[Clinicopathologic and molecular features of myoepithelial tumors of salivary glands]

Objective: To investigate the clinicopathological, and molecular characteristics of myoepithelial tumors (MTs) of salivary glands. Methods: A total of 37 MTs cases including 13 malignant epithelial tumors (MMTs) and 24 benign epithelial tumors (BMTs) of salivary glands were identified from the archives of the Department of Pathology, General Hospital of Eastern Theater Command, dating from 2006 to 2016. Clinical features, histological patterns, immunohistochemical characteristics and status of EWSR1 gene rearrangement by fluorescence in situ hybridization (FISH) analysis were reviewed in all cases. Results: Clinically, 37 MTs cases mainly occurred in the parotid glands, when most of the patients presented with painless masses. Of the 13 MMTs cases, male to female ratio was 7∶6, and the median age was 62 years old. Of the 24 BMTs cases, male to female ratio was 5∶7, and the median age was 54 years old. Immunohistochemically, 37 MTs cases were positive for CKpan, and at least one myoepithelial marker. Twenty six of 37 MTs cases were analyzable for the EWSR1 gene break by FISH. Based on the previous evaluation criterion, the EWSR1 translocation was detected in 4 cases of 11 MMTs, and 4 cases of 15 BMTs. According to the main histological composition of tumor cells, 4 EWSR1-positive MMTs covered 2 clear-cell cases and 2 epithelioid-cell cases, when 4 EWSR1-positive BMTs covered 2 clear-cell cases, 1 plasmacytoid-cell case, and 1 spindle-cell case. Conclusions: Males and females are affected equally. MTs express immunoreactivity for CKpan, and at least one myoepithelial marker. The EWSR1 rearrangement is present in a subset of MTs, with variable morphological characteristics, and has no statistical significance on clinical behavior.

[Comparison of parameters for diffusion-weighted intravoxel incoherent motion imaging in lung cancer patients with different histopathological subtypes]

Objective: To explore the intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) model in lung cancer patients with different histopathological subtypes. Methods: A total of 105 patients were recruited, including 68 cases of adenocarcinoma, 22 cases of squamous carcinoma and 15 cases of small cell carcinoma. All patients underwent magnetic resonance examination consisting of axial IVIM-DWI sequence on a 3.0 T whole body scanner, then the standard ADC (sADC), diffusion coefficient (D), pseudo-diffusion coefficient(D(*)), perfusion fraction (f), distributed diffusion coefficient (DDC) and water diffusion heterogeneity index (α) were calculated for each lesion within the IVIM-DWI model. Results: Mean sADC values were (1.45±0.26) ×10(-3)mm(2)/s, (1.36±0.48) ×10(-3)mm(2)/s and (1.35±0.40) ×10(-3)mm(2)/s for adenocarcinoma, squamous carcinoma and small cell carcinoma, respectively. Mean f values were (59.75±16.37) %, (47.41±18.69) % and (48.96±19.88) % for adenocarcinoma, squamous carcinoma and small cell carcinoma, respectively. Mean α values were 0.72±0.13 for adenocarcinoma, 0.62±0.12 for squamous carcinoma, and 0.63±0.11 for small cell carcinoma, respectively. Statistical analyses indicated that the sADC, f and α values among different histopathological subtypes were significantly different (P<0.05), while there was no significant difference in D, D(*) and DDC values (P>0.05). Furthermore, the comparison showed that the sADC, f and α values of patients with adenocarcinoma were significantly higher than those with squamous carcinoma or small cell carcinoma (P<0.05), whereas there was no significant difference between squamous carcinoma group and small cell carcinoma group (P>0.05). Conclusions: The sADC, f and α values derived from the IVIM-DWI model can be used for comprehensive non-invasive evaluation of diffusion, perfusion and heterogeneity of microenvironment in lung cancer patients. And the IVIM-DWI model may be a promising tool for predicting histopathological subtypes of lung cancer.

