Envafolimab combined with chemotherapy in the treatment of combined small cell lung cancer: A case report

BACKGROUND Combined small cell lung cancer(C-SCLC) is a special subtype of small cell lung cancer that is relatively rare, aggressive, and prone to early metastasis and has a poor prognosis. Currently, there are limited studies on C-SCLC, and there is no uniform standard treatment, especially for extensive C-SCLC, which still faces great challenges. In recent years, the development and progress of immunotherapy have provided more possibilities for the treatment of C-SCLC. We used immunotherapy combined with first-line chemotherapy to treat extensive-stage C-SCLC to explore its antitumor activity and safety.CASE SUMMARY We report a case of C-SCLC that presented early with adrenal, rib, and mediastinal lymph node metastases. The patient received carboplatin and etoposide with concurrent initiation of envafolimab. After 6 cycles of chemotherapy, the lung lesion was significantly reduced, and the comprehensive efficacy evaluation showed a partial response. No serious drug-related adverse events occurred during the treatment, and the drug regimen was well tolerated.CONCLUSION Envafolimab combined with carboplatin and etoposide in the treatment of extensive-stage C-SCLC has preliminary antitumor activity and good safety and tolerability.

Double-nylon purse-string suture in closing postoperative wounds following endoscopic resection of large(≥3 cm)gastric submucosal tumors

BACKGROUND Endoscopic full-thickness resection(EFTR)of gastric submucosal tumors(SMTs)is safe and effective;however,postoperative wound management is equally important.Literature on suturing following EFTR for large(≥3 cm)SMTs is scarce and limited.AIM To evaluate the efficacy and clinical value of double-nylon purse-string suture in closing postoperative wounds following EFTR of large(≥3 cm)SMTs.METHODS We retrospectively analyzed the data of 85 patients with gastric SMTs in the fundus of the stomach or in the lesser curvature of the gastric body whose wounds were treated with double-nylon purse-string sutures after successful tumor resection at the Endoscopy Center of Renmin Hospital of Wuhan University.The operative,postoperative,and follow-up conditions of the patients were evaluated.RESULTS All tumors were completely resected using EFTR.36(42.35%)patients had tumors located in the fundus of the stomach,and 49(57.65%)had tumors located in the body of the stomach.All patients underwent suturing with double-nylon sutures after EFTR without laparoscopic assistance or further surgical treatment.Postoperative fever and stomach pain were reported in 13(15.29%)and 14(16.47%)patients,respectively.No serious adverse events occurred during the intraoperative or postoperative periods.A postoperative review of all patients revealed no residual or recurrent lesions.CONCLUSION Double-nylon purse-string sutures can be used to successfully close wounds that cannot be completely closed with a single nylon suture,especially for large(≥3 cm)EFTR wounds in SMTs.

Historical records and the sources of polycyclic aromatic hydrocarbons in the East China Sea

The coastal cities are the most advanced regions in China.In the past few decades,the environment changed very significantly due to large scale human activities in the coastal regions.Polycyclic aromatic hydrocarbons (PAHs)in three dated sediment cores from the west coast of the Yellow Sea (core A01),the Yangtze River estuary (YRE;core A02)and the Oujiang River estuary (ORE;core A03)were analyzed to reconstruct the environmental evolutionary process of the east China coastal region over the past century. In the three cores,PAHs concentrations were increased rapidly.Lower concentrations of PAHs were measured in core A02 than in cores A01 and A03.The vertical variation of PAHs in the YRE Was dominated by the petrogenic sources.Historical records of PAHs in the ORE were controlled by pyrolytic sources.PAHs on the west coast of the Yellow Sea were contributed by the two sources.

variation in expression of small ubiquitin-like modifiers in injured sciatic nerve of mice

