Acquired MET D1228N Mutations Mediate Crizotinib Resistance in Lung Adenocarcinoma with ROS1 Fusion: A Case Report

Patients with non‐small cell lung cancer (NSCLC) containing ROS1 fusions can have a marked response to the ROS1‐targeted tyrosine kinase inhibitors (TKIs), such as crizotinib. Common resistance mechanisms of ROS1‐fusion targeted therapy are acquired mutations in ROS1. Along with the use of next‐generation sequencing in the clinical management of patients with NSCLC during sequential targeted therapy, many mechanisms of acquired resistance have been discovered in patients with activated tyrosine kinase receptors. Besides acquired resistance mutations, bypass mechanisms of resistance to epidermal growth factor receptor (EGFR)‐TKI treatment are common in patients with EGFR mutations. Here we describe a patient with metastatic lung adenocarcinoma with CD74‐ROS1 fusion who initially responded to crizotinib and then developed resistance by the acquired mutation of D1228N in the MET kinase domain, which showed short‐term disease control for cabozantinib.Key Points

• The D1228N point mutation of MET is an acquired mutation for crizotinib resistance.
• The patient obtained short‐term clinical benefit from cabozantinib therapy after resistance to crizotinib.
• The clinical use of next‐generation sequencing could maximize the benefits of precision medicine in patients with cancer.

     

变频式桡动脉穿刺示教器在急诊护理教学中的应用

目的探讨提升急诊科进修护士桡动脉穿刺技术水平的有效方法。方法将64名进修护士按照入科时间分为对照组34名,实验组33名。在统一理论教学后,对照组采用互动方式互相触摸桡动脉并讲解穿刺方法。实验组采用变频式桡动脉穿刺示教器进行穿刺练习。结果实验组进修护士动脉穿刺成功率显著高于对照组,穿刺并发症发生率及患者疼痛程度显著低于对照组(P0.05,P0.01)。结论采用变频式桡动脉穿刺示教器进行教学,可使进修护士多次进行模拟穿刺练习,提高其桡动脉穿刺水平。     

Iodine-125 brachytherapy alone for advanced primary parotid gland carcinoma

This study aimed to evaluate the efficacy of iodine-125 (¹²⁵I) brachytherapy alone for the treatment of advanced parotid gland carcinoma and to identify predictors of tumour control and patient survival. Primary parotid gland carcinoma patients (n = 23) treated with ¹²⁵I brachytherapy alone between 1 October 2005 and 31 July 2013 at Peking University Stomatology Hospital were enrolled in this retrospective study. All had clinical stage IV disease. The prescribed dose was 60–160 Gy. The local control rate, survival rate, and predictors of the prognosis were evaluated. Adverse events related to treatment were also noted. The average follow-up time was 29 months (range 9–74 months). Among the 23 patients, six had local failure and 11 died during the follow-up period. The 1-, 3-, and 5-year overall survival rates were 87.0%, 55.4%, and 47.5%, respectively. The 1-, 3-, and 5-year progression-free survival rates were 73.9%, 47.0%, and 39.2%, respectively. The 1-, 3-, and 5-year local control rates were 82.1%, 73.9%, and 73.9%, respectively. Age and distant metastasis were independent predictors of survival, while the preoperative duration of the disease was an independent predictor of local control. The use of ¹²⁵I seed brachytherapy alone for the treatment of primary parotid gland carcinoma can provide good short-term results without causing any severe side effects.     

以红斑、结节为首发表现的胰源性脂膜炎（胰腺癌伴肝转移）合并多发性关节炎综合征一例

患者女，72岁，因双下肢红斑、结节伴疼痛1个月余就诊。1个月前左下肢发生红斑、皮下结节，疼痛不显著。数日后右下肢出现皮下结节，疼痛较前加重，渐影响行走。期间因胃部不适曾行胃镜检查，示胃底小息肉及幽门螺旋杆菌感染……     

Initial HRCT findings of novel influenza A (H1N1) infection

Please cite this paper as: Yuan et al. (2012) Initial HRCT findings of novel influenza A (H1N1) infection. Influenza and Other Respiratory Viruses 6(601), e114–e119. Objectives The aim of our study was to describe the presentation and illustrate the imaging features of chest high‐resolution computed tomography (HRCT) of patients with novel influenza A (H1N1) virus infection. Methods Data were collected from 163 hospitalized patients between November 2009 and March 2011, who fulfilled the clinical criteria for H1N1 influenza infection and underwent HRCT examinations within 24 hours of admission. Results Abnormal findings were observed in 40·5% of the patients. The patients with positive imaging findings were significantly older than patients with normal HRCT findings (P = 0·02). The most common finding was ground‐glass opacity (GGO) (n = 35). Interlobular septal thickening (n = 31) and centrilobular nodules (n = 30) were the second most frequent findings. Other common findings were consolidation, reticulation, and linear shadow. The most common imaging finding for lung involvement was GGO with a patchy pattern. Pulmonary involvement of the disease may be extensive and variable, but the total volume of affected lung was mostly <1 lobe. Conclusion The baseline HRCT may be valuable and suggestive even for non‐severe H1N1 infections. When a severe case or a evolution is suspected, chest CT could be essential both for determining the precise extent of parenchymal damage and for monitoring its evolution.     

