Computed tomography scan detected a mass with multiseptated cystic-like areas. Due to the similarity of these findings to a primitive sarcomatous tumor of the retroperitoneum, an arteriographic study was also performed. The patient underwent en bloc resection of the mass, including a segment of the sigmoid colon. The final pathologic diagnosis was cystic mesothelioma. Further studies are needed to better understand the etiology and pathogenesis of this rare disease, and to define a more tailored treatment plan.

Pulmonary lymphangioleiomyomatosis-from Bill Travis and colleague

http://www.ncbi.nlm.nih.gov/pubmed/21128782

Arch Pathol Lab Med. 2010 Dec;134(12):1823-8.
Pulmonary lymphangioleiomyomatosis.
Zhang X, Travis WD.

Department of Pathology, State University of New York, Downstate Medical Center, Brooklyn, 11203, USA. xuchen.zhang@downstate.edu
Abstract
Lymphangioleiomyomatosis is an uncommon lung disease primarily affecting women of childbearing age. It is characterized by the progressive proliferating and infiltrating smooth musclelike cells (lymphangioleiomyomatosis cells), which lead to the cystic destruction of the lung parenchyma; obstruction of airways, blood vessels, and lymphatics; and loss of pulmonary function. Lymphangioleiomyomatosis cells coexpress smooth muscle markers (such as smooth muscle actin and desmin) and melanocytic markers (such as HMB-45, Melan-A/MART-1, and microphthalmia transcription factor). Dyspnea on exertion and recurrent pneumothorax are the most common clinical features. Somatic or genetic mutations of tumor suppressor genes tuberous sclerosis complex (TSC) 1 or TSC2 are closely related to lymphangioleiomyomatosis. The TSC1/TSC2 protein-related signaling pathways are involved in the pathogenesis and may provide novel therapeutic targets for lymphangioleiomyomatosis and diseases associated with TSC1 / TSC2 dysfunction.

From Victor Prieto at MD Anderson-Sentinal lymph nodes in cutaneous melanoma

http://www.archivesofpathology.org/doi/pdf/10.1043/2009-0502-RAR.1

Prieto VG
Sentinal lymph nodes in cutaneous melanoma
Arch Pathol Lab Med. 2010;134:1764–1769

Abstract:
Context.—Within the last 15 years, evaluation of sentinel
lymph nodes (SLNs) has become the most popular method
of early staging of several malignancies, including melanoma. Sentinel lymph nodes are usually examined on
formalin-fixed, paraffin-embedded sections and by routine
histology/immunohistochemistry (research protocols have
used other techniques such as polymerase chain reaction).
Approximately 20% of patients with cutaneous melanoma
have metastasis in the SLN. In most studies, detection of
positive SLN conveys a poorer prognosis for patients with
cutaneous melanoma.
Objective.—To review the morphologic patterns of
melanoma metastasis in the SLN, the differential diagnosis,
and the quantification of tumor burden as a prognostic factor.
Data Sources.—Personal observations and review of the
pertinent literature.
Conclusions.—Evaluation of sentinel lymph nodes is
certainly becoming a widespread technique and most
authors agree on its prognostic power for staging patients
with cutaneous melanoma. Current studies are evaluating
the possible therapeutic value of removal of positive SLNs.

Rheumatoid arthritis-related interstitial lung disease

http://www.ncbi.nlm.nih.gov/pubmed/21186169

Rheumatology (Oxford). 2010 Dec 24. [Epub ahead of print]
Patients with limited rheumatoid arthritis-related interstitial lung disease have a better prognosis than those with extensive disease.
Sathi N, Urwin T, Desmond S, Dawson JK.

Rheumatology Department, Doncaster Royal Infirmary, Doncaster, Department of Undergraduate Medicine, Faculty of Medicine, University of Liverpool, Liverpool, Department of Radiology, Whiston Hospital, St Helens and Knowsley NHS Trust, Prescot and Department of Rheumatology, St Helens Hospital, St Helens and Knowsley NHS Trust, St Helens, UK.

Cystic fibrosis: Renal function in children

http://www.ncbi.nlm.nih.gov/pubmed/21190043

Pediatr Nephrol. 2010 Dec 29. [Epub ahead of print]
Renal function in pediatric cystic fibrosis patients in the first decade of life.
Prestidge C, Chilvers MA, Davidson AG, Cho E, McMahon V, White CT.

