Plant growth correlates with net carbon gain on a whole plant basis. Over the last several decades, the driving factors shaping plant morphology and performance have become increasingly clear. This ...review seeks to explore the importance of these factors for grass performance. Briefly, these fall into factors influencing photosynthetic rates directly, competition between plants in a canopy, and nutrient status and availability.
Consensually non-monogamous (CNM) romantic and sexual relationships tend to be stigmatized. The present research examined this stigma across two studies. First, we qualitatively explored the specific ...ways that people in CNM relationships report experiencing stigma using thematic analysis and identified the following four themes: Expressions of discomfort/disapproval of CNM, Loss of resources/threatening behaviors, Character devaluation, and Relationship devaluation (Study 1; N = 372). Second, we examined the relationship between experienced stigma and psychological well-being for people in CNM relationships, using the framework of minority stress theory. We found that experienced stigma was positively associated with psychological distress and that this association was partially statistically mediated by anticipated stigma and internalized stigma (Study 2; N = 383). Overall, this research strives to achieve a better understanding of the processes and potential consequences of stigma toward CNM relationships and individuals.
People who are more defensive about their feedback on the Race-Attitudes Implicit Association Test (IAT) are less willing to engage in anti-bias behaviors. Extending on this work, we statistically ...clarified defensiveness constructs to predict willingness to engage in anti-bias behaviors among people who received pro-White versus no-bias IAT feedback. We replicated the finding that U.S. Americans are generally defensive toward pro-White IAT feedback, and that more defensiveness predicts less willingness to engage in anti-bias behaviors. However, people who believed their pro-White IAT feedback was an inaccurate reflection of their "true attitudes" were
willing to engage in anti-bias behaviors compared with people who received no-bias IAT feedback. These results better illuminate the defensiveness construct suggesting that receiving self-threatening feedback about bias may motivate people's willingness to engage in anti-bias behaviors in different ways depending on how people respond to that feedback.
Background
Lung cancer is the most common cause of cancer‐related death in the world, however lung cancer screening has not been implemented in most countries at a population level. A previous ...Cochrane Review found limited evidence for the effectiveness of lung cancer screening with chest radiography (CXR) or sputum cytology in reducing lung cancer‐related mortality, however there has been increasing evidence supporting screening with low‐dose computed tomography (LDCT).
Objectives
To determine whether screening for lung cancer using LDCT of the chest reduces lung cancer‐related mortality and to evaluate the possible harms of LDCT screening.
Search methods
We performed the search in collaboration with the Information Specialist of the Cochrane Lung Cancer Group and included the Cochrane Lung Cancer Group Trial Register, Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane Library, current issue), MEDLINE (accessed via PubMed) and Embase in our search. We also searched the clinical trial registries to identify unpublished and ongoing trials. We did not impose any restriction on language of publication. The search was performed up to 31 July 2021.
Selection criteria
Randomised controlled trials (RCTs) of lung cancer screening using LDCT and reporting mortality or harm outcomes.
Data collection and analysis
Two review authors were involved in independently assessing trials for eligibility, extraction of trial data and characteristics, and assessing risk of bias of the included trials using the Cochrane RoB 1 tool. We assessed the certainty of evidence using GRADE. Primary outcomes were lung cancer‐related mortality and harms of screening. We performed a meta‐analysis, where appropriate, for all outcomes using a random‐effects model. We only included trials in the analysis of mortality outcomes if they had at least 5 years of follow‐up. We reported risk ratios (RRs) and hazard ratios (HRs), with 95% confidence intervals (CIs) and used the I2 statistic to investigate heterogeneity.
Main results
We included 11 trials in this review with a total of 94,445 participants. Trials were conducted in Europe and the USA in people aged 40 years or older, with most trials having an entry requirement of ≥ 20 pack‐year smoking history (e.g. 1 pack of cigarettes/day for 20 years or 2 packs/day for 10 years etc.). One trial included male participants only. Eight trials were phase three RCTs, with two feasibility RCTs and one pilot RCT. Seven of the included trials had no screening as a comparison, and four trials had CXR screening as a comparator. Screening frequency included annual, biennial and incrementing intervals. The duration of screening ranged from 1 year to 10 years. Mortality follow‐up was from 5 years to approximately 12 years.
None of the included trials were at low risk of bias across all domains. The certainty of evidence was moderate to low across different outcomes, as assessed by GRADE.
In the meta‐analysis of trials assessing lung cancer‐related mortality, we included eight trials (91,122 participants), and there was a reduction in mortality of 21% with LDCT screening compared to control groups of no screening or CXR screening (RR 0.79, 95% CI 0.72 to 0.87; 8 trials, 91,122 participants; moderate‐certainty evidence). There were probably no differences in subgroups for analyses by control type, sex, geographical region, and nodule management algorithm. Females appeared to have a larger lung cancer‐related mortality benefit compared to males with LDCT screening. There was also a reduction in all‐cause mortality (including lung cancer‐related) of 5% (RR 0.95, 95% CI 0.91 to 0.99; 8 trials, 91,107 participants; moderate‐certainty evidence).