Molecular cloning and characterization of peroxiredoxin 4 involved in protection against oxidative stress in the silkworm Bombyx mori

Peroxiredoxins (Prxs) are a ubiquitous family of proteins that play important roles in insects in protection against oxidative stress through the detoxification of cellular peroxides. Here, we describe the cloning and characterization of a Prx4 cDNA of the silkworm Bombyx mori (BmPrx4). The BmPrx4 gene has an open reading frame of 744 bp encoding 248 amino acids and a conserved motif, VCP, involved in its presumed redox functions. The heterologously expressed proteins of the gene in Escherichia coli showed antioxidant activity, removed hydrogen peroxide and protected DnA. Western blotting analysis showed the presence of BmPrx4 in the haemolymph, suggesting that the protein is secretable. Moreover, BmPrx4 was expressed at all developmental stages. The expression level of BmPrx4 was relatively low during the feeding stage but high at the wandering stage. BmPrx4 was induced by quercetin or temperature stress. Immunohistochemical analysis revealed that BmPrx4 is present in the brain, neurones and olfactory organ of the head in silkworms. Overall, our results indicate that the expression profile of BmPrx4 correlates well with protection from oxidative damage. Our data provide clues for the development of control technology for agricultural and forestry pests as the silkworm is a representative of lepidopteran pests.     

2型糖尿病膝下动脉病变患者介入治疗前后缺血动脉内氧化应激标志物的变化及意义

目的观察2型糖尿病(T2DM)下肢动脉硬化闭塞症(ASO)患者下肢动脉介入治疗前后病变动脉内氧化应激标志物的变化,探讨T2DM合并ASO患者体内氧化应激水平及介入治疗对动脉内氧化应激标志物的影响。方法选择接受介入治疗的T2DM合并膝下动脉(胫腓动脉)病变的患者30例,入组患者均行下肢动脉造影检查(DSA),部分患者还需要行经皮腔内血管成形术(PTA)。单纯行DAS患者为14例(造影组),DSA+PTA患者为16例(治疗组)。造影组和治疗组患者均在介入手术前行常规检查并抽取静脉血测血脂、糖化血红蛋白(Hb A1c)和氧化应激标志物水平,包括超氧化物歧化酶(SOD)以及脂质过氧化物终产物丙二醛(MDA)。造影组、治疗组还需取介入治疗前动脉血3 mL,此外治疗组在缺血动脉远端同一部位取PTA术前术后动脉血。上述标本均测SOD、MDA水平。结果造影组患者下肢动脉造影未见明显狭窄。治疗组术前动静脉血SOD水平低于造影组,MDA水平高于造影组(P0.05)。造影组、治疗组各组内介入术前静脉血与动脉血SOD、MDA比较差异无统计学意义(P0.05)。治疗组介入术前缺血部位SOD水平较介入治疗前动脉血水平低(P0.05),MDA水平较介入治疗前动脉血水平高(P0.05)。治疗组介入术后缺血部位SOD水平较介入术前缺血部位及介入术前动脉血SOD均降低(P0.05),MDA水平较介入术前缺血部位及介入术前动脉血中水平均升高(P0.05)。结论介入术前后患者使用抗氧化应激药物可能会改善处理病变的远期预后,减少血管再狭窄发生。     

Cesarean Scar Pregnancy: Comparing the Efficacy and Tolerability of Treatment with High-Intensity Focused Ultrasound and Uterine Artery Embolization

The aim of this study was to investigate the clinical efficacy of high-intensity focused ultrasound (HIFU) for the treatment of a cesarean scar pregnancy compared with uterine artery embolization (UAE) and intra-arterial methotrexate infusion combined with uterine curettage. In this retrospective cohort study, 31 patients were treated with HIFU (HIFU group), and 45 patients were treated with UAE (UAE group). We compared the treatment and recovery of the patients, including follow-up. After UAE treatment, serum levels of the β subunit of human chorionic gonadotropin declined significantly on the first day, and the residual lesions disappeared in 3–17 wk. One patient underwent hysterectomy; intrauterine adhesions were found by hysteroscopic examination after 6 mo in 2 patients, whose menstrual function did not return to normal. The remainder of the 42 patients recovered normal menstrual functioning during the 3- to 18-wk follow-up. In the patients who underwent HIFU treatment, serum β-HCG levels did not decline rapidly; serum β-HCG levels increased in many patients and then declined to normal steadily within 2–12 wk. Lesions detached in 3–14 wk in all patients, and menstrual functioning was recovered in 3–9 wk without uterine curettage. Compared with the UAE group, the HIFU group had less pain and fewer complications; the patients in the HIFU group were not hospitalized or anesthetized and had lower costs. HIFU is an efficient, tolerable and non-invasive treatment.