Results of initial low-dose computed tomographic screening for lung cancer.

N Engl J Med. 2013 May 23;368(21):1980-91

Authors: National Lung Screening Trial Research Team, Church TR, Black WC, Aberle DR, Berg CD, Clingan KL, Duan F, Fagerstrom RM, Gareen IF, Gierada DS, Jones GC, Mahon I, Marcus PM, Sicks JD, Jain A, Baum S

Abstract
BACKGROUND: Lung cancer is the largest contributor to mortality from cancer. The National Lung Screening Trial (NLST) showed that screening with low-dose helical computed tomography (CT) rather than with chest radiography reduced mortality from lung cancer. We describe the screening, diagnosis, and limited treatment results from the initial round of screening in the NLST to inform and improve lung-cancer-screening programs.
METHODS: At 33 U.S. centers, from August 2002 through April 2004, we enrolled asymptomatic participants, 55 to 74 years of age, with a history of at least 30 pack-years of smoking. The participants were randomly assigned to undergo annual screening, with the use of either low-dose CT or chest radiography, for 3 years. Nodules or other suspicious findings were classified as positive results. This article reports findings from the initial screening examination.
RESULTS: A total of 53,439 eligible participants were randomly assigned to a study group (26,715 to low-dose CT and 26,724 to chest radiography); 26,309 participants (98.5%) and 26,035 (97.4%), respectively, underwent screening. A total of 7191 participants (27.3%) in the low-dose CT group and 2387 (9.2%) in the radiography group had a positive screening result; in the respective groups, 6369 participants (90.4%) and 2176 (92.7%) had at least one follow-up diagnostic procedure, including imaging in 5717 (81.1%) and 2010 (85.6%) and surgery in 297 (4.2%) and 121 (5.2%). Lung cancer was diagnosed in 292 participants (1.1%) in the low-dose CT group versus 190 (0.7%) in the radiography group (stage 1 in 158 vs. 70 participants and stage IIB to IV in 120 vs. 112). Sensitivity and specificity were 93.8% and 73.4% for low-dose CT and 73.5% and 91.3% for chest radiography, respectively.
CONCLUSIONS: The NLST initial screening results are consistent with the existing literature on screening by means of low-dose CT and chest radiography, suggesting that a reduction in mortality from lung cancer is achievable at U.S. screening centers that have staff experienced in chest CT. (Funded by the National Cancer Institute; NLST ClinicalTrials.gov number, NCT00047385.).

PMID: 23697514 [PubMed - indexed for MEDLINE]

Cell Therapy for Lung Diseases: Report from an NIH-NHLBI Workshop November 13-14, 2012.

Am J Respir Crit Care Med. 2013 May 28;

Authors: Matthay MA, Anversa P, Bhattacharya J, Burnett BK, Chapman HA, Hare JM, Hei DJ, Hoffman AM, Kourembanas S, McKenna DH, Ortiz LA, Ott HC, Tente W, Thébaud B, Trapnell BC, Weiss DJ, Yuan JX, Blaisdell CJ

Abstract
The National Institutes of Health- National Heart, Lung, and Blood Institute (NIH-NHLBI) convened the Cell Therapy for Lung Disease working group on November 13-14, 2012, to review and formulate recommendations for future research directions. The workshop brought together investigators studying basic mechanisms and the roles of cell therapy in preclinical models of lung injury and pulmonary vascular disease, with clinical trial experts in cell therapy for cardiovascular diseases and experts from NHLBI's Production Assistance for Cell Therapy (PACT) program. The purpose of the workshop was to discuss the current status of basic investigations in lung cell therapy, to identify some of the scientific gaps in current knowledge regarding the potential roles and mechanisms of cell therapy in the treatment of lung diseases, and to develop recommendations to the NHLBI and the research community on scientific priorities and practical steps that would lead to first-in-human trials of lung cell therapy.

PMID: 23713908 [PubMed - as supplied by publisher]

Continuous Positive Airway Pressure in Clinically Stable Patients with Mild-To-Moderate Obesity-Hypoventilation Syndrome and Obstructive Sleep Apnea.

Respirology. 2013 May 29;

Authors: Salord N, Mayos M, Miralda RM, Farré A, Carreras M, Sust R, Masuet-Aumatell C, Rodríguez J, Pérez A

Abstract
BACKGROUND AND OBJECTIVE: The use of continuous positive airway pressure (CPAP) treatment in patients with obesity hypoventilation syndrome (OHS) and obstructive sleep apnea (OSA) was evaluated and factors that might predict CPAP treatment failure were determined. METHODS: A sleep study was performed in 29 newly diagnosed, clinically stable OHS patients. CPAP treatment was commenced if the apnea-hypopnea index was >15. Lung function, night-time oximetry, blood adipokine and C-reactive protein levels were assessed prospectively on enrollment and after 3 months. Treatment failure at 3 months was defined as daytime PaCO2 >45 mmHg and/or oxygen saturation (SpO2) <90% for >30% of the night-time oximetry study. RESULTS: All patients had severe OSA (median apnea-hypopnea index (AHI) = 74.7(62-100) with a nocturnal mean SpO2 of 81.4±7) and all patient were treated with CPAP. The percentage of time spent below 90% saturation improved from 8.4% (0.0-39.0%) to 0.3% (0.4-4.0%). Awake PaCO2 decreased from 50 (47-53) mmHg to 43 (40-45) mmHg. Seven patients failed CPAP treatment after three month. PaCO2 at 1 month and mean night-time SpO2 during the first night of optimal CPAP were associated with treatment failure at 3 months [ODDS ratio 1.4(1.03-1.98); p=0.034 and 0.6(0.34-0.93); p=0.027]. CONCLUSIONS: CPAP treatment improves night-time oxygenation and daytime hypoventilation in selected clinically stable OHS patients who also have OSA. Patients with worse night-time saturation while on CPAP and higher daytime PaCO2 at one month were more likely to fail CPAP treatment.

PMID: 23714281 [PubMed - as supplied by publisher]