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Diffusing capacity predicts long-term survival after lung resection for cancer

OBJECTIVES

Predictors of long-term survival for patients with lung cancer assist in individualizing treatment recommendations. Diffusing capacity (DLCO) is a predictor of complications after resection for lung cancer. We sought to determine whether DLCO is also prognostic for long-term survival after lung resection for cancer.

 METHODS

We assessed survival among patients in our prospective database who underwent lung resection for cancer between 1980–2006. Potential prognostic factors for all-cause mortality were evaluated by computing average annual hazard rates, and variables significantly associated with survival were included in multivariable Cox modelling. Multiple imputation was used to address missing values.

 RESULTS

Among 854 unique patients, there were 587 deaths. The median follow-up time from surgery was 9.6 years. Predictors of survival included age, stage, performance status, body mass index, history of myocardial infarction, renal function and DLCO. On univariate analysis, the hazard ratio increased incrementally compared with those with a DLCO of ≥80% (70–79%, 1.12; 60–69%, 1.29; <60%, 1.35). On multivariable analysis, DLCO was an independent predictor of long-term survival for all patients (corrected for all other important covariates; HR 1.04 per 10-point decrement; 95% CI 1.00–1.08; P = 0.05). Its prognostic ability for long-term survival was above and beyond its influence on operative mortality.

 CONCLUSIONS

DLCO is an independent and clinically important determinant of long-term survival after major lung resection for cancer, a finding that is not generally known. Knowledge of this may help improve selection of patients for lung resection and may help tailor the extent of resection, when possible, in order to appropriately balance operative risk with long-term outcomes.

Nutrition and Asthma

Over the past four decades, the prevalence of asthma has markedly increased in Westernized countries and countries transitioning to this lifestyle.

It has been hypothesized that these increases are a consequence of changing environmental and/or behavioral factors. The modification of dietary habits (ie, decreased intake of fruits/vegetables and increased intake of “Westernized” processed foods) and a decrease in sun exposure have led to decreased intake of antioxidant vitamins and fatty acids and to decreased circulating levels of vitamin D, and have been proposed to explain the rise in asthma prevalence.

This article summarizes the main findings on foods and nutrients connected to asthma based on several exhaustive recent reviews on the topic, and examines the evidence for an effect of dietary patterns on asthma. Overall, findings underscore the importance of conducting prospective studies and clinical trials to better understand the role of diet in the etiology of asthma.

Recent Advances in the Epidemiologic Investigation of Risk Factors for Asthma: A Review of the 2011 Literature

 

The present review aims to identify and summarize epidemiologic investigations published during 2011 on the environmental risk factors for asthma.

Potentially eligible papers were identified by a MEDLINE search. In total, 1,130 items were retrieved. Based on a broad definition of environment, the following topics were included: obesity, diet, vitamin D, air pollution, farming environment, and social factors.

Some of the more relevant contributions included evidence that

  1. obesity precedes asthma,
  2. fruit consumption is longitudinally associated with a lower risk of asthma and atopy,
  3. a comprehensive statewide smoking ban was followed by a reduction in hospital admissions for asthma,
  4. asthma is one of the diseases showing the largest burdens due to environmental tobacco smoke,
  5. traffic-related urban air pollution is associated with bronchial inflammation as measured by fractional exhaled nitric oxide and uncontrolled asthma,
  6. aeroallergens and desert dust may contribute to the short-term effects of air pollution and asthma,
  7. and maternal exposure to air pollution before and during pregnancy may alter the immune competence in offspring.

Epigenetics, Asthma, and Allergic Diseases: A Review of the Latest Advancements

 

Environmental epigenetic regulation in asthma and allergic disease is an exciting area that has gained a great deal of scientific momentum in recent years. Environmental exposures, including prenatal maternal smoking, have been associated with asthma-related outcomes that may be explained by epigenetic regulation. In addition, several known allergy and asthma genes have been found to be susceptible to epigenetic regulation.

We review the latest experimental and translational studies that have been published this past year in several areas, including

  1. characterization of environmental asthma triggers that induce epigenetic changes,
  2. characterization of allergic immune and regulatory pathways important to asthma that undergo epigenetic regulation,
  3. evidence of active epigenetic regulation in asthma experimental models and the production of asthma biomarkers,
  4. evidence of transmission of an asthma-related phenotype across multiple generations,
  5. and  “pharmaco-epigenetics.” The field has certainly advanced significantly in the past year.

 

Symptom profile and risk factors of anaphylaxis in Central Europe

Anaphylaxis is the most severe manifestation of an IgE-dependent allergy. Standardized acquired clinical data from large cohorts of well-defined cases are not available. The aim of this study was to analyse the symptom profile and risk factors of anaphylaxis in a large Central European cohort.

Methods : We acquired data from patients in Germany, Austria and Switzerland who experienced a severe allergic reaction defined by the onset of severe pulmonary and/or severe cardiovascular symptoms. The data were gained via an online questionnaire from 83 medical centres specialized in allergy. Data were collected from 2006 to 2010 and analysed by using a multinomial regression model.

Results : A total of 2012 paediatric and adult patients were included into the present analysis. The skin (84%) was the most frequently affected organ followed by the cardiovascular (72%) and the respiratory (68%) system. The regression model analysing the onset of cardiovascular versus respiratory symptoms revealed a strong impact of age (adjusted OR = 6.08; 95% CI, 3.35–11.01; P < 0.001). Furthermore, the elicitor food (adjusted OR = 0.29; 95% CI, 0.21–0.41, P < 0.001) and the presence of atopic diseases (adjusted OR = 0.54; 95% CI, 0.40–0.73, P < 0.001) were significantly associated with the onset of respiratory symptoms.

Conclusion : Data from individuals who experienced anaphylaxis can support the identification of risk factors. The present study indicates that age, the elicitor itself and the presence of atopic diseases have an impact on the symptom profile of anaphylaxis. Identifying further risk factors of anaphylaxis is of significant importance for clinical practice in the future.

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