[Mediating effect of work engagement between job stress and depressive symptoms in State Grid employees]

Objective: To explore the relationship between job stress, work engagement and depressive symptoms of State Grid workers, and to analyze the mediating effect of work engagement between job stress and depressive symptoms. Methods: A cross-sectional survey was conducted to investigate 845 employees from a State Grid company, using the brief job stress questionnaire, the Patient Health Questionnaire (PHQ-9) and 9-item Utrecht Work Engagement Scale (UWES-9) in March 2017. Results: The average score of work engagement was 4.49±1.42, the mean value of job stress was 1.15±0.33, the average score of depressive symptoms was 6.44±4.30, and the positive rate of depressive symptoms was 66.9%.There was a negative correlation between work engagement with both job stress and depressive symptoms (r=-0.193, -0.397, both P<0.01) , and job stress was positively correlated with depressive symptoms (r=0.260, P<0.01) . The relationship between job stress and depressive symptoms was partly mediated by work engagement, and the mediating effect accounted for 27.2% of the total effect. Conclusion: The work engagement of State Grid staff acts as the mediator between job stress and depressive symptoms, alleviating the depressive symptoms caused by job stress.

[Association between Long Working Hours and Job Stress and Depression among Employees from a State Grid Company]

Objective: This study was to understand the current situation of long working hours and identify the association of long working hours and job stress and depression among workers from one district company of state grid. Methods: The project was done with the cross-sectional survey. All questionnaires were completed by self-administered with informed consent. Employees' weekly working hours was reported by themselves; Using the PHQ-9 scale to assess depression, the JDC Model to evaluate job stress, and SPSS software to analyze data, the single factor chi-square test and multivariate Logistic analysis were performed to identify the association between long working hours and job stress, depression. Results: there were 35.3 percent employees with over 44 hours a week. The association between increasing weekly working hours and job stress and depression was statistically significant. Compared to the reference group (≤44 h) , for those who worked more than 44 hours per week, the odds ratio of job stress was 2.02 (95%CI=1.27-3.23) times increased, and the odds ratio of depression was 1.60 (95%CI=1.01-2.55) times increased, especially for those (≥60 h) , the odds ratio was 3.69 (95%CI=1.45-9.41) and 2.76 (95%CI=1.09-7.03) respectively. Conclusion: Long working hours can significantly increase the risk of job stress and depression among workers. When their weekly working hours exceeds 60, long working hours will be the independent risk factor for both job stress and depression.

Synergistic antinociception between ZC88, an N-type voltage-dependent calcium channel blocker, and ibuprofen in mouse models of visceral and somatic inflammatory pain

BACKGROUND

A combination of analgesic agents with different mechanisms can induce additive or synergistic analgesia. The N-type voltage-dependent calcium channel (N-VDCC) is a novel therapeutic target for pain control. In addition to providing effective pain relief when used alone, N-VDCC blockers produce synergistic analgesia when used in combination with opiates. However, the interaction between N-VDCC blockers and nonsteroidal anti-inflammatory drugs (NSAIDs) remains unclear.

METHODS

Using isobolographic analysis and composite additive curve analysis, the antinociceptive interaction between ZC88, a selective N-VDCC blocker and ibuprofen, a classical NSAID, was investigated in two mouse models of visceral and somatic inflammatory pain.

RESULTS

In the acetic acid writhing test, both ZC88 (10.5-42 mg/kg, intraperitoneally) and ibuprofen (50-200 mg/kg, orally) produced dose-dependent antinociception, with ED₅₀ values of 27.2 and 100.5 mg/kg, respectively. ZC88 in combination with ibuprofen (ZC88 + ibuprofen) also induced significant antinociception, and isobolographic analysis revealed a synergistic interaction at 50% effect level. The experimental ED₅₀ (ED_{50 mix} ) of this combination (34.5 mg/kg) was significantly lower than the theoretical ED₅₀ (ED_{50 add} ; 63.8 mg/kg). Additionally, composite additive curve analysis displayed synergistic interaction at other effect levels. In the formalin test, ZC88 or ibuprofen alone significantly reduced late-phase rather than early-phase pain, with ED₅₀ values of 31.3 and 123.9 mg/kg, respectively. Similarly, both isobolographic analysis and composite additive curve analysis revealed synergistic antinociception of ZC88 + ibuprofen (40.6 mg/kg of ED_{50 mix} vs. 77.6 mg/kg of ED_{50 add} ).

