Real-world EGFR testing practices for non-small-cell lung cancer by thoracic pathology laboratories across Europe.

BACKGROUND: Testing for epidermal growth factor receptor (EGFR) mutations is an essential recommendation in guidelines for metastatic non-squamous non-small-cell lung cancer, and is considered mandatory in European countries. However, in practice, challenges are often faced when carrying out routine biomarker testing, including access to testing, inadequate tissue samples and long turnaround times (TATs). MATERIALS AND METHODS: To evaluate the real-world EGFR testing practices of European pathology laboratories, an online survey was set up and validated by the Pulmonary Pathology Working Group of the European Society of Pathology and distributed to 64 expert testing laboratories. The retrospective survey focussed on laboratory organisation and daily EGFR testing practice of pathologists and molecular biologists between 2018 and 2021. RESULTS: TATs varied greatly both between and within countries. These discrepancies may be partly due to reflex testing practices, as 20.8% of laboratories carried out EGFR testing only at the request of the clinician. Many laboratories across Europe still favour single-test sequencing as a primary method of EGFR mutation identification; 32.7% indicated that they only used targeted techniques and 45.1% used single-gene testing followed by next-generation sequencing (NGS), depending on the case. Reported testing rates were consistent over time with no significant decrease in the number of EGFR tests carried out in 2020, despite the increased pressure faced by testing facilities during the COVID-19 pandemic. ISO 15189 accreditation was reported by 42.0% of molecular biology laboratories for single-test sequencing, and by 42.3% for NGS. 92.5% of laboratories indicated they regularly participate in an external quality assessment scheme. CONCLUSIONS: These results highlight the strong heterogeneity of EGFR testing that still occurs within thoracic pathology and molecular biology laboratories across Europe. Even among expert testing facilities there is variability in testing capabilities, TAT, reflex testing practice and laboratory accreditation, stressing the need to harmonise reimbursement technologies and decision-making algorithms in Europe.

Novel cooperation between CX3CL1 and CCL26 inducing NK cell chemotaxis via CX3CR1: a possible mechanism for NK cell infiltration of the allergic nasal tissue.

BACKGROUND: Recent data indicated that natural killer (NK) cells and chemokines could play a pivotal role in nasal inflammation. CX3CR1, the only receptor for fractalkine/CX3CL1, is abundantly expressed by NK cells, and was recently shown to also be a receptor for eotaxin-3/CCL26. However, no reports explored the NK cells-CX3CL1-CCL26 axis via CX3CR1 in allergy. OBJECTIVE: Our goals were first to determine specifically NK cell recruitment pattern in nasal tissue of allergic chronic rhinosinusitis (ACRS) and non-allergic chronic rhinosinusitis (NACRS) patients in comparison with healthy controls, and secondly, to investigate the function of CX3CR1 in NK cell migration. METHODS: Immunohistochemistry, microchemotaxis chambers, flow cytometry and confocal microscopy were used in this study. RESULTS: Herein, we showed that NK cells infiltrated the epithelial layers of nasal tissue only in ACRS patients and not in NACRS patients or controls. NK cells were also more numerous in the stroma of the nasal tissue from ACRS patients compared with NACRS patients or controls. This migration could be mediated by both CX3CL1 and CCL26, as these two chemokines induced NK cell migration. Moreover, both molecules also stimulated cytoskeleton changes and F-actin reorganisation in NK cells. Chemotaxis and cytoskeleton changes were sensitive to genistein, a tyrosine kinase inhibitor. By flow cytometry, we demonstrated that a single antigen nasal provocation challenge increased the expression of CX3CR1 on NK cells in allergic rhinitis (AR) patients. The function of this receptor was associated with a significant augmentation of NK cell chemotaxis against the optimal doses of CX3CL1 and CCL26. CONCLUSIONS AND CLINICAL RELEVANCE: Our results highlight a novel role for CX3CR1 in NK cell migration that may contribute to the NK cell trafficking to the allergic upper airway. This could be mediated largely by CX3CL1 and CCL26 stimulation of the tyrosine kinase pathway.

[Fish and chips]. / Fish and chips.

