IntroductionIdiopathic pulmonary fibrosis (IPF) is a chronic and fatal disease of unknown cause characterised by progressive fibrotic formation in lung tissue. We hypothesise that disrupted metabolic pathways in IPF contribute to disease pathogenesis.MethodsMetabolomics of human IPF was performed using mass spectroscopy (IPF lung=8; donor lung=8). Gene expression of key metabolic enzymes was measured using microarrays. Of the 108 metabolites whose levels were found altered, 48 were significantly increased, whereas 60 were significantly decreased in IPF samples compared with normal controls.ResultsSpecific metabolic pathways mediating the IPF remodelling were found with a downregulated sphingolipid metabolic pathway but an upregulated arginine pathway in IPF. In addition, disrupted glycolysis, mitochondrial beta-oxidation and tricarboxylic acid cycle, altered bile acid, haem and glutamate/aspartate metabolism were found in IPF samples compared with control.ConclusionsOur results show alterations in metabolic pathways for energy consumption during lung structural remodelling, which may contribute to IPF pathogenesis. We believe that this is the first report of simultaneously and systemically measuring changes of metabolites involving nine metabolic pathways in human severe IPF lungs. The measurement of the metabolites may serve in the future diagnosis and prognosis of IPF.

Background NSW has a multicultural population with increasing migration from South East Asia, the Western Pacific and Eastern Mediterranean. Objective To compare cancer stage, treatment (first 12 months) and survival for 12 country of birth (COB) categories recorded on the population-based NSW Cancer Registry. Design Historic cohort study of invasive breast cancers diagnosed in 2003–2016. Patients Data for 48,909 women (18+ ages) analysed using linked cancer registry, hospital inpatient and Medicare and pharmaceutical benefits claims data. Measurement Comparisons by COB using multivariate logistic regression and proportional hazards regression with follow-up of vital status to April 30th, 2020. Results Compared with the Australia-born, women born in China, the Philippines, Vietnam and Lebanon were younger at diagnosis, whereas those from the United Kingdom, Germany, Italy and Greece were older. Women born in China, the Philippines, Vietnam, Greece and Italy lived in less advantaged areas. Adjusted analyses indicated that: (1) stage at diagnosis was less localised for women born in Germany, Greece, Italy and Lebanon; (2) a lower proportion reported comorbidity for those born in China, the Philippines and Vietnam; (3) surgery type varied, with mastectomy more likely for women born in China, the Philippines and Vietnam, and less likely for women born in Italy, Greece and Lebanon; (4) radiotherapy was more likely where breast conserving surgery was more common (Greece, Italy, and Lebanon) and the United Kingdom; and (5) systemic drug therapy was less common for women born in China and Germany. Five-year survival in NSW was high by international standards and increasing. Adjusted analyses indicate that, compared with the Australian born, survival from death from cancer at 5 years from diagnosis was higher for women born in China, the Philippines, Vietnam, Italy, the United Kingdom and Greece. Conclusions There is diversity by COB of stage, treatment and survival. Reasons for survival differences may include cultural factors and healthier migrant populations with lower comorbidity, and potentially, less complete death recording in Australia if some women return to their birth countries for treatment and end-of-life care. More research is needed to explore the cultural and clinical factors that health services need to accommodate.

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Background: NSW has a multicultural population with increasing migration from South East Asia, the Western Pacific and Eastern Mediterranean.Objective: To compare cancer stage, treatment (first 12 months) and survival for 11 country of birth (COB) categories recorded on the population-based NSW Cancer Registry.Design: Historic cohort study of invasive breast cancers diagnosed in 2003-2016.Patients: Data for 48,909 women (18+ ages) analysed using linked cancer registry, hospital inpatient and Medicare and pharmaceutical benefits claims data.Measurement: Comparisons by COB using multivariate logistic regression and proportional hazards regression, with follow-up of vital status to April 30th 2020.Results: Compared with the Australia-born, women born in China, the Philippines, Vietnam and Lebanon were younger at diagnosis, whereas those from the United Kingdom, Germany, Italy and Greece were older. Women born in China, the Philippines, Vietnam, Greece and Italy lived in less advantaged areas. Adjusted analyses indicated that: (1) stage at diagnosis was less localised for women born in Germany, Greece, Italy and Lebanon; (2) a lower proportion reported comorbidity for those born in China, the Philippines and Vietnam; (3) surgery type varied, with mastectomy more likely for women born in China, Philippines and Vietnam, and less likely for women born in Italy, Greece and Lebanon; (4) radiotherapy was more likely where breast conserving surgery was more common (Greece, Italy, and Lebanon) and the United Kingdom; and (5) systemic drug therapy was less common for women born in China and Germany. Five-year survival in NSW was high by international standards and increasing. Adjusted analyses indicate that, compared with the Australian born, survival (all causes of death) at five years from diagnosis was higher for women born in China, the Philippines, Vietnam, the United Kingdom and Greece.Conclusions: There is diversity by COB of stage, treatment and survival. Reasons for survival differences may include cultural factors and healthier migrant populations with lower comorbidity, and potentially, less complete death recording in Australia if some women return to their birth countries for treatment and end-of-life care. More research is needed to explore the cultural and clinical factors that health services need to accommodate.

BackgroundLittle is known about the delivery of surgical services and outcomes for women with ovarian cancer across New South Wales (NSW).AimThe study objective was to provide a descriptive analysis of the proportion of women who had surgery for ovarian cancer in NSW in specialist gynaecological oncology hospitals and compare outcomes for women attending specialist and non‐specialist services in NSW.Materials and MethodsThis study is a retrospective analysis of women with primary ovarian, fallopian tube or peritoneal cancer from 2009 to 2012. Data were analysed from the NSW Cancer Registry, NSW Admitted Patient Data Collection and Register of Births Deaths and Marriages. Treating hospitals were characterised as public specialist, public non‐specialist and private. Morbidity and mortality outcomes are reported.ResultsThe study included 1106 women. Fifty‐seven hospitals performed surgery: seven public specialist, 27 private and 23 public non‐specialist hospitals. The highest proportion of surgery was performed in public specialist hospitals (61%). There was considerable variation in the utilisation of public specialist hospitals between local health districts. There was no significant difference in outcomes related to the type of hospital where surgery was performed.ConclusionsAlthough the majority of women are having surgery in a specialist gynaecological oncology public hospital across NSW, many are not. Women living in regional and remote NSW were less likely to have their surgery in a specialist hospital. This is the first step in understanding where women in NSW are currently receiving their surgical care, as well as the outcomes related to this.