The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Small Cell Lung Cancer (SCLC) provide recommended management for patients with SCLC, including diagnosis, primary treatment, surveillance for relapse, and subsequent treatment. This selection for the journal focuses on metastatic (known as extensive-stage) SCLC, which is more common than limited-stage SCLC. Systemic therapy alone can palliate symptoms and prolong survival in most patients with extensive-stage disease. Smoking cessation counseling and intervention should be strongly promoted in patients with SCLC and other high-grade neuroendocrine carcinomas. The “Summary of the Guidelines Updates” section in the SCLC algorithm outlines the most recent revisions for the 2022 update, which are described in greater detail in this revised Discussion text.

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Objective To investigate whether cartilage degeneration is prevented or minimized in an anterior cruciate ligament (ACL) injury rat model following a single dose-escalated intra-articular injection of lubricin derived from human synoviocytes in culture (HSL). Methods Unilateral ACL transection (ACLT) of the right hindlimb was performed in Lewis rats (N = 56). Control animals underwent a capsulotomy alone leaving the ACL intact (N = 11). Intra-articular injections (50μl/injection) of PBS (N = 14) and HSL (N = 14; 1600μg/ml) were performed on day 7 post-surgery. Animals were euthanized on day 70 post-surgery. Histological specimens were immunoprobed for lubricin, and sulfated glycosaminoglycans. Urinary CTX-II (uCTX-II) levels were measured on day 35 and 70 post-surgery. Hindlimb maximum applied force was determined using a variable resistor walkway to monitor quadruped gait asymmetries. Results Increased immunostaining for lubricin in the superficial zone and on the surface of cartilage was observed in lubricin-treated and control animals but not the PBS-treated nor the untreated ACLT animals. On post-operative day 35 and 70, uCTXII levels of HSL-treated animals were lower than corresponding untreated and PBS-treated (p=0.005; p<0.001 respectively) animals. ACLT animals treated with HSL and control animals distributed their weight equally between hindlimbs compared to PBS treated or untreated animals (p<0.01). Conclusion A single intra-articular injection of concentrated lubricin, following ACLT, reduced collagen type II degradation and improved weight bearing in the affected joint. This study supports the practice of tribosupplementation with lubricin in retarding cartilage degeneration and possibly the development of post-traumatic OA.

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