Interstitial Pneumonia In Patients Research Articles

MiR-21 Exerts Anti-proliferative and Pro-apoptotic Effects in LPS-induced WI-38 Cells via Directly Targeting TIMP3.

Idiopathic pulmonary fibrosis (IPF) is a progressive lung disease, which was caused by a complex interplay of inflammatory responses and chronic damage. miR-21 is increased in patients with IPF, but its function in the embryonic lung-derived diploid fibroblasts cells subjected to LPS is elusive. miRNA expression profile was obtained from GEO database and target genes of miRNAs were forecasted by TargetScan. To mimic the LPS-induced injury, different concentrations of LPS were applied to treat WI-38 cells. Functional in vitro experiments were conducted to examine the role of miR-21 and TIMP3. Luciferase report assay was performed to verify the relationship between miR-21 and TIMP3. qRT-PCR, western blotting, and ELISA were conducted to detect the levels of the related miRNAs, proteins, and inflammatory factors. miR-21 presented higher levels in interstitial pneumonia patients and LPS-induced WI-38 cells. Overexpression of miR-21 was negatively correlated with the proliferative capability of LPS-treated WI-38 cells. miR-21 directly targets TIMP3. TIMP3 restored the suppressive impact of miR-21 mimic on the proliferation, while TIMP3 alleviated the promoting impact of miR-21 mimic on the apoptosis of WI-38 cells treated by LPS. miR-21 inhibited Bcl-2 but increased Bax, cleaved caspase-3, and cleaved caspase-9. Besides, miR-21 elevated the levels of IL-6 and IL-β but reduced the IL-10, which were weakened by TIMP3. Totally, miR-21 aggravated the LPS-induced lung injury and modulated inflammatory responses by targeting TIMP3.

Droplet exposure during tracheotomy : Case analysis and consequences with respect to COVID-19 patients

HintergrundDie Pandemie COVID-19 („coronavirus disease 2019“) zeichnet sich durch eine hohe Infektiosität bei Tröpfchenübertragung und hoher Virusdichte in den oberen Atemwegen aus. Schwere Krankheitsverläufe stehen mit interstitiellen, beatmungspflichtigen Pneumonien in Verbindung, bei denen regelmäßig Tracheotomien (TT), ein tröpfchen- und aerosolerzeugender medizinischer Eingriff, notwendig werden. Die TT als potenzielles Infektionsrisiko für medizinisches Personal wird in der Literatur kaum behandelt. Deshalb war es Ziel dieser Studie, die Tröpfchenexposition des Op.-Teams während der Tracheotomie zu quantifizieren, um hierdurch die Anforderungen an die notwendige persönliche Schutzausrüstung (PSA) besser zu definieren.Material und MethodenBei 4 nichtinfektiösen Patienten wurde eine chirurgische Tracheotomie durchgeführt, bei der der Chirurg und seine Assistenz jeweils eine chirurgische Mund-Nasen-Maske mit Klarsichtvisier trugen. Nach Durchführung des Eingriffs bestimmten wir Tröpfchenart, -verteilung und -menge auf dem Visier makroskopisch und mikroskopisch.ErgebnisseAuf den Visieren fanden sich durchschnittlich 29 Tröpfchen im mittleren Drittel des Visiers, 4 im rechten Drittel und 13 im linken Drittel, bei einer durchschnittlichen Tröpfchengröße von 571 µm (± 381 µm). Die kleinsten Tröpfchen waren 55 µm, die größten 1431 µm groß. Eine Zunahme der Tröpfchen fanden sich bei vermehrter Ventilation während des Eingriffs. Bluttröpfchen waren häufiger als Sekrettröpfchen.SchlussfolgerungEs konnte eine deutliche Kontamination des Gesichtsvisiers mit Tröpfchen dargestellt werden. Gerade im Fall einer TT von hochinfektiösen Patienten, z. B. COVID-19, ist demnach die Verwendung einer Kapuzen-Kopfbedeckung in Kombination mit einem Atemschutzgerät mit Luftreinigung mit Stromversorgung empfehlenswert, um einen Infektionsschutz des Operateurs und der Op.-Assistenz bestmöglich zu gewährleisten.