CONCLUSION

ZC88 in combination with ibuprofen produces synergistic antinociception in mouse models of somatic and visceral inflammatory pain.

SIGNIFICANCE

Because ZC88 + ibuprofen achieves the same antinociceptive effect at lower doses, the use of this combination could result in fewer dose-related untoward effects. The potentiation of ZC88 on ibuprofen-induced antinociception indicates that N-VDCC blocker has potential benefit to treat severe inflammatory pain.

Transcriptome profiling to identify key mediators of granulosa cell proliferation upon FSH stimulation in the goose (Anser cygnoides)

1. The low reproductive performance of geese has seriously hampered the development of the industry. Reproductive performance, particularly the egg laying rate mainly depends on the development of the follicle. Previous studies have shown that follicle-stimulating hormone (FSH) plays an important role in the process of follicular development, but the exact underlying mechanism remains unclear. 2. This study showed that FSH stimulated granulosa cell proliferation in a dose-dependent manner. The effect of FSH treatment on granulosa cell proliferation was greatest at a dose of 100 mIU/ml FSH for 24 h. 3. Secondly, the effect of different concentrations of FSH on goose granulosa cell proliferation was investigated, and de novo transcriptome assembly and gene expression analysis performed using short-read sequencing technology (Illumina). High-throughput sequencing results yielded 62.61 M reads and 7.8 G base pairs from granulosa cells treated with 100 mIU/ml FSH. These reads were assembled into 65,757 unigenes (mean length: 705 bp) with an N50 of 903 bp. A total of 110 upregulated and 510 downregulated differentially expressed genes (DEGs) were identified by RNA-seq. 4. Functional analysis by gene ontology (GO) and KEGG pathway annotation indicated that hormone biosynthesis (GO:0042446), positive regulation of hormone secretion (GO:0046887), steroid biosynthesis, oxidative phosphorylation and carbon metabolism pathways were involved in FSH-mediated proliferation of goose granulosa cells. 5. After screening, a group of key responsive genes including superoxide dismutase 1, fatty acyl-CoA reductase 1, transforming growth factor-beta receptor-associated protein 1 and follistatin were tested by real-time reverse transcription PCR to confirm differential expression in granulosa cells stimulated by FSH. 6. FSH-stimulated goose granulosa cells and DEG profiling data provided comprehensive gene expression information at the transcriptional level that could promote better understanding of the molecular mechanisms underlying follicle development in response to FSH stimulation.

Effect of sildenafil on pulmonary hypertension associated with left heart failure

This study aims to evaluate the effect of sildenafil on pulmonary hypertension (PH) associated with chronic left heart failure. Twenty patients with PH and left heart failure were divided into treatment group (10 cases, with an oral dose of sildenafil 75 mg daily for 8 weeks) and control group (10 cases, with treatment of cardiac glycosides, diuretics, angiotensin-converting enzyme inhibitor, angiotensin II receptor blocker and beta-blockers). Left ventricular systolic function (LVEF), the pulmonary artery systolic pressure (PH), the left ventricular fraction shortening (LVFS), the left atrium diameter (LAD) and the left ventricular end-diastolic diameter (LVD) were measured by echocardiography, the left ventricular mass index (LVMI) was also calculated. The level of N-terminal pro-brain natriuretic peptide (NT-proBNP) was detected by electrochemiluminescence and high sensitivity C-reactive protein (hsCRP) by immune transmission. The walking distance in 6-minute walk test (6-MWT) was calculated. Before treatment, there were no significant differences in LVEF, LVFS, NT–proBNP, hsCRP, 6-MWT, LVD, LAD and LVMI between the treatment group and control group. After four weeks intervention in the treatment group, LVEF, FS and 6-MWT were significantly increased, while NT–proBNP, hsCRP, 6-MWT, LVD and LVMI were significantly decreased, when compared with the control group. In conclusion, sildenafil can improve cardiac function and reduce pulmonary artery pressure. In addition, it can attenuate myocardial remodeling through its anti-inflammatory effect.