Small ubiquitin-like modifiers (SUMOs) have been shown to regulate axonal regeneration, signal transduction, neuronal migration, and myelination, by covalently and reversibly attaching to the protein substrates during neuronal cell growth, development, and differentiation. It has not been reported whether SUMOs play a role in peripheral nerve injury and regeneration. To investigate any association between SUMOylation and potential neuroprotective effects during peripheral nerve injury and regeneration, C57/BL mice were randomly divided into sham and experimental groups. The sciatic nerve was exposed only in the sham group. The experimental group underwent neurotomy and epineurial neurorrhaphy. Real-time quantitative polymerase chain reaction and western blot assay results revealed different mRNA and protein expression levels of SUMO1, SUMO2, SUM03 and UBC9 in sciatic nerve tissue (containing both 5 mm of proximal and distal stumps at the injury site) at various time points after injury. Compared with the sham group, protein levels of SUM01 and SUMO2/3 increased in both their covalent and free states after sciatic nerve injury in the experimental group, especially in the covalent state. UBC9 protein levels showed similar changes to those of SUMO1 and SUMO2/3 in the covalent states. Immunohistochemical staining demonstrated that SUMO1 and SUMO2/3 immunopositivities were higher in the experimental group than in the sham group. Our results verified that during the repair of sciatic nerve injury, the mRNA and protein expression of SUMO1, SUMO2, SUMO3 and UBC9 in injured nerve tissues changed in varying patterns and there were clear changes in the expression of SUMO-related proteins. These findings reveal that SUMOs possibly play an important role in the repair of peripheral nerve injury. All animal protocols were approved by the Institutional Animal Care and Use Committee of Tianjin Fifth Central Hospital, China (approval No. TJWZXLL2018041) on November & 2018.

Vedolizumab-associated diffuse interstitial lung disease in patients with ulcerative colitis:A case report

BACKGROUND Vedolizumab,a newer class of integrin antagonist biological agents,has been applied to treat patients with moderate-to-severe Crohn’s disease(CD)and ulcerative colitis(UC),especially for patients who are refractory to traditional therapies and tumor necrosis factor antagonists.However,some rare but lifethreatening adverse effects warrant pharmacovigilance.We describe the first fatal case of vedolizumab-associated severe diffuse interstitial lung disease in China.CASE SUMMARY We present a case of new-onset diffuse parenchymal lung disease developing under treatment with vedolizumab in a patient with UC.After two doses of vedolizumab,he developed persistent fever and progressively worsening dyspnea.Extensive workups,including bronchoalveolar lavage,transbronchial lung biopsy and metagenomic next-generation sequencing,identified no infectious causes,and other potential causes(such as tumors and cardiogenic pulmonary edema)were also excluded.As a result,a diagnosis of vedolizumabrelated interstitial lung disease was established.Unfortunately,although corticosteroids and empiric antibiotics were administered,the patient eventually died of respiratory failure.CONCLUSION Vedolizumab-related interstitial lung disease in patients with UC is rare but potentially lethal.Gastroenterologists and pulmonologists should be aware of vedolizumab-related adverse drug reactions.

Fungal corneal ulcer after repair of an overhanging filtering bleb:A case report

BACKGROUND Overhanging filtering bleb is a common complication after trabeculectomy and surgical repair is an effective treatment when the patient presents with apparent symptoms.Filtering bleb relevant infection including in the filtering bleb itself and even endophthalmitis in some severe cases has been reported.However,corneal fungal infection after filtering bleb repair is rarely reported.CASE SUMMARY A 57-year-old Chinese man who had sensations of redness and foreign body sensations in the left eye 3 wk after repair of overhanging filtering bleb.3 wk ago,due to sensations of a foreign body in the left eye for 3 years with worsening for 3 mo.The patient was diagnosed as overhanging filtering bleb and underwent a repair of overhanging filtering bleb.Postoperative,the filtering bleb formed well and the intraocular pressure is normal.But the patient gradually develop redness,pain and a grey infiltrate of the cornea in the eye.Finally it developed into fungal corneal ulcer.Through asking the medical history,we found the patient had irregularly self-medicated for years with glucocorticoid eye drops for years to relieve the foreign body sensation in the eye caused by filtering bleb overhanging.Because the glucocorticoid eye drops he used years ago had provide normal sensation to the eye.After 3 mo of anti-fungal treatment,the inflammation was controlled.CONCLUSION In addition to avoiding the development of overhanging filtering bleb after trabeculectomy,the present case report also suggests that clinicians should pay more attention to the patient’s ocular self-medication history.Particularly in patients with a history of glaucoma or eye surgery.Because these patients may be exposed to more types of eye drops than other individuals,they may select the wrong medi-cations for long-term use,based on their previous experience.

