Expert consensus of management of adverse drug reactions with anaplastic lymphoma kinase tyrosine kinase inhibitors

Anaplastic lymphoma kinase (ALK) rearrangements occur in ∼3%-6% of patients with advanced non-small-cell lung cancer (NSCLC). Small molecular drugs that effectively inhibit ALK gene have revolutionized the therapeutic paradigm for patients with ALK rearrangements, resulting in significant improvements in objective response rate, progression-free survival, and overall survival compared with classical platinum-based chemotherapy. Several ALK tyrosine kinase inhibitors (ALK-TKIs), including crizotinib, alectinib, ceritinib, brigatinib, ensartinib, and lorlatinib, have been recommended as standard first-line treatment for advanced NSCLC patients with ALK rearrangements. Patients with ALK rearrangements typically exhibit long-term durable responses to ALK-TKIs; therefore, the management of adverse drug reactions (ADRs) with ALK-TKIs is crucial in clinical practice to maximize clinical benefits, prevent an adverse impact on quality of life, and improve patient compliance. In general, ALK-TKIs are well tolerated. There are, however, a number of serious toxicities that may necessitate dose modification or even discontinuation of treatment and the management of ADRs with ALK-TKIs has grown in importance. The therapeutic use of this class of medications still carries some risk because there are currently no pertinent guidelines or consensus recommendations for managing ADRs caused by ALK-TKIs in China. In order to improve the clinical management of ADRs with ALK-TKIs, the Chinese Society of Clinical Oncology (CSCO) Non-small Cell Lung Cancer Professional Committee led the discussion and summary of the incidence, diagnosis and grading standards, and prevention and treatment of ADRs caused by ALK-TKIs.

[Peripheral blood KCNMA1 methylation level is associated with the occurrence and progression of lung cancer]

OBJECTIVE

To explore the association of KCNMA1 gene methylation levels in peripheral blood with lung cancer.

METHODS

The methylation levels of 4 CpG sites in KCNMA1 gene were quantitatively detected in 285 patients with lung cancer, 186 age- and sex-matched patients with benign pulmonary nodules and 278 matched healthy control subjects using mass spectrometry (MALDI-TOF-MS). The association of KCNMA1 methylation levels with lung cancer was analyzed using logistic regression models adjusted for covariates. The KCNMA1 methylation levels in different subgroups of lung cancer patients were compared using Mann-Whitney U test.

RESULTS

In subjects over 55 years and in female subjects, the highest quartile (Q4) vs the lowest quartile (Q1) of KCNMA1_CpG_5 methylation levels were significantly correlated with lung cancer (for subjects over 55 years: OR=2.60, 95% CI: 1.25-5.41, P=0.011; for female subjects: OR=2.09, 95% CI: 1.03?4.26, P=0.042). From Q2 to Q4 of KCNMA1_CpG_5 methylation levels, their correlation with lung cancer became gradually stronger (P=0.003 and 0.038, respectively). In male subjects, the OR of Q4 of KCNMA1_CpG_5 methylation levels was 0.35 in patients with lung cancer as compared with patients with benign nodules (95% CI: 0.16-0.79, P=0.012). KCNMA1_CpG_3 methylation level was significantly lower in invasive adenocarcinoma than in noninvasive adenocarcinoma (P=0.028), and that of KCNMA1_CpG_1 was significantly higher in patients with larger tumors (T2-4) than in those with smaller tumors (T1) (P=0.021).

CONCLUSION

The change of peripheral blood KCNMA1 methylation level is correlated with the occurrence and development of lung cancer.

An efficiently working brain characterizes higher mental flow that elicits pleasure in Chinese calligraphic handwriting

The mental flow that commonly emerges during immersion in artistic activities is beneficial for maintaining mental health. However, there is not that much converging neurobiological evidence about how flow emerges and elicits pleasure in arts. Using an imitation task of Chinese calligraphic handwriting with self-rated subjective flow experience, we investigated the neural interactions supporting flow. Our results show that calligraphic handwriting requires cooperation between widespread multimodal regions that span the visual and sensorimotor areas along the dorsal stream, the top-down attentional control system, and the orbito-affective network. We demonstrate that higher flow is characterized by an efficiently working brain that manifests as less activation particularly in the brain regions within dorsal attention network and functional connectivity between visual and sensorimotor networks in calligraphy. Furthermore, we also propose that pleasure during calligraphy writing arises from efficient cortical activity in the emergence of flow, and the orbito-caudate circuit responsible for feelings of affection. These findings provide new insight into the neuropsychological representations of flow through art, and highlight the potential benefits of artistic activities to boost well-being and prosperity.

