ObjectiveTo study and compare the effects of inhaled preparations with open airway and conventional inhaled preparation on asthma patients.MethodsThe patients diagnosed with asthma and treated with the same inhaled preparation only who visited the outpatient department of West China Hospital of Sichuan University, were selected as the study subjects from April to September, 2019. The subjects were divided into the test group and the control group according to random ratio 1∶1. The conventional inhaled preparations were used in the control group. The inhaled preparations with open airway were used in the test group. Asthma control, life quality and treatment satisfaction rate were compared between the two groups after 3 months.ResultsA total of 150 subjects were included and one case dropped-off, then 149 effective subjects were obtained in which 75 cases in the test group and 74 cases in the control group. After 3 months’ treatment of inhaled preparations, the proportion of effective asthma control patients in the test group was higher than that in the control group, and the number of patients satisfied with the treatment of inhaled preparations was higher than that in the control group, with statistically significant differences (all P<0.05). The life quality of patients in both groups was improved compared with baseline, and the difference was statistically significant (P<0.05). However, the increase of scores in the test group was more than that in the control group, and the difference was also statistically significant (P<0.05). ConclusionInhaed preparations with open airway is superior to conventional inhaled preparation on asthma patients in asthma control, life quality and treatment satisfaction rate.
Objective To explore the correlation between EZR-ROS1 fusion mutation and acquired resistance to immune checkpoint inhibitors (ICIs) in patients with lung adenocarcinoma, and to provide a reference for clinical diagnosis and treatment after ICIs resistance.MethodsThe clinical data of 1 patient with advanced lung adenocarcinoma who developed acquired resistance after receiving ICIs combined with chemotherapy, was found to have EZR-ROS1 fusion mutation by gene detection, and was treated with entrectinib targeted therapy were reported. Combined with the results of literature retrieval, the related mechanisms of ROS1 fusion mutation-induced ICIs resistance were analyzed.ResultsThe 46-year-old female patient was diagnosed with left lower lobe lung adenocarcinoma (cT3N3M1a, stage IVA). She received first-line pemetrexed + carboplatin + sintilimab chemoimmunotherapy combined with maintenance therapy, and achieved sustained partial response (PR) for about 12 months before disease progression. Second-line docetaxel combined with sintilimab therapy was ineffective. Pelvic lymph node biopsy suggested adenocarcinoma metastasis, immunohistochemistry showed ROS1 protein positivity, and next-generation sequencing (NGS) detected EZR-ROS1 fusion mutation (copy number 6.3%). After third-line entrectinib targeted therapy, the efficacy evaluation was sustained PR for 8 months, then the disease progressed again, and the patient eventually died of lung cancer progression and renal failure. No case reports on the correlation between EZR-ROS1 fusion mutation and ICIs acquired resistance in lung adenocarcinoma were found in the literature retrieval. Only 4 cases of lung adenocarcinoma patients with ROS1 fusion mutation (3 cases were CD74-ROS1 fusion) after chemotherapy or ICIs treatment were retrieved, all of which responded to ROS1 tyrosine kinase inhibitor (TKI) treatment but progressed rapidly. ConclusionsEZR-ROS1 fusion mutation may be a rare driving mechanism of acquired resistance to ICIs in patients with lung adenocarcinoma. When ROS1 fusion mutation is detected after ICIs resistance, timely switching to ROS1-TKI treatment can achieve short-term efficacy, which provides a new idea for clinical individualized diagnosis and treatment after ICIs resistance.
Objective To evaluate the diagnostic value and utility of flexible bronchoscopy in the preoperative assessment in patients with solitary pulmonary nodules (SPNs). Methods A total of 111 patients with SPNs of unknown origin treated between January and June 2016 were retrospectively enrolled. The clinical characteristics, bronchoscopy findings and surgical strategies were collected. Results In the total 111 cases, malignant and benign SPNs were 79 and 32 cases, respectively. The mean diameter of malignant SPNs was larger than that of benign SPNs [(2.04±0.58) vs. (1.70±0.75) cm, P<0.05]. Bronchoscopy identified 9 cases (8.1%) unsuspected findings. Surgeries were modified or cancelled in 3 patients (2.7%) because of bronchoscopy findings. Transbronchoscopy biopsies were performed in 26 patients, 9 of whom were diagnosed lung cancer preoperatively, with a sensitivity of 45% (9/20) and a specificity of 100% (6/6). Conclusions Flexible bronchoscopy can be contributed to diagnosis of SPN before surgery and determination of surgical strategies. It is suggested that flexible bronchoscopy could be included in the routine preoperative work-up of SPN.