Eosinophilic pleural effusion due to lung cancer has a better prognosis than non-eosinophilic malignant pleural effusion

Objective Tumor-related eosinophilia may have extended survival benefits for some cancer patients. However, there has been no report on the prognosis difference between eosinophilic pleural effusion (EPE) and non-EPE in lung cancer patients. Our study aimed to investigate the prognosis difference between EPE and non-EPE due to lung cancer. Patients and methods We retrospectively reviewed patients diagnosed with lung cancer who presented with malignant pleural effusion (MPE) between May 2007 and September 2020 at the National Hospital Organization Kochi Hospital. EPE is defined as pleural fluid with a nucleated cell count containing 10% or more eosinophils. Results A total of 152 patients were included: 89 were male (59%). The median age was 74.4 years (range 37–101), and all patients were pathologically shown to have MPE. Most patients (140; 92%) had an Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) of 0/1. Twenty patients had EPE. The median overall survival (OS) of all 152 lung cancer patients with MPE was 298 days. The median OS of the patients with EPE was 766 days, and the median OS of the patients with non-EPE was 252 days. Kaplan–Meier univariate analysis showed that lung cancer patients with EPE had a significantly better prognosis than patients with non-EPE (P < 0.05). Cox proportional regression analysis showed that EPE, ECOG PS, sex, and the neutrophil-to-lymphocyte ratio in the serum (sNLR) may be independent prognostic factors affecting survival in patients with MPE. Conclusion Lung cancer patients with EPE have a better prognosis than those with non-EPE

Late-onset acute type 1 diabetes mellitus 7 months after discontinuation of pembrolizumab against lung cancer

Immune-related adverse events (irAEs) occur in rare cases, even after the completion of immune checkpoint inhibitor (ICI) therapy. We encountered a lung cancer patient diagnosed with acute-onset type 1 diabetes mellitus (DM) 7 months after the cessation of ICI. A 68-year old woman was referred to our hospital for chest abnormalities. She was diagnosed with lung adenocarcinoma cT4N2M1c, stage IVB. Immunostaining showed that the expression of programmed death ligand 1 in tumor cells was negative. A genetic analysis using the Oncomine Dx Target Test Multi-CDx System revealed that the primary tumor was positive for ERBB2. Combined immunotherapy with carboplatin, pemetrexed, and pembrolizumab was performed as first-line therapy, followed by maintenance therapy with pemetrexed plus pembrolizumab, which was successful. After the seventh course, maintenance therapy was stopped because only the primary tumor showed local enlargement. Local chest radiotherapy (66 Gy/33 Fr) was performed, and the patient was followed up. HbA1c was 4.9% 3 months after the completion of pembrolizumab, and dry mouth and polyuria occurred after 5 months. Seven months later, the patient developed diabetic ketoacidosis with a blood glucose of 348 mg/dL and an HbA1c of 11.3%. Antiglutamic acid decarboxylase antibodies were negative and urinary C-peptide was 9.3 μg/day. The patient was diagnosed with acute-onset type 1 diabetes and received insulin therapy. There has been no case report of type 1 diabetes diagnosed 7 months after the last administration of an ICI. These results indicate that irAE needs to be considered even after the cessation of ICI

Non-small cell lung cancer with EGFR (L858R and E709X) and CNNB1 mutations responded to afatinib

Lung cancer with complex epidermal growth factor receptor (EGFR) and CTNNB1 comutations is rare, and the efficacy of tyrosine kinase inhibitors (TKIs) is generally poor. Here, we encountered a lung cancer patient with complex EGFR (L858R and E709X) and CTNNB1 comutations who successfully responded to afatinib. A 78-year-old woman visited our hospital with a cough and bloody sputum that had worsened over the past year. She had multiple mass shadows in both lungs and nodular shadows in the bronchi. The patient was diagnosed with lung adenocarcinoma cT4N3M1c stage IVB. A genetic analysis of the primary tumor using the Oncomine Dx target test multi-CDx system revealed positivity for EGFR (L858R and E709X) and CTNNB1 mutations. The expression of programmed death ligand 1 (22C3 clones) in tumor cells was negative by immunostaining. The patient was treated with afatinib as first-line therapy and achieved clinical improvement and a partial response and is continuing treatment 1 year later. Case reports of lung cancer patients with EGFR/CTNNB1 comutations are rare, and TKIs are not considered to be effective. We herein present the first case report of lung cancer with the co-occurrence of uncommon and complex EGFR (L858R and E709X) and CTNNB1 mutations that was successfully treated with afatinib

