John West - ένας γίγαντας της Φυσιολογίας του Αναπνευστικού

Σημείωμα του ATS για το θρυλικό John West (από τον ιστότοπο της Αμερικανικής Πνευμονολογικής Εταιρείας)

When John West, MD, PhD, was born in Adelaide, Australia, in 1928, his parents knew great things were to come. But they probably never anticipated their son would one day join Sir Edmund Hillary on one of the most famous Himalayan expeditions in modern history.

In 1960, Dr. West joined Hillary and a small group of physiologists on what later became known as the “Silver Hut” expedition. The team spent several months at 19,000 feet, just south of Mount Everest, where they studied acclimatization and the effect of oxygen deprivation on human health.

This experience was the beginning of what has become a lifelong study of high-altitude medicine and physiology for Dr. West. In, 1981 he returned to Everest, this time heading up the American Medical Research Expedition where the world’s first physiological measurements were taken on the summit.

Today at age 84, Dr. West serves as professor of medicine and physiology at the School of Medicine, University of California-San Diego, where he has been since 1969. His research there now focuses on a new technique known as oxygen conditioning. The limited oxygen at high altitudes can have adverse effects on health—impacting mental function to pulmonary capacity to sleep. But now with this new technique, oxygen can be added to air conditioning systems.

“It is not yet used extensively, but it has a tremendous future,” explains Dr. West, who serves as editor-in-chief of the journal High Altitude Medicine & Biology. “Oxygen conditioning will bring great changes. Students will be able to learn better. The neonatal death rate, which is high at high altitudes, will likely drop. Overall, people working and living at high altitudes will be able to function more effectively.”

After completing his medical degree at the University of Adelaide, Dr. West spent 15 years at the Royal Postgraduate Medical School in London. It was there that he became interested in effects of gravity on the lung and participated in a groundbreaking study that discovered a way to demonstrate regional differences of blood flow to the lungs. Then, in 1967, he took a sabbatical to the NASA Ames Research Center.

“At that time, the U.S. space program was just getting under way. While I was there, I applied to NASA to conduct research measuring pulmonary function in space. It was funded, so I moved to California to do this work,” he explains.

Since moving to UCSD to pursue the project in 1969, Dr. West has not stopped researching, writing, and teaching. For the past 35 years, he has been in charge of the physiology course for first year medical students and his book, Respiratory Physiology: The Essentials, is used by medical students worldwide.

“John West is one of the giants in respiratory physiology with the ability to take a complicated topic and make it appear simple, while still retaining the rigor of the discipline. His lectures on respiratory physiology are simultaneously accessible and accurate,” says Kim Prisk, PhD, DSc, professor in the Departments of Medicine and Radiology at UCSD, who has worked with Dr. West for 32 years, including five space shuttle missions and work on the International Space Station.

Professor Frank Powell, PhD, professor of Medicine in the Division of Physiology at UCSD, agrees that Dr. West is not only a giant in the field, but a visionary. “John immediately demonstrated his extremely broad interest in physiology, which has characterized a career that tackled questions ranging from lung function in astronauts in microgravity in the space shuttle to bar headed geese flying over Mount Everest.”

Dr. West joined ATS in1969, and in 2002, he was awarded the Edward Livingston Trudeau Medal by the ATS, recognizing his lifetime of contributions and leadership in pulmonary medicine.

“Many wonder about the future of physiology because of the advances that have happened in molecular biology,” Dr. West says. “But physiology will always be the basis of the intelligent practice of medicine. It is not outdated, and it is extremely important for medical students.”

Dr. West has a son who is a professor at Stanford University, a daughter who works with a non-profit in New York, as well as three grandchildren. He enjoys Baroque music, and he sits on the board of the Bach Collegium San Diego.

Μνήμη Edward Livingston Trudeau

Στις 15 Νοεμβρίου 2015, συμπληρώνονται 100 χρόνια από το θάνατο του Έντουαρντ Λίβινγκστον Τρουντώ. Ο Δρ Τρουντώ ήταν πρωτεργάτης της δημιουργίας σανατορίων και ίδρυσε το πρώτο εργαστήριο για την αντιμετώπιση της φυματίωσης στις ΗΠΑ. Ακολουθεί σημείωμα από την ιστοσελίδα της Αμερικανικής Πνευμονολογικής Εταιρείας (http://news.thoracic.org/?p=7540)  

   

On Nov. 15, 2015, the world will mark the centennial of Edward Livingston Trudeau’s death. Dr. Trudeau launched the sanitarium movement in the U.S., established the country’s first tuberculosis laboratory, served as the first president of the organization that would become the American Lung Association, and helped found its medical division, now the American Thoracic Society.

