A case of hepatoid adenocarcinoma of the lung harboring KRAS G12C responded favorably to sotorasib.

Hepatoid adenocarcinoma of the lung is a rare variant of adenocarcinoma. We describe a case of hepatoid adenocarcinoma of the lung that harbored KRAS G12C and responded favorably to sotorasib. A man in his 70s was found to have an abnormality on his chest X-ray. He underwent right middle lobectomy, and a pathological examination of the surgical specimen showed conventional invasive adenocarcinoma with highly focal hepatoid adenocarcinoma. He received chemoradiotherapy and concurrent radiation, followed by durvalumab for postoperative recurrence. After three doses of durvalumab, he reported feeling short of breath. A computed tomography scan showed emerging broad consolidation in the right lower lobe. Transbronchial lung biopsy specimens from the consolidation showed hepatoid adenocarcinoma harboring KRAS G12C mutation. Therefore, he was started on sotorasib 960 mg daily. Eight days later, a computed tomography scan showed that the area of consolidation had reduced in size. Progressive disease was detected after 42 days of treatment with sotorasib. The patient died 1 month after cessation of sotorasib and 3 months after postoperative recurrence. We have encountered what we believe to be the first case of hepatoid adenocarcinoma of the lung with KRAS G12C mutation that responded favorably to treatment with sotorasib.

Bronchoscopic visualization of the inner cavity caused by Pasteurella multocida infection.

We report a 69-year-old man who presented to our hospital with cough and sputum production. He had been in close contact with six domestic cats. He had a smoking history of 40 pack-years and had been in close contact with six domestic cats. A chest computed tomography scan revealed multiple consolidations with cavities in both lung fields. Pasteurella multocida was cultured from his sputum. On bronchoscopic evaluation, the flexible bronchoscope was navigated through the right middle lobe bronchus, which opened inside the cavity, allowing visualization of a spider-web-appearing architecture consisting of many cord-like lung tissues loosely adherent to the cavity lumen. Using these findings, a diagnosis of cavity formation was made secondary to Pasteurella multocida infection. Pasteurella infection should be considered as a cause of a lung cavity in patients with chronic lung disease. History taking regarding animal exposure is important for its diagnosis.

Pulmonary miliary sarcoidosis masquerading the reactivation of tuberculosis 30 years later.

Key Clinical Message: Sarcoidosis may occur after treatment with pulmonary tuberculosis and requires differential diagnosis from tuberculosis reactivation. Miliary sarcoidosis should be promptly differentiated from miliary tuberculosis associated with high mortality. Abstract: Clinical, histological, and radiological similarities between sarcoidosis and tuberculosis render differential diagnosis challenging. The association between these two diseases has long been discussed, although the coexistence or subsequent occurrence of tuberculosis and sarcoidosis is rare. We report a case of miliary sarcoidosis that developed 30 years after tuberculous pleurisy treatment. Sarcoidosis may occur after treatment with pulmonary tuberculosis and requires differential diagnosis from tuberculosis reactivation. Although miliary sarcoidosis is uncommon, it should be promptly differentiated from miliary tuberculosis associated with high mortality. This study reignites the debate on the causal association between tuberculosis and sarcoidosis.

Black pleural effusion caused by a pancreaticopleural fistula secondary to chronic alcoholic pancreatitis exacerbation accompanying COVID-19.

Pancreaticopleural fistula should be considered in alcohol abusers with pleural effusion, which can exhibit a black color.

Surfactant protein D: A useful biomarker for distinguishing COVID-19 pneumonia from COVID-19 pneumonia-like diseases.

Introduction: Computed tomography is useful for the diagnosis of coronavirus disease (COVID-19) pneumonia. However, many types of interstitial lung diseases and even bacterial pneumonia can show abnormal chest shadows that are indistinguishable from those observed in COVID-19 pneumonia. Thus, it is necessary to identify useful biomarkers that can efficiently distinguish COVID-19 pneumonia from COVID-19 pneumonia-like diseases. Herein, we investigated the usefulness of serum Krebs von den Lungen 6 (KL-6) and surfactant protein D (SP-D) for identifying patients with COVID-19 pneumonia among patients with abnormal chest shadows consistent with COVID-19 pneumonia. Method: This was a retrospective cohort study of consecutive patients who underwent evaluation of serum KL-6 and SP-D at a single center from February 2019 to December 2020. A total of 54 patients with COVID-19 pneumonia and 65 patients with COVID-19 pneumonia-like diseases were enrolled in this study from the source population. Serum KL-6 and SP-D levels in both groups were analyzed. Result: The serum levels of KL-6 and SP-D in patients with COVID-19 pneumonia were significantly lower than those in patients with COVID-19 pneumonia-like disease (median [interquartile range]: 208.5 [157.5-368.5] U/ml vs. 430 [284.5-768.5] U/ml, p < 0.0001 and 24.7 [8.6-51.0] ng/ml vs. 141 [63.7-243.5] ng/ml, p < 0.0001, respectively). According to receiver operating characteristic (ROC) analysis, the areas under the ROC curves (95% confidence intervals) of serum KL-6 and SP-D levels for distinguishing COVID-19 pneumonia from COVID-19 pneumonia-like diseases were 0.761 (0.675-0.847) and 0.874 (0.812-0.936), respectively. The area under the ROC curve of serum SP-D was significantly larger than that of serum KL-6 (p = 0.0213), suggesting that serum SP-D can more efficiently distinguish COVID-19 pneumonia from COVID-19 pneumonia-like diseases. Conclusion: Serum SP-D is a promising biomarker for distinguishing COVID-19 pneumonia from COVID-19 pneumonia-like diseases. Serum SP-D can be useful for the management of patients with abnormal chest shadow mimicking COVID-19 pneumonia.

