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The relationship between tyrosine kinase inhibitor therapy and overall survival in patients with non-small cell lung cancer carrying EGFR mutations.

The relationship between tyrosine kinase inhibitor therapy and overall survival in patients with non-small cell lung cancer carrying EGFR mutations.

Chin J Cancer. 2012 Dec 7;

Authors: Suzuki H, Hirashima T, Okamoto N, Yamadori T, Tamiya M, Morishita N, Shiroyama T, Otsuka T, Kitai K, Kawase I

Abstract
For patients with epidermal growth factor receptor (EGFR) mutation-positive lung cancer, the relationship between the dose or duration of treatment with tyrosine kinase inhibitor (TKI) and overall survival remains unclear. Here, we retrospectively analyzed clinical data for 39 patients who were diagnosed with EGFR mutation-positive non-small cell lung cancer and treated with TKI, but subsequently died. Several parameters were measured in this study: overall survival; first, second, and overall TKI therapy durations; first TKI intensity (actual dose/normal dose); and TKI rate (overall TKI therapy duration/overall survival). The response rate to TKI therapy was 50%, and the median survival was 553 days. After TKI therapy failed, 38.5% patients were re-challenged with TKI. We observed a moderate relationship [r = 0.534, 95% confidential interval (CI) = 0.263- 0.727, P < 0.001] between overall TKI therapy duration and overall survival. However, we found no relationship between overall survival and first TKI intensity (r = 0.073, 95% CI = -0.380 to 0.247, P = 0.657) or TKI rate (r = 0.0345, 95% CI = -0.284 to 0.346, P = 0.835). Non-small cell lung cancer patients with mutation-positive tumors remained on TKI therapy for, on average, 33% of the overall survival time. These findings suggest that patients with EGFR mutation-positive tumors should not stick to using TKIs.

PMID: 23237215 [PubMed - as supplied by publisher]

The incidence and etiology of community-acquired pneumonia in fever outpatients.

The incidence and etiology of community-acquired pneumonia in fever outpatients.

Exp Biol Med (Maywood). 2012 Nov 1;237(11):1256-61

Authors: Bao Z, Yuan X, Wang L, Sun Y, Dong X

Abstract
The purpose of this study was to analyze the incidence, etiology and clinical characteristics of community-acquired pneumonia (CAP) among outpatients with sore throat and/or cough, and thus to provide theoretical basis for timely and accurate diagnosis and treatment for CAP. We used chest X-rays for fever (a temperature greater than 37.5°C) patients, who were recruited since 2007, presenting with sore throat and/or cough. The patients' age, gender, days of fever, respiratory symptoms (e.g. cough and sputum), peripheral blood count and etiology (pathogens) of CAP were recorded. Of all the 6539 fever outpatients, those aged 10-39 and above 60 years old accounted for 61.0% and 15.6%, respectively. In total, 402 were diagnosed with CAP with an incidence rate of 6.1%. Among them, 38.1% were above 60 years old. The prevalence increased with age. Of the 402 CAP patients, 36.8% (148/402) presented no respiratory symptoms and 30.1% (121/402) had positive etiology. The top three pathogens were Mycoplasma pneumoniae (23.1%), Streptococcus pneumoniae (17.3%) and Haemophilus influenzae (9.1%). Among the 121 etiology-positive patients, 14 cases were mixed infections (at least one atypical pathogen). Nine cases were M. pneumoniae mixed with bacterial/virus infection, and five cases were Chlamydia pneumoniae mixed with other bacteria/mycoplasma infection. We found that fever outpatients have a higher prevalence of CAP, which increases with age, i.e. older people are more susceptible to CAP. S. pneumoniae and H. influenzae are common pathogens in CAP; however, atypical pathogens, especially M. pneumoniae, remain the most common pathogens in CAP.

PMID: 23239436 [PubMed - in process]

Severe metapneumovirus infections among immunocompetent and immunocompromised patients admitted to hospital with respiratory infection.

Severe metapneumovirus infections among immunocompetent and immunocompromised patients admitted to hospital with respiratory infection.

J Med Virol. 2012 Dec 12;

Authors: Souza JS, Watanabe A, Carraro E, Granato C, Bellei N

Abstract
Human metapneumovirus (hMPV) is considered an important cause of acute respiratory infections. hMPV can cause morbidity in hematopoietic stem cell transplant recipients and recent research has demonstrated that it is an important virus in patients admitted to hospital with respiratory infections and suspected of having pandemic 2009 influenza A (H1N1pdm09) virus. The purpose of this study was to investigate infections caused by hMPV in two groups of patients admitted to hospital: Immunocompromized patients with a potential risk of severe outcomes and immunocompetent patients with severe acute respiratory syndrome. A total of 288 samples were tested: 165 samples were collected from patients with suspected influenza A (H1N1) pdm09 infection during the first pandemic wave in 2009; and 123 samples were collected from patients of a hematopoietic stem cell transplantation program in 2008-2009. Amplification of the hMPV genes was performed by polymerase chain reaction. This was followed by sequencing and phylogenetic analysis. hMPV was detected in 14.2% (41/288) of all samples: 17% (28/165) of immunocompetent patients with suspected H1N1 infection and 10.6% (13/123) among hematopoietic stem cell transplant recipients. hMPV accounted for 12.1% (8/66) of immunocompetent adults patients with severe respiratory infections (median age, 55.9 years). Two hMPV subtypes were identified, A2 (26.9%; 7/26) and B2 (73.1%; 19/26) but no difference was observed between the patient groups in terms of age or immunosuppression level. This study highlights the significance of hMPV in immunocompetent adult patients with severe infections and further investigations are recommended for understanding the impact of this virus. J. Med. Virol. © 2012 Wiley Periodicals, Inc.