Although the prevalence of TB and the care of those infected with the bacterium is vastly different from when Dr. Trudeau opened the Adirondack Cottage Sanitarium in Saranac Lake, New York, in 1882, Dr. Trudeau’s philosophy and approach to taking on the greatest killer in human history are still reflected in the work of the ATS.

Born in 1848, Edward Livingston Trudeau was a teenager when his brother James was diagnosed with tuberculosis. Young Edward cared for his brother for three months before he died. A few years later, Edward, himself, showed the first signs of having contracted the disease while studying at Columbia University’s College of Physicians and Surgeons.

At that time, TB was erroneously characterized as, in Dr. Trudeau’s words, “a non-contagious, generally incurable and inherited disease, due to inherited constitutional peculiarities, perverted humors and various types of inflammation.”

When Dr. Trudeau graduated, medical education was conducted almost exclusively in lecture halls, without patients and without microscopic studies. His career, however, would change our understanding of TB and help revolutionize medical education and research in the process.

By the time Dr. Trudeau was formally diagnosed with TB, he was a husband and recent father. The disease was so quickly debilitating that he abandoned his fledgling medical practice and traveled in the summer of 1873 to the Adirondack Mountains. If the fresh air and rest did not arrest his decline, he was prepared to die in a place he loved as a child.

Fortunately, his health did improve, and, a few years later, he moved his family permanently to Saranac Lake. There in 1884, he opened his sanitarium cottage, dubbed “The Little Red” because of its color and 250-square-foot size.

He was inspired by reports from two German physicians published in 1882. In the first, Robert Koch identified the bacterium that causes TB. In the second, Hermann Brehmer, described the success of the sanitarium he founded.

Dr. Trudeau would build on both men’s work. He outfitted a laboratory in his house to study TB and conducted rigorous experiments. This was the origin of what is now the Trudeau Institute, a biomedical research center in Saranac Lake.

In his most famous experiment, Dr. Trudeau infected 10 rabbits with mycobacterium tuberculosis. He exposed half the infected rabbits to inhospitable conditions—dank, tight quarters, with inadequate nutrition. The other five rabbits he turned loose on a small island with plenty of food. All five of the rabbits in the first group died while only one of the five infected rabbits who had the run of the island did. He also subjected five uninfected rabbits to the same harsh conditions as the five that had been infected. Though weakened, the five uninfected rabbits did not develop TB, proving the disease could not develop in the absence of the bacterium.

As the sanitarium grew, other physicians joined and conducted their own research. On his 60th birthday, these associates presented Dr. Trudeau with two bound volumes containing 70 scientific papers on tuberculosis they had published in U.S. and international journals.

From the beginning, Dr. Trudeau wanted his sanitarium to serve working-class patients. Dr. Trudeau did not charge for his services, and by soliciting friends he made among the wealthy businessmen who traveled to the Adirondacks to hunt, he was able to offer care for less than it cost. The Little Red’s first tenants were two sisters who had worked in factories. Eventually, the sanitarium had sufficient funds—its endowment was $600,000 in 1914—to offer free care to many.

Equally important, Dr. Trudeau recognized that residents needed to feel productive. In addition to being involved in the day-to-day tasks of the sanitarium, interested patients were taught bookbinding, leather work, woodcarving, and illuminating.

One of his greatest achievements was turning the sanitarium into an education center. In 1912, a nursing school for former patients who wanted to work with TB patients opened, and a year after his death, Dr. Trudeau’s vision for offering specialized training for physicians in TB care and research came to fruition with a six-week postgraduate program.

His career also underscored the importance of public health. “The sanitarium, research, education programs, and founding of the ALA and ATS, were all part of his aim of engaging the public in the issue of public health that have lasted beyond his lifetime,” says past president Dean Schraufnagel, MD, who is co-author along with Philip Hopewell and John Murray of an article on the history of treating TB that will be published in the November Annals of the American Thoracic Society.

By the time the Adirondack Cottage Sanitarium closed in 1954, less than a decade after the first effective antibiotic against TB became available, Saranac Lake had been home to more than 15,000 TB patients, most of whom did survive. Although Dr. Trudeau did not discover a cure for tuberculosis, he demonstrated how clinical care, research, and education can work together to thwart a formidable threat to public health. He also revealed the importance of hope to every patient.

“Trudeau’s great talent, I now understand, was for hope—a commodity in short supply during the worst years of the White Plague,” writes his great grandson, the cartoonist Garry Trudeau, in the foreword to Portrait of Healing, a book about Dr. Trudeau and his sanitarium. “People came to Saranac Lake to cure, not to die, and that was new”._

Συναισθηματική Νοημοσύνη & ΧΑΠ

Η συναισθηματική νοημοσύνη, ως παράμετρος της ποιότητας ζωής ασθενών με Χρόνια Αποφρακτική Πνευμονοπάθεια, εξετάζεται στη μελέτη Emotional Intelligence: A Novel Outcome Associated with Wellbeing and Self-Management in Chronic Obstructive Pulmonary Disease (ATS Journals).