Cortical thickness of the left parahippocampal cortex links central hearing and cognitive performance in aging

Hearing impairment is considered a leading modifiable risk factor of cognitive decline and dementia. While most evidence has been established on clinical assessment of peripheral hearing loss, understanding of how central hearing in real-world conditions is associated with cognitive aging is limited. This study analyzed the data of 473 unrelated healthy adults aged 36-100 years old from the Lifespan Human Connectome Project in Aging. Central hearing was evaluated using the Words-in-Noise decibel threshold. Cognitive functions were evaluated by the performance on cognitive tests, and cortical thickness was estimated from magnetic resonance imaging (MRI) data. Here, we show that a higher hearing threshold was associated with a lower performance on immediate and delayed episodic memory retrieval, switching aspect of executive function, working memory, reading decoding, and vocabulary comprehension. Cortical thickness in the left parahippocampal cortex (lPHC) was negatively associated with the hearing threshold and acted as a significant partial mediator in the association of central hearing with immediate recall, switching, reading decoding, and vocabulary comprehension. These findings suggest that cortical thickness in the lPHC, an early target of dementia, partially links central hearing and performance in multiple cognitive domains in aging.

The Trajectory of Anthropomorphism and Pro-Environmental Behavior: A Serial Mediation Model

Anthropomorphism of nature can promote pro-environmental behavior (PEB). However, its underlying mechanism and these age-related changes are unclear. We propose that connectedness to nature and environmental guilt mediate the relationship between anthropomorphism of nature and PEB. The present study tests the hypotheses based on a cross-sectional sample of 1364 residents aged 15-76 years, using structural equation modeling. We found that: (1) environmental guilt decreases, but PEB increases, with age; (2) anthropomorphism of nature decreases in early adulthood and increases in old age; (3) connectedness to nature decreases in mid-late adolescence and increases in early adulthood. Connectedness to nature and environmental guilt have a serial mediating effect in the relationship between anthropomorphism of nature and PEB, with cross-age stability. These findings contribute to enriching the understanding of PEB from the human and nature perspective, and enhancing anthropomorphism of nature that could promote PEB in residents at different ages, through connectedness to nature and environmental guilt.

The standard for healthy Chinese older adults (2022)

Healthy older adults refer to the elderly aged 60 and above who can take care of themselves or basically take care of themselves.

Intergenerational support and depressive symptoms in old age: The difference between urban and rural China

Objectives

Intergenerational support is associated with fewer depressive symptoms in old age. Uneven development has resulted in huge urban-rural disparities in China, which could lead to different intergenerational relationships. The present study aimed to examine whether intergenerational support was associated with depressive symptoms differently among urban and rural Chinese older participants.

Methods

A sample of 3,498 participants from nine pairs of urban subdistricts and rural villages were included in the present study. Depressive symptoms were measured by the 10-item Center for Epidemiological Studies Depression Scale, and the intergenerational support mechanisms (financial, instrumental, and emotional) were assessed with a self-designed questionnaire.

Results

Significant areas by support effect for depressive symptoms indicated different associations between intergenerational financial and emotional support and depressive symptoms in urban and rural areas. Specifically, urban older participants receiving emotional support from adult children and rural older participants receiving financial support from adult children showed fewer depressive symptoms. In both areas, participants receiving instrumental support showed fewer depressive symptoms.

Conclusion

Our study is the first to compare the urban-rural disparity in association between intergenerational support and depressive symptoms in a developing country, China. The results support modernization theories proposing weakened economic function but intensified emotional ties in societies with higher level of development. Communication-based intergenerational emotional support should be promoted in urban areas, and formal support systems should provide financial and instrumental support to the vulnerable rural older population.

[Clinical characteristics and prediction model of early death in severe/very severe aplastic anemia with immunosuppressive therapy]

Objective: Early death (ED) characteristics and predictive factors analysis in patients with severe/very severe aplastic anemia (SAA/VSAA) treated with intensive immunosuppression therapy and establish an ED prediction model. Methods: The clinical data of 232 patients with SAA/VSAA treated with Antithymocyte immunoglobulin (ATG) at the Peking Union Medical College Hospital from August 2003 to August 2021 were collected. The characteristics and causes of ED within 90 days were analyzed retrospectively. Cox proportional hazards model was used to screen the ED risk factors and build a prediction model. Results: Only 19 patients (8.2% ) developed ED with a median time of 24 (3-85) days among the 232 patients with SAA/VSAA who received ATG treatment. The main cause of ED was infection (84.2% ) , followed by cerebral hemorrhage (10.5% ) . Multivariate analysis showed that VSAA (HR=15.359, 95% CI 1.935-121.899, P=0.010) , fungal infection prevention by posaconazole (HR=0.147, 95% CI 0.019-1.133, P=0.066) , lymphocyte count (LYM) ≤ 0.5×10(9)/L (HR=3.386, 95% CI 1.123-10.206, P=0.030) , and PLT ≤ 5×10(9)/L (HR=8.939, 95% CI 1.948-41.019, P=0.005) were ED's independent influencing factors. To build a clinical prediction model, VSAA, fungal infection prevention by posaconazole, LYM ≤ 0.5×10(9)/L, and PLT ≤ 5×10(9)/L were scored with 3, -2, 1, and 2, respectively. The integral model AUC=89.324 (95% CI 80.859-97.789) . The ED risk in patients with a score ≥ 3 was 23.1 (95% CI 5.3-100.2) times that in patients with a score<3. Conclusion: ED caused by infection and cerebral hemorrhage is an important challenge for SAA/VSAA to be treated with ATG. VSAA, LYM ≤ 0.5×10(9)/L, and PLT ≤ 5×10(9)/L patients who did not use posaconazole to prevent fungal infection had a high ED risk.

