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'ros1 gene'
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The development of biomarker-driven targeted therapy has resulted in substantial benefits for patients with non–small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutations, and rearrangements involving the anaplastic lymphoma kinase (ALK) gene or the ROS1 gene. For patients with EGFR-mutant NSCLC EGFR tyrosine kinase inhibitors (eg, gefitinib, erlotinib, and afatinib) have a superior objective response rate and progression-free survival compared with chemotherapy in the first-line setting. For patients who have disease progression on EGFR tyrosine kinase inhibitor and with NSCLC with an EGFR T790M mutation osimertinib has demonstrated a superior response rate and progression-free survival compared with chemotherapy in the second-line setting.4 For patients with ALK rearrangements ALK tyrosine kinase inhibitors (eg, crizotinib, ceritinib) have a superior response rate and progression-free survival compared with chemotherapy in the first-line setting, and for patients who experience disease progression, ceritinib and alectinib have demonstrated clinically relevant response rates and progression-free survival..For patients with ROS1 rearrangements, targeted therapy, is associated with a higher response rate and longer progression-free survival than has been observed with chemotherapy. These molecular alterations are more common in NSCLC with adenocarcinoma histology and in the minority of patients with a light smoking or never smoking history. The success of these targeted therapies in molecularly defined subsets of NSCLC made the development of targeted therapies and identification of predictive biomarkers a focus of thoracic oncology research. Routine molecular testing is now the standard of care for patients with NSCLC with adenocarcinoma histology
Postoperative Pulmonary Complications Br J Anaesth. 2017;118(3):317-334. Changes to the respiratory system occur immediately on induction of general anaesthesia: respiratory drive and muscle function are altered, lung volumes reduced, and atelectasis develops in > 75% of patients receiving a neuromuscular blocking drug..The respiratory system may take 6 weeks to return to its preoperative state after general anaesthesia for major surgery. clinicians should be aware of non-modifiable and modifiable factors in order to recognize those at risk and optimize their care.Preventative measures include preoperative optimization of co-morbidities, smoking cessation, and correction of anaemia, in addition to intraoperative protective ventilation strategies and appropriate management of neuromuscular blocking drugs. Protective ventilation includes low tidal volumes, which must be calculated according to the patient's ideal body weight. the most beneficial level of PEEP is required,
Lung cancer (cancer of the lung) is common worldwide. Around 8 in 10 cases develop in people over the age of 60 years, usually in smokers. If lung cancer is diagnosed at an early stage, there is a chance of a cure. In general, the more advanced the cancer (the more it has grown and spread), the less chance that treatment will be curative. However, treatment can often slow the progress of the cancer.
India has very good doctors, but most of them work with known information instead of generating knowledge, ” says Salim. ‘’But, mostly borrowed information could be outdated or even wrong
Personalised Medicine for Asthma and Chronic Obstructive Pulmonary Disease Asthma and chronic obstructive pulmonary disease (COPD) are prevalent condition sboth significant heterogeneity within each of these conditions and additionally significant overlap in many of the clinical and inflammatory features useful clinical and immunological biomarkers which inform about prognosis and response to therapy have emerged in both asthma and COPD. These biomarkers will allow both better targeting of existing treatments and the identification of those patients who will respond to novel therapies which are now becoming available Delivery of precision medicine in airways disease is now feasible and is a core component of a personalised healthcare delivery in asthma and COPD
An Update on Lymphocyte Subtypes in Asthma and Airway Disease Inflammation is a hallmark of many airway diseases. Improved understanding of the cellular and molecular mechanisms of airway disease will facilitate the transition in our understanding from phenotypes to endotypes, thereby improving our ability to target treatments based on pathophysiologic characteristics. For example, allergic asthma has long been considered to be driven by an allergen-specific T helper 2 response. However, clinical and mechanistic studies have begun to shed light on the role of other cell subsets in the pathogenesis and regulation of lung inflammation.
A definitive diagnosis of pleural TB depends on the isolation of Mycobacterium tuberculosis in the sputum, pleural fluid or pleural biopsy specimens, or the demonstration of caseating granulomas in the parietal pleura. However, lymphocytic exudades with a high ADA content (>35–40 U/L) are generally accepted as tuberculous in the correct clinical context. ● When the cause of a pleural effusion remains obscure after the standard initial workup, which may eventually include pleural biopsy, medical history and all available diagnostic examinations should be revisited. Most of these effusions will resolve spontaneously
EBUS lymphnode 1. Size short axis : less or more than 1cm 2. Shape : Oval or round ; when ratio of short axis vs . long axis of lymph node is smaller than 1.5cm , the lymph node defined as round. If ration more than 1..5cm it is oval. 3. Margin indistinct or distinct : if more than 50% is clearly visible with a high echoic border they are distinct . If less than 50% and margin unclear determined indistinct. 4.Echogenecity; Homogenous or heterogenous. 5. Presence or absence of central hilar structure CHS CHS defined as linear flat hyperechoic area in the center of lymph node which indicate prediction of metastatic L node
Fleischner Society Guideline Update 2017: Management of Solid Pulmonary Nodules. Updated 2017 Fleischner Society guidelines advise a less intensive approach to the management of most small pulmonary nodules incidentally discovered on CT scans. The Fleischner Society now recommends that solid nodules 6 mm or less in diameter in low-risk adults >35 years old generally need no further follow-up. In higher-risk patients, a follow-up CT scan should be considered optional. The recommendations apply even if multiple solid pulmonary nodules ≤6 mm are present.
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