Diffuse Interstitial Lung Disease as a First Manifestation of Waldenström's Macroglobulinemia: Case Report and Review of the Literature

Waldenström's macroglobulinemia (WM) is a lymphoid malignancy characterized by infiltration, mainly of the bone marrow and lymph nodes, by small mature lymphocytes showing plasmacytoid differentiation, associated with an IgM monoclonal band, and in general, a low degree of aggressiveness. We present the first case reported in the Spanish literature of interstitial lung disease presenting as MW and we review the literature.     

Oxidative Stress and Respiratory System: Pharmacological and Clinical Reappraisal of N-Acetylcysteine

The large surface area for gas exchange makes the respiratory system particularly susceptible to oxidative stress-mediated injury. Both endogenous and exogenous pro-oxidants (e.g. cigarette smoke) trigger activation of leukocytes and host defenses. These mechanisms interact in a “multilevel cycle” responsible for the control of the oxidant/antioxidant homeostasis. Several studies have demonstrated the presence of increased oxidative stress and decreased antioxidants (e.g. reduced glutathione [GSH]) in subjects with chronic obstructive pulmonary disease (COPD), but the contribution of oxidative stress to the pathophysiology of COPD is generally only minimally discussed. The aim of this review was to provide a comprehensive overview of the role of oxidative stress in the pathogenesis of respiratory diseases, particularly COPD, and to examine the available clinical and experimental evidence on the use of the antioxidant N-acetylcysteine (NAC), a precursor of GSH, as an adjunct to standard therapy for the treatment of COPD. The proposed concept of “multilevel cycle” helps understand the relationship between respiratory diseases and oxidative stress, thus clarifying the rationale for using NAC in COPD. Until recently, antioxidant drugs such as NAC have been regarded only as mucolytic agents. Nevertheless, several clinical trials indicate that NAC may reduce the rate of COPD exacerbations and improve small airways function. The most plausible explanation for the beneficial effects observed in patients with COPD treated with NAC lies in the mucolytic and antioxidant effects of this drug. Modulation of bronchial inflammation by NAC may further account for these favorable clinical results.     

玻璃体腔内注射雷珠单抗治疗湿性AMD的护理

目的 总结玻璃体腔内注射雷珠单抗治疗湿性AMD的护理经验。方法 对30例湿性AMD患者行玻璃体腔内注射雷珠单抗注射液治疗,总结术前、术中及术后护理实施经验。结果 全组手术过程顺利,术后未出现严重并发症,30例31眼患者术后随访视力提高26眼（83.9%）,视力不变5眼,患者术后满意度100%。结论 玻璃体腔内注射雷珠单抗治疗湿性AMD,在治疗过程中需术前给予细致的指导和心理护理,做好术前检查,术中严格无菌操作,术后叮嘱患者定期随访,以确保疗效。     

High-throughput identification of off-targets for the mechanistic study of severe adverse drug reactions induced by analgesics

Drugs may induce adverse drug reactions (ADRs) when they unexpectedly bind to proteins other than their therapeutic targets. Identification of these undesired protein binding partners, called off-targets, can facilitate toxicity assessment in the early stages of drug development. In this study, a computational framework was introduced for the exploration of idiosyncratic mechanisms underlying analgesic-induced severe adverse drug reactions (SADRs). The putative analgesic-target interactions were predicted by performing reverse docking of analgesics or their active metabolites against human/mammal protein structures in a high-throughput manner. Subsequently, bioinformatics analyses were undertaken to identify ADR-associated proteins (ADRAPs) and pathways. Using the pathways and ADRAPs that this analysis identified, the mechanisms of SADRs such as cardiac disorders were explored. For instance, 53 putative ADRAPs and 24 pathways were linked with cardiac disorders, of which 10 ADRAPs were confirmed by previous experiments. Moreover, it was inferred that pathways such as base excision repair, glycolysis/glyconeogenesis, ErbB signaling, calcium signaling, and phosphatidyl inositol signaling likely play pivotal roles in drug-induced cardiac disorders. In conclusion, our framework offers an opportunity to globally understand SADRs at the molecular level, which has been difficult to realize through experiments. It also provides some valuable clues for drug repurposing.     

Elimination of socioeconomic and racial disparities related to lung cancer: Closing the gap at a high volume community cancer center

BackgroundHealthcare disparities have afflicted the healthcare industry for decades and there have been many campaigns in recent years to identify and eliminate disparities. The purpose of this study was to identify disparities in the lung cancer population of a single community cancer center and to report the results in accordance with industry goals.MethodsThis was a retrospective cohort study of data on non-small cell lung cancer patients recorded in the Christiana Care Tumor Registry (CCTR) in Delaware. Gender, age, race, socioeconomic status and insurance status were used as potential variables in identifying disparities.ResultsWe found no significant disparities between sexes, race or patients who were classified as having socioeconomic status 1–3. There was a lower survival rate associated with having the poorest socioeconomic status and in patients who used Medicare. Uninsured patients had the best survival outcomes and patients with Medicare had the poorest survival outcomes.ConclusionAlthough we have closed the gap on sex and racial disparities, there remains a difference in survival outcomes across socioeconomic classes and insurance types.