Changes in Body Weight and Serum Albumin Levels in Patients Requiring Home Long-term Oxygen Therapy.

Purpose: To investigate the long-term changes in body weight and serum albumin levels in patients with respiratory failure, and those with chronic heart failure, who were treated with home long-term oxygen therapy (LTOT) to understand the current status and contribute to future measures.Methods: Patients with chronic obstructive pulmonary disease (COPD), those with interstitial pneumonia (IP), and those with chronic heart failure (CHF) undergoing home LTOT for 6 months or more between January 2011 and January 2019 were included in the study. Body weight and serum albumin levels were assessed at the start of home LTOT and at the end of the observation period, a minimum of 6 months after commencing home LTOT.Results: Sixty-two patients (29 COPDs, 23 IPs, and 10 CHFs) were included. In COPD patients and IP patients, body weight decreased (P = 0.0017, P = 0.0018, respectively, Wilcoxon signed-rank test). Serum albumin levels decreased in IP patients (P = 0.0185) but not in COPD patients. There was neither significant decrease in body weight nor serum albumin levels in patients with CHF.Conclusion: Chronic respiratory failure patients who have home LTOT were likely to have a decreased nutritional status. In order to provide prolonged home LTOT, medical staff need to pay close attention to the nutritional status of patients receiving home LTOT.

P44.02 Mild Interstitial Pneumonia as a Risk Factor for Chemotherapy-Induced Acute Exacerbation of Interstitial Pneumonia in Patients with Lung Cancer

Co-existing of interstitial pneumonia is reported to be a risk factor for chemotherapy-induced acute exacerbation of interstitial pneumonia in patients with lung cancer (LC). Although it has been recently demonstrated that co-existing of interstitial lung abnormalities on chest CT is associated with poor prognosis in patients with advanced non-small cell lung cancer, it has not been clarified the association between mild interstitial pneumonia and chemotherapy-induced acute exacerbation of interstitial pneumonia in detail. The goal of this study was to determine the clinical significance of mild interstitial pneumonia shadows on chest CT prior to the initiation of chemotherapy in patients with advanced LC. We retrospectively analyzed the patients with advanced LC treated with chemotherapy in our department from 2014 to 2016. Chest CT findings at the diagnosis of LC (baseline CT) were reviewed, and the patients were divided into three groups; 1) patients without interstitial pneumonia shadows, 2) with interstitial pneumonia shadows which was recognized (RIPS), and 3) with mild interstitial pneumonia shadows which had not been recognized (UMIPS) by treating physicians on baseline CT. The frequency of chemotherapy-induced acute exacerbation of interstitial pneumonia in patients with RIPS and UMIPS was compared with that of chemotherapy-induced lung injury in patients without interstitial pneumonia shadows. We included 112 patients with treatment naïve IIIB/IV LC in this study. The median age was 69 years (37-87 years), and the frequency of non-small cell lung cancer was 79%. The number of advanced LC patients with RIPS and UMIPS were 26 (23%) and 13 (12%), respectively. Chemotherapy-induced acute exacerbation of interstitial pneumonia was found in 7 (27%) RIPS and 2 (13%) UMIPS patients. On the other hand, chemotherapy-induced lung injury was occurred in only 3 out of 73 (4%) patients without interstitial pneumonia shadows on baseline CT. In patients with advanced LC, interstitial pneumonia shadows on chest CT, even in instances of mild shadows, should be considered as a risk factor of chemotherapy-induced acute exacerbation of interstitial pneumonia.

Characteristics of anti-IL-17/23 biologics-induced interstitial pneumonia in patients with psoriasis.

