Advances in the Treatment of RET Fusion-positive Advanced Non-small Cell Lung Cancer / 中国肺癌杂志

Rearranged during transfection (RET) fusions are found in 0.7% to 2% of non-small cell lung cancer (NSCLC). Fusions between RET gene and other domains represent the distinct biological and clinicopathological subtypes of NSCLC. Recent years have witnessed the remarkable advancement of RET fusion-positive advanced NSCLC therapy. Conventional chemotherapy produced moderate clinical benefits. Prior to the introduction of targeted therapy or in the context of unavailability, platinum-based systemic regimens are initial therapy options. Immunotherapy predicted minimal response in the presence of RET fusions while currently available data have been scarce, and the single-agent immunotherapy or in combination with chemotherapy regimens are not recommended as initial systemic therapy in this population. The repurpose of multi-target kinase inhibitors in patients with RET fusion-positive NSCLC showed encouraging therapeutic activity, with only cabozantinib and vandetanib being recommended as initial or subsequent options under certain circumstances. However, there are still unmet clinical needs. Pralsetinib and selpercatinib have been developed as tyrosine kinase inhibitors (TKI) selectively targeting RET variation of fusions or mutations, and both agents significantly improved the prognosis of patients with RET fusion-positive NSCLC. Pralsetinib and selpercatinib have been established as preferred first-line therapy or subsequent therapy options. As observed with other TKIs treatment, resistance has also been associated with RET targeted inhibition, and the acquired resistance eventually affect the long-term therapeutic effectiveness, leading to limited subsequent treatment options. Therefore, it is essential to identify resistance mechanisms to TKI in RET fusion-positive advanced NSCLC to help reveal and establish new strategies to overcome resistance. Here, we review the advances in the treatment of RET fusion-positive advanced NSCLC.
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Selection of perfusion flow in cardiopulmonary bypass surgery for adult patients with valvular heart disease / 实用医学杂志

Objective To investigate the effect of flow rate on pH,urine volume and cerebral oxygen saturation during cardiopulmonary bypass (CPB) in patients with valvular heart disease.Methods 40 with valvular heart disease were divided into the high flow group (n =20) and the low flow group (n =20).The cerebral oxygen saturation value,lactic acid,BE value and the amount of urine between the two groups after induction of anesthesia (T1),at the beginning of CPB (T2),5 min after declamping shock (T3),5 min after recovery temperature (T4),5 min after aortic opening (T5),5 min after the end of aortic bypass (T6) were compared.Results (1) The cerebral oxygen saturation at the beginning of T2 was slightly lower than that of T1 after anesthesia induction.(2) The cerebral oxygen saturation was slightly higher and the absolute value of lactic acid and BE was slightly lower at T4 than that of T3.(3) The cerebral oxygen saturation was higher and the absolute value of BE was lower at T5 than that of T4.(4) The cerebral oxygen saturation of high flow group at T3,T4 and T5 was higher than that of the low flow group,while the absolute value of lactic acid and BE was lower than that of the low flow group.Conclusion High flow rate can increase cerebral oxygen saturation,reduce blood lactic acid,maintain the balance of pH,and increase renal blood perfusion.

Application of magnifying colonoscopy in diagnosis and treatment of colorectal neoplastic lesions / 中国康复理论与实践

@#ObjectiveTo evaluate the clinical value of magnifying endoscopy in diagnosis and treatment of colorectal benign neoplastic lesions.Methods78 colorectal lesions in 61 patients were examined with magnifying colonoscopy after indigo carmine dye, and a pit pattern diagnosis was made for every lesion according to Kudo's classification.All the lesions were totally resected, and the specimen were sent for pathologic examinations.ResultsThe diagnostic sensitivity of neoplastic lesions was 98.4% and specificity was 85.7% when types Ⅰ and Ⅱ represented the pit pattern of nonneoplastic lesions, whereas types Ⅲ, Ⅳ, and Ⅴ represented adenoma and early colorectal cancer. The overall accuracy in differentiating adenoma and early colorectal cancer from nonneoplastic lesions was 96.2%.94.5% of adenomarous lesions were treated by colonoscopy.ConclusionThe magnifying colonoscopy can provide an instantenous accurate diagnosis of tumorous lesions in colon and rectum. Synchronize, minimally invasive and curative treatment is possible to be completed by using it for a large number of lesions.