Hu Luo

Background: Acute fibrinous and organizing pneumonia (AFOP) is a rare and distinct histopathological pattern of acute lung injury characterized by intra-alveolar fibrin deposition. It poses significant diagnostic and therapeutic challenges due to its heterogeneous etiologies and the lack of standardized clinical guidelines. Case presentation and methods: We report the clinical course of a 58-year-old male presenting with Aspergillus fumigatus -associated AFOP complicated by spontaneous subcutaneous and mediastinal emphysema. Diagnosis was confirmed via CT-guided percutaneous lung biopsy. Additionally, we conducted a systematic literature review of PubMed and EMBASE databases (January 2019 to July 2024) to analyze the clinical-radiological features, etiological spectrum, and treatment outcomes of 31 unique AFOP cases. Results: The case patient presented with fever, chest pain, and dyspnea. Following confirmation of A. fumigatus -induced AFOP and management of secondary mediastinal emphysema via negative-pressure closed thoracic drainage, the patient showed a favorable response to combined corticosteroid and antifungal therapy. The literature review of 31 patients revealed a male predominance (17/31, 54.8%) with a mean age of 55 ± 15 years (range: 22–78). Fever was the most prevalent clinical presentation (23/31, 74.2%), followed by cough (19/31, 61.3%) and dyspnea (13/31, 41.9%). Chest computed tomography (CT) predominantly revealed consolidation (22/31, 71.0%) and ground-glass opacities (12/31, 38.7%). Identified etiologies were highly heterogeneous, including idiopathic forms, infections, hematologic malignancies, and autoimmune disorders. Glucocorticoid-based regimens achieved an overall treatment response rate exceeding 73%. Conclusion: AFOP is a multifaceted pulmonary disorder associated with non-specific symptoms and radiological features like consolidation and ground-glass opacities. Aspergillus infection can trigger AFOP, which may be rarely complicated by spontaneous mediastinal emphysema. Early histopathological confirmation and individualized immunomodulatory therapy are crucial for favorable clinical outcomes. Limitations: This study is limited by a small literature cohort size, a lack of multivariable analysis, and limited molecular epidemiological data.

Background: Immunotherapy combined with chemotherapy is highly beneficial for patients with driver gene-negative non-small cell lung cancer (NSCLC), the predominant form of lung cancer. However, the overall response in unscreened patients receiving immunotherapy is still modest, which is crucial for immune response prediction. Accurate prediction of single indicators [such as programmed death-ligand 1 (PD-L1) expression] has grown challenging, and multidimensional and multi-indicator combinations may produce more accurate results. Meanwhile, additional combination radiotherapy may increase survival benefits for individuals with poor immune responses. We aimed to predict the effectiveness of immunotherapy in patients by screening out individuals who have no durable benefit (NDB) using optimum models, and compare the survival of patients treated with and without radiotherapy based on the immunotherapy received in the first line. Methods: The data were randomly divided into training and validation sets in a 7:3 ratio. Ten machine learning algorithms were used to build predictive models using a univariate and multivariate logistic regression approach to screen variables with an endpoint of whether or not there was durable benefit (no progression for more than 6 months). For the training and validation sets, compute area under receiver operating characteristic curve (ROC-AUC), area under precision-recall curve (PR-AUC), draft calibration curves and decision curve analysis (DCA) in order to determine the best model and display the representation. Results: A total of 161 patients were enrolled in the study, with 113 in the training set and 48 in the validation set, and tumor stage, tumor mutation burden (TMB) and Ki-67 were found to be independent predictors of prognosis following screening. Light gradient boosting machine (LightGBM) was chosen as the best model following a thorough comparison, with the ROC-AUC values of 0.858 and 0.852 for the training and validation sets, respectively. Fifty-two patients were selected for potential NDB based on model prediction, 27 were in the combination therapy group (radiotherapy plus immunotherapy), and 25 were in the control group (immunotherapy). The combination therapy group experienced a significantly lower incidence of NDB than the control group (29.6% vs. 64.0%, χ²=6.1706, P=0.03). The survival analysis revealed that the two groups’ median progression-free survival (PFS) were 9.6 [95% confidence interval (CI): 7.882–11.318] and 5.6 (95% CI: 4.988–6.212) months, respectively, and that the patients in the combination therapy group had a better PFS than the control group (log-rank test P=0.04). Conclusions: We have successfully developed a prediction model for the effectiveness of immunotherapy for NSCLC in this study. This model allows us to more precisely identify those individuals who have NDB from immunotherapy, and for these patients, additional radiotherapy combined with first-line treatment can produce better therapeutic effects.