ObjectivesAnti-IL-17/23 biologics are increasingly used to treat psoriasis. We aimed to elucidate characteristics of drug-induced interstitial pneumonia (DIIP) caused by anti-IL-17/23 biologics.MethodsWe retrospectively analyzed the clinical data of psoriasis patients treated with anti-IL-17/23 biologics. Chest CT was performed to evaluate DIIP. Serum KL-6 levels were measured before treatment (baseline) and during treatment.ResultsA total of 603 psoriasis patients were treated with anti-IL-17/23 biologics with mean follow-up of 21.1 months. Six patients developed DIIP at mean 14 months after initiation of the therapy. Older age, higher baseline KL-6 value and more frequent pre-existing IPs were associated with development of DIIP by univariate analysis. At the onset of DIIP, elevated serum KL-6 levels with concomitantly increased ground glass opacity (GGO) in Chest CT were demonstrated. DIIP was improved by only cessation of causative agents in five patients but steroid therapy was needed in one patient.ConclusionsDIIP is a plausible complication of anti-IL-17/23 biologics. Age, baseline KL-6 level and underlying IP could be the risk factors for DIIP development. Serum KL-6 levels and chest CT are useful for not only predicting but also detecting DIIP caused by anti-IL-17/23 biologics.

A novel variant of SFTPA2 in a Han Chinese family with interstitial lung disease and lung cancer

Interstitial lung disease (ILD) presents as progressive scarring of lung tissue, which may affect respiratory function and restrict oxygen-exchange into the bloodstream, finally leading to dyspnea, dry cough and decreased quality of life. Increasing evidence indicates that genetic factors may be crucial in the development of ILD. At present, the main pathogenic genes of ILD include genes vital for surfactant metabolism and function and telomere biology associated genes. Mutations in both sets of genes may induce the apoptosis of alveolar epithelial cells and finally result in remodeling of the lung interstitium. In this study, one Han Chinese family with interstitial pneumonia and lung cancer was recruited. The proband was selected for whole exome sequencing analysis. After data filtering, only a novel mutation (c.404G > A /p.G135E) of SFTPA2 (NM_001098668) was identified. No other meaningful mutations were detected. The mutation co-segregated with the affected patients in the pedigree and was absent in the healthy controls. Bioinformatics analysis predicted that this variant is pathogenic and located in an evolutionarily conserved site of the SP-A2 protein. This study further expands the variant spectrum of the SFTPA2 gene and may be helpful in the genetic counseling of interstitial pneumonia and lung cancer patients.

Long-term effects of home-based pulmonary rehabilitation on idiopathic interstitial pneumonia patients

Currently, interstitial lung disease (ILD) has no unified treatment plan. Home-based pulmonary rehabilitation (PR), as a non-pharmacological treatment, is a non-invasive and low-cost option for improving exercise capacity and quality of life. This study explores the impact of home-based PR on lung function, and the quality of life of patients with ILD. In this randomized prospective study, 60 patients with ILD were randomly assigned to the home-based PR intervention and traditional drug treatment groups, and they were followed for 12 months. The outcome measures were the 6-min walk distance (6MWD), exercise-related dyspnea, and St George’s Respiratory Questionnaire score (SGRQ). It found that the 6MWD results were significantly improved from 348.5 ± 106.1 m at baseline to 403.6 ± 100.3 m on the completion of PR and 443.8 ± 96.5 at 1-year follow-up (P = 0.001). Compared with the control group, the home-based PR group had slightly improved pulmonary function. Furthermore, the severity of dyspnea evaluated with mMRC in the home-based PR group improved from 2.9 ± 1.1 at baseline to 2.2 ± 0.9 after the home-based PR program, and this improvement persisted after 12 months (P = 0.001). Additionally, home-based PR for patients with ILD improved the functional pulmonary performance and the SGRQ score results.

Prophylactic antibiotic treatment with TMP-SMX decreased the incidence of interstitial pneumonia in patients with B-cell lymphoma on chemotherapy

