Pemetrexed in Previously Treated Non-small Cell Lung Cancer Patients with Poor Performance Status

Background and objective Pemetrexed have been approved for the treatment of patients affected by advanced non-small cell lung cancner(NSCLC) in progression after first-line chemotherapy.We evaluated the activity and feasibility of pemetrexed in previously treated NSCLC.Methods Patients with histologically or cytologically confirmed NSCLC were evaluated from April 2007 to March 2009.The patients had relapsed or progressed after prior chemotherapy treatment.Pemetrexed(500 mg/m2) was administered intravenously once every 3 weeks after progression to prior chemotherapy.The tumor response was evaluated according to RECIST criteria by chest CT at every 2 cycles of chemotherapy.Results A total 61 patients were eligible for analysis.Performance status of them(100%) was over 2.The response rate and disease control rate were 14.7% and 37.7% respectively.Non-squamous cell carcinoma histology was significantly associated with a superior response rate(P=0.045) and disease control rate(P=0.008).The median survival time and the median progression free survival(PFS) time were 6.11 months and 2.17 months,respectively.Comparing the efficacy of pemetrexed in these two settings [second-line versus(12/61) more than third(49/61)],there was no significant difference in regard to median survival(11.18 months vs 11.46 months,P=0.922,5),but PFS was more longer in third-or further-line groups than second-line group(1.39 months vs 2.25 months,P=0.015,3).Conclusion Pemetrexed is a feasible regimen in previously treated NSCLC with poor performance status.

Sarcomatoid carcinoma of the pancreas—multimodality imaging findings with serial imaging follow-up:A case report and review of literature

BACKGROUND Sarcomatoid carcinoma of the pancreas is extremely rare and has an extremely poor prognosis.Although a few cases of sarcomatoid carcinoma of pancreas have been reported,most are focused on a histopathological review.To the best of our knowledge,there are no reports documenting multimodality imaging characteristics and chronological changes with emphasis on radiologic features.CASE SUMMARY A 64-year-old woman was admitted to Chungnam National University Hospital with acute appendicitis.Contrast-enhanced computed tomography of the abdomen revealed a 2.6 cm×2.8 cm multilobular cystic mass in the pancreatic tail.The pancreatic lesion showed suspected mural nodules and thin septa.Hence,mucinous cystic neoplasm of pancreas was considered.After 7 mo,the patient was readmitted for repeated epigastric abdominal pain and nausea.Follow-up contrast-enhanced computed tomography of the abdomen and magnetic resonance imaging revealed a marked enlargement(5.4 cm×4 cm),with a predominant internal solid component.The mass showed low signal intensity on a T1-weighted image and heterogeneously intermediate high signal intensity on a T2-weighted image. It showed diffusion restriction and peripheral rimenhancement on an arterial phase image, and progressive enhancement on portalvenous and delayed phase images. Distal pancreatectomy was performed. Basedon the morphology and immunohistochemical staining of the specimen,pancreatic sarcomatoid carcinoma was diagnosed.CONCLUSIONWe present the computed tomography, magnetic resonance imaging, and positronemission tomography computed tomography findings, pathologic features, andchronological changes for preoperative diagnosis.

Severe mediastinitis and pericarditis after endobronchial ultrasoundguided transbronchial needle aspiration:A case report

BACKGROUND Endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA)is a safe and minimally invasive diagnostic tool for mediastinal and hilum evaluation.However,infectious complications may occur after EBUS-TBNA.Among these,mediastinitis and pericarditis are rare.CASE SUMMARY A 67-year-old woman was referred to our hospital due to paratracheal lymph node enlargement on chest computed tomography(CT).EBUS-TBNA was performed on the lymph node lesions,and prophylactic oral antibiotics were administered.Seven days after EBUS-TBNA,the patient visited the emergency room with a high fever and chest pain.Laboratory test results revealed leukocytosis with a left shift and elevated C-reactive protein level(25.7 mg/dL).Chest CT revealed the formation of a mediastinal abscess in the right paratracheal lymph node and pericardial and bilateral pleural effusions.The patient received intravenous antibiotic treatment,cardiac drainage through pericardiocentesis,and surgical management.The patient recovered favorably and was discharged 31 d after the operation.CONCLUSION Mediastinitis and pericarditis after EBUS-TBNA are rare but should be considered even after the use of prophylactic antibiotics.

Appendectomy in patient with suspected COVID-19 with negative COVID-19 results: A case report

BACKGROUND Even at present,we are in the middle of the novel coronavirus disease 2019(COVID-19)pandemic and are facing challenges in trial and error.Presently,emergency surgery for patients with suspected COVID-19 is burdensome not only for patients but also for healthcare workers.Therefore,we established a surveillance system in the emergency room and established principles for managing patients suspected of COVID-19 who require emergency surgery.CASE SUMMARY A 67-year-old man was diagnosed with appendicitis in March 2020.His wife was diagnosed with COVID-1910 d earlier,and the patient was in close contact with her.The patient tested negative twice on an upper respiratory COVID-19 reverse transcription–polymerase chain reaction screening test,but chest X-ray and chest computed tomography revealed patchy ground-glass opacity in both upper lobes of the patient’s lungs.The same emergency surgery procedure for patients with confirmed COVID-19 was applied to this patient suspected of having the disease to ensure that surgery was not delayed while waiting for the reverse transcription–polymerase chain reaction results.A few hours after surgery,the upper respiratory tract specimen taken in the emergency room was negative for COVID-19 but the lower respiratory tract specimen was found to be positive for the disease.CONCLUSION When COVID-19 is suspected,emergency surgery should be performed as for confirmed COVID-19 without delay.

Expression Pattern of the Hippo Pathway Effector TAZ in Cellular and Fibrotic Nonspecific Interstitial Pneumonia

Interstitial lung disease （ILD） is a comprehensive term referring to a group of lung diseases affecting the interstitium of the lung. Idiopathic pulmonary fibrosis （IPF） is the most common idiopathic ILD, and nonspecific interstitial pneumonia （NSIP） is the second most common. As the name suggests, NSIP is diagnosed atter many other diseases are excluded. The main pathological finding in NSIP is homogeneous interstitial inflammation with or without fibrosis. NSIP can be categorized by cellular type or fibrotic type, according to the grade of inflammation and fibrosis. The cellular type has mostly inflammatory lesions with good responses to steroid, but the fibrotic type has a large proportion of fibrosis mixed with inflammatory lesions and a relatively poor response to steroid treatment So far, the exact mechanism underlying idiopathic lED has not been clarified. Determining key regulators of these ILDs will be helpful in the diagnosis and development of novel drugs for ILD.