Plasmacytoma can manifest as a solitary pulmonary mass, which can be accurately diagnosed through a combination of Bone scan, serum protein electrophoresis, computed tomography (CT)‐guided biopsy and bone marrow biopsy. Notably, this case diagnosed with multiple myeloma (MM) with extramedullary plasmacytoma (EMP) demonstrated an exceptional treatment response to radiotherapy and proteasome inhibitor–based chemotherapy.

Background: Non-small cell lung cancer (NSCLC) presents the most common type of lung cancer, accounting for 80–85% of cases. Combining immunotherapy with radiotherapy (RT) has emerged as a significant research area in recent years. However, the risk of radiation pneumonitis, especially in lung cancer patients, poses a significant concern. Iodine-125 (I¹²⁵) seed implantation offers a precise, less invasive alternative, minimizing damage to surrounding lung tissues and reducing side effects. This study aims to evaluate the safety and efficacy of I¹²⁵ seed implantation combined with immune checkpoint inhibitors (ICIs) and chemotherapy (CT) in treating driver gene-negative NSCLC patients. Methods: Retrospective analysis of 95 patients with driver gene-negative NSCLC who presented to the First Affiliated Hospital of Army Medical University was conducted. Among them, 33 cases in the observation group were treated with I¹²⁵ seed implantation combined with CT and ICIs (ICIs + CT + I¹²⁵), and 62 cases in the control group were treated with extracorporeal RT combined with CT and ICIs (ICIs + CT + RT). The primary observational endpoint was median progression-free survival (mPFS), while the secondary observational endpoints included the 1- and 2-year PFS rate and the incidence of adverse events. Results: mPFS was not reached in the observation group but 11.8 months [95% confidence interval (CI): 9.743–13.857] in the control group, a statistically significant difference (PConclusions: Compared to RT in combination with CT and immunotherapy, patients with driver gene-negative NSCLC who received I¹²⁵ seed implantation had greater advantages with longer survival and fewer adverse effects.

Purpose: Our study aims to delineate the epidemiological distribution of pulmonary carcinoids, including atypical carcinoid (AC) and typical carcinoid (TC), identify independent prognostic factors, develop an integrative nomogram and examine the effects of various surgical modalities on atypical carcinoid‐specific survival (ACSS).Methods: Joinpoint regression model and age‐group distribution diagram were applied to determine the epidemiological trend of the pulmonary carcinoids. Univariate and least absolute shrinkage and selection operator (LASSO)‐based Cox regression models were used to identify independent factors, and a nomogram and web‐based predictor were developed to evaluate prognosis of AC patients individually. We performed Kaplan–Meier survival analyses to compare the scope of various surgical interventions, with and without G‐computation adjustment, utilising restricted mean survival time (RMST) to assess survival disparities.Results: A total of 1132 patients were recruited from the Surveillance, Epidemiology, and End Results database (SEER) and a separate medical centre in China. The mean age of AC patients was 63.4 years and a smoking history was identified in 79.8% of AC patients. Joinpoint analysis shows rising annual rates of new AC and carcinoid cases among lung cancers. Both the proportion of pulmonary TC and AC within the total lung cancer population exhibits an L‐shaped trend across successive age groups. The nomogram predicted 1, 3 and 5 years of AC with excellent accuracy and discrimination. Kaplan–Meier survival analyses, conducted both pre‐ and post‐adjustment, demonstrated that sublobar resection's survival outcomes were not inferior to those of lobectomy in patients with stage I‐II and stage III disease.Conclusion: This study is the first to reveal epidemiological trends in pulmonary carcinoids over the past decade and across various age cohorts. For patients with early‐stage AC, sublobar resection may be a viable surgical recommendation. The established nomogram and web‐based calculator demonstrated decent accuracy and practicality.