BackgroundSeveral studies have reported the incidence of interstitial pneumonia (IP) among patients with non-Hodgkin lymphoma (NHL) that are undergoing combination chemotherapy plus rituximab; however, the effective prophylactic treatment for IP remains unclear. This study aims to explore the prophylactic effect of trimethoprim-sulfamethoxazole (TMP-SMX) on IP and identify IP-associated risk factors in NHL patients.MethodsBetween March 2013 and April 2018, 498 patients (264 males, 53%) with B-cell NHL undergoing first-line RCHOP-like chemotherapy treatment with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone were enrolled in this study.ResultsThese patients had a median age of 56 years, and 311 of the 498 patients (62.4%) were administered once daily with the prophylactic treatment of TMP-SMX. IP occurred in 65 patients (13.1%), indicating a significant reduction in the IP incidence rate (21.4% vs. 8.0%; p < 0.001). Among patients treated with TMP-SMX, 2 (1.2%) exhibited rashes, 38 (12.2%) suffered from nausea and vomiting, 52 (16.7%) showed signs of neutropenia, and 18 (5.8%) suffered from kidney dysfunction. Both univariate and multivariate analysis showed that gender (male), history of diabetes, and absence of prophylactic TMP-SMX treatment were significant risk factors associated with IP. Disease progression was observed in 55/311 (17.7%) patients that underwent prophylactic TMP-SMX treatment and in 63/187 (33.7%) patients that did not (p < 0.001).ConclusionsThis study revealed that the occurrence of IP was common in B-cell NHL patients undergoing combined chemotherapy plus rituximab treatment. IP could be reduced with prophylactic treatment of once-daily oral TMP-SMX.

Low dose anti-inflammatory radiotherapy for the treatment of pneumonia by covid-19: A proposal for a multi-centric prospective trial

BackgroundCOVID-19 is a highly contagious viral infection with high morbidity that is draining health resources. The biggest complication is pneumonia, which has a serious inflammatory component, with no standardized treatment. Low-dose radiation therapy (LD-RT) is non-invasive and has anti-inflammatory effects that can interfere with the inflammatory cascade, thus reducing the severity of associated cytokine release and might be useful in the treatment of respiratory complications caused by COVID-19. Study design and methodsThis multicentric prospective clinical trial seeks to evaluate the efficacy of bilateral lung LD-RT therapy as a treatment for interstitial pneumonia in patients with COVID-19 for improving respiratory function.This prospective study will have 2 phases: I) an exploratory phase enrolling 10 patients, which will assess the feasibility and efficacy of low-dose lung irradiation, evaluated according to an increase in the PaO2/FiO2 ratio of at least 20% at 48–72 h with respect to the pre-irradiation value. If a minimum efficiency of 30% of the patients is not achieved, the study will not be continued. II) Non-randomized comparative phase in two groups: a control group, which will only receive pharmacological treatment, and an experimental arm with pharmacological treatment and LD-RT. It will include 96 patients, the allocation will be 1: 2, that is, 32 in the control arm and 64 in the experimental arm. The primary end-point will be the efficacy of LD-RT in patients with COVID-19 pneumonia according to an improvement in PaO2/FiO2. Secondary objectives will include the safety of bilateral lung LD-RT, an improvement in the radiology image, overall mortality rates at 15 and 30 days after irradiation and characterizing anti-inflammatory mechanisms of LD-RT by measuring the level of expression of adhesion molecules, anti-inflammatory cytokines and oxidative stress mediators.Trial registration: ClinicalTrial.gov NCT-04380818 https://clinicaltrials.gov/ct2/show/NCT04380818?term=RADIOTHERAPY&cond=COVID&draw=2&rank=4.

Correlation of increased serum leucine-rich α2-glycoprotein levels with disease prognosis, progression, and activity of interstitial pneumonia in patients with dermatomyositis: A retrospective study.

ObjectiveTo investigate whether leucine-rich α2-glycoprotein (LRG) can be a biomarker for the disease activity, progression, and prognosis of interstitial pneumonia (IP) in patients with dermatomyositis (DM).MethodsCorrelations between the clinical findings and serum LRG levels were investigated in 46 patients with DM-IP (33 with acute/subacute IP [A/SIP] and 13 patients with chronic IP [CIP], including 10 fatal cases of IP).ResultsThe median serum LRG level of 18.4 (14.6–25.2) μg/mL in DM-IP patients was higher than that in healthy control subjects. The median levels of serum LRG at baseline and at 2 and 4 weeks after the initiation of treatment in the patients who died were significantly higher than those in the surviving patients (P = 0.026, 0.029, and 0.008, respectively). The median level of serum LRG in the DM-A/SIP patients was significantly higher than that in the DM-CIP patients (P = 0.0004), and that in the anti-MDA5-Ab-positive group was slightly higher than that in the anti-ARS-Ab-positive group. The serum LRG levels correlated significantly with the serum levels of LDH, C-reactive protein, ferritin, AaDO2, %DLco, and total ground-glass opacity score. The survival rate after 24 weeks in patients with an initial LRG level ≥ 17.6 μg/mL (survival rate: 40%) was significantly lower than that in patients with an initial LRG level < 17.6 μg/mL (100%) (P = 0.0009).ConclusionThe serum LRG level may be a promising marker of disease activity, progression, and prognosis in patients with DM-IP.