Clinical-Pathological Correlation of Breast Non-mass Enhancing Lesions

Introduction/Objective

MRI imaging of breast is mainly reserved for screening high-risk individuals with occasional application in women bearing moderate or average risk. Areas showing enhancement in MRI without space-occupying mass are defined as non-mass enhancement (NME). As biopsy of NME lesion is rare encounter in clinical practice, thorough clinical-pathological investigation is warranted.

Methods/Case Report

289 patients who underwent core biopsy for NME lesion(s) in our institution between 2011 to 2021 were included in this retrospective study. Pathological diagnoses were lumped into 3 categories, namely benign, precursor lesions (atypical ductal hyperplasia, atypical lobular hyperplasia, and lobular carcinoma in situ), and malignant lesions (ductal carcinoma in situ, pleomorphic lobular carcinoma in situ, and invasive carcinoma). The age distribution, MRI indications, and pathological diagnoses stratified by indications were studied. MRI patterns of NME lesions were compared between malignant versus benign lesions.

Results (if a Case Study enter NA)

Patient’s age ranges 25-79 yo (mean age 51.9 yo, median age 50 yo). Indications of MRI include high-risk screening (162 cases, 162/289, 56%), pre-operative staging (116 cases, 116/289, 40%), and problem-solving (11 cases, 11/289, 4%). There are 220 benign cases (220/289, 76%), 50 malignant cases (50/289, 17%), and 19 precursor lesions (19/289, 7%) in this study. There were 16 malignant cases identified in the high-risk group (16/162, 10%), 24 in the pre-operative staging group (24/116, 20.7%), and 2 in problem-solving group (2/11, 18.2%). Focal distribution is significantly associated with malignant lesions as compared to other patterns (linear, segmental, and regional) (Chi-square test, p&lt;0.001).

Conclusion

High-risk screening is the major indication for biopsy NME lesions, followed by pre-operative staging, and problem-solving. Benign lesions are the predominant pathological findings of NME lesions, followed by malignant and then precursor lesions. Malignant lesions were mostly identified in high-risk group, followed by pre-operative staging and problem-solving group. Malignant lesions tend to assume the “focal distribution” than other MRI patterns.

Impact of limbs pneumatic compression during cardiopulmonary resuscitation (CPR) on cardiac arrest patients: a randomized controlled trial

Background

Limbs pneumatic compression during cardiopulmonary resuscitation (CPR) for cardiac arrest patient were rarely reported.

Purpose

To evaluate the effect of this therapy on the patients of cardiac arrest.

Methods

A randomized, controlled and trial, a total of 62 elderly (75.8±8.3 yrs) cardiac arrest patients were included and randomized to “CPR group” (n=31) and “CPR + Pneumatic Compression group” (n=31). Each individual in CPR group received standard CPR. In addition to the standard CPR, all patients in “Pneumatic Compression group” accepted intermittent pneumatic compression (IPC) by Air Compression Therapy System, which digital six-tiered rippling full-body pressure (0.45–0.6 kg/cm2) and 1 minute interval every 5 minutes.

Results

Compared with standard CPR group, significant improvements of cardiac output (CO) and survival of patient were found in Pneumatic Compression group (Figure 1). Patients with pneumatic compression had lower incidence (19.4% vs. 45.2%, p=0.03) of acute kidney injury (AKI) than that in standard CPR group. Besides, the lower occurrence of hypoxic ischemic encephalopathy (HIE) was observed in Pneumatic Compression group (Figure 2). There was no ischemic myonecrosis of limbs caused by compression.

Conclusions

Intermittent limbs pneumatic compression during cardiopulmonary resuscitation (CPR) maybe could improve the blood flow of the crucial organs (e.g. brain) and increase survival of cardiac arrest patients, which is superior to the strategy for CPR alone.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): SHOU FA2020-4-1045 Fundation