Epithelial mesenchymal transition (EMT), a spectrum of states: role in lung development, homeostasis and disease.
Dev Dyn. 2017 Jun 24;:
Authors: Jolly MK, Ward C, Eapen MS, Myers S, Hallgren O, Levine H, Sohal SS
Epithelial Mesenchymal Transition (EMT) plays key roles during lung development and many lung diseases such as Chronic Obstructive Pulmonary Disease (COPD), lung cancer and pulmonary fibrosis. Here, integrating morphological observations with underlying molecular mechanisms, we highlight the functional role of EMT in lung development and injury repair, and discuss how it can contribute to pathogenesis of chronic lung disease. We discuss the evidence of manifestation of EMT and its potential driving role in COPD, idiopathic pulmonary fibrosis (IPF), bronchiolitis obliterans syndrome (BOS), and lung cancer, while noting that all cells need not display a full EMT in any of these contexts, i.e. often cells co-express epithelial and mesenchymal markers but do not fully convert to extracellular matrix-producing fibroblasts. Finally, we discuss recent therapeutic attempts to restrict EMT in chronic lung disease. This article is protected by copyright. All rights reserved.
PMID: 28646553 [PubMed - as supplied by publisher]
Item usage in a multidimensional computerized adaptive test (MCAT) measuring health-related quality of life.
Qual Life Res. 2017 Jun 23;:
Authors: Paap MCS, Kroeze KA, Terwee CB, van der Palen J, Veldkamp BP
PURPOSE: Examining item usage is an important step in evaluating the performance of a computerized adaptive test (CAT). We study item usage for a newly developed multidimensional CAT which draws items from three PROMIS domains, as well as a disease-specific one.
METHODS: The multidimensional item bank used in the current study contained 194 items from four domains: the PROMIS domains fatigue, physical function, and ability to participate in social roles and activities, and a disease-specific domain (the COPD-SIB). The item bank was calibrated using the multidimensional graded response model and data of 795 patients with chronic obstructive pulmonary disease. To evaluate the item usage rates of all individual items in our item bank, CAT simulations were performed on responses generated based on a multivariate uniform distribution. The outcome variables included active bank size and item overuse (usage rate larger than the expected item usage rate).
RESULTS: For average θ-values, the overall active bank size was 9-10%; this number quickly increased as θ-values became more extreme. For values of -2 and +2, the overall active bank size equaled 39-40%. There was 78% overlap between overused items and active bank size for average θ-values. For more extreme θ-values, the overused items made up a much smaller part of the active bank size: here the overlap was only 35%.
CONCLUSIONS: Our results strengthen the claim that relatively short item banks may suffice when using polytomous items (and no content constraints/exposure control mechanisms), especially when using MCAT.
PMID: 28646374 [PubMed - as supplied by publisher]
Why do physicians lack engagement with smoking cessation treatment in their COPD patients? A multinational qualitative study.
NPJ Prim Care Respir Med. 2017 Jun 23;27(1):41
Authors: van Eerd EAM, Bech Risør M, Spigt M, Godycki-Cwirko M, Andreeva E, Francis N, Wollny A, Melbye H, van Schayck O, Kotz D
Smoking cessation is the only effective intervention to slow down the accelerated decline in lung function in smokers with chronic obstructive pulmonary disease. Nevertheless, physicians often do not routinely provide evidence-based smoking cessation treatment to their patients. To understand underlying reasons, we explored how physicians engage in smoking cessation treatment in their chronic obstructive pulmonary disease patients. In total, 21 focus group discussions were held with general practitioners and pulmonologists in seven different countries in Europe and Asia. We generated three themes, whereby some of the issues concerned smokers in general: first, 'physicians' frustration with chronic obstructive pulmonary disease patients who smoke'. These frustrations interfered with the provision of evidence-based treatment and could result in this group of patients being treated unequally. Second: 'physicians' limited knowledge of, and negative beliefs about, smoking cessation treatment'. This hindered treating smokers effectively. Third: 'healthcare organisational factors that influence the use of smoking cessation treatments'. Money and time issues, as well as the failure to regard smoking as a disease, influenced how physicians engaged in smoking cessation treatment. Our results indicate that there is a number of barriers to the provision of effective smoking cessation treatment in patients with chronic obstructive pulmonary disease and smokers in general. Introducing an informative smoking cessation programme, including communication skills and ethical issues, in the vocational and postgraduate medical training may help to address these barriers. This is important in order to increase engagement with smoking cessation treatment and to improve quality of chronic obstructive pulmonary disease care.
CHRONIC LUNG DISEASE: CHANGING ATTITUDES TO HELP PATIENTS STOP SMOKING: Doctors should be given careful, ethically-informed guidance during medical training to help them to support patients to quit smoking. The most important part of treatment for patients with chronic obstructive pulmonary disease (COPD) is help to stop smoking. However, there is evidence to suggest that doctors don't always motivate COPD patients to quit. Eva Anne Marije van Eerd at Maastrict University, The Netherlands, together with an international team of scientists, conducted focus group interviews with doctors in seven different countries to assess barriers to smoking cessation. They found that doctors' frustration with and negative attitudes towards patients who continued to smoke contributed to poor cessation management and treatment inequalities in some cases. Many doctors also cited a lack of experience with smoking cessation techniques alongside time and money issues as barriers to effective treatment.
PMID: 28646217 [PubMed - in process]
Association between chronic obstructive pulmonary disease and increased risk of benign prostatic hyperplasia: a retrospective nationwide cohort study.
BMJ Open. 2017 Jun 23;7(6):e015581
Authors: Peng YH, Huang CW, Liao WC, Chen HJ, Yin MC, Huang YM, Wu TN, Ho WC
OBJECTIVE: Chronic obstructive pulmonary disease (COPD) and benign prostatic hyperplasia (BPH) are common disorders in ageing male populations. Nevertheless, the relationship between the two diseases has rarely been explored. The objective of this study was to examine whether patients with COPD are at an increased risk of BPH.
DESIGN: Retrospective nationwide cohort study.
SETTING: Data retrieved from the Taiwan National Health Insurance Research Database.
PARTICIPANTS: Overall, 19 959 male patients aged 40 years and over with newly diagnosed COPD between 2000 and 2006 were included as the COPD group, and 19 959 sex-matched and age-matched enrollees without COPD were included as the non-COPD group. Both groups were followed-up until the end of 2011.
OUTCOME MEASURES: A Cox proportional hazards regression model was used to compute the risk of BPH in patients with COPD compared with enrollees without COPD.
RESULTS: The overall incidence rate of BPH was 1.53 times higher in the COPD group than that in the non-COPD group (44.7 vs 25.7 per 1000 person-years, 95% CI 1.46 to 1.60) after adjusting for covariates. An additional stratified analysis revealed that this increased risk of BPH in patients with COPD remained significantly higher than that in enrollees without COPD in all men aged 40 years and over.
CONCLUSION: After adjustment for covariates, male patients with COPD were found to be at a higher risk of BPH. We suggest that clinicians should be cautious about the increased risk of BPH in male patients with COPD.
PMID: 28645971 [PubMed - in process]
Feasibility of average volume-assured pressure support ventilation in the treatment of acute hypercapnic respiratory failure associated with chronic obstructive pulmonary disease: What are its limits?
J Crit Care. 2017 May 23;:
Authors: Briones Claudett KH
PMID: 28645728 [PubMed - as supplied by publisher]