Auto-antibody evaluation in idiopathic interstitial pneumonia and worse survival of patients with Ro52/TRIM21auto-antibody.

Some patients with interstitial pneumonia (IP) have auto-antibodies, but do not fit the criteria for specific connective tissue diseases. Examination of auto-antibodies is recommended for diagnosis idiopathic pulmonary fibrosis. A prospective cohort study was performed in 285 patients with IP. Eleven auto-antibodies were assessed and patients were followed for 2 years. All 285 patients underwent the myositis panel test (MPT) for 11 auto-antibodies. Among them, 23.5% (67/285) of the patients had a positive MPT and 14.7% (42/285) had connective tissue diseases. Among the 49 MPT positive patients without connective tissue diseases, 29 patients (59.2%) were positive for Ro52, including 17 patients with Ro52 mono-positivity. Among interstitial pneumonia patients without connective tissue diseases, the Ro52 mono-positive patients showed worse at 2-years survival than those who were Ro52 negative (p = 0.022, HR = 5.88, 95% CI 1.29–26.75). Most of the Ro52 positive patients also showed a low titer of anti-nucleolar antibody. About 20% of IP patients had auto-antibodies detectable by the MPT, and Ro52 positive patients accounted for more than half of the MPT positive patients without connective tissue diseases. Detection of Ro52 auto-antibodies may be useful for assessing the risk of progression in idiopathic interstitial pneumonia patients without connective tissue diseases and a low anti-nucleolar antibody titer.

Real-life experiences in a single center: efficacy of pirfenidone in idiopathic pulmonary fibrosis and fibrotic idiopathic non-specific interstitial pneumonia patients.

Background:Pirfenidone is the first antifibrotic drug approved for the treatment of idiopathic pulmonary fibrosis (IPF) and it is used in the treatment of other interstitial pneumonias, such as unclassifiable interstitial lung disease (ILD) and connective tissue-related ILD. This study examined the efficacy of pirfenidone in patients with IPF and fibrotic idiopathic non-specific interstitial pneumonia (f-iNSIP).Methods:In a retrospective real-life study, 67 IPF and 24 f-iNSIP patients were enrolled and classified into a pirfenidone group and a non-antifibrotic group. The level of forced vital capacity (FVC) and diffusing capacity of lung for carbon monoxide (DLco) at baseline, 6, 12 and 24 months were recorded. The level of KL-6 in serum was detected by chemiluminescence enzyme immunoassay (CLEIA). The prognosis and safety outcomes were collected from patients.Results:In IPF patients, pirfenidone decreased the mean change of FVC and DLco, and decreased the proportion of patients with a ⩾10% decline in FVC or a ⩾15% decline in DLco compared with the non-antifibrotic group. There was no difference in the mean change of FVC and DLco between smokers and non-smokers who received pirfenidone treatment. There was an improvement in progression-free survival, defined as the time to the first occurrence of acute exacerbation or death related to pulmonary fibrosis. Moreover, the ratio of patients who experienced acute exacerbation and death related to pulmonary fibrosis was lower in the pirfenidone group. There was no change in lung function and prognosis between the pirfenidone and non-antifibrotic groups in f-iNSIP patients. The KL-6 level slightly decreased after 1 year of pirfenidone treatment but not significantly. Gastrointestinal and skin-related adverse events were most common, and four patients ceased treatment due to the side effects.Conclusions:Pirfenidone safely reduced disease progression by improving the lung function and progression-free survival in IPF patients, with acceptable side effects. The efficacy of pirfenidone on f-iNSIP was not significant, suggesting the need for further studies.The reviews of this paper are available via the supplemental material section.

