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Last month’s “Airwaves” celebrated musicals and this month we show that sitcoms are in the list of The Triumvirate’s guilty pleasures.
Fawlty towers
There is little doubt that eponymous hotel in Devon, Fawlty Towers, could have done with some organisation and specialist service, indeed any service, delivery! What is less clear is what impact specialist service delivery might have on outcomes in patients with lung cancer. In this issue of Thorax (page 547) Adizie and colleagues use data from the National Lung Cancer Audit to demonstrate organisational delivery of specialist services, measured by 11 key service factors, was associated with increased chance of treatment within 62 days higher rates of surgery with curative intent, and increased 1 year survival. It is clear that improved organisational delivery can have substantial impacts, what is somewhat less predictable is how Basil Fawlty might respond to any kind of organisational management?
The big bang theory
It was always obvious that team science could be very funny and even microbiologists could generate laughs. However, the bugs themselves are not so funny. In this issue of Thorax (page 580) Ebenezer and colleagues describe some of the biochemical consequences of pseudomonas aeruginosa (PsA) infection. PsA infection of mice lead to phosphorylation of sphingosine kinase 2 (SPHK2) and acetylation of histones H3 and H4 in epithelial cells which in turn lead to secretion of cytokines. This inflammatory response was inhibited in mice with the sphk2 gene deleted or treated with an inhibitor of protein kinase C d suggesting potential therapeutic avenues of exploration in diseases where PsA leads to inflammation such as cystic fibrosis. Maybe they could also be used to reduce the impact of some of Sheldon Cooper’s more inflammatory comments?
The Hitchhiker’s Guide to the Galaxy
Following the destruction of the Earth to make way for an intergalactic bypass, Arthur Dent travels to Magrathea. Here he learns that the answer to the ultimate question of life, the universe, and everything is 42. Wang and colleagues (page 565) may have considered Arthur’s oxygen depleted surroundings on Magrathea as inspiration for their study on the pathogenesis of hypoxia-induced pulmonary hypertension (HPH), although their answer was 17. Indeed, the investigation of IL-17 in human lung tissue and serum samples combined with studies using an IL-17 knockout HPH mouse model, IL-17 was shown to contribute to HPH through upregulation of β-catenin. Targeting IL-17 may be the next step in HPH management but we will have to reconcile that with the ultimate question of life, the universe, and everything.
Father Ted
The surreal sitcom “Father Ted” featured three priests, exiled to Craggy Island for various misdemeanours: Father Ted, Father Jack and Father Dougal. But what about Father ISAAC? In this month’s journal, Morales et al (page 532) use data from the International Study of Asthma and Allergies in Childhood (ISAAC) to evaluate the relationship between healthy lifestyle and asthma, rhinoconjunctivitis and eczema. They conclude that a combination of four or five healthy lifestyle factors would lead to a 16% reduction in cases of asthma: if the associations were causal. The prolific ISAAC questionnaire has been the “father” of 280 publications since 1995. If healthy lifestyle is so good for health then Father Ted will have to quit the fags, Father Jack will have to stop drinking and Father Dougal will have to give up Mrs Doyle’s cakes. “Oh go on father, you will…”
Frazier
In the eponymous sitcom, Frazier favoured a refreshing cup of stimulant at “Café Nervosa” whereas Niles would have the ersatz “double short, low fat, no foam latte”. Frazier featured two egocentric psychiatrists and a Mancunian physiotherapist. In contrast, the paper by Shergis and colleagues (page 540) in this issue hails from Australia, China and Chicago and focuses on Ginseng, rather than coffee. The authors randomised 168 patients with COPD to 24 weeks of ginseng capsules or placebo. They found no significant difference in the co-primary outcomes between groups (the St George’s Respiratory Questionnaire, the COPD Assessment Test and the Short Form Health Survey). Perhaps the next trial in COPD could look at the therapeutic benefits of espresso?
Red Dwarf
Lister and his companions, Rimmer, Cat and Holly encountered many mishaps, including time travel, during the 11 series. It was by using time travel that the Red Dwarf crew could predict the future and indeed it is predicting the future that Winter and colleagues investigated as part of the external validation and recalibration of the Brock model to predict cancer in pulmonary nodules (page 552) . Although the Brock model achieved a high AUC (0.91) when validated on the NLST data set, the model required updating and recalibration, incorporating emphysema, spiculation and nodule count. Despite this, the model was unable to discriminate between malignant and benign cases. Perhaps we need a ride in Red Dwarf to predict the future for nodule surveillance.
Pen and India ink
Upstart Crow features the imaginary comic adventures William Shakespeare who uses pen and ink to confound his arch enemy Robert Greene. See the image in this month’s Thorax (page 624) where India ink stain is used to diagnose an unusual pulmonary infection.
