Neil Colman

The use of biomarkers in the prediction of survival in patients with pulmonary carcinoma

Data on ten variables and 16 biomarkers were obtained on 119 patients with newly diagnosed pulmonary cancer. The prognostic value of 16 biomarkers (alpha‐1‐antitrypsin [AAT], adrenocorticotropic hormone [ACTH], alpha‐fetoprotein [AFP], carcinoembryonic antigen [CEA], human chorionic gonadotropin [HCG], immune complexes, immunoglobulins, N‐terminal peptide of proopiomelanocortin[NTERM], and tumor‐associated antibody [TAA]) was tested by adding these to the model of age, gender, stage, morphology, Feinsteins classification of symptoms, Karnofsky scale, leukocyte count, recent weight loss, and liver enzymes. Using Coxs regression method and a forward stepwise procedure, seven biomarkers (ACTH, AAT, AFP, calcitonin, HCG, TAA, and prolactin) entered the model. Elevated levels of cortisol and TAA were associated with longer survival. The selection of biomarkers by stepwise regression needs to be interpreted with caution, especially since the Z scores were found to be dependent on the particular variables included in the model. Furthermore, when dichotomized on maximum of the normal laboratory values, HCG and AFP were infrequently (2%) elevated. The lack of correlation among the biomarkers supports the hypothesis of random derepression of the genome of cancer cells. Further studies in improved modeling and the formulation of a biomarker index could enhance our understanding of the biology of cancer.

Validation of The 30 Second Asthma Test™ as a measure of asthma control

BACKGROUND The primary objective of asthma management is to help patients establish and maintain optimal disease control. Simple and efficient tools are needed to assess patient-reported symptoms so that they can be used with or without airway function to evaluate asthma control. OBJECTIVE The objective of the present study was to evaluate the validity of The 30 Second Asthma Test (GlaxoSmithKline Inc, Canada), based on the Canadian Asthma Guidelines, by estimating its relationship with criterion measures of control. RESULTS The discriminative and diagnostic validity of The 30 Second Asthma Test was examined in a sample of 81 patients with a confirmed diagnosis of asthma. Based on a cut-off score of two or greater on The 30 Second Asthma Test, the overall agreement with specialist ratings was 65%, and 58% with per cent predicted forced expiratory volume in 1 s. The 30 Second Asthma Test scores distinguished between groups of patients who were classified based on the change in intensity of therapy. CONCLUSION The results support the use of The 30 Second Asthma Test as a brief screening tool for asthma control.

Evaluating asthma control: a comparison of measures using an item response theory approach.

Self-reported symptoms, FEV1, and clinician judgment are all used to evaluate asthma control. The relative utility of each measure of control cannot be easily assessed. Item response theory (IRT) approaches allow for the direct comparison of the utility of different types of measures used to assess control. The objective of this study was to evaluate the validity and reliability of evaluating asthma control using symptom, clinical, and physiologic measures by applying an IRT approach. Subjects receiving care at an asthma clinic were evaluated on measures of asthma control. Based on 114 evaluations, IRT parameters were estimated to evaluate whether measures assessed a single underlying construct, the hierarchical relationship between the measures and the level of control each measure assessed, whether measures targeted all levels of asthma control, and whether the scoring categories distinguished between different levels of control. Infit statistics (0.74–1.5) for individual items showed that all items fit the underlying concept of asthma control. The reproducibility of the hierarchal scale was high (0.9). The results also demonstrated that items differentiated two strata (high, low) of control. The gaps in the hierarchal scale showed that for many subjects (37%) there were no items at their level of asthma control. The IRT approach identified gaps in current measurement that need to be addressed to provide more precise evaluations of control required to accurately monitor changes in patient status.

Salvage B-cell depletion therapy in rapidly progressive dermatomyositis-associated interstitial lung disease

Joint Bone Spine - In Press.Proof corrected by the author Available online since samedi 21 septembre 2013