NHLBI Workshop: Improving Outcomes for Pulmonary Vascular Disease.

Circulation. 2012 Mar 2;

Authors: Robbins IM, Moore TM, Blaisdell CJ, Abman SH

Abstract
Recognizing the importance of improving cardiopulmonary health through research, the National Heart, Lung, and Blood Institute (NHLBI) convened a workshop of multi-disciplinary experts for the following purpose: 1) to review the current scientific knowledge underlying the basis for treatment of adults and children with pulmonary vascular diseases (PVD); 2) to identify gaps, barriers and emerging scientific opportunities in translational PVD research and the means to capitalize on these opportunities; 3) to prioritize new research directions that would be expected to affect the clinical course of PVD; and 4) to make recommendations to the Recognizing the importance of improving lung health through lung disease research, the National Heart, Lung, and Blood Institute (NHLBI) convened a workshop of multi-disciplinary experts for the following purpose: 1) to review the current scientific knowledge underlying the basis for treatment of adults and children with pulmonary vascular diseases (PVD); 2) to identify gaps, barriers and emerging scientific opportunities in translational PVD research and the means to capitalize on these opportunities; 3) to prioritize new research directions that would be expected to affect the clinical course of PVD; and 4) to make recommendations to the NHLBI on how to fill identified gaps in adult and pediatric PVD clinical research. (SELECT FULL TEXT TO CONTINUE).

PMID: 22388326 [PubMed - as supplied by publisher]

Lung infections in the HIV-infected adult.

Curr Opin Pulm Med. 2012 Mar 1;

Authors: Raju R, Peters BS, Breen RA

Abstract
PURPOSE OF REVIEW: This review describes current epidemiology, diagnosis, treatment and prevention of adult HIV-related lung infections using evidence published within the past 2 years. RECENT FINDINGS: Recent evidence has helped better determine the importance of early initiation of antiretroviral therapy in co-infected individuals with advanced immune suppression. Although this has led to a greatly reduced incidence of opportunistic infections in people with HIV, Pneumocystis pneumonia remains common. Pneumonia due to bacterial pathogens, such as Streptococcus pneumoniae, also causes considerable disease burden, but emerging evidence of the clinical efficacy of pneumococcal vaccination, especially conjugated vaccines, offers considerable promise. As HIV-infected populations become older, more emphasis should be given to the potential benefit of influenza prevention, particularly with vaccination, and encouraging smoking cessation. Co-infection with tuberculosis is still a huge problem worldwide, but the recent development and use of simple clinical algorithms based on symptoms and point-of-care testing for recognizing active disease offers great potential. SUMMARY: The lung remains an important site of disease in HIV-infected individuals. Increasing emphasis should be placed upon prevention of infection and modification of risk factors.

PMID: 22388588 [PubMed - as supplied by publisher]

Treatment of interstitial lung diseases associated with connective tissue diseases.

Expert Rev Clin Pharmacol. 2012 Mar;5(2):219-27

Authors: Kobayashi A, Okamoto H

Abstract
A variety of interstitial lung diseases (ILDs) have been reported in association with connective tissue diseases (CTDs). ILD is commonly associated with multiple CTDs and accounts for significant morbidity and mortality in these conditions. In rheumatoid arthritis and systemic sclerosis, ILD commonly occurs in the course of these disorders (incidence: 20-44%). The pathological findings of ILDs are similar to those of idiopathic interstitial pneumonia. A wide variety of histopathologic features, such as various types of interstitial pneumonia and airway involvement, have been observed that are specific for ILDs in rheumatoid arthritis, and this high variety makes its pathology complicated. The diagnosis of ILD is generally based on clinical presentation, bronchioalveolar lavage fluid and high-resolution computed tomography, among others. The most important differential diagnosis is infection, especially pneumocystis pneumonia, and treatment-related toxic damage. The immunosuppressive agents most widely used for the treatment of ILDs are cyclophosphamide, azathioprine, mycophenolate mofetil and calcineurin inhibitors. Other therapeutic strategies are currently being extensively studied, such as antifibrotic agents, endothelin-1 receptor antagonists, tyrosine kinase inhibitors and newer biological agents. In this article, we describe novel therapies for ILDs associated with CTDs.

PMID: 22390563 [PubMed - in process]

The Effectiveness of Erlotinib Against Brain Metastases in Non-Small-cell Lung Cancer Patients.

Am J Clin Oncol. 2012 Mar 2;

Authors: Bai H, Han B

Abstract
BACKGROUND:: Brain metastases commonly occur in non-small-cell lung cancer (NSCLC), and patient prognosis is poor. Erlotinib, a specific inhibitor of epidermal growth factor receptor-associated tyrosine kinase, has shown antitumor activity in advanced NSCLC. This study evaluates erlotinib in the treatment for brain metastases from NSCLC. PATIENTS AND METHODS:: We retrospectively reviewed 40 NSCLC patients with brain metastases. All were treated with oral erlotinib and followed until disease progression, death, or intolerable side effects. EGFR mutations within surgical specimens were retrospectively examined in 9 patients. RESULTS:: For intracranial diseases, partial response (PR) was observed in 4 patients (10%), stable disease (SD) in 21 (52.5%), and progressive disease in 15 (37.5%), with an objective response rate of 10% and a disease control rate (DCR) of 62.5%. For extracranial diseases, DCR was observed in 17 patients (42.5%) (3 PRs+14 SDs) and progressive disease in 23 patients (57.5%). DCR within brain lesions in patients with activating EGFR mutations was 80% (1 PR+3 SDs), compared with 25% (1 SD) in patients with negative EGFR mutation. The median progression-free survival and median survival were 3.0 months and 9.2 months, respectively. There were no clinical factors associated with the response to erlotinib and survival as well (all P>0.05), whereas only the DCR in the brain was related to survival in multivariate analysis (P=0.000). CONCLUSIONS:: Erlotinib is modestly active and well-tolerated by NSCLC patients with brain metastases. Erlotinib seems to be more effective in patients with activating EGFR mutations. Erlotinib may be an alternative to traditional treatments in this patient population.

PMID: 22391431 [PubMed - as supplied by publisher]