Tislelizumab for squamous lung cancer combined with basal cell carcinoma of the skin: A case report.

INTRODUCTION: Surgery is the preferred treatment for basal cell carcinoma (BCC), locally advanced or metastatic BCC, radiation therapy or systemic therapy can be considered. Programmed death receptor 1 (PD-1) inhibitors are rarely used to treat cutaneous BCC. In the present case, we found that tislelizumab, a PD-1 immunosuppressant, had a positive effect on BCC. PATIENT CONCERNS: A 74-year-old male patient presented with a mass in the left back in October 2021, which was surgically removed and diagnosed as BCC. The patient was diagnosed with squamous lung cancer after presenting with a cough and coughing up a small amount of white, sticky sputum in December 2021. DIAGNOSIS: BCC and squamous lung cancer. INTERVENTIONS: Docetaxel + nedaplatin systemic chemotherapy combined with tislelizumab immunotherapy. OUTCOMES: Both BCC and squamous lung cancer were significantly reduced in size. CONCLUSION: After 2 cycles of immunotherapy with tislelizumab, the lung tumor shrank, the back mass disappeared, and the wound healed.

Astragaloside IV attenuates TGF-ß-mediated epithelial-mesenchymal transition of pulmonary fibrosis via suppressing NLRP3 expression in vitro.

Pulmonary fibrosis (PF) is a severe chronic disease. Although astragaloside IV (ASV) is known to have therapeutic effects on PF, the therapeutic targets of ASV require further study. This study was designed to elucidate the regulatory effect of ASV on PF via NLRP3. PF was triggered by transforming growth factor-ß (TGF-ß) in vitro. The relative activity of TGF-ß was measured by luciferase reporter assay. Protein levels were determined by western blotting assay. The NLRP3 expression was analyzed using immunofluorescence analysis. mRNA levels were detected by qRT-PCR. MTT assay was performed to determine cell viability. Wound healing and transwell assays were conducted to investigate cell migration and invasion. We found that ASV markedly suppressed TGF-ß activity, Smad2/3 and NLRP3 protein expression levels. ASV inhibited cell viability, migration and invasion ability. Moreover, ASV mediated downregulation of N-cadherin and Snail and upregulation of E-cadherin, which further suppressed the epithelial-mesenchymal transition (EMT). However, overexpression of NLRP3 reversed the effects of ASV and promoted Collagen I, Collagen II and α-SMA protein expressions. In conclusion, ASV efficiently retarded PF progress via suppressing NLRP3 expression in vitro.

A scoring system to effectively evaluate central nervous system tuberculosis in patients with military tuberculosis.

There is currently no convenient way to effectively evaluate whether a miliary tuberculosis patient is complicated with central nervous system (CNS) tuberculosis. We aimed to find such a way by analyzing the clinical data of these patients. Fifty patients with confirmed miliary tuberculosis and 31 patients with confirmed miliary tuberculosis complicated with CNS tuberculosis from 2010 to 2014 were selected. Their general conditions, clinical features and laboratory tests were analyzed. Factors that were significantly different between them were chosen to performed multivariate and univariate logistic regression analyses, and factors with significant P values were used to establish a scoring system. Eight factors, i.e., age, cough, nausea, headache, hemoglobin (HGB), serum albumin (ALB), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), were significantly different (P < 0.05). Multivariate logistic regression analysis showed that ALB was the independent risk predictor (HR = 1.29, 95% CI 1.09-1.52, P < 0.01), whereas the others were non-independent predictors except age (P < 0.05). The scoring system was based on a summation of the scores of the assigned values of the seven predictors and had an area under the curve (AUC) of 0.86 to confirm CNS tuberculosis, with a sensitivity of 81.5% and a specificity of 81.4% at a score of 0.75 and with a specificity of 95.3% at a score of 2.75. In contrast, a score below -0.75 excluded CNS tuberculosis, with a sensitivity of 88.9% and a specificity of 62.7%. The scoring system should be useful to evaluate whether a miliary tuberculosis patient is complicated with CNS tuberculosis and could help doctors avoid excessive investigation.

