Small Cell Lung Cancer: Are We Making Progress?

Although the incidence of small cell lung cancer (SCLC) has declined during the past 30 years, it remains a significant cause of cancer mortality in the United States and across the world. With appropriate treatment, about 20% of patients who present with limited stage SCLC can be cured of their disease. Unfortunately, the outcome for the remainder of patients is extremely poor. The only significant advance in extensive stage SCLC in the past 2 decades is the recent discovery that prophylactic cranial irradiation improves survival in those patients whose disease has responded to initial chemotherapy. Numerous attempts to enhance the antitumor effects of traditional chemotherapy for SCLC have not been successful. As the understanding of the biology of SCLC increased, a number of rational molecular targets for therapy have been identified. Although initial attempts at “targeted therapy” in SCLC have been unsuccessful, several newly identified targets hold promise and give hope that significant improvements in therapy for this challenging disease are not far away.     

When Should 99mTc Bone Scintigraphy Be Performed in cT1N0 Non-Small Cell Lung Cancer Patients?

The aim of this retrospective study was to investigate the risk factors for bone metastases (BM) in clinical T1N0 non-small cell lung cancer (NSCLC) patients.From January 2010 to June 2012, 739 patients with primary diagnosed cT1N0 NSCLC were eligible for this study. Clinical variables, including sex, smoking history, age at diagnosis, tumor size, pathologic subtype, preoperative serum Carcino embryonie antigen (CEA) level, lesion imaging performance, and skeletal system symptom, were collected.BM were found in 7 patients (0.95%), in whom 6 patients had skeletal system symptom and 1 had silent metastasis. The frequency of BM was significantly high in younger patients (P = 0.007) and in patients with higher preoperative serum CEA level (P = 0.05). In multivariate analysis, age less than 50 years old (OR = 2.23, 95% CI: 1.56–4.21, P = 0.02), presence of clinical symptom (OR = 3.15, 95% CI: 1.98–6.42, P = 0.008), and CEA level over 5 μg/mL (OR = 2.14, 95% CI: 1.37–3.53, P = 0.03) were independently associated with BM in cT1N0 NSCLC patients.Presence of skeletal system symptom is not the unique criteria for performing BS. Younger age at diagnosis and higher preoperative serum CEA level are also risk factors for BM in cT1N0 NSCLC patients. Therefore, the selection of early-stage NSCLC patients being performed BS should be more precise in the future.     

In Vitro Susceptibility Testing in Fungi: What is its Role in Clinical Practice?

An increasing number of patients are undergoing transplantation procedures or receiving aggressive immunosuppression and chemotherapy. The growing population of immunocompromised hosts has led to a rise in the prevalence of invasive fungal infections due to yeasts and molds. The introduction of new antifungal agents and recent reports of resistance emerging during treatment of fungal infections have highlighted the need for in vitro susceptibility testing. Various testing procedures have been proposed, including macrodilution and microdilution, agar diffusion, disk diffusion, and Etest (AB Biodisk, Solna, Sweden). Establishing clinical correlation with antifungal susceptibility testing, however, is a huge challenge because susceptibility techniques do not take into account the dynamic and complex biology of fungi exposed to an antifungal in vivo. This paper reviews the available methods for antifungal susceptibility testing of yeasts and filamentous fungi and the data regarding the clinical implications of in vitro testing.     

Evaluation of Clinical Innovation: A Gray Zone in the Ethics of Modern Clinical Practice?

BACKGROUND

Various stakeholders can have differing opinions regarding ethical review when introducing new procedures with patients.

OBJECTIVE

This pilot study examines the way in which Research Ethics Boards (REBs; Institutional Review Boards) and clinical biochemists (CBs; laboratory medicine specialists) differ in their interpretation of what is research and what should be considered common practice versus innovation versus experimentation when introducing new procedures with patients. It also explores whether these groups agree on who is responsible for the ethical review of new procedures.

METHODS

A validated case scenario for the introduction of a new diagnostic test into clinical practice was sent to CBs and REBs across Canada. Participants were asked to determine whether the scenario constituted research; whether the test procedure should be considered as experimental, innovative, or commonly accepted care; and whether the project required approval by a REB and, if not, who should be responsible for ethical review.

RESULTS

Results showed 81% of 37 CBs and 52% of 27 REBs identified the scenario as research. Responsibility for ethical review was assigned to REBs by 44% of REBs and 54% of CBs. Of all participants, 53% classified the test procedure as ‘innovative’, 8% as ‘experimental’, whereas 17% classified it as ‘commonly accepted’.

CONCLUSIONS

This pilot study indicates a substantial variation in the ethical assessment of innovation in clinical care. This suggests the need to further elaborate on the types of innovation in health care and categorize the nature of the risks associated with each.

     

Quantitative Computed Tomography: What Clinical Questions Can it Answer in Chronic Lung Disease?

Quantitative computed tomography (QCT) has recently gained an important role in the functional assessment of chronic lung disease. Its capacity in diagnostic, staging, and prognostic evaluation in this setting is similar to that of traditional pulmonary function testing. Furthermore, it can demonstrate lung injury before the alteration of pulmonary function test parameters, and it enables the classification of disease phenotypes, contributing to the customization of therapy and performance of comparative studies without the intra- and inter-observer variation that occurs with qualitative analysis. In this review, we address technical issues with QCT analysis and demonstrate the ability of this modality to answer clinical questions encountered in daily practice in the management of patients with chronic lung disease.

     

Growth Assessment in Clinical Practice: Whose Growth Curve?

Differences in growth curves can influence the diagnosis of under- and overnutrition, and the interpretation of adequate growth following nutrition intervention. This effect is notable when comparing the World Health Organization (WHO) 2006 Growth Standard and the Centers for Disease Control and Prevention (CDC) 2000 Growth Reference for infants and children to 59 months of age. Important differences relate to conceptual approaches for generating growth standards to describe what population growth should be, compared to a reference of what growth is. WHO included only term infants exclusively or predominantly breast-fed beyond 4 months, and data for infants and children indicative of excess adiposity and growth failure were removed. Thus, fewer children are diagnosed with poor weight gain, and more with excess adiposity, using the WHO Growth Standard than when using the CDC Growth Reference. Adequate growth is based on proportional height and weight gains that track along growth curve trajectories. Use of the WHO curves should assist in prevention of inappropriate intervention or overfeeding in young children.