Department of Pediatrics, Division of Nephrology, BC Children's Hospital, 4480 Oak Street, ACB K4-151, Vancouver, British Columbia, Canada.
Abstract
With increasing life expectancy and the need for lung transplantation in the cystic fibrosis (CF) population, there are increasing reports of chronic kidney disease (CKD). However, values for baseline or longitudinal glomerular filtration rate (GFR) as measured by exogenous clearance markers are lacking in this population. Retrospective cross-sectional study in 2 to 18-year-olds cared for at a single CF center who had a GFR measured by plasma disappearance of Technetium-99 m diethylenetriaminepentaacetic acid (mGFR). The primary outcome was evidence of renal dysfunction as defined by CKD stage II or below (mGFR < 90 ml/min/1.73 m(2), persistent abnormalities in urinary sediment, abnormal renal imaging). Of 63 patients evaluated, four had apparent renal dysfunction, one demonstrated decreased mGFR, and three others had persistent microscopic hematuria. The mean mGFR was substantially higher (140 ± 24 ml/min/1.73 m(2)) than expected or previously reported for healthy children. We did not demonstrate the presence of significant renal impairment after limited aminoglycoside exposure in the first decade following diagnosis with CF. However, we did document the presence of glomerular hyperfiltration in a significant proportion of our CF patients.

Diabetes and depression

http://www.ncbi.nlm.nih.gov/pubmed/21192528

Diabetes Forecast. 2010 Dec;63(12):29-31.
Down but not out. The link between depression and diabetes.
Gebel E.

Women's health in Massachusetts

http://www.ncbi.nlm.nih.gov/pubmed/21185986

Womens Health Issues. 2011 Jan-Feb;21(1):1-5.
Lessons for Women's Health From the Massachusetts Reform: Affordability, Transitions, and Choice.
Sered S, Proulx MD.

Department of Sociology, Suffolk University, Boston, Massachusetts.
Abstract
Three years into Massachusetts' health insurance reform, we are beginning to see what that experience portends for women nationally in the wake of legislation similar to the Massachusetts model. Although the Massachusetts reform has been successful in terms of reducing the number of uninsured men and women, interviews with Massachusetts women reveal significant problems that remain to be addressed. In this paper, we offer snapshots of three women whom we interviewed on the cusp of the Massachusetts reform. None of the women had insurance at the time; thus, health care reform represents a significant improvement in their access to care. However, as these snapshots indicate, major challenges remain in terms of affordability, continuity of coverage, and systemic complexities in choosing plans.

NEJM: from Wake Forest law school-safety net access for the uninsured

http://www.ncbi.nlm.nih.gov/pubmed/21190449

N Engl J Med. 2010 Dec 29. [Epub ahead of print]
Rethinking Safety-Net Access for the Uninsured.
Hall MA.

From Wake Forest University School of Law, Winston-Salem, NC.

Abstract
Now that health insurance reform has begun, safety-net programs throughout the United States are struggling to adapt their missions to suit the post-reform composition of the uninsured population. Most such programs are organized at the local level, with funding largely premised on their serving low-income uninsured residents. Examples include well-structured comprehensive care programs in some major cities, more than 1000 limited-service free clinics, and dozens of volunteer physician-referral programs. When the Affordable Care Act (ACA) is fully implemented, 8% of the U.S. population is projected to remain uninsured.

Improving primary care practice's office relationships

http://www.ncbi.nlm.nih.gov/pubmed/21192207

Qual Manag Health Care. 2011 Jan-Mar;20(1):49-61.
Up Close and (Inter)personal: Insights From a Primary Care Practice's Efforts to Improve Office Relationships Over Time, 2003-2009.
Howard J, Shaw EK, Clark E, Crabtree BF.

Department of Family Medicine and Community Health, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Somerset (Drs Howard, Shaw, Clark, and Crabtree); and Cancer Institute of New Jersey, New Brunswick, New Jersey (Dr Crabtree).
Abstract
A growing body of literature suggests that interpersonal relationships between personnel in health care organizations can have an impact on the quality of care provided. Some research recommends that the fundamental practice transformation that is being urged in this current climate of health care reform may be aided by strong interpersonal practice relationships and communication. There is much to be learned, however, about what is involved in the process of addressing and improving interpersonal relationships in primary care practices. This case study offers insights into this process by examining 1 primary care practice's efforts to address interpersonal office issues over the course of its participation in 2 back-to-back quality improvement (QI) intervention studies. Our analysis is based on extensive qualitative data on this practice (observational data, interviews, and audio-recorded QI meetings) from 2003 to 2009. By tracing common themes and patterns of interaction over an extended period of time, we identify a variety of facilitators of and barriers to addressing interpersonal issues in the practice setting. We conclude by suggesting some implications from this case for future QI research.

Lung cancer surgery in underweight patients

http://www.ncbi.nlm.nih.gov/pubmed/21191692

Surg Today. 2011 Jan;41(1):60-6. Epub 2010 Dec 30.
The results of surgery under general anesthesia in patients with lung cancer.
Suemitsu R, Takeo S, Hamatake M, Morokuma A, Suemori Y, Tanaka H.

Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan.
Abstract
PURPOSE: There are few reports of surgical complications for underweight patients. This study evaluated the complications associated with lung cancer surgery and anesthesia in underweight patients in a comparison with obese ones.