Mimicking pancreatic malignancy: a systemic sarcoidosis.

Systemic sarcoidosis that initially presents as a pancreatic mass has rarely been reported. A 47-year-old man presented with idiopathic epigastric abdominal pain. Abdominal CT showed multiple enlarged lymph nodes in the retroperitoneal area and a suspected tumor mass in the pancreatic head region. The preliminary diagnosis was celiac metastasis of a pancreatic malignancy. The definitive diagnosis was systemic sarcoidosis, which was supported by granulomas on histology, clinical radiographic findings, and clinical response to steroids. A review of published reports on sarcoidosis presenting initially as a pancreatic or celiac mass from the Chinese biomedical database (1978-2010) is included.

Gefitinib in combination with prednisolone to avoid interstitial lung disease during non-small cell lung cancer treatment: A case report.

Gefitinib-induced interstitial lung disease (ILD) is a rare but lethal drug adverse event, which usually leads to the withdrawal of gefitinib and causes complications with anticancer treatment. In this study, gefitinib administration combined with prednisolone in a female with stage IIIb non-small cell lung cancer (NSCLC) produced a good outcome without inducing ILD. The results suggested that combined administration of gefitinib with glucocorticoids may be an efficient method to treat NSCLC while avoiding complications with ILD.

[The relationships between oxygenation index and prognosis in acute respiratory failure patients treated by invasive mechanical ventilation].

OBJECTIVE: To investigate the effect of oxygenation index (PaO(2)/FiO(2)) on patients' prognosis through comparative analyzing the monitoring indicators of acute respiratory failure patients treated by invasive mechanical ventilation. METHODS: Data from 91 acute respiratory failure patients treated by invasive mechanical ventilation in respiration intensive care unit (ICU) of the General Hospital of PLA of Lanzhou from November 2006 to August 2011 were retrospectively analyzed. Patients were divided into survival group (n=55) and death group (n=36) by the outcome, the critical severity scores of the diseases and changes in blood gas analysis during ventilation were compared, and their correlation with prognosis were analyzed. RESULTS: There were no significant differences in acute physiology and chronic health evaluationIII (APACHEIII) score, multiple organ dysfunction syndrome (MODS) score, acute lung injury (ALI) score between survival and death group before ventilation (62.77±22.92 vs. 74.62±25.77, 6.46±2.45 vs. 6.62±3.03, 1.90±0.57 vs. 2.10±0.73, all P>0.05). There was no significant difference in PaO(2)/FiO(2) between survival and death group on the first day of mechanical ventilation (132.18±67.29 mm Hg vs. 139.24±78.36 mm Hg, P>0.05). PaO(2)/FiO(2) in survival group were significantly higher than that in death group on the 3 days and 7 days of mechanical ventilation (3 days: 205.47±74.71 mm Hg vs. 149.76±70.38 mm Hg, 7 days: 225.37±67.20 mm Hg vs. 120.94±85.58 mm Hg, P<0.05 and P<0.01). CONCLUSIONS: The present study demonstrated that the level of PaO(2)/FiO(2) is related with the prognosis of acute respiratory failure patients treated by invasive mechanical ventilation. Continuously monitoring the changes in PaO(2)/FiO(2) can be used as an important reference index to evaluate the prognosis of critical patients.

Comparative study of solitary thin-walled cavity lung cancer with computed tomography and pathological findings.

