Impact of socio-economic position on cancer stage at presentation: Findings from a large hospital-based study in Germany.

We explored the relationship between socio-economic characteristics and cancer stage at presentation. Patients admitted to a university hospital for diagnosis and treatment of cancer provided data on their education, vocational training, income, employment, job, health insurance and postcode. Tumor stage was classified according to the Union International Contre le Cancer (UICC). To analyze disparities in the likelihood of late-stage (UICC III/IV vs. I/II) diagnoses, logistic regression models adjusting for age and gender were used. Out of 1,012 patients, 572 (59%) had late-stage cancer. Separately tested, increased odds of advanced disease were associated with post-compulsory education compared to college degrees, with apprenticeship and no vocational training, with unemployment, disability pension, jobs with a low hierarchy level, blue collar jobs and with low income. Health insurance and community size were not related with late-stage cancer. Jointly modelled, there was evidence for an independent effect of unemployment (odds ratio (OR) 1.7, CI 1.0-2.8), disability pension (OR 1.8, CI 1.0-3.2) and very low income (OR 2.6, CI 1.1-6.1) on the likelihood of advanced disease stage. It is of great concern that these socio-economic gradients occur even in systems with equal access to health care.

Diffuse Interstitial Pulmonary Infiltrates in Malignant Melanoma.

Only a few cases of sarcoidosis-like reaction to a pharmacologic compound have been reported in patients with melanoma in the literature. Long-term treatment with interferon alpha may be assumed. We report a case of a 25-y-old man who presented to our department with diffuse interstitial pulmonary infiltrates and slightly enlarged mediastinal lymph nodes as determined by computed tomography. He had a history of malignant melanoma with 18 months of interferon alpha-2 therapy. Histological analysis of a transbronchial biopsy revealed sarcoidosis-like reactions.

Effects of nasal high flow on ventilation in volunteers, COPD and idiopathic pulmonary fibrosis patients.

BACKGROUND: A high flow of air applied by large bore nasal cannulae has been suggested to improve symptoms of chronic respiratory insufficiency. In pediatric patients, nasal high-flow (nHF) ventilation was similarly effective compared to noninvasive ventilation with a face mask. OBJECTIVES: The aim of this study was to describe changes in respiratory parameters. METHODS: We measured pressure amplitudes during the respiratory cycle and mean pressures in patients with idiopathic pulmonary fibrosis (IPF) and COPD. In order to achieve tidal volume and minute volume measurements, we used a polysomnography device. Capillary blood was taken for blood gas analysis before and after nHF breathing (8 h). RESULTS: nHF led to an increase in pressure amplitude and mean pressure in healthy volunteers and in patients with COPD and IPF in comparison with spontaneous breathing. In COPD, nHF increased tidal volume, while no difference in tidal volume was observed in patients with IPF. Interestingly, tidal volume decreased in healthy volunteers. Breathing rates and minute volumes were reduced in all groups. Capillary pCO2 decreased in patients with IPF and COPD. CONCLUSIONS: nHF resulted in significant effects on respiratory parameters in patients with obstructive and restrictive pulmonary diseases. The rise in pressure amplitude and mean pressure and the decrease in breathing rate and minute volume will support inspiratory efforts, helps to increase effectiveness of ventilation and will contribute to a reduction in the work of breathing. A CO2 wash-out effect in the upper airway part of the anatomical dead space may contribute to the beneficial effects of the nHF instrument.

Candidate genes upregulated in density dependent growth inhibition of lung cancer cells.

Prognosis of lung cancer remains poor despite the recent development of new chemotherapeutic agents. Novel therapeutic strategies therefore need to be developed. The search for factors inhibiting tumor growth in a paracrine/autocrine fashion might result in a well-tolerated adjuvant tumor therapy. In this study we aimed to identify candidate genes for such inhibitors of tumor cell growth. Native and heat-inactivated supernatants of confluent, slow growing H460 tumor cell cultures and of sparse (non-confluent), fast growing H460 tumor cell cultures were tested in proliferation assays. We observed that native supernatant of confluent H460 and A549 cells contain proteins inhibiting tumor cell growth of NSCLC cell lines. Microarray gene expression analysis of sparse and confluent H460 cells exhibited overexpression of 7 candidate genes in confluent, slow growing cells. The products of these genes possess cell growth inhibitory function and also exist in the extracellular compartment. The increased expression level of these genes was verified using real-time RT-PCR analysis. Our results show that especially components of IGF pathway appear to be involved in exogenous growth inhibition of confluent cells. Further investigations of these factors may result in the identification of autocrine/paracrine tumor cell growth inhibitory proteins for future use in clinical applications.