Academic hospital laboratories should offer patients the possibility to have the most accurate diagnosis by the development of new analyses, such as molecular biology tests including FISH (Fluorescent In Situ Hybridization) and chips (microarrays,...). The purpose of this article is to describe the principles and the potential applications of these techniques.

Health effects of job insecurity among employees in the Swiss general population.

This study looks at the health consequences of the social distress caused by perceived levels of job insecurity. Through interviews with full- and part-time employees drawn from a random sample (N = 2,024) of the Swiss general population, the authors measured prevalence rates of ten self-reported indicators of health and health-related behavior according to three levels of perceived job insecurity (low, middle, high), and estimated odds ratios using logistic regression adjusted for relevant respondent characteristics. The results show that the psychosocial stress induced by job insecurity (fear of unemployment) has a negative effect on these health indicators. Fear of unemployment had a stronger unfavorable effect on health for highly educated employees than for the less educated. The authors make some recommendations for raising awareness about the health effects of job insecurity and taking these effects into account in policies and legislation affecting the labor market and work environment.

Daily consumption of (red) meat or meat products in Switzerland: results of the 1992/93 Swiss Health Survey.

OBJECTIVE: The present study aimed to examine the frequency of daily meat and meat product consumption and the preference for red meat in Switzerland. DESIGN: Cross-sectional Study. SETTINGS AND SUBJECTS: Data were taken from the 1992/1993 Swiss Health Survey, which collected data on a random sample of persons aged 15 and over, living in Switzerland. The survey, which had a response rate of 71%, included 7930 male and 7358 female respondents. Bivariate analyses and multivariate logistic regressions controlling for sociodemographic and lifestyle factors were performed. RESULTS: Daily consumption of meat or meat products (25%) and more frequent consumption of red than white meat (26% of meat eaters) were prevalent in Switzerland. Men, middle-aged persons, participants with a low level of education, persons living in the German or Francophone regions of Switzerland, those with Swiss nationality, smokers, overweight and obese people, those with daily alcohol consumption and physically inactive persons were found to consume daily meat or meat products more frequently. A preference for red meat rather than white meat was more often observed in men, young people, persons living in the German or Francophone regions of Switzerland, smokers and participants who consumed alcohol at least once daily. CONCLUSIONS: The analysis of data from the 1992/1993 Swiss Health Survey shows that in specific subgroups of the Swiss population meat and meat product consumption is still more frequent than recommended, but crude comparisons with older and more recent studies indicate a decrease in meat consumption. The observed clustering of daily meat consumption with other risk factors underscores the necessity to include dietary recommendations in health programs addressing other unhealthy lifestyles. European Journal of Clinical Nutrition (2000) 54, 136-142

[Inadequate fruit and vegetable consumption in Switzerland: results of the Swiss Health Survey 1992/93]. / Ungenügender Früchte- und Gemüsekonsum in der Schweiz: Resultate der Schweizerischen Gesundheitsbefragung 1992/93.

Inadequate consumption of fruit and vegetables increases the risk of various (chronical) diseases. It is therefore recommended to eat at least three portions of vegetables and two portions of fruit every day. The present study aims to determine the prevalence of inadequate fruit and vegetable (potatoes are not regarded as vegetables in Switzerland) consumption in Switzerland and to determine sociodemographic and lifestyle correlates of inadequate consumption. Data presented in this study were taken from the first national representative health survey for Switzerland (conducted 1992/1993) including 7930 men and 7358 women (response rate 71%), age 15 and over. Bivariate analyses and multivariate logistic regressions controlling for sociodemographic and lifestyle factors were done. Inadequate consumption of fruit and vegetables was common among the study population. Less than daily consumption of fruit was reported by about 30%, of vegetables by 17%. About 25% of study participants do not eat fruit or vegetables every day, for 11% the consumption of both is insufficient. Men, young people, study participants with a low educational background, people living in the French and Italian speaking part of Switzerland, smokers and participants with low physical activity reported more often inadequate fruit and vegetable intake than women, older people, well educated study participants, inhabitants of the German speaking part of Switzerland, nonsmokers, and less physically active people. These results stress the need for nutrition education programs aimed at increased consumption of fruit and vegetables in Switzerland.

