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<p><b>BACKGROUND AND OBJECTIVE</b>Epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) has been widely used as the second- and third-line therapy in patients with advanced non-small cell lung cancer (NSCLC). However, its effect in the first-line treatment is unclear. The aim of this study was to evaluate the efficacy and safety of EGFR-TKI as first-line therapy.</p><p><b>METHODS</b>The clinical characteristics, responses rate, disease control rate and overall survival were retrospectively analyzed in 77 chemonaive patients with advanced NSCLC. All of the patients received oral gefitinib (250 mg/d) or erlotinib (150 mg/d) until disease progression or unacceptable toxicity occurrence.</p><p><b>RESULTS</b>The overall response rate was 33.8% and the disease control rate was 68.8%. The median progression-free survival and the median survival time were 6.0 months and 8.9 months, respectively. One-year survival rate was 61.4%. Responses correlated significantly with histology, PS score, smoking history, skin rash, EGFR mutations and serum CEA. Histology and skin rash were the independent predictors of survival. Common toxicities were skin rash and mild diarrhea. EGFR-TKI could improve the clinical symptoms and the quality of life.</p><p><b>CONCLUSION</b>EGFR-TKI is effective and well tolerated as first-line therapy in patients with advanced NSCLC.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Administration, Oral , Carcinoma, Non-Small-Cell Lung , Drug Therapy , Mortality , Erlotinib Hydrochloride , Kaplan-Meier Estimate , Quinazolines , Therapeutic Uses , ErbB Receptors , Retrospective StudiesABSTRACT
Invasive pulmonary aspergillosis [IPA] among patients with chronic obstructive pulmonary disease [COPD] is increasing in frequency. We conducted this study to find out the approximate incidence of IPA in patients with acute exacerbation of COPD [AECOPD], and to determine whether using a combination of two tests [galactomannan [CM] antigen and 1,3-[3-glucan [BG] detection] would result in a more specific diagnosis of IPA. The study included 261 patients with AECOPD admitted over two years. The patients were categorized according to the modified definitions for IPA. CM antigen and BG were detected by the Platelia Aspergillus and Glucatell tests. Two patients had proven IPA, three had probable IPA, and two had possible IPA. The rate of proven or probable IPA in patients with AECOPD was 1.91% [5/261]. Four patients with proven and probable IPA had been treated with a systemic or inhaled corticosteroid before hospitalization and the typical symptoms and diagnostic signs of IPA were relatively less common in them. Mortality in patients with proven and probable IPA was 80%. The specificity of combined CM and BG detection was 98.8%. Combining two serological tests increased the specificity of diagnosis but further trials are needed to prove the value of this approach
Subject(s)
Humans , Middle Aged , Aged , Male , Female , Invasive Pulmonary Aspergillosis/diagnosis , Pulmonary Disease, Chronic Obstructive/complications , Incidence , Sensitivity and Specificity , Seroepidemiologic Studies , Prospective Studies , ChinaABSTRACT
BACKGROUND: Lung protective ventilation strategies and positive endexpiratory pressure (PEEP) have been widely used as an effective ventilation pattern in clinical practice of administration of acute respiratory distress syndrome (ARDS) in recent years, but there arestill great arguments on the therapeutic effects.OBJECTIVE: To observe the changes of oxygenation index and inflammatory transmitters in peripheral blood and bronchoalveolar lavage fluid(BALF) of different lung areas [superior area of lung (upper lobe), ventral side of inferior lung (heart lobe), and dorsalis inferior lung (diaphragm lobe)] of ARDS dogs caused by pulmonary and extrapulmonary insults under lung protective ventilation treatment.DESIGN: A randomized control animal study.SETTING: Department of Respiratory Medicine, the General Hospital of Chinese PLA.MATERIALS: Twenty-four adult healthy male mongrel dogs were randomly divided into four groups with 6 dogs in each: pulmonary ARDS experimental group, pulmonary ARDS control group, extrapulmonary ARDS experimental group and extrapulmonary ARDS control group.METHODS: Models of extrapulmonary ARDS were induced by intravenous injection of oleic acid (0.1-0.15 mg/kg), and the pulmonary ARDS models were established by intratracheal administration of diocty sulfosuccinate sodium salt. After lung injury, the experimental groups received lung protective ventilation treatment (tidal volume: 8 mL/kg, PEEP: 0.981 kPa)for 3 hours, and the control groups also received ventilation of large tidal volume (tidal volume: 14-17 mL/kg, PEEP: 0 kPa).MAIN OUTCOME MEASURES: ① changes of oxygenation index in each group; ② dynamically observed the changes of the inflammatory transmitters [tumor necrosis factor alpha (TNF-α), interleukin-1 