A single dose of pembrolizumab treatment causing a profound and durable response in lung cancer

Profound and durable responses to a single dose of pembrolizumab in lung cancer are rare. We encountered a non-small cell lung cancer patient showing a deep and durable response with a single dose of pembrolizumab. A 79-year-old man reported bloody sputum for several weeks and visited a general physician. A chest x-ray revealed a tumor shadow in the right middle lung field at that time, and the patient was referred to our hospital. He was diagnosed with adenocarcinoma of the lung by transbronchial biopsy. The expression of programmed death ligand 1 in tumor cells was 100% by immunostaining. Based on the above, immunotherapy with pembrolizumab was performed as first-line therapy. Cancer cells had significantly shrunk at the end of the first cycle. The patient had grade-3 immune-related hepatitis at the end of the first cycle. Pembrolizumab treatment was stopped and prednisolone (80 mg/body) was initiated. Subsequently, liver function normalized, and prednisolone was tapered and discontinued. Since then, no tumor recurrence has been detected for 1.5 years without treatment. There have been few reports of profound and durable responses to a single dose of pembrolizumab in lung cancer. The results indicate that a single dose of pembrolizumab alone may be sufficient to cause durable response and serious immune-related adverse events in some cases

Complete and durable response of pulmonary large-cell neuroendocrine carcinoma to pembrolizumab

Background: Pulmonary large cell neuroendocrine carcinoma (LCNEC) is a rare and aggressive tumor with a poor prognosis and standard therapy has not yet been established. Case: A 65-year-old male with a cough for 2 months presented to our hospital. He was clinically diagnosed with non small cell lung cancer cT3N1M0 stage IIIA and underwent right pneumonectomy. The final diagnosis was pulmonary LCNEC pT3N1M0 stage IIIA. Multiple subcutaneous masses were detected 4 months after surgery, and biopsy revealed postoperative recurrence and metastasis. Chemotherapy with carboplatin plus etoposide was initiated. Subcutaneous masses increased and multiple new brain metastases developed after two cycles. Additional tests revealed that epidermal growth factor receptor and anaplastic lymphoma kinase were negative, and the programmed death ligand 1 (PD-L1) expression rate in tumor cells was 40% (22C3 clones). The primary cells infiltrating the tumor were CD3-positive T cells and CD138-positive plasma cells. Second-line treatment with pembrolizumab was started. The shrinkage of subcutaneous masses was observed after one cycle, and the tumor had completely disappeared after six cycles. Treatment was continued for approximately 2 years. This response has been maintained for 4 years and is still ongoing. Conclusion: Pembrolizumab may be used as a treatment option for pulmonary LCNEC

Dramatic response to immunochemotherapy followed by salvage surgery in an elderly lung cancer patient

Immune checkpoint inhibitors (ICIs) have caused a paradigm shift in the treatment of lung cancer. Here, we encountered a case of inoperable locally advanced squamous cell carcinoma of the lung that became operable with pembrolizumab-based immunochemotherapy and achieved a pathological complete response. An 82-year-old man suspected of having lung cancer was referred to our hospital. The patient was clinically diagnosed with left upper lobe squamous cell carcinoma cT2aN3M0 c-stage IIIC. Immunostaining revealed the expression of programmed death-ligand 1 in 60% of tumor cells. The cancer cells disappeared after two cycles of chemotherapy with carboplatin and nanoparticle albumin-bound paclitaxel plus pembrolizumab. As the abnormal accumulation of 18F-fluorodeoxyglucose (FDG) on FDG-positron emission tomography/computed tomography before chemotherapy almost disappeared after pembrolizumab-based immunochemotherapy, left upper lobectomy and lymph node dissection were performed. No cancer cells were pathologically detected from the resected tissue. Therefore, ICIs combined with chemotherapy may enable inoperable advanced lung cancer patients to undergo surgery and achieve a complete response

Leptospirosis in Squirrels Imported from United States to Japan

We diagnosed leptospirosis in 2 patients exposed to southern flying squirrels imported from the United States to Japan. Patients worked with exotic animals in their company. Leptospira isolates from 1 patient and 5 of 10 squirrels at the company were genetically and serologically identical and were identified as Leptospira kirschneri