[Incidence of operations in Switzerland related to insurance status]. / Die Häufigkeit von Operationen in der Schweiz nach Versicherungsstatus.

Several studies reported in the literature show that surgical procedures can be carried out for other than clinical indications. In Switzerland, no statistics on the "demography" of surgical procedures are available. But an earlier analysis of the "Swiss Health Survey 1992/93" gave first indications on differences in rates of surgical procedures (hysterectomy, appendectomy, tonsillectomy and operation of the hip and gallbladder) by sex, educational status and region. This study, based on the same datasource (N = 10792), reveals an additional link with the health insurance status. The prevalence of surgical procedures is higher in privately insured than in persons with only basic insurance, independent of age, sex and region. The highest rates of surgical procedures (except tonsillectomy) are found among privately insured persons with a low educational status. Among 25-74 year old privately insured women, the lifetime-prevalence of a hysterectomy is 30% with low and 13% with high educational status (p < .001). The corresponding prevalences of at least one of the mentioned surgical procedures (without tonsillectomy) are 49% versus 28% (p < .001). As these are lifetime-prevalences, these rates do not necessarily reflect the actual surgical procedures. However, an analysis of the period of operation for hysterectomy and for the gallbladder shows the same pattern as the mentioned lifetime-prevalences. Higher rates among privately insured are also a frequent finding in the international literature. These findings should stimulate patients to ask for a "second opinion". Furthermore, there is an urge for the implementation of general hospital statistics to verify such findings. In addition, the scientific consensus on the indication of several surgical procedures should be promoted on the way to more evidence-based-medicine.

Social class gradients in years of potential life lost in Switzerland.

Analysis of the official Swiss mortality data have shown considerable social differences. In an earlier study of Swiss men aged 15-74 for the period 1979-1982 the social class mortality differentials have been analysed using standardized mortality ratios (SMR). The present study extends this previous work by calculating years of potential life lost (YPLL) before age 75, an additional indicator of mortality that puts more importance on deaths at younger ages. Emphasis is given on causes contributing to most years of life lost, especially to accidents and violent deaths, which result in more than 30% of total years of life lost. The distribution of years of life lost of the most important causes to social classes is illustrated also for age-specific groups. Additionally, this article presents all causes which account for more than 3% of total years of life lost. The social inequalities are shown as ratios between the social class with the highest (skilled manual workers) and the lowest risk (professionals). Most years of life are lost by skilled manual workers not only in general but also cause-specific. While the SMR from all causes of death showed a 2-fold difference between professionals and skilled manual workers, the social gradient in YPLL rate was even larger (2.5). Hence, the measure of years of potential life lost emphasizes the disadvantage of skilled manual workers to die earlier than professionals. The concept of YPLL proved to be a useful additional indicator not only of mortality in general, but also especially for monitoring causes, related to the lower social classes.

[Melanoma mortality in switzerland 1970-1986]. / Die Melanommortalität in der Schweiz 1970-1986.

Time trends of mortality from malignant melanoma in Switzerland are presented. The death rates are based on the death certificates routinely collected by the Federal Office of Statistics and are age-adjusted (standard Europe). Mortality rates in Switzerland are the highest of any country in central Europe. Time trends in mortality show a significant increase in the elderly (aged over 64 years), whereas in the younger age group (30-64 years), the trend remains constant (no significant increase). For all age groups there is a significant increase in mortality (26% for men and 20% for women). Risk factors are presented. A higher risk of mortality from malignant melanoma among upper socioeconomic strata also applies to Switzerland. In view of the reported time trend in mortality, it is suggested that elderly people be addressed more specifically in future melanoma education campaigns.

[Problems in definition and comparison of perinatal and infant mortality]. / Probleme der Definition und Vergleichbarkeit der perinatalen und Säuglingssterblichkeit.

One of the reasons for variations in infant mortality could be the differences in registration of vital events. In this paper the legal definitions regarding spontaneous abortion, stillbirth and live birth are studied taking into account international and time related differences. One of the often cited influencing factors on registration--the religion--has possibly influenced differences between Swiss cantons before the sixties.