PMID: 23239530 [PubMed - as supplied by publisher]

Prise en charge des toux chroniques difficiles en médecine générale et attente des médecins généralistes

June 2012
Publication year: 2012
Source:Revue de Pneumologie Clinique, Volume 68, Issue 3



La toux chronique, motif fréquent de consultation en médecine générale, pose des problèmes dignostiques comme thérapeutiques. Peu de données existent sur leur prise en charge en médecine générale ainsi que sur les attentes des praticiens envers leurs correspondants spécialistes. La prise en charge en médecine générale de patients avec toux chronique, adressés spécifiquement en pneumologie, a été analysée par le biais d’un questionnaire, et l’avis des médecins traitants sur leur pratique professionnelle a été recueilli par téléphone. Les 34 patients sont principalement des femmes, l’âge moyen est supérieur à 50ans et la majorité sont non-tabagiques. Plus d’une fois sur deux, l’histoire médicale est ancienne (plus de six mois) occasionnant plusieurs consultations (plus de cinq). La majorité des patients ont reçu un traitement dès la première consultation, principalement des antitussifs, des corticoïdes puis des bronchodilatateurs. Huit fois sur dix une radiographie pulmonaire a été réalisée. Par ordre décroissant, les avis spécialisés demandés étaient ORL ou pneumologique, gastro-entérologique, allergologique ou cardiologique. La majorité des patients se déclare satisfaits de la prise en charge en médecine générale, malgré des symptômes persistants. Vu des médecins généralistes, la toux chronique reste majoritairement problématique. Leur principale attente – en adressant le patient à un spécialiste – était un diagnostic étiologique précis. À la question « À l’avenir, de quoi pensez-vous qu’il vous serait le plus utile de disposer ? », la réponse « algorithme étiologique simple » est arrivée devant « un traitement efficace ». Bien que la persistance du symptôme motive de nombreuses consultations, la demande principale des médecins traitants est l’élaboration d’un algorithme diagnostic précis. Chronic cough represents a persistent dilemma, for general practitioner (GP), inducing a lot of medical investigations. Few data are available about French GP practice and their expectancy from cough specialists. We studied management in primary care and impressions of GP of patients with chronic cough. Thirty-four patients were studied. They were mostly women, mean age was above 50years-old, and the waste majority of patients were non-smokers. Halftime, the symptom was persistent (more than 6months), had promoted numerous medical consultations (more than five). Drugs were prescribed since the first visit for the majority of patients, principally cough-sedation drugs, steroids and bronchodilatators. A chest radiography was realized in almost all patients. Advices were asked (with a decreasing frequency) to physicians specialized in: ear-nose-throat or respiratory, gastroenterology, allergy, or cardiology. The majority of patients were satisfied of their GP, despite persistent symptoms. From the point of the GP, chronic cough remains a relentless dilemma. Their main purpose, when they addressed their patient to a specialized physician, was to obtain an etiologic diagnosis. When they were asked “which tool will be more adequate for you in the next future?”, the preferred response was “a simple etiologic algorithm”. Despite persistent symptoms, inducing furthers medical consultations, the main ask from GP was to promote a simple etiologic algorithm.




Vieillissement de l’appareil respiratoire : modifications anatomiques et conséquences physiologiques

October 2012
Publication year: 2012
Source:Revue de Pneumologie Clinique, Volume 68, Issue 5



Le système respiratoire subit une involution progressive avec l’âge, se traduisant par des modifications anatomiques et fonctionnelles qui s’exercent à tous les niveaux. La cage thoracique se rigidifie et les muscles respiratoires s’affaiblissent. Les bronchioles distales diminuent de diamètre et tendent à se collaber. Les volumes pulmonaires mobilisables diminuent avec l’âge alors que le volume résiduel augmente. Les échanges gazeux se modifient avec une baisse linéaire de la PaO2 jusqu’à l’âge de 70ans et une diminution de la capacité de diffusion du monoxyde de carbone. Les réponses ventilatoires à l’hypercapnie et à l’hypoxie, ainsi que l’adaptation à l’exercice diminuent chez le sujet âgé. La connaissance des modifications de l’appareil respiratoire en rapport avec l’avancée en âge constitue un enjeu médical de grande importance afin de distinguer les effets du vieillissement de ceux des maladies. The respiratory system undergoes progressive involution with age, resulting in anatomical and functional changes that are exerted on all levels. The rib cage stiffens and respiratory muscles weaken. Distal bronchioles have reduced diameter and tend to be collapsed. Mobilized lung volumes decrease with age while residual volume increases. Gas exchanges are modified with a linear decrease of PaO2 up to the age of 70 years and a decreased diffusing capacity of carbon monoxide. Ventilatory responses to hypercapnia, hypoxia and exercise decrease in the elderly. Knowledge of changes in the respiratory system related to advancing age is a medical issue of great importance in order to distinguish the effects of aging from those of diseases.




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