BACKGROUND: Solitary thin-walled cavity lung cancer is a specific form of lung cancer, the diagnosis of which remains a formidable challenge. OBJECTIVE: By comparing the computed tomography (CT) presentations and pathological findings, the purpose of present study was to explain the possible mechanism of thin-walled cavity formation and to improve the diagnostic accuracy for this disease. METHODS: The medical records of eighteen patients with solitary thin-walled cavity lung cancer were analyzed retrospectively. RESULTS: Chest CT demonstrated that solitary thin-walled cavities located at pulmonary periphery, and all these cavity lesions displayed suspected malignant signs. Pathological findings after surgery confirmed these lesions were adenocarcinoma, most of which were moderately or well differentiated. Microscopic findings showed tumor cells proliferated in the surface of thin-wall cavity in nine patients and infringed bronchiolar wall in five patients. No obvious necrotic tumor cell was observed in each patient. CONCLUSION: It was suggested some thin-walled cavities may be formed as a result of unidirectional check-valve mechanism. Together, a high index of awareness of this suspected CT signs is required for early diagnosis of this disease.

Early clinical diagnosis of synchronous multiple primary lung cancer.

The diagnosis of synchronous multiple primary lung cancer (SMPLC) remains a formidable challenge. The aim of the present study was to identify useful clues for the clinical diagnosis of SMPLC, in particular for the early stages. The medical records of 10 patients diagnosed with SMPLC with different histological types were analyzed retrospectively. Chest computed tomography (CT) findings showed two pulmonary lesions in all patients. The two lesions displayed malignant characteristics of primary lung cancer. The levels of a number of tumor markers, including carcinoembryonic antigen, neuron-specific enolase, cytokeratin fragment 21-1, squamous cell carcinoma and CA125 increased in 2 patients. Auxiliary examinations of other physical sites in these patients did not show signs of neoplasm metastasis. Two tumors were separately staged and appropriate treatment was carried out based on the revised stage, which provided more benefits for SMPLC patients. The diagnosis of SMPLC might be delayed or mistaken owing to its similarity to neoplasm metastasis. A high index of awareness is required for the early diagnosis of this disease. The malignant characteristics of primary lung cancer in various lesions may be valuable clues for the diagnosis of SMPLC. Alterations in the levels of tumor markers may be a poor diagnostic tool for the detection of SMPLC. Separate biopsies for different pulmonary masses should be performed for clinical staging as soon as possible and reasonable treatment based on the stage should also be selected.

Clinical stage of lung cancer revised by accidental pneumothorax and positron emission tomography.

Clinical lung cancer staging is an important basis for choosing treatment modalities and prognosing outcomes. However, it is not always accurate. We reported an interesting process of clinically staging in a case with lung cancer. According to admission computer tomography findings, he was preliminarily diagnosed as stage IV with nonprimary-tumor lobe metastasis and chest wall invasion. Computer tomography findings after accidental pneumothorax resulting from percutaneous puncture biopsy and positron emission tomography findings denied the chest wall invasion and nonprimary-tumor lobe metastasis. His diagnosis was revised as stage IIa that was confirmed subsequently by histological staging after surgery and follow-up. Our experiences indicate computer tomography scanning after artificial pneumothorax is a useful tool for identifying whether or not chest wall is invaded directly by an adjacent tumor, and positron emission tomography scanning needs to be considered for accurately evaluating the nature of concurrent pulmonary nodules in patients with lung cancer.

Recurrent respiratory papillomatosis arising in trachea not affecting larynx.

Recurrent respiratory papillomatosis (RRP) is an infrequent benign neoplasm commonly involving the upper respiratory tract with laryngeal predilection. The diagnosis and treatment of this disease are challenging due to its nonspecific clinical presentations and recurrent nature. We report here a rare juvenile case of RRP arising in the trachea without laryngeal lesions. Our experiences indicate that a high awareness of RRP and proper consideration in the right clinical context are prerequisites for early diagnosis, and a combination of multiple treatment modalities should be considered as a feasible treatment regimen.

Recurrent respiratory papillomatosis: an overview.

