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Osimertinib-induced interstitial lung disease (ILD) is an uncommon, but fatal pulmonary toxicity in some patients. We report a case of a 64-year-old male with stage IV adeno-non-small cell lung cancer (NSCLC) harboring an exon 19 deletion in the epidermal growth factor receptor (EGFR) treated with osimertinib 80 mg/d for first-line targeted therapy. On day 60 after initiating treatment of osimertinib, the patient developed ILD. Osimertinib was discontinued immediately and oral prednisone 60 mg/d was initiated, ILD improved within 13 d. After balancing the risk and benefit, osimertinib was restarted concurrently with prednisone. The patient showed neither disease progression nor a recurrence of ILD for more than 16 months. Based on our case and literature review, retreatment with osimertinib under steroid coverage could be considered as an effective treatment option after careful risk-benefit assessment for patients with EGFR-mutant NSCLC. .
Subject(s)
Humans , Male , Middle Aged , Acrylamides/therapeutic use , Aniline Compounds/therapeutic use , Carcinoma, Non-Small-Cell Lung/genetics , ErbB Receptors/genetics , Lung Diseases, Interstitial/genetics , Lung Neoplasms/genetics , Prednisone , Protein Kinase Inhibitors/adverse effectsABSTRACT
Objective:To explore the clinical efficacy of consolidation chemotherapy combined with microtransplantation in the treatment of elderly patients with acute myeloid leukemia (AML).Methods:The clinical data of 45 elderly patients with AML in Suzhou Yongding Hospital from January 2016 to December 2018 were retrospectively analyzed. After 1 or 2 courses of induced chemotherapy, the patients achieved complete response (CR). Among them, 20 patients were given consolidation chemotherapy (single group), and 25 patients were given consolidation chemotherapy combined with microtransplantation (combined group). After 3 courses of treatment, the minimal residual disease (MRD), quantitative expression of WT1 gene and adverse reactions were compared between 2 groups; the quality of life before treatment and after treatment was evaluated by quality of life-BREF (QOL-BREF). The patients were followed up to November 1, 2020, and the median follow-up was 30 months. The overall survival and progress-free survival (PFS) were recorded.Results:The MRD negative rate and WT1 gene negative rate after treatment in combined group were significantly higher than those in single group: 60.00% (15/25) vs. 25.00% (5/20) and 52.00% (13/25) vs. 20.00% (4/20), and there were statistical differences ( P<0.05). The recovery times of neutrophils and platelets in combined group were significantly shorter than those in single group: 10 (8, 12) d vs. 16 (13, 20) d and 14 (11, 17) d vs. 24 (19, 30) d, and there were statistical differences ( Z = 3.152 and 4.285, P<0.05). No adverse reactions such as liver and kidney abnormalities or gastrointestinal reactions occurred in 2 groups; and no specific graft versus host disease (GVHD) occurred in the combined group. The each item scores of QOL-BREF after treatment in combined group were significantly higher than those in single group, and there were statistical differences ( P<0.01). The 2-year overall survival rate and PFS rate in combined group were significantly higher than those in single group: 60.00% (15/25) vs. 35.00% (7/20) and 52.00% (13/25) vs. 25.00% (5/20), and there were statistical differences ( χ2 = 4.235 and 4.742, P = 0.040 and 0.029). Conclusions:Consolidation chemotherapy combined with microtransplantation is effective and safe in the treatment of elderly patients with AML. It can significantly improve the quality of life, and improve the overall survival rate and PFS rate.
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Objective To compare ultra-performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS) and chemiluminescence immunoassay(CLIA) measurement of human serum androgen levels in polycystic ovarian syndrome(PCOS). Methods 160 PCOS patients and 146 healthy subjects(control group) were recruited and their serum androgen levels——measurements of testosterone and dehydcoepiandrosterone sulfate (DHEA-S) were tested by UPLC-MS/MS and CLIA. The androgen results combined with body mass index(BMI) were analyzed by ROC curve. According to area under curve(AUC) calculated by SPSS, a better method will be selected to provide accurate test results for physicians. Results (1)AUC of DHEA-S tested by UPLC-MS/MS was significantly higher than the one tested by CLIA(P<0.01). There was no significant difference between the AUC of T tested by UPLC-MS/MS and the one tested by CLIA. (2)AUC of T combined with DHEA-S tested by HPLC was not only significantly higher than the AUC of two combined indicators tested by CLIA(P<0.01),but also significantly higher than the AUC of a single indicator——either T(P<0.01) or DHEA-S(P<0.01) tested by UPLC-MS/MS. (3)The AUC of T,DHEA-S combined with BMI tested by HPLC was not only significantly higher than the AUC of three combined indicators tested by CLIA(P<0.01),but also higher than the AUC of two combined indicators tested by UPLC-MS/MS(P<0.05). Conclusion T and DHEA-S tested by UPLC-MS/MS combined with BMI has a certain reference value in the diagnosis of PCOS.
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Objective To observe the clinical efficacy of thrombolytic therapy combined with psychological intervention in treatment of patients with acute myocardial infarction.Methods 80 cases were treated in department of emergency, Hangzhou First People’s hospital were randomly divided into observation group and control group from February 2014 to February 2015.40 cases in each group.Observation group was given psychological intervention conventional therapy plus thrombolytic therapy, control group were treated with thrombolytic therapy alone, recorded and analysed of therapeutic effect of two groups of patients.Results NOS (nitric oxide synthase), ET (endothelin) values of observation group post-treatment were (45.9 ±5.1)U/mL,(87.3 ±7.1) pg/mL,which were better than control group (39.1 ±3.6)U/mL,(96.5 ±9.3)pg/mL (P<0.05); observation group total effective rate was 75.0% better than control group ( 70.0%) , but the two groups had no significant difference in efficiency.Conclusion Thrombolytic therapy combined with psychological intervention in the treatment of acute myocardial infarction is effective , precise, and can be effectively improve the symptoms of acute myocardial infarction, it is worthy of further research and application.
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Objective To evaluate the current methods for psychiatry clinical internship and needs for innovation from the perspectives of medical undergradutes.Methods Independent interview on patients and their relatives as well as social psychological interview were conducted for five-year psychiatry majors in clinical internship (n =72).Self-made questionnaire was used to investigate the teaching feedback concerning the practice effect and teaching method tendency.Data were analyzed by t test and P ＜ 0.05 signifies statistically significant differences.Results Medical students considered the clinical internship as the main source of psychiatry knowledge (rising from 29.4 ％ (20/69) to 36.2％ (25/69),t =4.67,P ＜0.01).Respective interviewing with patients and their families and then doing focus-group discussion was the most acceptable method for medical undergraduates:82.6％(57/69) of medical undergraduates thought this method helped expose defects of clinical skills and prejudice against psychiatry; 54.3％ (37/69) of medical undergraduates thought this method was more beneficial to acquire psychiatry knowledge.The second acceptable method was the demonstration of a typical case by teacher:27.3％ (19/69) thought this method helped expose defects of clinical skills and prejudice against psychiatry; 27.2％ (19/69) thought this method was more beneficial to acquire psychiatry knowledge.62.0％ (43/69) of medical undergraduates ranked the characteristics of the symptomatology and core symptoms differentiation as the first place.49.0％ (34/69) considered the training of interviewing skills with patients as the second important in the clinical training.91.3％ (63/69) expected to see more kinds of mental disorders.65.2 ％ (45/69) expected to learn more about the interviewing skills.Conclusions It is necessary to pay more attention to the method of doing respective interviewing with patients and their families and then making focus-group discussion.Meanwhile training of interviewing skills in the clinical internship of psychiatry should be enhanced.