METHODS: A single-center retrospective evaluation of perioperative complications was conducted in 756 patients who underwent thoracic surgery under general anesthesia between 1996 and 2006. The body mass index showed that 39 were extremely underweight (<17.2 kg/m(2)), 45 were underweight (17.2-18.4 kg/m(2)), 513 were normal (18.5-24.9 kg/m(2)), and 159 were obese (>24.9 kg/m(2)).

RESULTS: Extremely underweight patients had the most preoperative thoracic disease such as emphysema, whereas obese patients had the most preoperative cardiovascular disease such as hypertension. The postresection-predicted pulmonary function showed no difference among the four groups. Extremely underweight patients had an increased incidence of intraoperative hypotension and arrhythmia in comparison to underweight patients. On the other hand, obese patients had the majority of intraoperative thoracic complications such as hypoxia. Extremely underweight patients had more postoperative thoracic complications, especially pneumonia and pulmonary air leakage, than other patients.

CONCLUSIONS: Extremely underweight patients as well as obese patients had a high risk of perioperative complications, especially postoperative thoracic complications. Extremely underweight patients should therefore be carefully observed with regard to respiratory management.

LKB1 in lung cancer in Japan

http://www.ncbi.nlm.nih.gov/pubmed/21191700

Surg Today. 2011 Jan;41(1):107-10. Epub 2010 Dec 30.
LKB1 gene alterations in surgically resectable adenocarcinoma of the lung.
Okuda K, Sasaki H, Hikosaka Y, Kawano O, Moriyama S, Yano M, Fujii Y.

Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Science, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
Abstract
PURPOSE: Germline mutations of LKB1 (also known as SKT11; locus 19p13.3) cause the occurrence of autosomal dominant Peutz-Jeghers syndrome (PJS). Nearly half of the non-small cell lung cancer (NSCLC) cell lines and one-third of lung adenocarcinoma in Caucasian patients have an LKB1 mutation.

METHODS: This study examined the mutational hot spots of the LKB1 gene in surgical resectable lung adenocarcinoma. Exons 1, 6, and 7 of the LKB1 gene were sequenced in 174 Japanese patients with lung adenocarcinoma (including 157 men and 17 women).

RESULTS: Only five patients had LKB1 gene alterations (2.9%). All of them were male smokers, and no LKB1 mutation was observed in any of the females. The details of LKB1 alterations were: one 5 bp deletion in intron 5, one Gly to Phe substitution at codon 279 of exon 6, and three Pro to Leu substitutions at codon 281 of exon 6. The P281L alteration and 5 bp deletion in the intron 5 were found to be germline polymorphisms. The G279F was confirmed to be a novel somatic mutation. None of the five patients with an LKB1 alteration showed either an EGFR or K-ras mutation.

CONCLUSION: The LKB1 gene alteration is rare in Japanese patients with lung adenocarcinoma, and is generally limited to male smokers.

Is miR-16 prognostic for lung cancer?

http://www.ncbi.nlm.nih.gov/pubmed/21192009

J Surg Oncol. 2010 Dec 29. [Epub ahead of print]
Prognostic implications of miR-16 expression levels in resected non-small-cell lung cancer.
Navarro A, Diaz T, Gallardo E, Viñolas N, Marrades RM, Gel B, Campayo M, Quera A, Bandres E, Garcia-Foncillas J, Ramirez J, Monzo M.

Human Anatomy and Embryology Unit, Molecular Oncology and Embryology Laboratory, School of Medicine, University of Barcelona, IDIBAPS, Barcelona, Spain.
Abstract
BACKGROUND: MicroRNAs are novel regulators of gene expression that are linked to the main oncogene networks, including the p53 pathway. p53 regulates the maturation process of miR-16 and miR-143. We analyzed the role as prognostic markers of miR-16 and miR-143 in 70 non-small-cell lung cancer (NSCLC) patients.

METHODS: MicroRNAs were analyzed by TaqMan MicroRNA assays. Disease-free survival (DFS) and overall survival (OS) were examined using Kaplan-Meier curves with log-rank tests and the Cox proportional hazard model.

RESULTS: When patients were classified in three groups according to their miR-16 expression levels, those with normal levels had the best outcome while those with high levels had the worst. DFS was 22.4 months for patients with high levels, 71.8 months for those with normal levels, and 55.8 months for those with low levels (P = 0.05). OS was 23.9 months for patients with high levels, 97.6 months for those with normal levels, and 63.5 months for those with low levels (P < 0.001). In the multivariate analyses, high miR-16 levels emerged as an independent prognostic factor for poor DFS (P = 0.001) and OS (<0.001).

CONCLUSIONS: Our results provide the first hints that miR-16 levels in tumor samples may be a prognostic marker in NSCLC.