Effects of Talaromyces marneffei infection on mortality of HIV/AIDS patients in southern China: a retrospective cohort study

OBJECTIVE

Talaromyces marneffei is an opportunistic infection with high morbidity among human immunodeficiency virus (HIV)/AIDS patients in Southeast Asia and southern China. Its effects on mortality in HIV/AIDS patients has not been clearly elucidated.

METHODS

We conducted a retrospective cohort study of hospitalized HIV-infected individuals at the Fourth People's Hospital of Nanning, Guangxi, China during 2012-2015. Kaplan-Meier analyses were used to calculate the cumulative mortality. Cox proportional hazard models and 1:1 propensity score matching (PSM) were used to evaluate the effects of T. marneffei infection on mortality of HIV/AIDS patients.

RESULTS

In total, 6791 HIV/AIDS patients were included, 1093 of them (16.1%) with documented T. marneffei co-infection. The mortality of T. marneffei-infected patients (25.0 per 100 person-months, 95% CI 21.5-26.7) was the highest among all AIDS-associated complications and was significantly higher than that of T. marneffei-uninfected HIV/AIDS patients (13.8 per 100 person-months, 95% CI 12.5-15.1; adjusted hazard ratio (AHR) 1.80, 95% CI 1.48-2.16). The results using PSM were similar (AHR 4.52 95% CI 2.43-8.42). The mortality of T. marneffei-infected patients was also significantly higher than that of patients without any complications. When stratified by demographic characteristics, T. marneffei infection has higher mortality risk in all stratifications. Co-infection with T. marneffei carries a higher mortality risk in patients at any CD4⁺ T-cell count.

CONCLUSIONS

Talaromyces marneffei infection is commonly found in hospitalized HIV/AIDS patients in southern China and was associated with a higher mortality rate than most HIV-associated complications. These results highlight the need for improved diagnosis, treatment and prevention of infection by this neglected fungal pathogen in southern China.

[The volume and mass growth of persisted pulmonary nodules detected in low-dose CT screening and its influence factors]

Objective: To evaluate the changes of volume and mass of pulmonary nodules which were detected in low-dose computed tomography (LDCT) screening, and to analyze the influencing factors. Methods: This retrospective study analyzed the CT images of the participants who underwent at least two chest LDCT scanning from March 2009 to December 2015 in National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. The inclusion criteria was the nodule diameter ≥6 mm; the volume growth was defined as ≥20%. Fifty-one pulmonary nodules (PNs) were selected among 51 enrolled participants (26 men and 25 women). According to characteristic of nodule and risk stratification of participant, the nodules were classified into different groups (10 non-solid nodules, 17 part-solid nodules and 24 solid nodules; 14 PNs in high-risk group, 12 PNs in moderate-risk group and 25 PNs in low-risk group). The Lung-VCAR software was used to measure the diameter and volume of the PNs, and all nodules were calculated for the volume doubling time (VDT) and mass doubling time (MDT). Results: Among the 51 PNs, the diameter of 33 nodules increased more than 1.5 mm while 18 nodules increased less than 1.5 mm. The median VDT of part-solid nodules was 364 days, which was shorter than that of non-solid nodules and solid nodules (761 and 819 days, respectively), the differences were statistically significant (both P<0.05). The median MDT of part-solid nodules was 351 days, which was lower than that of non-solid nodules and solid nodules (772 days and 840 days, respectively). The difference was statistically significant (P<0.05). The median VDT and MDT of the pulmonary nodules in the high-risk group were 181 days and 256 days, respectively, which were lower than those in the low risk group (1 037 days and 1 035 days, respectively). VDT has good correlation with MDT (r=0.909, P<0.001). Conclusions: Both the characteristic of PNs and the risk status of the participants could affect the growth of nodules in LDCT screening. The part-solid nodules and high-risk group nodules grew relatively faster, which should be closely focused on. Compared with the two-dimensional diameter, the three-dimensional quantitative indicators (VDT and MDT) were more sensitive for nodule growth. The mass changes of part-solid nodules were earlier than that of volume.