Invasive tests occurred more frequently in the LDCT group (RR 2.60, 95% CI 2.41 to 2.80; 3 trials, 60,003 participants; moderate‐certainty evidence). However, analysis of 60‐day postoperative mortality was not significant between groups (RR 0.68, 95% CI 0.24 to 1.94; 2 trials, 409 participants; moderate‐certainty evidence).
False‐positive results and recall rates were higher with LDCT screening compared to screening with CXR, however there was low‐certainty evidence in the meta‐analyses due to heterogeneity and risk of bias concerns. Estimated overdiagnosis with LDCT screening was 18%, however the 95% CI was 0 to 36% (risk difference (RD) 0.18, 95% CI ‐0.00 to 0.36; 5 trials, 28,656 participants; low‐certainty evidence).
Four trials compared different aspects of health‐related quality of life (HRQoL) using various measures. Anxiety was pooled from three trials, with participants in LDCT screening reporting lower anxiety scores than in the control group (standardised mean difference (SMD) ‐0.43, 95% CI ‐0.59 to ‐0.27; 3 trials, 8153 participants; low‐certainty evidence).
There were insufficient data to comment on the impact of LDCT screening on smoking behaviour.
Authors' conclusions
The current evidence supports a reduction in lung cancer‐related mortality with the use of LDCT for lung cancer screening in high‐risk populations (those over the age of 40 with a significant smoking exposure). However, there are limited data on harms and further trials are required to determine participant selection and optimal frequency and duration of screening, with potential for significant overdiagnosis of lung cancer. Trials are ongoing for lung cancer screening in non‐smokers.
Chronic non-productive coughing is a major complication of pulmonary disease and can also occur in many individuals without identifiable underlying pathology. The common clinical link in patients ...with cough is an enhanced sensitivity of the respiratory system to stimuli that subsequently evoke excessive coughing. The aetiology of this 'cough hypersensitivity syndrome' is unclear but believed to involve hypersensitivity of the sensory neural pathways that innervate the airways and lungs.
In the present study, we used functional brain imaging to compare central neural responses to airway stimulation using inhaled capsaicin in healthy people and patients with cough hypersensitivity.
Hypersensitivity in response to inhaled capsaicin coincided with elevated neural activity in the midbrain in a region encompassing the nucleus cuneiformis (left: p<0.001; right: p<0.001) and periaqueductal gray (p=0.008) in comparison to normal sensitivity in controls. The enhanced activity noted in the midbrain is similar to that occurring in patients with chronic pain, thus providing empirical evidence to support the notion that cough and pain share neurobiological similarities. Furthermore, patients with cough hypersensitivity displayed difficulty controlling their cough, which manifested as a failure to suppress cough during capsaicin challenge (ie, reduced cough frequency) in controls compared with patients with cough hypersensitivity (p=0.046). Cough suppression was associated with reduced activity in a forebrain network that included the dorsomedial prefrontal and anterior mid-cingulate cortices. Additionally, cough frequency was correlated with activity in the right inferior frontal gyrus (R(2)=0.6, p<0.001) and right anterior insula (R(2)=0.6, p<0.001), regions previously implicated in voluntary cough suppression.
These findings provide insight into the central neurobiology of cough hypersensitivity and suggest that both central amplification of cough sensory inputs and reduced capacity to suppress cough motor behaviours define patients with problematic cough.
Multiple guidance modalities may be combined during bronchoscopic investigation of peripheral pulmonary lesions (PPLs). The relative contribution of each modality to diagnostic performance remains ...uncertain.Endobronchial ultrasound (EBUS) with virtual bronchoscopy (VB) was routinely performed, with electromagnetic navigation (EMN) utilised only where EBUS was unable to locate PPLs or where the probe was adjacent to the lesion and on-site cytologic examination was nondiagnostic.236 consecutive patients with 245 PPLs had lesion size 22.8±12.4 mm (mean±sd). PPLs were localised using EBUS+VB alone in 188 (77%) and was diagnostic in 134 of these (71.3%). EBUS localisation was predicted by PPL size (23.7±10.5 versus 19.7±9.8 mm, p=0.003), but not by bronchus sign, PPL-hilum distance or PPL-pleura distance. EMN in 57 patients achieved EBUS localisation in a further 17 patients (30.9%), improving overall visualisation yield to 85%. Nine of these 57 procedures achieved a definitive diagnosis (16%), improving overall diagnostic yield to 58.4%. Probe position and lesion type influenced overall diagnostic yield. Sensitivity for diagnosis of lung cancer was 70% (131/188; 95% CI 63-76%).Localisation rate and diagnostic sensitivity of radial probe EBUS+VB alone for diagnosis of PPLs is high. EBUS localisation rates and procedural yield are improved only modestly (by 8% and 4%, respectively) with addition of EMN. Sampling following EMN should include all available methods to maximise diagnostic yield.