ヨシ Phragmites australis Trin ノ セイチョウカテイ ニ オケル ヨウメンセキ カンイ ソクテイホウ

緑色植物の葉の大きさは光合成による物質生産やその成長を左右する基本的要素の一つであり、生態学の領域において関心の高い要素である。葉面積の測定には自動葉面積計(Murata 1967)を用いるのが一般的であるが、近年は画像解析ソフトを用いたパソコン上での解析方法(石井2007)も提唱されている。また、植物群落の生産構造では、葉の乾燥重量を物質生産の場の大きさとしてとらえる間接的な方法も採られている。いずれの方法においても葉面積の測定には、対象の葉を植物体から切り離して行うのが通例であり、対象の葉は1回限りである。しかし、植物の成長期間中の成長量を調べようとする場合にはフィールドにおいて同一植物体の同一葉を連続的に測定することが必要となり、前述の方法で生かしたまま多数の同一葉を繰返し測定することは困難である。このような問題を解決するため、生育中の実の部分的な計測によって面積を求めることができないかということについて検討した。多くの植物で、同一種の植物の葉は互いに相似形を採っているのがほとんどであり、ヨシやススキ、ササ類などイネ科植物の実は広線形で全線といった単純な形態をしており、その大きさを左右する要素は葉身の長さと幅である。筆者らは、青森県の津軽平野を流れる岩木川下流の河川敷におけるヨシ群落の人為的な撹乱による影響を調べるにあたって、ヨシの成長に伴う葉面積拡大の経緯の追跡や葉面積指数の推定を行う目的で、ヨシの葉の葉長と葉幅から葉面積を求める方法と、葉の乾燥重量から葉面積を得る簡易的な方法を得たので報告する。なお、本研究は岩木川における河川生態学術研究会の総合的な調査研究の一環として実施されたものである

Yolk-sac absorption, mouth size development, and first exogenous feeding of sultan fish, leptobarbus hoevenii

Sultan fish, Leptobarbus hoevenii is an important species for aquaculture in several Southeast Asian countries, including Thailand and Malaysia. However, knowledge on its yolk absorption, mouth size development, and first food ingestion timing is still lacking up-to-date. This information on the correct feeding of the L. hoevenii larvae are crucial to farmers. The present study hence examined these parameters in the L. hoevenii. The newly hatched L. hoevenii larvae were obtained through natural spawning with the aid of chemicals injection, and sampled consecutively every 2 hours to measure their yolk volumes, mouth height, and to confirm the ingestion time of the first Moina into the larval gut. Also, a starvation experiment was conducted to detect the larval point-of-no-return (PNR). It was found that the yolk sac volume of the newly hatched L. hoevenii larvae was 77.51 µm, and it was completely absorbed at 108 hours after hatching (hAH). The larval mouth has first opened at 36 hAH (mouth height 215±22.59 µm) but the larvae only commenced first exogenous feeding on Moina (approximately 207 μm in width) at 62 hAH, when its mouth height reached 372.91±79.11 µm. The L. hoevenii larvae required about 18 hrs from 62–80 hAH, to adapt themselves to feed on the given Moina, and the PNR was estimated to happen at 70–72 hAH. It was recommended that Moina should be given to the L. hoevenii larvae best within 62–72 hAH, at the rearing water temperature of 27 to 29°C

Comprehensive analysis including the nutritional point of view on the pathogenesis of periodontal disease

To clarify risk factors for periodontal disease from the viewpoints of physiology, blood biochemistry, and nutrition, a survey involving 364 persons (224 males, 140 females) who consulted the Medical Examination Center of Matsumoto Dental University Hospital was conducted. The pathogenesis of periodontal disease was investigated using the maximum Community Periodontal Index (CPI) and Attachment Loss (AL) values, and their distributions with respect to the sex were analyzed using Wilcoxonʼs rank sum test. Based on the CPI and AL values, the subjects were divided into 3 groups: healthy (0), mild (1–2), and severe (3–4). The mean values obtained from the physiological, dental, blood biochemical, and nutritional findings in the 3 groups were analyzed using the multiple comparison test. Furthermore, their distributions with respect to sex and smoking in the 3 groups were analyzed using Fisherʼs direct probability test. A p–value of 0.05 was regarded as significant. Factors influencing the CPI included the sex (male), body mass index (BMI), abdominal circumference, diastolic blood pressure, AL, alanine aminotransferase (ALT), fasting blood glucose, neutral fat, HDL cholesterol, and smoking. Factors influencing the AL included the sex (male), age, current number of teeth, CPI, lipid intake, manganese intake, vitamin C intake, monounsaturated fatty acid intake, polyunsaturated fatty acid intake, n–6 fatty acid intake, fruit intake, and smoking. The results suggest that the physiological, blood biochemical, and nutritional states are involved in the pathogenesis of periodontal disease. The CPI was associated with metabolic error in the presence of metabolic syndrome. There was an association between the AL and diet as an environmental factor