We report the case of an 85-year-old man who was surgically diagnosed with lung adenocarcinoma (pT2aN1M0 stage IIA). He was administered platinum combination chemotherapy as first-line treatment for lung cancer recurrence. The patient's pleural fluid sample was obtained and analysed using a next-generation sequencer, which demonstrated the presence of mesenchymal-epithelial transition gene (MET) exon 14 skipping mutations. As the patient developed progressive disease after receiving first-line chemotherapy, crizotinib was administered as the second-line treatment. The treatment was effective, and the patient had a stable disease for 7 months. This case suggests that crizotinib is effective against non-small cell lung cancer with MET exon 14 alterations.
Metronidazole is an antibiotic classically used against most anaerobic bacteria and protozoa. Because an intravenous form of metronidazole has recently entered the market, the use of this antibiotic is attracting renewed interest in many clinical settings in Japan. However, neurotoxicity is a major adverse event: in the central nervous system metronidazole-induced encephalopathy is a rare but serious condition. We performed a literature review of 34 cases including 2 of our cases, 25 from domestic conference abstracts, and 7 cases presented in full research papers. The mean patient age was 64.7 years. The conditions most commonly treated with metronidazole were brain abscess (35.3%), liver abscess (17.6%), and Clostridium difficile infection (14.7%). The most common predisposing conditions were liver dysfunction (26.5%), diabetes and other metabolic disorders (20.6%), and hematologic or solid organ malignancy (14.7%). The mean period of administration before the onset of encephalopathy symptoms was 61.3 days, and the mean total dose was 95.9g. The initial chief complaints were dysarthria (in 70.6% of the cases) and ataxia (61.8%); 82.4% of the cases were diagnosed on the basis of MRI (T2-weighted or FLAIR imaging). The key imaging finding was high intensity in the dentate nucleus bilaterally (82.4%). Stopping the metronidazole led to symptom remission within 8.5 days, but the MRI changes remained longer than the clinical symptoms. Two patients (6.0%) developed irreversible disturbance of consciousness. Although the mechanisms of this type of encephalopathy have not yet been elucidated, localized nerve-cell edema is likely caused by decreased metronidazole metabolism associated with liver and metabolic dysfunction. Careful observation for neurologic signs should be conducted during the treatment of brain abscesses associated with metronidazole administration, because patients with brain abscesses are naturally at high risk of metronidazole-induced encephalopathy.
Enhanced green fluorescent protein (GFP) irreversibly loses not only fluorescence but also antigenicity recognized with conventional anti-GFP antibodies by heat denaturation. This hinders combinatory applications of the GFP immunodetection technique with heat-requiring procedures, such as in situ hybridization histochemistry, antigen retrieval, and Western blot. Here we produced new rabbit and guinea pig antibodies against heat-denatured GFP. The polyclonal antibodies affinity-purified with the antigen column detected a single band corresponding to the molecular size of GFP in Western blot analysis, with mouse brain expressing GFP from the GAD67 locus. By immunofluorescence labeling, the new antibodies detected GFP molecules in heat (≥70C)-treated sections but not in untreated sections of the mouse brain. When the sections were incubated at ≥37C with in situ hybridization buffer containing 50% formamide, a denaturing reagent, the sections lost immunoreactivity with the conventional anti-GFP antibodies but acquired immunoreactivity with the new antibodies to heat-denatured GFP. Finally, GFP immunofluorescence was successfully visualized with the new antibodies in sections of the GFP-expressing mice labeled by fluorescence in situ hybridization histochemistry against GAD67 mRNA. Thus, the antibodies produced in this study may provide an opportunity to combine GFP immunodetection with procedures requiring heat treatment. This manuscript contains online supplemental material at http://www.jhc.org . Please visit this article online to view these materials.
The effect of heat-treatment in vacuo and hydrogen on ductility and UTS of the sintered 95.5 W-3.0 Ni-1.5 Fe and 91.3 W-5.8 Ni-2.9 Fe (by wt%) heavy alloys has been studied. The influence of composition and microstructure upon the mechanical properties of the cold worked (swaging) alloys is also presented in this paper.These materials were heated at 400-1200°C in hydrogen atmosphere and in vacuo, and the mechanical properties of heat treated alloys were tested.The effect of vacuum treatment was attributed to the removal of hydrogen embrittlement, and values of UTS and elongation increased after the vacuum treatment.The scanning electron micrographs of the fracture surfaces showed that hydrogen weakens mainly the interface between tungsten-matrix phase boundaries, and W-grain boundaries.High ductility was found to be connected to a high binding strength between the tungsten grains and the matrix phase.
A 59-year-old male, who had Mycobacterium abscessus lung disease and chronic obstructive pulmonary disease, visited our hospital because of dyspnea. Chest computed tomography showed ground-glass opacity and consolidation mainly in the left upper lobe. Antibiotics treatment with levofloxacin and tazobactam/piperacillin was not effective. He underwent bronchoscopy and based on pathological findings, organizing pneumonia (OP) was diagnosed. No other underlying factors causing OP, such as collagen vascular diseases, drug, or inhalation were detected. He had the diagnosis of secondary OP due to M. abscessus lung disease. Oral predonizolone with 30 mg was initiated, and the opacity improved rapidly. Secondary OP due to M. abscessus lung diseases should be considered during M. abscessus lung diseases when antibiotics and/or antimycobacterial drugs are not effective.
