T790M mutation positive squamous cell carcinoma transformation from EGFR-mutated lung adenocarcinoma after low dose erlotinib: A case report and literature review.

RATIONALE: Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are widely used for the treatment of EGFR mutation positive advanced nonsmall cell lung cancer (NSCLC); however, acquired resistance is known to develop during these treatments. Among these mechanisms, histological transformation is seldom encountered. Although platinum based chemotherapy has been reported to be effective in the treatment of patients with small cell lung cancer transformation, there is a lack of information on the treatment of patients with squamous cell carcinoma (SQ) transformation. PATIENT CONCERNS AND DIAGNOSIS: An 80-year-old nonsmoking woman was referred to our hospital because of an abnormal shadow on her chest radiograph. Diagnostic bronchoscopy was performed and pathological examination revealed adenocarcinoma. Mutation analysis of the EGFR gene revealed deletion of E746-A750 in exon 19. She refused both surgical treatment and radiation therapy, and preferred periodic radiologic follow-up. Unfortunately, approximately a year and a half after the initial diagnosis, the primary lesion enlarged, and many pleural nodules were newly detected (clinically T4N2M1a, stage IVA). INTERVENTIONS AND OUTCOMES: Based on EGFR mutation analysis, a reduced dose of daily erlotinib was prescribed, which achieved a partial response and 34 months of progression-free survival (PFS). A repeated biopsy with an endobronchial cryoprobe was performed on the enlarged primary lesion. Pathological examination revealed SQ harboring an identical EGFR mutation with a secondary EGFR T790M mutation. Osimertinib 80 mg once a day was started as second line therapy, which resulted in 8 months of PFS and 15 months of survival. LESSON: The literature review and our report suggest that osimertinib is a promising treatment for NSCLC regardless of histology if T790M is present as an acquired mutation.

Socioeconomic Status and the Sense of Coherence among Japanese People Living with HIV.

People living with HIV (PLWH) are forced to live with multiple and severe stressors. Focusing on sense of coherence (SOC), which is a concept of salutogenic and stress coping capacity, is useful in PLWH support. This study aimed to examine the association between SOC and socioeconomic status (SES) for Japanese PLWH. Methods: This study used data from the HIV Futures Japan national survey, which is an online survey with a cross-sectional design. This survey of PLWH in Japan was conducted from July 2013 to February 2014 and December 2016 to July 2017, resulting in 1422 valid responses. The mean age (SD) was 38.6 years (8.3). The 13-item SOC scale score was divided into two groups, based on Japanese standard score in a previous study, and logistic regression analysis was performed. Results: Education levels were indirectly associated with SOC through occupation. Compared to freelance-profession/self-employed, "unemployed job seekers" (OR [95%CI] = 2.16 [1.16, 4.04]) and "homemaker/recuperating/student" (2.09 [1.09, 4.02]) were directly related to poor SOC, regardless of income. Also, there is a clear SOC disparity in income (compared to ">8 million yen/year", "<1 million yen/year" was 2.94 [1.46, 5.92], and "1−2.99 million yen/year" was 2.49 [1.33, 4.68]). Conclusion: It became clear that there is a relationship between SOC and SES. The results of this research provide important evidence for health promotion measures for PLWH.

[HIV-related public stigma and knowledge regarding the campaign slogan "undetectable=untransmittable" among Japanese people].