溴芬酸钠滴眼液在眼科中的临床应用

非甾体抗炎滴眼液常用于眼表、眼前段及眼术后炎症的抗炎镇痛治疗。作为新一代非甾体抗炎药,溴芬酸钠因其独特的化学结构,使其既是一种强效抗炎药,又是一种可渗透到眼部组织中的亲脂分子,从而增加作用的持续时间。溴芬酸钠滴眼液作为一种抗炎药,在治疗白内障和屈光手术后眼部疼痛及炎症方面有着广泛的全球安全记录。目前,学者还开发出溴芬酸钠滴眼液除了抗炎、镇痛外的其他眼科应用,发现溴芬酸钠滴眼液具有强效、安全且便利的特点。本文归纳了溴芬酸钠滴眼液在眼科中的应用进展及前景,以期为今后的临床治疗提供新思路。

Two methods of lung biopsy for histological confirmation of acute fibrinous and organizing pneumonia:A case report

BACKGROUND Acute fibrinous and organizing pneumonia(AFOP)is a rare,noninfective lung disease,histologically characterized by a patchy distribution of intra-alveolar fibrin“balls”and organizing pneumonia.The clinical manifestations of AFOP are nonspecific.Diagnosis depends on pathology.Surgical lung biopsy is optimal for tissue sampling to diagnose AFOP.However,many patients have no tolerance to the operation,including mentally and physically.There is still no standard therapy for AFOP and the methods remain controversial.Therefore,further clinical attention and discussion are warranted.CASE SUMMARY A 53-year-old woman presented with fever,cough and dyspnea for 15 d.Antiinfective therapy was ineffective.Chest computed tomography showed bilateral patchy consolidation,especially in the lower lobes.We performed both ultrasound-guided transbronchial lung biopsy and ultrasound-guided percutaneous fine needle puncture at different lung lesion locations.Both samples supported the diagnosis of AFOP.The patient had a good clinical course after treatment with methylprednisolone,and no side effects of steroids.CONCLUSION Percutaneous needle biopsy combined with transbronchial lung biopsies may be a good choice in the absence of surgical biopsy.Methylprednisolone alone is effective in the treatment of idiopathic AFOP.

Outcomes of seromuscular bladder augmentation compared with standard bladder augmentation in the treatment of children with neurogenic bladder

BACKGROUND Intestinal seromuscular bladder augmentation(SMBA)surgery has produced no mucosal-related complications,but its outcomes need to be studied.AIM To evaluate the safety and effectiveness of SMBA in the treatment of children with neurogenic bladder.METHODS A retrospective analysis of the clinical data of children with SMBA was performed from March 2008 to February 2018,and the data were compared with those of children receiving standard cystoplasty(SC).RESULTS In a cohort of 67 children who underwent bladder augmentation,the 46 children in the SC group had an average age of 10.6 years and a follow-up time of 36 mo,and the 21 children in the SMBA group had an average age of 7.6 years and a follow-up time of 29.7 mo.The preoperative and postoperative bladder volumes in the SMBA group were 151.7 mL and 200.4 mL,respectively,and those in the SC group were 173.9 mL and 387.0 mL,respectively.No significant difference in preoperative urinary dynamic parameters was found between the two groups,but the difference after operation was statistically significant.The main complications after SMBA were residual ureteral reflux and failed bladder augmentation,with incidences of 33.3%and 28.6%,respectively.In all 6 patients with failed augmentation in the SMBA group,ileum seromuscular patches were used for augmentation,and SC was chosen for reaugmentation.During reoperation,patch contracture and fibrosis were observed.CONCLUSION The improvement of urinary dynamic parameters in the SMBA group was significantly lower than that in the SC group.Children with SMBA had a higher probability of patch contracture and reaugmentation,which might be related to impaired blood supply and urine stimulation,and the sigmoid colon patch should be the priority.