Background: Our goal was to organize the data from randomized controlled trials that evaluated first-line chemotherapy for chemo-naïve extensive disease small-cell lung cancer (ED-SCLC). Methods: The protocol following PRISMA methodology was submitted as PROSPERO 154049. We included individually randomized trials comparing two or more chemotherapy regimens as the first-line treatment for chemo-naïve ED-SCLC regardless of the age, sex, performance status, co-morbidities, and organ functions written in the English language since 2000. Molecular targeted agents and immune checkpoint inhibitors were considered chemotherapy along with cytotoxic medications. We pooled the logarithm of hazard ratio (HR) and its standard error using the frequentist weighted least squares approach random-model network meta-analysis. Results: A total of 46 eligible trials that involved 11,987 patients were included. The primary endpoint, HR of overall survival (OS, HRos) of the selected comparisons was as follows: carboplatin+amrubicin (HRos 0.56, 95% confidence interval (CI) 0.33–0.96), carboplatin+etoposide+atezolizumab (HRos 0.70, 95% CI 0.53–0.92), and carboplatin+irinotecan (HRos 0.73, 95% CI 0.58–0.91) were compared with carboplatin+etoposide. The carboplatin+etoposide+atezolizumab regimen was compared with carboplatin+irinotecan (HRos 0.97, 95% CI 0.68–1.37) and cisplatin+irinotecan regimen (HRos 0.87, 95% CI 0.58–1.31). “Selective carboplatin or cisplatin (CBDCA/CDDP)”+etoposide+durvalumab was compared with CBDCA/CDDP+etoposide (HRos 0.73, 95% CI 0.59–0.91). Platinum+etoposide+durvalumab was compared with platinum+irinotecan (HRos 0.88, 95% CI 0.67–1.15). Cumulative meta-analysis suggested that platinum+irinotecan was associated with better OS than platinum+etoposide as of 2010 through 40 out of 46 trials in our review that used platinum+etoposide as a reference regimen. Conclusion: Patients treated with carboplatin+amrubicin, carboplatin+etoposide+atezolizumab, CBDCA/CDDP+etoposide+durvalumab, and platinum+irinotecan showed better HRos than those treated with platinum+etoposide, one of the standard regimens.
Entrectinib is a recently approved multikinase inhibitor to treat advanced c-ros oncogene1 (ROS1) positive non-small cell lung cancer (NSCLC). Although molecular targeted therapy is generally well tolerated, cardiovascular adverse events have been described in recent years. We report a case of NSCLC with ROS1 rearrangement where the patient developed drug-induced heart failure after receiving entrectinib. A 74-year-old non-smoker female patient was diagnosed with stage IVB lung adenocarcinoma with ROS-1 positive and right breast cancer stage I. We started on entrectinib as the first-line therapy for lung cancer. Five days after, she developed oral dysesthesia and blood creatinine increased. These findings gradually worsened, so we temporarily discontinued entrectinib. After withholding the drug for 14 days, these findings improved, and we resumed entrectinib at a reduced dose. On day 19 of the reduced entrectinib dose, she presented to the outpatient with shortness of breath and bilateral lower extremity edema, accompanied by respiratory failure. Laboratory evaluation revealed elevated N-terminal pro-brain natriuretic peptide (NT-pro BNP), troponin I, creatine kinase (CK), and C reactive protein (CRP), and transthoracic echocardiogram showed congestive heart failure (CHF) with a preserved ejection fraction (HFpEF). She did not complain of chest pain and fever, so we did not consider ischemic heart disease and viral myocarditis in the initial evaluation. There was no other causative cause of CHF. Therefore, we suspected entrectinib-related heart failure. Her symptoms improved and she recovered her cardiac function to baseline within a week of discontinuation of entrectinib and standard heart failure treatment. She developed heart failure after a one-step dose reduction and was prone to cardiotoxicity due to entrectinib. Considering that she could be treated with crizotinib, we decided discontinuation of entrectinib permanently. This case report highlights the potential cardiotoxicity of entrectinib and suggests the need for close monitoring of the cardiac functions of patients receiving entrectinib.
failure.We aimed to examine the effect of NIV on ventilator-free days in patients admitted to the intensive care unit (ICU) with acute hypoxaemic respiratory failure.Methods: We conducted a retrospective study of patients admitted to the ICU with acute hypoxaemic respiratory failure at Waikato Hospital, New Zealand, from 1st January 2009 to 31st December 2018.Patients treated with NIV were compared to controls treated with early intubation.The two groups were matched using a propensity score developed using baseline characteristics and treatment allocation of the cohort.The primary outcome was ventilator-free days at day-28.Secondary outcomes were ICU and hospital length of stay, and in-hospital mortality.Results: 175 patients were eligible for inclusion, with 79 in the NIV group and 79 in the early intubation group matched using the propensity score.When compared to early intubation, NIV was associated with a significantly higher median ventilator-free days (17 days vs 23 days, p-value: 0.01289).There was no significant difference in median ICU length of stay (112.5 hours vs 117.67 hours), hospital length of stay (14 days vs 14 days), or in-hospital mortality (31.6% vs 37.9%) between the NIV and early intubation group.