Introduction: This study was to investigate the diagnostic value of percutaneous closed pleural brushing (CPBR) followed by cell block technique for malignant pleural effusion (MPE) and the predictive efficacy of pleural fluid carcinoembryonic antigen (CEA) for epidermal growth factor receptor ( EGFR ) mutations in lung adenocarcinoma patients with MPE. Methods: All patients underwent closed pleural biopsy (CPB) and CPBR followed by cell block examination. MPE‐positive diagnostic rates between the two methods were compared. Univariate and multivariate analyses were performed to determine factors influencing the EGFR mutations. Receiver operating characteristic (ROC) curve was used to analyze the predictive efficacy of pleural fluid CEA for EGFR mutations. Results: The cumulative positive diagnostic rates for MPE after single and twice CPBR followed by cell block examination were 80.5% and 89.0%, higher than CPB (45.7%, 54.3%) ( P < 0.001). Univariate analysis showed that EGFR mutation was associated with pleural fluid and serum CEA ( P < 0.05). Multivariate analysis showed that pleural fluid CEA was an independent risk factor for predicting EGFR mutation ( P < 0.001). The area under the curve (AUC) of pleural fluid CEA for EGFR mutation prediction was 0.774, higher than serum CEA ( P = 0.043), but no difference with the combined test ( P > 0.05). Conclusion: Compared with CPB, CPBR followed by the cell block technique can significantly increase the positive diagnostic rate of suspected MPE. CEA testing of pleural fluid after CPBR has a high predictive efficacy for EGFR mutation in lung adenocarcinoma patients with MPE, implying pleural fluid extracted for cell block after CPBR may be an ideal specimen for genetic testing.

Purpose We aimed to investigate the annual percentage change (APC) in the proportion of AC in lung carcinoids to determine the epidemiology of AC and to develop a comprehensive nomogram that could reliably evaluate the prognosis of patients with AC. Methods The demographic and treatment information of AC patients were extracted retrospectively from the Surveillance, Epidemiology, and End Results database (SEER) and a separate medical centre in China. A joinpoint regression model was applied to determine the proportional trend of the AC. Univariate and least absolute shrinkage and selection operator (LASSO)-based Cox regression models were used to identify independent factors, and a nomogram and web-based predictor were developed to evaluate prognosis individually. The receiver operating characteristic curve, the area under the ROC, calibration plots, and decision curve analysis were performed to assess the model. Results Most patients with AC were women (60.5%); the mean age of AC patients was 63.4 years, with a lower tumour site (42.7%), T1 (51.5%), N1 (64.4%), and M0 (87.1%). The proportion of patients with AC and pulmonary carcinoids increased annually from 6.3% in 2004 to 10.5% in 2010 and 16.1% in 2019. Age at diagnosis, primary tumour site, surgery, and tumour-node-metastasis (TNM) stage were independent risk factors in patients with AC. The nomogram predicted 1, 3, and 5 years of AC with excellent accuracy and discrimination. Conclusion The proportion of patients with AC and pulmonary carcinoids increased annually. The nomogram and web-based predictors were more accurate and discriminative than the TNM stage.

Purpose We aimed to develop a novel risk stratification system based on a prognostic nomogram to identify patients with pIII-N2 non-small cell lung cancer (NSCLC) who may benefit from postoperative radiotherapy (PORT) after complete resection. Methods We retrospectively enrolled 3,520 eligible NSCLC patients with pIII-N2 stage disease from the Surveillance, Epidemiology, and End Results database. Stabilized inverse probability of treatment weighting (sIPTW) was used to equilibrate the characteristic baseline to reduce bias. We established a risk stratification tool using a nomogram that incorporated independent factors identified using least absolute shrinkage and selection operator (LASSO) Cox regression. Kaplan–Meier and subgroup survival analyses were conducted to estimate the benefit of PORT in every risk stratification. Results Kaplan–Meier survival analysis observed that high-risk patients owned a significant improvement in overall survival (OS) after PORT (p = 0.002), while those in low- or intermediate-risk cohorts did not show such improvement. Subgroup survival analysis suggested that patients with a high lymph node ratio ≥ 0.56 (hazard ratio [HR] = 0.803; 95% confidence interval [CI]:0.661–0.975, p = 0.027), without postoperative chemotherapy (HR = 0.782; 95% CI: 0.619–0.989; p = 0.040), and those in the high-risk group (HR = 0.577; 95% CI: 0.410–0.812; p = 0.001) achieved a significant OS advantage from PORT. Conclusion This novel risk stratification system based on nomogram provides a preliminary identification of potential pIII-N2 NSCLC patients who are more likely to benefit from PORT.