ABSTRACT
Smoke exposure from bushfires, such as those experienced in Australia during 2019–2020, can reach levels up to 10 times those deemed hazardous. Short‐term and extended exposure to high ...levels of air pollution can be associated with adverse health effects, although the most recent fires have brought into sharp focus that several important knowledge gaps remain. In this article, we briefly identify and discuss the existing Australian evidence base and make suggestions for future research.
Cigarette smoking has reached epidemic proportions within many regions of the world and remains the highest risk factor for chronic obstructive pulmonary disease (COPD) and lung cancer. Squamous cell ...lung cancer is commonly detected in heavy smokers, where the risk of developing lung cancer is not solely defined by tobacco consumption. Although therapies that target common driver mutations in adenocarcinomas are showing some promise, they are proving ineffective in smoking‐related squamous cell lung cancer. Since COPD is characterized by an excessive inflammatory and oxidative stress response, this review details how aberrant innate, adaptive and systemic inflammatory processes can contribute to lung cancer susceptibility in COPD. Activated leukocytes release increasing levels of proteases and free radicals as COPD progresses and tertiary lymphoid aggregates accumulate with increasing severity. Reactive oxygen species promote formation of reactive carbonyls that are not only tumourigenic through initiating DNA damage, but can directly alter the function of regulatory proteins involved in host immunity and tumour suppressor functions. Systemic inflammation is also markedly increased during infective exacerbations in COPD and the interplay between tumour‐promoting serum amyloid A (SAA) and IL‐17A is discussed. SAA is also an endogenous allosteric modifier of FPR2 expressed on immune and epithelial cells, and the therapeutic potential of targeting this receptor is proposed as a novel strategy for COPD–lung cancer overlap.
Linked Articles
This article is part of a themed section on Inflammation: maladies, models, mechanisms and molecules. To view the other articles in this section visit http://dx.doi.org/10.1111/bph.2016.173.issue-4
Screening for lung cancer Manser, Renée; Lethaby, Anne; Irving, Louis B ...
Cochrane database of systematic reviews,
06/2013, Letnik:
2013, Številka:
6
Journal Article
Recenzirano
Odprti dostop
Background
This is an updated version of the original review published in The Cochrane Library in 1999 and updated in 2004 and 2010. Population‐based screening for lung cancer has not been adopted in ...the majority of countries. However it is not clear whether sputum examinations, chest radiography or newer methods such as computed tomography (CT) are effective in reducing mortality from lung cancer.
Objectives
To determine whether screening for lung cancer, using regular sputum examinations, chest radiography or CT scanning of the chest, reduces lung cancer mortality.
Search methods
We searched electronic databases: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 5), MEDLINE (1966 to 2012), PREMEDLINE and EMBASE (to 2012) and bibliographies. We handsearched the journal Lung Cancer (to 2000) and contacted experts in the field to identify published and unpublished trials.
Selection criteria
Controlled trials of screening for lung cancer using sputum examinations, chest radiography or chest CT.
Data collection and analysis
We performed an intention‐to‐screen analysis. Where there was significant statistical heterogeneity, we reported risk ratios (RRs) using the random‐effects model. For other outcomes we used the fixed‐effect model.
Main results
We included nine trials in the review (eight randomised controlled studies and one controlled trial) with a total of 453,965 subjects. In one large study that included both smokers and non‐smokers comparing annual chest x‐ray screening with usual care there was no reduction in lung cancer mortality (RR 0.99, 95% CI 0.91 to 1.07). In a meta‐analysis of studies comparing different frequencies of chest x‐ray screening, frequent screening with chest x‐rays was associated with an 11% relative increase in mortality from lung cancer compared with less frequent screening (RR 1.11, 95% CI 1.00 to 1.23); however several of the trials included in this meta‐analysis had potential methodological weaknesses. We observed a non‐statistically significant trend to reduced mortality from lung cancer when screening with chest x‐ray and sputum cytology was compared with chest x‐ray alone (RR 0.88, 95% CI 0.74 to 1.03). There was one large methodologically rigorous trial in high‐risk smokers and ex‐smokers (those aged 55 to 74 years with ≥ 30 pack‐years of smoking and who quit ≤ 15 years prior to entry if ex‐smokers) comparing annual low‐dose CT screening with annual chest x‐ray screening; in this study the relative risk of death from lung cancer was significantly reduced in the low‐dose CT group (RR 0.80, 95% CI 0.70 to 0.92).
Authors' conclusions
The current evidence does not support screening for lung cancer with chest radiography or sputum cytology. Annual low‐dose CT screening is associated with a reduction in lung cancer mortality in high‐risk smokers but further data are required on the cost effectiveness of screening and the relative harms and benefits of screening across a range of different risk groups and settings.
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