Objectives　This study targeted adult males and females living in Japan with the following three objectives. The first was to clarify the public stigma toward people living with HIV (PLWH). The second was to clarify changes in public stigma by gathering information about the "undetectable=untransmittable" (U=U) campaign. The third was to clarify the relationship between changes in public stigma and contributing factors, and the experiences of PLWH.Methods　We conducted a cross-sectional online survey in September, 2019 for male and female internet research monitors in their 20s to 60s who were heterosexual, not HIV-positive, and not acquainted with PLWH. In total, the results from 2,268 people were analyzed. Public stigma toward PLWH was measured by a modified vignette for PLWH using a social distance scale for people with mental illness. The social distance scale included "becoming a neighbor," "greeting and talking," "asking them to take care of your children," "becoming friends," "becoming colleagues at work," and "marrying your relatives." We provided information on "U=U" to participants and then evaluated the changes in acceptance of each social distance factor into four categories: "unacceptable," "acceptable ⇒ unacceptable," "unacceptable ⇒ acceptable," and " acceptable."Results　All items in the social distance scale except "greeting and talking" exhibited significantly positive changes (male odds ratio 1.76 to 4.18, female odds ratio 2.25 to 7.00) after providing information. The factor most often deemed "unacceptable" was "marrying your relatives," in 57.5% of men and 58.1% of women; 37.0% of men and 37.3% of women answered "asking them to take care of your children;" and 19.0% of men and 11.1% of women answered "becoming friends." Multinomial logistic regression analysis demonstrated that experience with PLWH in both men and women was associated with "marrying your relatives." The experience of watching television and listening to radio programs, watching movies and plays, and reading books related to PLWH was significantly related to the category of "unacceptable" compared with "acceptable." (Male odds ratio 0.38 to 0.63, female odds ratio 0.50 to 0.56).Conclusion　The acceptance of PLWH was low in personal matters, such as family and child-rearing. The explanation of "U=U" improved acceptance in each social distance factor. Independent experiences, such as viewing, appreciation, and reading about PLWH, improved acceptance.

Assessment of Assistance in Smoking Cessation Therapy by Pharmacies in Collaboration with Medical Institutions- Implementation of a Collaborative Drug Therapy Management Protocol Based on a Written Agreement between Physicians and Pharmacists.

This study built a protocol for drug therapy management (hereinafter "the protocol") that would enable continuous support from the decision making of smoking cessation therapy to the completion of therapy through the collaboration of physicians and community pharmacists, after which we evaluated whether the use of this protocol would be helpful to smoking cessation therapy. This study utilized the "On the Promotion of Team-Based Medical Care", a Notification by the Health Policy Bureau as one of the resources for judgment, and referred to collaborative drug therapy management (CDTM) in the United States. After the implementation of this protocol, the success rate of smoking cessation at the participating medical institutions rose to approximately 70%, approximately 28-point improvement compared to the rate before the implementation. In addition to the benefits of the standard smoking cessation program, this result may have been affected by the intervention of pharmacists, who assisted in continuing cessation by advising to reduce drug dosage as necessary approximately one week after the smoking cessation, when side effects and the urge to smoke tend to occur. Additionally, the awareness survey for the intervention group revealed that all respondents, including patients who failed to quit smoking, answered that they were satisfied to the question on general satisfaction. The question about the reason for successful cessation revealed that the support by pharmacists was as important as, or more important than, that by physicians and nurses. This infers that the pharmacists' active engagement in drug therapy for individual patients was favorably acknowledged.

Recreational drug use and related social factors among HIV-positive men in Japan.

This study aims to determine the relationship between recreational drug use in HIV-positive males in the past year and socio-economic factors and/or social support networks in Japan. A national online survey in a cross-sectional study was conducted by HIV Futures Japan project from July 2013 to February 2014. Of the 1095 HIV-positive individuals who responded, 913 responses were determined to be valid; responses from the 875 males were analysed. A total of 282 participants used addictive drugs (32.2%) in past year. New psychoactive substances were used by 121 participants (13.8%), methamphetamine or amphetamine by 47 (5.4%), air dusters/sprays/gas by 31 (3.5%), 5-methoxy-N,N-diisopropyltryptamine (5MeO-DIPT) by 16 (1.8%) and cannabis (1.0%) by 9. Multiple logistic regression analysis was performed with the use of alkyl nitrites, addictive drugs, air dusters and thinners, which are low illegality, as dependent variables. We found that the odds ratio (95% confidence interval) for use among participants with full-time and temp/contracted/part-time employees compared to management/administration professions were 2.59 (0.99-6.77) and 2.61 (0.91-7.51). Also, a correlation was observed between alkyl nitrites and new psychoactive substances and usage rates in people engaged in few HIV-positive networks. It is necessary to develop targeted policies for drug use prevention and user support among HIV-positive men and to support and provide care for drug users who are isolated or have a narrow HIV/AIDS support network.