Pulmonary Langerhans cell histiocytosis and multiple system involvement:A case report

BACKGROUND Pulmonary Langerhans cell histiocytosis(PLCH)is a relatively rare type of lung disease,common in middle-aged smoking men.It is characterized by proliferation and infiltration of Langerhans cells,and the formation of multiple parabronchial mesenchymal nodules in lung tissue,and may lead to organ dysfunction.There are no typical symptoms and signs,and it is easily misdiagnosed or missed,and therefore deserves clinical attention and further discussion.CASE SUMMARY We describe the case of a nonsmoking 46-year-old man with PLCH diagnosed based on clinical manifestations of fever and dry cough,with a history of hypothyroidism and diabetes insipidus for 9 years.Computed tomography(CT)-and CT-guided puncture examinations revealed no abnormalities,and he ultimately underwent thoracoscopic biopsy to confirm the diagnosis.The pathological diagnosis was PLCH.Thyroid function was maintained by medication.Pituitary magnetic resonance imaging showed that the pituitary stalk had become thinner.CONCLUSION LCH often involves multiple systems.Moreover,the pathogenesis is not clear,clinical manifestations lack specificity,and diagnosis requires special attention.Diagnosis of PLCH can significantly benefit from comprehensive multidisciplinary analysis.

Lung adenocarcinoma harboring rare epidermal growth factor receptor L858R and V834L mutations treated with icotinib:A case report

BACKGROUND Epidermal growth factor receptor(EGFR)tyrosine-kinase inhibitors are widely used for the treatment of non-small-cell lung cancer with EGFR mutations.However,patients with rare,even compound EGFR mutations have different responses to EGFR-tyrosine-kinase inhibitors,which bring uncertainty to clinical treatment.CASE SUMMARY A 45-year-old female patient presented with a 3-mo history of cough and white sputum without chest pain.Chest computed tomography revealed lung spaceoccupying lesions and multiple lymphadenectasis.Bronchoscopy and pathology suggested lung adenocarcinoma.Compound variation of EGFR gene(exon 21 L858 R/V834 L)was detected in both tissue and circulating tumor deoxyribonucleic acid samples.As a result of next-generation sequencing and her family’s wishes,the patient was given oral treatment with icotinib hydrochloride(125 mg/d,tid)from March 21,2019 and has achieved stable disease for the last 1 year.CONCLUSION Non-small cell lung adenocarcinoma with EGFR L858 R/V834 L was treated successfully with icotinib,and it may be a new medication treatment option.

Paracentral acute middle maculopathy secondary to high intraocular pressure: a case report

Dear Editor,Paracentral acute middle maculopathy(PAMM), defined as an optical coherence tomography(OCT) finding characterized by a band-like, hyperreflective lesion at the level of the inner nuclear layer(INL), is the result of impaired flow in the deep and intermediate retinal capillary plexuses[1]. It has been demonstrated that PAMM was related to various retinal vascular disorders, including central retinal vein occlusion。

Imported parasitic diseases in China's Mainland:current status and perspectives for better control and prevention

Background:The high prevalence of parasitic diseases leads to millions of deaths and disabilities each year in developing countries.China has also been greatly affected by parasitic infections,including filariasis,leishmaniasis,malaria,schistosomiasis,and soil-transmitted nematodosis.However,the situation in China improved dramatically after comprehensive parasitic disease control efforts were strengthened,leading to the elimination of filariasis in 2006 and to significant control over other diseases.However,imported parasitic disease cases are inevitable,and such cases have increasingly been reported as a result of enhanced globalization and international or regional cooperation.These imported diseases represent a major obstacle to the elimination of several parasitoses,such as malaria.Main text:This paper reviews imported cases of parasitic diseases in China's Mainland,particularly malaria and schistosomiasis,based on data reported separately by the Chinese annual reports and from other published papers.We summarize the new challenges that face parasitic disease control efforts in China's Mainland and perspectives regarding better control.We argue that both the provision of professional education and updated training for medical care personnel and the management and surveillance of people entering China are essential.We recommend that Chinese migrant workers should be considered a priority group for health education and that public awareness of imported diseases should be emphasized.Furthermore,we underscore the importance of investigating the distribution of introduced/potential vectors,parasite susceptibility,and improvements in diagnostic techniques and drug stocks.Conclusions:Imported cases have become the main challenge to the elimination of several parasitoses,such as malaria and schistosomiasis,in China's Mainland.China should act to meet these challenges,which are closely associated with national biological safety.