[Clinical study on growth impairment induced by oral glucocorticoids based on FGF23/Klotho homeostasis observations]

OBJECTIVES

To observe the correlation between growth impairment induced by long-term oral glucocorticoids (GC) therapy and the ratio of FGF23/Klotho in children with primary nephrotic syndrome (PNS).

METHODS

A prospective study was conducted on 56 children with GC-sensitive PNS who had discontinued GC therapy for more than 3 months and revisited the Department of Pediatrics of the First Affiliated Hospital of Henan University of Traditional Chinese Medicine between June 2022 and December 2022. After monitoring qualitative and quantitative urine protein levels upon admission, the children with proteinuria relapse were treated with GC (GC group; n=29), while those without relapse did not receive GC treatment (non-GC group; n=27). In addition, 29 healthy children aged 3 to prepuberty were selected as the control group. Height, bone age, growth rate, and the FGF23/Klotho ratio were compared among the groups. The correlations of the FGF23/Klotho ratio with height, bone age, and growth rate were analyzed.

RESULTS

The FGF23/Klotho ratio in the GC group was significantly higher than that in the non-GC group after 1 month of GC therapy (P<0.05), and the height and bone age growth rates within 6 months were lower than those in the non-GC group (P<0.05). Correlation analysis showed significant negative correlations between the FGF23/Klotho ratio after 1 month of treatment and the growth rates of height and bone age within 6 months in children with PNS (r=-0.356 and -0.436, respectively; P<0.05).

CONCLUSIONS

The disturbance in FGF23/Klotho homeostasis is one of the mechanisms underlying the growth impairment caused by long-term oral GC therapy.

[Recommendations from Experts in the Management of Adverse Reactions to ALK Inhibitors (2021 Version)]

Anaplastic lymphoma kinase (ALK) fusion gene, as a tumor driver gene, was crucial for the occurrence and development of non-small cell lung cancer (NSCLC). Recently, targeted ALK fusion gene has become the main treatment method for ALK-positive NSCLC. The first and second generation ALK inhibitors (ALKi), such as crizotinib, ceritinib, alectinib and ensartinib have been approved in China. However, there was no guidance for the management of ALKi adverse reactions. Therefore, this "Recommendations from experts in the management of adverse reactions to ALK inhibitors (2021 version)" has been summarized, led by Lung Cancer Professional Committee of Sichuan Cancer Society and Sichuan Medical Quality Control Center for Tumor Diseases, to provide practical and feasible strategies for clinical ALKi management specification of adverse reactions.
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[Lung Adenocarcinomas with Pulmonary Miliary Metastases: A Case Report and Literature Review]

BACKGROUND

Lung adenocarcinoma with miliary metastasis in both lungs is easily misdiagnosed. The aim of this study is to investigate the clinical features of lung adenocarcinoma with miliary metastases in both lungs and to improve the clinician's understanding of the disease.

METHODS

The clinical manifestation, radiology and pathology were analyzed in one patient with miliary intrapulmonary carcinomatosis in Affiliated Hospital of Zunyi Medical University. A review of literature was performed with "miliary intrapulmonary carcinomatosis", "lung cancer miliary", "pulmonary nodule, lung cancer" and "EGFR miliary" as key words in PubMed, Wangfang datebase and CNKI.

RESULTS

The patient was a 52 year-old woman with a history of productive cough for 2 months, which aggraveted with shortness of breath for 1 month. Her computed tomography of chest showed diffuse military nodules distributed at bilateral lungs. Computed tomography (CT)-guided needle biopsy of the left lung revealed lung adenocarcinoma and epidermal growth factor receptor (EGFR) exon 21 L858R mutation. The patient was treated with gefitinib 250 mg per day. The chest CT was reviewed several times during this period, which shows the double lung nodules were reduced. The patient is generally in good condition and her symptoms have improved. By literature review, we found relevant 7 Chinese articles and 56 English articles, a total of 16 cases have been reported. 17 patients were lung adenocarcinoma, 2 patients did not describe whether to detect EGFR gene mutations, 1 patient did not have EGFR gene mutation; 10 patients were EGFR exon 19 deletion, 1 patient was ALK positive, 1 patient was EGFR exon 21L858R mutation, 2 patients were EGFR exon 20 insertion.

CONCLUSIONS

Lung adenocarcinoma with miliary metastasis in both lungs is a rare phenomenon. We should pay attention to the performance to avoid misdiagnosis. Most of the adenocarcinoma subtypes have EGFR mutations, and EGFR-tyrosine kinase inhibitors (EGFR-TKIs) are the preferred treatment choice for this type of patients.