Πρόκειται για ενδιαφέρουσα προσέγγιση της δυνατότητας να αξιοποιηθούν στην κλινική πράξη τα ωφέλη που μπορεί να προσφέρει η μέθοδος σε συνδυασμό με την Πνευμονική Αποκατάσταση.

Συσχέτιση Διακοπής Καπνίσματος & Θνητότητας

Προδημοσίευση στο περιοδικό της Αμερικανικής Πνευμονολογικής Εταιρείας – ATS (The Association Between Smoking Abstinence and Mortality in the National Lung Screening Trial Nichole T Tanner, et al. | Am J Respir Crit Care Med | Oct 26, 2015 Articles in Press).

Η διακοπή του καπνίσματος οδηγεί σε μείωση του κινδύνου θανάτου από καρκίνο του πνεύμονα και αρκετές άλλες αιτίες. Άτομα με καρκίνο του πνεύμονα που συνεχίζουν να καπνίζουν μετά τη διάγνωση παρουσιάζουν χειρότερα αποτελέσματα σε σύγκριση με την πρώην καπνιστές ή άτομα που δεν είχαν καπνίσει ποτέ.

Στις ΗΠΑ, η μελέτη National Lung Screening Trial [NLST] έδειξε ότι ο προσυμπτωματικός έλεγχος (screening) ατόμων υψηλού κινδύνου με χαμηλής δόσης αξονική τομογραφία οδήγησε σε τρεις λιγότερους θανάτους για κάθε 1.000 άτομα που συμμετείχαν.

Η τρέχουσα μελέτη  είναι η πρώτη που επιχείρησε να ποσοτικοποιήσει το όφελος της διακοπής του καπνίσματος σε συνδυασμό με τον προσυμπτωματικό έλεγχο για καρκίνο του πνεύμονα σε μια ομάδα ασυμπτωματικών ατόμων. Ο συνδυασμός της διακοπής επί 15 χρόνια του καπνίσματος και του προσυμπτωματικού ελέγχου με αξονική τομογραφία είχε ως αποτέλεσμα τη μείωση του κινδύνου θανάτου κατά 38%, που ήταν σημαντικά μεγαλύτερη σε σύγκριση με τον προσυμπτωματικό έλεγχο μόνο. Οι πρώην καπνιστές, μετά από 7 χρόνια της αποχής από το κάπνισμα, παρουσίασαν μείωση του κινδύνου παρόμοια με εκείνους που υποβάλλονταν σε προσυμπτωματικό έλεγχο.

Σε σχέση με εκείνους που διέκοψαν το κάπνισμα, οι καπνιστές είχαν αυξημένη θνητότητα από καρκίνο του πνεύμονα (κατά περισσότερο από δύο φορές) ή από άλλα αίτια. Οι πρώην καπνιστές, που διέκοψαν το κάπνισμα για 7 χρόνια, παρουσίασαν μείωση κατά 20% της θνητότητας κι αυτό το ώφελος ήταν συγκρίσιμο με το ώφελος που αποκομίζουν όσοι υποβάλλονται σε προσυμπτωματικό έλεγχο. Το μέγιστο ώφελος παρατηρήθηκε με το συνδυασμό διακοπής του καπνίσματος επί 15 έτη και προσυμπτωματικού ελέγχου με αξονική τομογραφία, που οδήγησαν σε μείωση της θνητότητας από καρκίνο του πνεύμονα κατά 38% (HR 0,62, 95% CI 0,51-0,76). 

Για τις Επιστημονικές Δημοσιεύσεις στην Ογκολογία

Σχόλια από δημοσιευμένο προχθές στο περιοδικό JAMA Oncology κείμενο. Αφορά στην υποδοχή που επιφυλάχθηκε από το σύνολο του επιστημονικού κι ευρύτερου τύπου σε μια σειρά από εγκεκριμένα και μη ογκολογικά σκευάσματα. Ανεξάρτητα από την (πιστοποιημένη) αποτελεσματικότητα των περισσότερων φαρμάκων, οι χαρακτηρισμοί που τα συνοδεύουν είναι εκτυφλωτικά επαινετικοί.

Ολόκληρο το κείμενο υπάρχει στο : τεύχος της 29ης Οκτωβρίου 2015 του JAMA Oncology

The Use of Superlatives in Cancer Research 

"...the use of superlatives to describe approved (50%) and nonapproved cancer drugs (50%) is common. Superlatives are used for all types of medications, including those, such as therapeutic cancer vaccines, which historically have low response rates and drugs that have not yet shown overall survival benefits (eg, palbociclib). Of concern, 14% of drugs were praised without any human data".