beta (IL1β) and interleukin-6 (IL-6)] in pe. Ripheral blood and BALF of different lung areas (upper lobe, heart lobe and diaphragm lobe) of ARDS dogs under lung protective ventilation treatment.RESULTS: All the 24 dogs were involved in the analysis of results. ①After lung injury, the oxygenation indexes were significantly decreased in all the groups, and the oxygenation indexes after lung protective ventilation in the experimental groups were obviously higher than those in the control groups (P ＜ 0.05). At 2 and 3 hours after lung protective ventilation, the oxygenation indexes in the extrapulmonary ARDS experimental group were markedly higher than those in the pulmonary ARDS experimental group (P＜ 0.05). ② After lung injury, the levels of the inflammatory transmitters in peripheral blood were all obviously increased in all the groups, which were decreased to different extent after the lung protective ventilation treatment,but the therapeutic effect in the pulmonary ARDS experimental group was not as good as that in the extrapulmonary ARDS experimental group. ③The levels of inflammatory transmitters in BALF of lung upper lobe and heart lobe were obviously higher in pulmonary ARDS dogs than in extrapulmonary ARDS dogs.CONCLUSION: The ameliorations of the release of inflammatory transmitters and oxygenation index at different areas are obviously different between ARDS dogs caused by pulmonary and extrapulmonary insults, and lung protective ventilation has good effect on extrapulmonary ARDS dogs,but has bad effect on pulmonary ARDS ones.
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OBJECTIVE To study the treatment effect of macrolides on nontypeable Haemophilus influenzae biofilm formation.METHODS Two strains of H.influenzae were isolated from sputum specimens from patients with acute exacerbation of chronic obstructive pulmonary diseases.Formation of bacterial biofilm was examined by crystal violet assay and scanning electron microscope.The biofilms were measured under varying concentrations of macrolides in vitro.RESULTS Biofilm synthesis was observed at subMIC and became thicker in roxithromycin and erythromycin at 1/8 MIC,Disruption of mature biofilms could be achieved at relatively higher concentration,Azithromycin displayed more powerful activity.CONCLUSIONS H.influenzae is capable to form biofilm in vitro,especially in subconcentration.Sufficient antibiotics dosage might affact early formation of biofilms.Azithromycin exerts better effects on biofilm formation than other macrolides.
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OBJECTIVE To investigate the etiology of ventilator-associated pneumonia(VAP) in our respiratory intensive care unit(RICU) and to explore the antimicrobial resistance of predominant pathogens in last ten years. METHODS From 1992 to 2003,totally 149 cases with VAP were collected for analyzing in our RICU.Standard disk diffusion susceptibility tests were performed on the predominant pathogens. RESULTS During this period,the incidence of VAP in RICU was 35.57%,33 cases were infected by two or more pathogens(67.35% VAP cases).The main pathogens of VAP were Gram negative organisms(65.51%) whose predominant pathogens were Pseudomonas aeruginosa and Acinetobacter.On the other hand,the main Gram positive organisms were Staphylococcus epidermidis.During the recent 10 years,the incidence of Acinetobacter rose up from 8.99% to 15.49% and the rate of Candida decreased from 13.33% to 7.04%. CONCLUSIONS The main pathogens of VAP in our RICU are P.aeruginosa and Acinetobacter,and the changes in pathogens distribution and infection spectrum have been taken place during the past 10 years.
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Objective To analyze the differences in gene expression between human lung giant cell carcinoma cell strains of high metastatic 95D and low metastatic 95C and to screen lung cancer metastasis-associated genes using cDNA microarray.Methods The mRNAs were extracted from human lung giant cell carcinoma cell strains of high metastatic 95D and low metastatic 95C,and reversely transcribed to the cDNAs and labeled by Cy5-dUTP and Cy3-dUTP to prepare the hybridization probes.The mixed probes were hybridized to the cDNA microarray chip.The information was obtained by managing the cDNA microarray chip with Scan Array 3000 scanner and ImaGene3.0 software.A part of genes whose expressions changed in cDNA microarray analysis were further identified by RT-PCR.Results The cDNA microarray analysis showed that the expressions of 466 genes changed,among which 108 pairs of Double Gene had the same GenBank ID and some of the genes,including Fln29,RUVBL2,C14orf3 et al,were further confirmed by RT-PCR.The results of RT-PCR was coincided well with the cDNA microarray results.Conclusion Many different genes are involved in the metastasis of lung cancer.cDNA microarray technique might be a useful method in screening lung cancer metastasis-associated genes.