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The clinical application of immune checkpoint inhibitors (ICIs) lead to dramatic changes in the treatment strategy for patients with advanced non-small cell lung cancer (NSCLC), but the efficacy of ICIs in oncogene-driven NSCLC is controversial. Existing research shows that the efficacy of ICIs may be related to different types of driver genes, programmed cell death-ligand 1 (PD-L1) level, and tumor mutational burden (TMB). It may involved in other factors, such as clinical characteristics, and immune cell density. ICIs monotherapy or combination therapy may play a role in a subset of oncogene-driven NSCLC patients, but further studies are needed to select these patients, which may be an important direction for the future development of advanced NSCLC.
Subject(s)
Humans , B7-H1 Antigen , Genetics , Biomarkers, Tumor , Carcinoma, Non-Small-Cell Lung , Drug Therapy , Immunotherapy , Lung Neoplasms , Drug TherapyABSTRACT
Electronic cigarettes (EC) are battery-powered devices that deliver aerosolized nicotine to users.EC has been reported to contain less carcinogens than traditional cigarettes,cause less lung effects and may help with smoking cessation.EC are an increasingly popular device that could serve as a smoking cessation product.But the effect of smoking cessation has not been confirmed and use of EC may bring potential health problem.This study reviewed the research progress in smoking cessation by using EC.
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<p><b>BACKGROUND</b>Acute kidney injury (AKI) is a common complication of sepsis, which is associated with higher risks of adverse outcomes. Recently, kidney disease: improving global outcomes (KDIGO) recommended a new guideline for AKI, including a little modification on the AKI staging criteria.</p><p><b>METHODS</b>This retrospective study included 211 septic patients admitted to the intensive care unit (ICU) at Xiangya Hospital, Central South University from January 2008 to January 2011. AKI was diagnosed and classified according to the KDIGO or acute kidney injury network (AKIN) criteria. Differences between the AKI and non-AKI groups for baseline characteristics, laboratory examinations, etiology, outcomes, as well as the risk factors for AKI and 28-day mortality were analyzed. The reliability of the KDIGO criteria was also evaluated by comparing it with the AKIN criteria.</p><p><b>RESULTS</b>The overall incidence of AKI in septic patients was 47.9%, and the 28-day mortality was 32.7%. The incidence of AKI was significantly higher in patients with more severe sepsis. Indicators of hepatic and respiratory function were significantly worse in the AKI group. Furthermore, a higher proportion of patients were infected with Enterobacter cloacae in the AKI group. The independent risk factors for AKI were shock, the number of organ failures, blood urea nitrogen (BUN) levels, and the use of vasopressors. The independent risk factors for mortality were BUN and creatine kinase-MB (CK-MB) levels. Both the KDIGO criteria and the AKIN criteria were significantly associated with 28-day mortality.</p><p><b>CONCLUSIONS</b>The incidence and 28-day mortality of AKI were very high in ICU septic patients. Greater attention should be paid to AKI-induced hepatic and respiratory dysfunction in clinical practice. Patients with an intra-abdominal source of infection were more likely to develop AKI. KDIGO criteria are reliable in AKI staging.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Acute Kidney Injury , Epidemiology , Intensive Care Units , Retrospective Studies , Risk Factors , Sepsis , EpidemiologyABSTRACT
OBJECTIVE To investigate the pathogenic bacteria distribution and susceptibility of lower respiratory tract infection in patients in our respiratory ward.METHODS All the clinical isolates from sputum or secretion of lower respiratory tract from 2003 to 2007 were analyzed retrospectively.RESULTS A total of 1529 clinical isolates were collected,including 1326 strains of Gram-negative bacilli(86.7%) and 203 strains of Gram-positive cocci(13.3%).The proportion of Gram-negative bacilli was higher in lung underlying diseases group when compared with non-lung underlying diseases.Haemophilus parainfluenzae and H.influenzae were susceptible to spectinonycin,doxycycline and third-generation cephalosporins.Pseudomonas aeruginosa and Acinetobacter baumanni were susceptible to meropenem,cefoperazone/sulbactam and cefepime.Klebsiella pneumoniae and Escherichia coli were susceptible to meropenem,cefoperazone/sulbactam and amikacin.The major Gram-positive isolates were highly resistant to azithromycin,erythromycin,penicillin.All Staphylococcus aureus isolates were susceptible to vancomycin.Streptococcus pneumoniae isolates were highly susceptible to meropenem,levofloxacin,cefazolin and vancomycin.CONCLUSIONS Infection caused by Gram-negative bacilli are predominant in lower respiratory tract infection patients,especially in the patients with lung underlying diseases.Antibiotics resistance of some pathogens become increasingly severe.Therefore,the rational use of antibiotics is important for the containment of bacterial resistance.
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Objective To investigate the clinical manifestations, imaging features, diagnosis and management of pulmonary mycosis.Methods Fifty-four patients were identified with pulmonary mycosis by pathological examination in our hospital from January 2002 to June 2008. Data of clinical manifestations, imaging features, diagnosis and management were retrospectively reviewed.Results Of the 54 cases, 30 (55.6%) were pulmonary aspergillosis, 15 (27.8%) were pulmonary cryptococcosis. Underlying disease was reported in 42 of 54 (77.8%) cases. The diagnosis of all the patients was confirmed by pathological exami-nation. Lung or bronchi tissue was obtained by operation in 30 (55.6%) cases, by bronchofibroscope in 12 (22.2%) cases, by CT-guided percutaneous needle biopsy in 9 (16.7%) cases, and by lymphoid node biopsy in 4 cases. Main symptoms included cough (41, 75.9%), expectoration (30, 55.6%), hemoptysis (20, 37.0%), fever (16, 29.6%), and asymptomatic (6, 11.1%). The X-ray and chest CT showed masses or nodule lesions (41, 75.9%), patchy lesions (8, 14.8%), cavity (12, 22.2%), diffuse milliary nodules (1 case). Bilateral lungs were involved in 7 cases (13.0%);right lung alone in 26 cases (48.1%);left lung alone in 21 cases (38.9%). Among the 54 cases, 41 (75.9%) were misdiagnosed before pathological examination. Thirty (55.6%) cases underwent surgical resection of pulmonary lesions. One patient suffered from cryptococcal meningitis after operation. Twenty (37.0%) patients received systemic anti-fugal therapy. Cure or significant improvement was found in 16 cases. Conclusions The most frequently isolated fungi were Aspergillus, followed by Cryptococcus. Final diagnosis is mainly dependent on pathological examination. Clinical manifestations, imaging features, diagnostic procedures and management are different due to the difference of pathogenic fungi. Satisfactory Results can be obtained by anti-fungal therapy combined with surgical management.