Recurrent respiratory papillomatosis (RRP) primarily caused by human papillomas virus is a rare and benign neoplasm, primarily involving the epithelium mucosae of the respiratory tract. RRP may occur anywhere in the respiratory tract with a predilection to the laryngeal area and may potentially threaten life. Because of the absence of specific clinical manifestations, the diagnosis of this disease is easily delayed. The high awareness of RRP and performing endoscopy as soon as possible in suspected patients are the prerequisites for early diagnosis. Surgical removal on endoscope is still a fundamental treatment. Adjuvant treatment is required only in some patients. Because of the potential of malignant transformation and recurrence, careful follow-up for RRP is required for early detection and treatment.

Xuebijing protects against lipopolysaccharide-induced lung injury in rabbits.

Interleukin (IL)-23 has been identified as a member of the IL-12 cytokine family. It plays an important role in inflammation. To demonstrate the changes of IL-23 in acute lung injury (ALI) and investigate the protective effect of Xuebijing in ALI and the underlying molecular mechanism, ALI was induced by intravenous injection of lipopolysaccharide (LPS, 750 microg/kg). Japanese white rabbits challenged with or without LPS were treated with Xuebijing at the same time or saline. Before and after administration of LPS, arterial blood gas and lung weight gain were examined. Pathological changes of lung tissue were measured by light microscopy. IL-23 in serum was detected by enzyme-linked immunosorbent assay (ELISA). All animals demonstrated drops in arterial oxygen tension (Pao(2)) and oxygenation index (Pao(2)/Fio(2)) after LPS application, which were significantly reversed by Xuebijing treatment. Administration of Xuebijing reduced lung water gain. Histopathological study also indicated that Xuebijing treatment markedly attenuated lung histopathological changes, alveolar hemorrhage and inflammatory cells infiltration. Furthermore, IL-23 was higher than control group after LPS treatment, which could be blunted by Xuebijing. These findings confirmed significant protection by Xuebijing against LPS-induced lung vascular leak and inflammation and implicated inhibition of IL-23 expression a potential role for Xuebijing in the management of ALI.

[Clinical analysis of value of different modes of respiratory support in the treatment of critical patients].

OBJECTIVE: To investigate the relationship between the successful results with different methods and time of initiation of respiratory support in critically ill patients. METHODS: The clinical data of 458 critical care patients were reviewed and analyzed. Among the patients, there were 47 cases of cardio-pulmonary resuscitation, 105 cases of acute airway obstruction, 156 cases of acute respiratory failure, and 150 cases of chronic respiratory failure. Intubation, or tracheostomy, or non-invasive positive pressure ventilation (NPPV) at different times and occasions were performed in the patients. RESULTS: One hundred and seventeen cases (25.5%) died during the respiratory support treatment, 49 cases gave up the treatment, and 292 patients (63.8%) were cured after mechanical ventilation. As the success rate was the lowest in patients who survived cardio-pulmonary resuscitation (21.3%, 10/47), it was higher in acute respiratory failure (55.1%, 86/156), and the best result (82.8%, 87/105) was obtained in the acute airway obstruction group and patients with chronic respiratory failure (72.7%, 109/150). In the group of patients undergoing early respiratory support, the cure rate was 95.0% (57/60) in patients with invasive method, and 95.5% (21/22) in the NPPV group. The result was significantly different compared with that of later treatment group [81.7% (68/82) in invasive group, and 60.9% (2/29) in NPPV group, both P<0.01]. It demonstrated that the earlier the respiratory support was given the better results. If the respiratory support was delayed, cure rate was significantly reduced [65.6% (63/96) in invasive group and 48.1% (13/27) in NPPV group, both P<0.01]. The cure rate was no difference between different modes of respiratory support between early treatment groups, however, invasive respiratory support was much better than NPPV [44.4% (40/90) and 0 (0/5)] when instituted in the late stages (all P<0.01). CONCLUSION: It is of prime importance to ensure optimal ventilation in the early stage of diseases, the difficulty and risk of establishment of a patent airway are main problems in the treatment of critically ill patients.