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The spectrum of clinical and radiographic presentations of lung adenocarcinoma is increasingly broad, including in the metastatic setting. Here, we report on a patient who initially presented with a mild chronic cough that remained stable over a decade, with serial CT scans showing gradual worsening of multifocal areas of consolidation and ground-glass opacities of the bilateral lungs. The patient was ultimately diagnosed with ROS1 rearranged lung adenocarcinoma and achieved a dramatic response with entrectinib. This case highlights the variable presentation of non-small cell lung cancer (NSCLC) and the importance of comprehensive molecular testing for newly diagnosed metastatic NSCLC. [ABSTRACT FROM AUTHOR]

Individuals with cystic fibrosis (CF) have lower bone mineral density (BMD) by DXA and are at higher risk of fracture than healthy controls. However, the 2-dimensional measurement of areal BMD (aBMD) provided by DXA is influenced by bone size and the true extent of the bone deficit is unclear. Our objective was to use high-resolution peripheral quantitative computed tomography (HR-pQCT) and individual trabecula segmentation (ITS) analysis to compare volumetric BMD (vBMD), microarchitecture and estimated strength at the distal radius and tibia in 26 young adults with CF and 26 controls matched for age, gender, and race. To assess the effect of limb length and minimize the confounding effects of size on HR-pQCT outcomes, we scanned participants at both the standard fixed HR-pQCT measurement sites and at a subject-specific relative site that varied according to limb length. CF participants did not differ significantly in age, height, weight, or BMI from controls. Ulnar and tibial lengths were 9 mm shorter in CF patients, though differences were not significant. CF patients had significantly lower BMI-adjusted aBMD by DXA at the lumbar spine (8.9%, p < 0.01), total hip (11.5%, p < 0.01) and femoral neck (14.5%, p < 0.01), but not at the forearm. At the fixed radius site, thickness of trabecular plates and torsional stiffness were significantly lower in CF participants than controls. At the relative radius site, only torsional stiffness was significantly lower in CF participants. At the tibia, total, trabecular and cortical vBMD were significantly lower at both fixed and relative sites in CF participants, with fewer, more widely-spaced trabecular plates, lower trabecular connectivity, and lower axial and torsional stiffness. Our results confirm that aBMD is lower at the spine and hip in young adults with CF, independent of BMI and body size. We also conclude that vBMD and stiffness are lower at the weight-bearing tibia. The pathogenesis of these differences in bone density and strength at the tibia appear to be related to trabecular drop-out and reduced trabecular connectivity and to be independent of differences in limb length, as assessed by scanning participants at both standard and relative sites. We concluded that significant deficits in bone structure and strength persist in young adults with CF, despite advances in care that permit them to attain relatively normal height and weight. [ABSTRACT FROM AUTHOR]

Our radiotherapy department is situated onsite at a university-affiliated hospital where medical students undertake clinical rotations. However, no formal programme for attachments to the radiation oncology service was previously in place. Student experience was limited to occasional classroom-based lectures and sporadic contact with cancer patients while rotating through other clinical services. Under-exposure to radiation oncology (RO) (and oncology generally) during medical school is common. A 2016 survey of medical students at two US universities found that only 4% of third year and 7% of fourth year students completed an RO rotation (Osvarak et al 2016). And 47% of Australian and New Zealand medical students recently reported that RO was not incorporated into their curriculum at all (Bravery et al 2020). We identified improving medical student involvement as a priority for our department. We collaborated with tutors at the University to arrange for medical students to have allocated RO rotations during their clinical attachments at the hospital. Agreed learning objectives fitted into three categories: -fundamental clinical skills in history taking and physical examination -care of cancer patients -an introduction to RO and its role in the care of cancer patients. A multidisciplinary effort with involvement of consultant and trainee radiation oncologists, radiation therapists, nurses, and university representatives allowed us to develop a programme to deliver these learning objectives. The programme began in January 2022. One radiation oncologist takes overall responsibility for day-to-day operations and acts as the primary point of contact for the students and other staff members in case of any issues. Students receive tutorials on oncological emergencies and are involved in academic sessions in the department. They are supervised as they spend time contouring organs at risk and clinical targets and also have dedicated sessions with radiation therapists where they observe the delivery of external beam radiotherapy. Clinical experience is gained via attendance at outpatient clinics and on the inpatient oncology ward. Feedback on history taking and clinical examination is provided via tutorials with radiation oncologists and trainees. Students provided feedback which indicated that they had enjoyed their experience of the specialty and found the rotation beneficial. The rotation has been well-received by students and the university tutors. The primary goal of incorporating RO rotations into the medical school curriculum was successful and these attachments will continue in future. Involvement of relevant stakeholders within the department and the university contributed to the successful implantation. [ABSTRACT FROM AUTHOR]