[Two-year outcomes of pulpotomy in primary molars using mineral trioxide aggregate: a retrospective study]

OBJECTIVE

To evaluate the two-year outcomes of primary molars pulpotomy using mineral trioxided aggregate (MTA) and to find out the potential influence factor, with the help of electronic medical record database.

METHODS

Children who received primary molars pulpotomy in the Department of Pediatric Dentistry in Peking University School and Hospital of Stomatology from May, 2014 to November, 2015 were searched in the Electronic Medical Record Database of Peking University School and Hospital of Stomatology, via the database for scientific research provided by the corporation of Kaientai. The children who were healthy, no more than 8 years old and followed up over 1.5 years were selected as the subjects of this study. At the same time, those children who didn't have complete medical records and X-rays before and after treatment were removed. Basic information, the relevant medical records and radiographic records of those children were collected. All molars were examined clinically and radiographically, and classified into 1 of 5 outcomes: N, H, P0, PX, PY. Molars classified into P0, PX and PY were regarded as failed. Survival analysis was applied. The survival rate and survival time of the deciduous teeth were calculated.Multivariate analysis was performed by using Cox proportional hazard model.

RESULTS

One hundred and fifteen children were finally included,aged from 2.6 to 8.2 years, with the mean age of (4.5±1.1) years. 211 primary molars were included, and the average follow up time was (880±154) days. A good level of agreement between the raters was found for molars with five outcomes(κ=0.913). Intrarater reliability was good for molars with five outcomes (κ=0.916). Forty-nine molars failed by September, 2017. Forty-three molars had abnormal radiographic manifestation. Six molars suffered premature loss. Only fourteen molars had an associated gingival swelling or parulis, or pathologic mobility upon clinical examination. The cumulative survival probability of half a year, one year, one year and a half, two years, two year and a half for the pulpotomy was 100%, 98.5%, 92.9%, 90.5%,73.8% through the Kaplan-Meier method, respectively. Through the analysis of Cox proportional hazard model, the survival probability was significantly higher when the age was younger. When sodium hypochlorite and the saline were used as the irrigation at the same time, the survival probability was not improved for those teeth with more bleeding in the operation compared with that used saline only. The teeth with preformed metal crown (PMC) gained longer median survival time than those restored with resin composite and others, but the difference was not significant, either. What's more, gender, the restoration time of PMC, the restoration of the opposite teeth were not found to be associated with the success of the treatment.

CONCLUSION

The cumulative survival probability of two years after the primary pulpotomy was 90.5%, complying the current instructions in our department. The survival probability of the molars after the treatment was significantly affected by the age.

The morphological changes of bronchovascular bundles within subsolid nodules on HRCT correlate with the new IASLC classification of adenocarcinoma

AIM

To observe the morphological changes of bronchovascular bundles within subsolid nodules on high-resolution (HR) computed tomography (CT) and analyse the correlation with the new adenocarcinoma classification.

MATERIALS AND METHODS

Two hundred and sixteen lesions (absent consolidation on mediastinal window) were reviewed retrospectively. CT features including dimensions, contour, morphological changes of the blood vessels, and bronchi/bronchioles, vacuole signs, and their correlation with histopathology were evaluated.

RESULTS

Excluding nine non-cancerous lesions, 34 pre-invasive lesions (PILs) including 15 atypical adenomatous hyperplasias (AAHs) and 19 adenocarcinomas in situ (AISs), 21 minimally invasive adenocarcinomas (MIAs), and 152 invasive adenocarcinomas (IACs) were analysed. Lepidic, acinar, and papillary patterns were identified in this cohort of adenocarcinomas. IACs were grouped into three types: type I (lepidic pattern ≥80%, n=47), type II (lepidic pattern ≥50%, <80%, n=67), and type III (lepidic pattern <50%, n=38). The contour of lesions, and morphological changes in vessels and bronchi/bronchioles significantly correlated with the classification of PIL, MIA, and IACs (p=0.000, p=0.000, and p=0.017, respectively). In IACs, the prevalence of vascular abnormalities on HRCT significantly correlated with (p=0.000) the proportion of non-lepidic pattern (23.40% in type I, 58.21% in type II, and 76.32% in type III); the prevalence of bronchial/bronchiolar abnormalities was higher (p=0.008) in type II/III (20.95%) compared with type I (6.38%).