Interstitial pneumonia in patients with diffuse large B-cell lymphoma receiving RCHOP and RCDOP regimens

目的比较RCHOP和RCDOP方案治疗弥漫大B细胞淋巴瘤（DLBCL）后间质性肺炎的发生情况。方法回顾性分析2013年1月至2018年8月上海交通大学医学院附属瑞金医院血液科收治的DLBCL患者836例，其中接受RCDOP方案者114例，根据年龄、性别、IPI评分等因素1∶1配对，选出114例接受RCHOP方案的患者作为对照组。收集患者的基础疾病状况、性别、年龄、有无B症状、IPI评分、疾病分期、血LDH、血β2-微球蛋白等相关临床资料，进一步分析间质性肺炎发生的危险因素。结果RCHOP方案和RCDOP方案治疗DLBCL后间质性肺炎的发生率分别为2.60％和28.95％，差异有统计学意义（P<0.01）。RCDOP方案中，随着脂质体阿霉素剂量自25～30 mg/m2增加至35~40 mg/m2，患者的完全缓解率自76.90％增至85.50％（P>0.05），间质性肺炎的发生率也自17.30％增至38.71％（P<0.05）。多因素回归分析显示，应用RCDOP方案、治疗前Ann Arbor分期高是患者预后不良的独立危险因素。结论应用RCDOP方案治疗DLBCL时需加强对间质性肺炎的预防和监测。

Alveolar microbiota profile in patients with human pulmonary tuberculosis and interstitial pneumonia

BackgroundThe presence of the human lung microbiota has been demonstrated in patients with different lung diseases, mainly in sputum samples. However, for study of the alveolar microbiota, a bronchoalveolar lavage (BAL) sample represents the lower respiratory tract (LRT) environment. It is currently unknown whether there is a specific alveolar microbiota profile in human lung diseases, such as pulmonary tuberculosis (TB) and interstitial pneumonia (IP). MethodsBAL samples from six active TB patients, six IP patients and ten healthy volunteers were used for DNA extraction followed by amplification of the complete bacterial 16S ribosomal RNA gene (16S rDNA). The 16S rDNA was sequenced with a MiSeq Desktop Sequencer, and the data were analysed by QIIME software for taxonomic assignment. ResultsThe alveolar microbiota in TB and IP patients and healthy volunteers was characterized by six dominant phyla, Firmicutes, Proteobacteria, Bacteroidetes, Actinobacteria, Fusobacteria and Cyanobacteria. A significant reduction in the abundance of Firmicutes was observed in IP patients. In TB and IP patients, the diversity of the alveolar microbiota was diminished, characterized by a significant reduction in the abundance of the Streptococcus genus and associated with increased Mycobacterium abundance in TB patients and diminished Acinetobacter abundance in IP patients with respect to their abundances in healthy volunteers. However, an important difference was observed between TB and IP patients: the Fusobacterium abundance was significantly reduced in TB patients. Exclusive genera that were less abundant in patients than in healthy volunteers were characterized for each study group. ConclusionsThis study shows that the alveolar microbiota profile in BAL samples from TB and IP patients, representing infectious and non-infectious lung diseases, respectively, is characterized by decreased diversity.

Using SpO2 Recovery Index after a 6-Minute Walk Test to Predict Respiratory-Related Events in Hospitalized Patients with Interstitial Pneumonia

Although the prognostic factors of interstitial pneumonia (IP) patients have been reported, IP has poor prognosis. Hospitalized patients with IP have severely impaired pulmonary diffusion capacity and prominent desaturation. We hypothesized that determining oxygen saturation recovery (SpO2 recovery index) after the 6-minute walk test (6MWT) can provide additional prognostic information regarding rehospitalization for respiratory-related events. We evaluated 73 IP patients at our hospital for demographic characteristics, pulmonary function tests and 6MWT. The Kaplan–Meier method was used to estimate rehospitalisation for respiratory-related events using SpO2 recovery index. Cox regression analysis revealed a relationship between SpO2 recovery index and rehospitalisation. The optimum cutoff value of SpO2 recovery index was 4% (sensitivity, 71.4%; specificity, 79.2%). SpO2 recovery index was most closely related to pulmonary diffusion capacity (r = 0.684, P < 0.001). In a multivariable model, it was the strongest independent predictor of rehospitalisation for respiratory-related events (hazard ratio, 0.3; 95% confidence interval, 0.10–0.90; P = 0.032). In this study, we estimated pulmonary diffusion capacity using SpO2 recovery index values obtained from 6MWT. A SpO2 recovery index of <4% can be useful in predicting rehospitalisation for respiratory-related events.