Adaptive attention-based human machine interface system for teleoperation of industrial vehicle.

This study proposes a Human Machine Interface (HMI) system with adaptive visual stimuli to facilitate teleoperation of industrial vehicles such as forklifts. The proposed system estimates the context/work state during teleoperation and presents the optimal visual stimuli on the display of HMI. Such adaptability is supported by behavioral models which are developed from behavioral data of conventional/manned forklift operation. The proposed system consists of two models, i.e., gaze attention and work state transition models which are defined by gaze fixations and operation pattern of operators, respectively. In short, the proposed system estimates and shows the optimal visual stimuli on the display of HMI based on temporal operation pattern. The usability of teleoperation system is evaluated by comparing the perceived workload elicited by different types of HMI. The results suggest the adaptive attention-based HMI system outperforms the non-adaptive HMI, where the perceived workload is consistently lower as responded by different categories of forklift operators.

Fingolimod sensitizes EGFR wild­type non­small cell lung cancer cells to lapatinib or sorafenib and induces cell cycle arrest.

Epidermal growth factor receptor (EGFR) is a receptor tyrosine kinase and mutations in this gene are major drivers of lung cancer development. EGFR tyrosine kinase inhibitors (TKIs) are standard first­line therapies for patients with advanced non­small cell lung cancer (NSCLC) with activating EGFR mutations, but are not effective in patients with wild­type EGFR. In the present study, the cytotoxic effects of various TKIs against EGFR were investigated in wild­type NSCLC cells as single treatments or in combination with Fingolimod (FTY720), which has been approved for treating multiple sclerosis and has cytotoxic effects against several tumor cell lines. It was found that the combined treatment with TKIs lapatinib (Lap) or sorafenib (Sor) and FTY720 synergistically suppressed the viability of the NSCLC cell lines A549 and H596. Additionally, FTY720 inhibited lysosomal acidification and suppressed autophagy flux. Immunoblotting and reverse transcription­quantitative polymerase chain reaction showed that FTY720 combined with Lap or Sor, enhanced endoplasmic reticulum (ER) stress loading and cell cycle arrest in A549 cells. The enhancement of ER stress loading and cell cycle arrest induced by combined treatment with Lap or Sor and FTY720, which was associated with the cytotoxicity induced by the combination of these drugs. These findings suggested that FTY720 improved TKI therapy in NSCLC patients with wild­type EGFR, by sensitizing NSCLC cells to TKIs.

Off-Site Indoor Localization Competitions Based on Measured Data in a Warehouse.

The performance of indoor localization methods is highly dependent on the situations in which they are used. Various competitions on indoor localization have been held for fairly comparing the existing indoor localization methods in shared and controlled testing environments. However, it is difficult to evaluate the practical performance in industrial scenarios through the existing competitions. This paper introduces two indoor localization competitions, which are named the "PDR Challenge in Warehouse Picking 2017" and "xDR Challenge for Warehouse Operations 2018" for tracking workers and vehicles in a warehouse scenario. For the PDR Challenge in Warehouse Picking 2017, we conducted a unique competition based on the data measured during the actual picking operation in an actual warehouse. We term the dead-reckoning of a vehicle as vehicle dead-reckoning (VDR), and the term "xDR" is derived from pedestrian dead-reckoning (PDR) plus VDR. As a sequel competition of the PDR Challenge in Warehouse Picking 2017, the xDR Challenge for Warehouse Operations 2018 was conducted as the world's first competition that deals with tracking forklifts by VDR with smartphones. In the paper, first, we briefly summarize the existing competitions, and clarify the characteristics of our competitions by comparing them with other competitions. Our competitions have the unique capability of evaluating the practical performance in a warehouse by using the actual measured data as the test data and applying multi-faceted evaluation metrics. As a result, we successfully organize the competitions due to the many participants from many countries. As a conclusion of the paper, we summarize the findings of the competitions.

Electrophysiological measurement of interest during walking in a simulated environment.

A reliable neuroscientific technique for objectively estimating the degree of interest in a real environment is currently required in the research fields of neuroergonomics and neuroeconomics. Toward the development of such a technique, the present study explored electrophysiological measures that reflect an observer's interest in a nearly-real visual environment. Participants were asked to walk through a simulated shopping mall and the attractiveness of the shopping mall was manipulated by opening and closing the shutters of stores. During the walking task, participants were exposed to task-irrelevant auditory probes (two-stimulus oddball sequence). The results showed a smaller P2/early P3a component of task-irrelevant auditory event-related potentials and a larger lambda response of eye-fixation-related potentials in an interesting environment (i.e., open-shutter condition) than in a boring environment (i.e., closed-shutter condition); these findings can be reasonably explained by supposing that participants allocated more attentional resources to visual information in an interesting environment than in a boring environment, and thus residual attentional resources that could be allocated to task-irrelevant auditory probes were reduced. The P2/early P3a component and the lambda response may be useful measures of interest in a real visual environment.