CONCLUSIONS

The morphological changes of vessels and bronchi/bronchioles within the subsolid nodules on HRCT help to differentiate IAC from PIL and MIA, and are more common in non-lepidic predominant adenocarcinomas.

A lethal fungal pathogen directly alters tight junction proteins in the skin of a susceptible amphibian

Bacterial and viral pathogens can weaken epithelial barriers by targeting and disrupting tight junction (TJ) proteins. Comparatively, however, little is known about the direct effects of fungal pathogens on TJ proteins and their expression. The disease, chytridiomycosis, caused by the fungal pathogen Batrachochytrium dendrobatidis (Bd), is threatening amphibian populations worldwide. Bd is known to infect amphibian skin and disrupt cutaneous osmoregulation. However, exactly how this occurs is poorly understood. This study considered the impact of Bd infection on the barrier properties of the Australian green tree frog (Litoria caerulea) epidermis by examining how inoculation of animals with Bd influenced the paracellular movement of FITC-dextran (4 kDa, FD-4) across the skin in association with alterations in the mRNA and protein abundance of select TJ proteins of the epidermal TJ complex. It was observed that Bd infection increased paracellular movement of FD-4 across the skin linearly with fungal infection load. In addition, Bd infection increased transcript abundance of the tricellular TJ (tTJ) protein tricellulin (tric) as well as the bicellular TJ (bTJ) proteins occludin (ocln), claudin (cldn) -1, -4 and the scaffolding TJ protein zonula occludens-1 (zo-1). However, while Tric protein abundance increased in accord with changes in transcript abundance, protein abundance of Cldn-1 was significantly reduced and Ocln protein abundance was unchanged. Data indicate that disruption of cutaneous osmoregulation in L. caerulea following Bd infection occurs, at least in part, by an increase in epidermal paracellular permeability in association with compromised integrity of the epidermal TJ complex.

Association Between Osteoprotegerin Gene Polymorphisms and Risk of Coronary Artery Disease: A Systematic Review and Meta-analysis

Osteoprotegerin (OPG) has been demonstrated to be a novel biomarker for predicting prevalence and severity of coronary artery disease (CAD). Furthermore, recent studies have shown that OPG gene polymorphisms are associated with a susceptibility to CAD. However, published studies showed inconsistent results. Therefore, a meta-analysis of eligible studies reporting the association between OPG gene polymorphisms and CAD was carried out. A systematic search was conducted using PubMed, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure (CNKI) and Chinese Wan Fang databases. Odds ratio (OR) with corresponding 95% confidence interval (95% CI) were calculated. Overall, six eligible studies were included and four OPG gene polymorphisms (G209A, T245G, T950C and G1181C) were further evaluated for the association with susceptibility to CAD in this meta-analysis. Meta-analysis showed that G1181C and T950C polymorphisms were strongly associated with the risk of CAD, but no association existed between G209A and T245G polymorphisms and the risk of CAD. In conclusion, our meta-analysis is the first report to estimate the association between OPG gene polymorphisms and susceptibility to CAD. Further large scale case-control studies with rigorous design should be conducted to confirm the above conclusions in the future.

[Detection of epidermal growth factor receptor gene mutations in different types of non-small cell lung cancer by droplet digital PCR and amplification refractory mutation system]