Acute respiratory distress syndrome (ARDS) is characterized by non-cardiogenic pulmonary edema caused by inflammation, which can lead to serious respiratory complications. Due to the high mortality of ARDS caused by sepsis, biological markers that enable early diagnosis are urgently needed for clinical treatment. In the present study, we used the public microarray data of whole blood from patients with sepsis-induced ARDS, patients with sepsis-alone and healthy controls to perform an integrated analysis based on differential expressed genes (DEGs) and co-expression network to identify the key genes and pathways related to the development of sepsis into ARDS that may be key targets for diagnosis and treatment. Compared with controls, we identified 180 DEGs in the sepsis-alone group and 152 DEGs in the sepsis-induced ARDS group. About 70% of these genes were unique to the two groups. Functional analysis of DEGs showed that neutrophil-mediated inflammation and mitochondrial dysfunction are the main features of ARDS induced by sepsis. Gene network analysis identified key modules and screened out key regulatory genes related to ARDS. The key genes and their upstream regulators comprised a gene panel, including EOMES, LTF, CSF1R, HLA-DRA, IRF8 and MPEG1. Compared with the healthy controls, the panel had an area under the curve (AUC) of 0.900 and 0.914 for sepsis-alone group and sepsis-induced ARDS group, respectively. The AUC was 0.746 between the sepsis-alone group and sepsis-induced ARDS group. Moreover, the panel of another independent blood transcriptional expression profile dataset showed the AUC was 0.769 in diagnosing sepsis-alone group and sepsis-induced ARDS group. Taken together, our method contributes to the diagnosis of sepsis and sepsis-induced ARDS. The biological pathway involved in this gene biomarker panel may also be a critical target in combating ARDS caused by sepsis.

Background: Silicosis, a severe lung disease caused by inhaling silica dust, predominantly affects workers in industries such as mining and construction, leading to a significant global public health challenge. The purpose of this study is to analyze the current disease burden of silicosis and to predict the development trend of silicosis in the future the world by extracting data from the GBD database.Methods: We extracted and analyzed silicosis prevalence, incidence, mortality, and disability-adjusted life years (DALYs) data from the Global Burden of Disease 2019 program for 204 countries and territories from 1990 to 2019. The association between the Sociodemographic Index (SDI) and the burden of age-standardized rates (ASRs) of DALYs has been examined at the regional level. Jointpoint regression analysis has been also performed to evaluate global burden trends of silicosis from 1990 to 2019. Furthermore, Nordpred age-period-cohort analysis has also been projected to predict future the burden of silicosis from 2019 to 2044.Results: In 2019, global ASRs for silicosis prevalence, incidence, mortality, and DALYs were 5.383, 1.650, 0.161, and 7.872%, respectively which are lower than that in 1990. The populations of 45–59 age group were more susceptible to silicosis, while those aged 80 or above suffered from higher mortality and DALY risks. In 2019, the most impacted nations by the burden of silicosis included China, the Democratic People’s Republic of Korea, and Chile. From 1990 to 2019, most regions observed a declining burden of silicosis. An “M” shaped association between SDI and ASRs of DALYs for silicosis was observed from 1990 to 2019. The age-period-cohort analysis forecasted a decreasing trend of the burden of silicosis from 2019 to 2044.Conclusion: Despite the overall decline in the global silicosis burden from 1990 to 2019, some regions witnessed a notable burden of this disease, emphasizing the importance of targeted interventions. Our results may provide a reference for the subsequent development of appropriate management strategies.