P2.05-09 FDG-PET for Predicting Acute Exacerbation of Interstitial Pneumonia After Lung Cancer Surgery

Acute exacerbation of interstitial pneumonia (IP) is a critical complication after lung cancer resection. Although FDG-PET is commonly used for preoperative assessment of lung cancer, its role for predicting acute exacerbation of IP after lung cancer resection is unclear. We retrospectively analyzed data of lung cancer patients that underwent surgical resection at Gunma University Hospital between 2008 and 2016. We analyzed data from patients with IP based on computed tomography findings (IP group). As control, we also analyzed data in patients with no underlying lung disease (normal group) and with emphysema (emphysema group). Patients with sufficient FDG-PET data were selected and a final of 92 patients in the IP group, 21 patients in the normal group, and 20 patients in the emphysema group were enrolled in analysis. The FDG-PET values were measured at the aorta and the basal lung. Aorta values were used for reference and we calculated the basal/aorta ratio and analyzed correlation with preoperative factors, including acute exacerbation of IP and mortality. The basal/aorta ratio was significantly higher in the IP group when compared to normal and emphysema group (both p<0.01). The incidence of acute exacerbation of IP was 10.9%, and the sensitivity and specificity of basal/aorta value for predicting acute exacerbation of IP were 70.0% and 77.2%, respectively (cutoff of basal/aorta ratio at 0.833). Patients were further classified into high basal/aorta ratio group (n=35) and low basal/aorta ratio group (n=57). The incidence of acute exacerbation of IP was significantly higher in the high basal/aorta ratio group (p=0.035). We also compared the value of basal/aorta ratio in comparison to the existing IP acute exacerbation score. Patients were divided into low score (less than 10, n=64) and high score (higher or equal to 11, n=28). The sensitivity and specificity for predicting acute exacerbation of IP was 60.0% and 82.3%, respectively, and there was no significant difference between the high and low score groups (p=0.062). The basal/aorta ratio of FDG-PET values showed a significant correlation with the incidence of postoperative acute exacerbation of IP. Since FDG-PET is commonly used for preoperative assessment of lung cancer in Japan, it may be used not only for lung cancer staging but also for surgical indication in IP patients with lung cancer by preoperatively detecting patients at high risk for acute exacerbation.

Association between F-18 fluorodeoxyglucose uptake of noncancerous lung area and acute exacerbation of interstitial pneumonia in patients with lung cancer after resection

BackgroundIdiopathic pulmonary fibrosis is defined as a specific form of progressive fibrosing interstitial pneumonia. Postoperative acute exacerbation is considered a lethal comorbidity for patients with lung cancer, particularly when it is accompanied with idiopathic pulmonary fibrosis. Thus, pretherapeutic risk stratification for acute exacerbation has been anticipated. In this study, we aimed to investigate whether the maximum standardized uptake value of F-18 fluorodeoxyglucose is useful for assessing the postoperative risk of acute exacerbation and severe respiratory adverse events in patients with lung cancer after surgical resection. MethodsA total of 822 patients with lung cancer who underwent preoperative high-resolution computed tomography, fluorodeoxyglucose-positron emission tomography/computed tomography, and pulmonary resection between July 2012 and July 2018 were assessed. Maximum standardized uptake value of the main tumor and that of the noncancerous lung area were measured using a 3-dimensional workstation. Multivariable analyses for acute exacerbation and severe respiratory adverse events were performed using the logistic regression model. ResultsAmong all patients, 120 (14.6%) had idiopathic pulmonary fibrosis findings on high-resolution computed tomography whereas severe respiratory adverse events were observed in 35 (4.2%) patients, including those with acute exacerbation (n = 15, 1.8%). Maximum standardized uptake value of the main tumor and that of the noncancerous lung area were independently associated with both acute exacerbation and severe respiratory adverse events on multivariable analysis, both in all patients and in the 120 patients with idiopathic pulmonary fibrosis. Risk stratification analysis showed that 19.0% and 30.2% of patients who were positive for idiopathic pulmonary fibrosis on high-resolution computed tomography and with a maximum standardized uptake value of the main tumor and that of the noncancerous lung area 1.69 or greater (the optimal cutoff value relevant to acute exacerbation) experienced acute exacerbation and severe respiratory adverse events, respectively. ConclusionsMaximum standardized uptake value of the main tumor and that of the noncancerous lung area were independently associated with the incidence of postoperative acute exacerbation and severe respiratory adverse events in patients with lung cancer.