Objective: To compare amplification refractory mutation system(ARMS) and droplet digital PCR (ddPCR) in the detection of epidermal growth factor receptor (EGFR) gene mutations in patients with non-small cell lung cancer (NSCLC), and to investigate the clinical value of ddPCR. Methods: A total of 79 specimens of NSCLC, including 22 cases of cell block, 18 cases of surgical specimens, 12 cases of biopsy specimens and 27 cases of plasma samples, were analyzed for the mutation status of EGFR gene by ARMS and droplet digital PCR method. Results: In 18 cases of surgical specimens and 12 cases of biopsy specimens, the detection results by the two methods were identical with positive rates of 9/18 and 5/12, respectively. In 22 cases of effusion cell blocks, ARMS detected 19-del and L858R of EGFR gene in two cases, in which droplet digital PCR detected 19-del+ T790M mutations in one case and L858R+ T790M mutation in another. L858R mutation was detected by droplet digital PCR in one case but ARMS assay was negative. The remaining 19 cases were consistent by the two methods. In blood samples, the positive rate was 33.3%(9/27) by ARMS and 37.0%(10/27) by droplet digital PCR. Two cases showed L858R and 19-del+ T790M mutation by droplet digital PCR but ARMS assay detected only 19-del. The remaining 25 cases were consistent by the two methods. Conclusion: Droplet digital PCR method is more sensitive and accurate than ARMS for the detection of EGFR mutations in pleural fluid and blood samples, can be used in clinical test.

First-line icotinib versus cisplatin/pemetrexed plus pemetrexed maintenance therapy for patients with advanced EGFR mutation-positive lung adenocarcinoma (CONVINCE): a phase 3, open-label, randomized study

BACKGROUND

Icotinib has been previously shown to be non-inferior to gefitinib in non-selected advanced non-small-cell lung cancer patients when given as second- or further-line treatment. In this open-label, randomized, phase 3 CONVINCE trial, we assessed the efficacy and safety of first-line icotinib versus cisplatin/pemetrexed plus pemetrexed maintenance in lung adenocarcinoma patients with epidermal growth factor receptor (EGFR) mutation.

PATIENTS AND METHODS

Eligible participants were adults with stage IIIB/IV lung adenocarcinoma and exon 19/21 EGFR mutations. Participants were randomly allocated (1 : 1) to receive oral icotinib or 3-week cycle of cisplatin plus pemetrexed for up to four cycles; non-progressive patients after four cycles were maintained with pemetrexed until disease progression or intolerable toxicity. The primary end point was progression-free survival (PFS) assessed by independent response evaluation committee. Other end points included overall survival (OS) and safety.

RESULTS

Between January 2013 and August 2014, 296 patients were randomized, and 285 patients were treated (148 to icotinib, 137 to chemotherapy). Independent response evaluation committee-assessed PFS was significantly longer in the icotinib group (11.2 versus 7.9 months; hazard ratio, 0.61, 95% confidence interval 0.43-0.87; P = 0.006). No significant difference for OS was observed between treatments in the overall population or in EGFR-mutated subgroups (exon 19 Del/21 L858R). The most common grade 3 or 4 adverse events (AEs) in the icotinib group were rash (14.8%) and diarrhea (7.4%), compared with nausea (45.9%), vomiting (29.2%), and neutropenia (10.9%) in the chemotherapy group. AEs (79.1% versus 94.2%; P < 0.001) and treatment-related AEs (54.1% versus 90.5%; P < 0.001) were significantly fewer in the icotinib group than in the chemotherapy group.

CONCLUSIONS

First-line icotinib significantly improves PFS of advanced lung adenocarcinoma patients with EGFR mutation with a tolerable and manageable safety profile. Icotinib should be considered as a first-line treatment for this patient population.

[Application of neuroendoscope combined with minimal-access for elderly patients with idiopathic trigeminal neuralgia in enhanced recovery after surgery of microvascular decompression]

Objective: To explore the value of neuroendoscope and minimal-access in enhanced recovery after surgery of microvascular decompression (MVD) for treatment elderly patients with idiopathic trigeminal neuralgia (ITN). Methods: The clinical data of 62 elderly patients with ITN who undergoing neuroendoscope-assisted minimal-access microvascular decompression were analyzed retrospectively, including operative data and follow-up results. Results: In 62 cases, the effective rate was 96.8%, with 88.7% complete cure and 8.1% little residual pain. Sixty successful cases were followed-up for an average of 61 months.Three cases recurred within 3 years after operation.Eight cases had complications after MVD. Conclusions: There was no serious complications that could be ascribed to old age and the operative result was satisfactory compared with younger age cases.Endoscope and minimal-access can help shorten operation time, raise the effectiveness of MVD, reduce postoperative recurrence rate, and enhanced recovery after surgery for elderly patients.