Risk factors for acute exacerbation of idiopathic interstitial pneumonia in patients undergoing lung cancer treatment.

Identifying risk factors for cancer treatment-related acute exacerbations (AEs) of idiopathic interstitial pneumonia (IIP) in patients with lung cancer. We retrospectively reviewed clinical records of 98 patients with concurrent lung cancer and IIPs diagnosed and treated at the Sapporo Medical University Hospital from January 2010 to December 2014. Of the 98 patients with concurrent lung cancer and IIPs, 14 patients (14.3%) had AEs. A total of 10 patients died. The univariate analysis revealed that the patients with idiopathic pulmonary fibrosis (IPF) or usual interstitial pneumonia (UIP) patterns on chest computed tomography (CT) had significantly higher rates of AE than those with non-IPF or non-UIP patterns, respectively. Further, those with a reduced percentage of forced vital capacity (%FVC) predictive values or elevated Krebs von den Lungen-6 (KL-6) presented significantly higher rates of AE. Our multivariate analysis identified that UIP pattern on chest CT and each 10% decrease in %FVC were significant independent risk factors for AEs. Of the 14 patients who experienced AEs, 10 cases were associated with cancer treatment. The treatment-specific incidences were 3/40 (7.5%) for surgery, 5/50 (10.0%) for chemotherapy, and 2/26 (7.7%) for radiation therapy. After comparing the AE incidences in 55 cases receiving one treatment (monotherapy group) and in 29 cases receiving two types of treatment or more (multitherapy group), we found no significant differences. Chest CT UIP patterns and reduced %FVC are independent risk factors for AE. Moreover, AE incidence did not increase in the multitherapy group compared with the monotherapy group.

Exploiting local facilities for post-pulmonary rehabilitation maintenance programs in fibrotic idiopathic interstitial pneumonia patients: A pilot study

Exploiting local facilities for post-pulmonary rehabilitation maintenance programs in fibrotic idiopathic interstitial pneumonia patients: A pilot study

Association of Immune Thrombocytopenia and Interstitial Pneumonia.

Objective Chest physicians often encounter patients with interstitial pneumonia with autoimmune features. However, there have so far been few reports of patients presenting with concurrent immune thrombocytopenia (ITP) and interstitial pneumonia. The prevalence of interstitial pneumonia in patients with ITP is less well known. Methods We surveyed patients diagnosed with ITP and interstitial pneumonia at the departments of Hematology and Respiratory Medicine to evaluate the association between these diseases. Results Among 73 patients with ITP, 7 patients (9.6%) presented with interstitial pneumonia, including 4 patients (2%) who developed ITP in the course of 204 patients with interstitial pneumonia. All 7 patients were men. Four patients were positive for some autoantibodies. Two patients had autoimmune diseases other than ITP. There were significant differences in age and gender between the ITP patients with and without interstitial pneumonia. Conclusion The present study suggests the possibility that the development of ITP, other autoimmune diseases, and interstitial pneumonia may be mutually associated. Advanced age and male sex in ITP may be significant predisposing factors for interstitial pneumonia. Clinicians should be aware of the potential for the coexistence of these diseases.