Background Idiopathic pulmonary fibrosis (IPF) is a chronic progressive lung disease that profoundly impacts patients’ daily lives. While pharmacological therapies continue to advance, less is known about how patients experience the burden of disease across different periods after IPF diagnosis, resulting in a lack of evidence for the development and optimisation of patient-centred intervention strategies. Therefore, this study aimed to explore how individuals with IPF experience the disease and its impact on daily life in China.Methods This multicentre qualitative study was conducted using semistructured interviews with participants from six geographic regions in China between November 2024 and March 2025. Participants were grouped by time since diagnosis to reflect different periods following diagnosis. Data were collected and analysed inductively and iteratively by using practical thematic analysis until thematic saturation was achieved.Results 53 participants were interviewed to explore the patient experience at different periods following IPF diagnosis. Thematic analysis identified that participants commonly reported the influence of IPF on quality of life, including (1) symptom experience, (2) sleep, (3) eating habits, (4) physical activity, (5) social participation, (6) psychological well-being and (7) financial status. Cough and breathlessness were consistently reported as the most troubling symptoms, often accompanied by psychological challenges related to diagnosis and disease progression.Conclusions The findings highlight the experience and need for patient-centred care across China that addresses not only clinical symptoms but also emotional and social dimensions of living with IPF. Enhancing public awareness may also help reduce stigma and social isolation.

BACKGROUND:Elevated serum tumor-associated antigens (TAAs) were reported to be common in patients with interstitial lung disease (ILD) and correlated with pulmonary involvement or malignancy development. However, there were no adequate longitudinal studies on the association between elevated TAAs and various types of ILDs in Chinese patients. RESEARCH DESIGN AND METHODS:The treatment-naïve ILD patients were retrospectively enrolled. The clinical, laboratory, imaging characteristics, and prognosis were analyzed and compared among those with normal and different number of elevated TAAs. RESULTS:An increase of at least one TAA was present in 169/308 (54.87%) of our patients. Both baseline alveolar and interstitial scores were much higher, and lung involvement tended to be worse during follow-up in patients with two and three or more elevated TAAs than in normal TAAs. Patients with three or more elevated TAAs had the highest interstitial scores and a higher all-cause mortality during follow-up than those with one elevated TAA or normal TAAs. The occurrence of malignancy was similar in all patients. CONCLUSION:Elevated TAAs were present in 54.87% of ILD patients and associated with lung interstitial lesions, which might be a marker for lung involvement progression, while not for malignancy development in ILD.

BACKGROUND:Senescence significantly participates in shaping the pathobiological process underlying chronic obstructive pulmonary disease (COPD). Currently, the mechanisms underlying the anti-aging effects of hydrogen sulfide (H 2 S) in COPD are not fully illustrated. METHODS:Immunohistochemistry (IHC) staining was performed on human lung tissue to detect the expression levels of sirtuin 3 (Sirt3), cyclin-dependent kinase 4 inhibitor (P16), and cystathionin gamma lyase (CTH). An animal COPD model including wild-type (WT) and Sirt3 knockout (KO) mice was established by exposing them to cigarette smoking (CS) for 24 weeks, with or without intraperitoneal injection of sodium hydrosulfide (NaHS, 50 µmol∙L -1 ∙kg -1 ) 30 min prior to CS exposure. Lung function was assessed. The expression levels of P16, cyclin-dependent kinase inhibitor 1A (P21), Sirt3, manganese superoxide dismutase (SOD2), manganese acetylated superoxide dismutase (ac-SOD2), interleukin-6 (IL-6), IL-8, malondialdehyde (MDA), and glutathione (GSH), as well as the activity of SOD2 and Sirt3, were evaluated. Human bronchial epithelial BEAS-2B cells were subjected to diverse cigarette smoking extract (CSE) concentrations for 48 h with or without sodium hydrosulfide (NaHS). Subsequently, the levels of total intracellular reactive oxygen species (T-ROS), mitochondrial reactive oxygen species (mitoROS), mitochondrial membrane potential (MMP), senescence-associated β-galactosidase (SA-β-gal) staining positive cells, and related marker proteins and cytokines were assessed. Furthermore, the Sirt3-specific inhibitor 3-TYP and small interfering RNAs (siRNAs) of Sirt3 were used to examine the mechanisms whereby H 2 S inhibits oxidative stress and senescence in COPD. RESULTS:IHC showed a significant reduction of CTH and Sirt3 protein levels in the lung tissue of COPD with smoking patients and smokers without COPD compared to non-smokers. Furthermore, the expression of the aging marker protein P16 was notably elevated in the COPD with smoking group compared to the smokers without COPD and non-smoker groups. Furthermore, our results demonstrated that exposure to CS resulted in imbalanced oxidative and cellular senescence, including elevated mitoROS, T-ROS, MDA, and ac-SOD2, along with increased proportions of SA-β-gal staining positive cells and the increased expression levels of IL-6, IL-8, P21, and P16, as well as decreased GSH levels, SOD2 and Sirt3 activities, and Sirt3 expression, which ultimately contribute to emphysema development and impaired lung function. However, pretreatment with NaHS effectively reversed these detrimental effects. Nevertheless, the protective effect of NaHS was alleviated in Sirt3 KO mice and in cellular models treated with Sirt3  siRNA and 3-TYP. CONCLUSION:Our study indicates that H 2 S inhibits oxidative stress and cellular senescence by modulating the Sirt3/SOD2 signaling pathway, therefore attenuating the emphysema and impaired lung function induced by CS.

Introduction Idiopathic pulmonary fibrosis (IPF) is a rare, chronic and progressive lung disease with a significant impact on patients’ quality of life. While much research has focused on disease mechanisms and treatment efficacy, limited attention has been paid to the landscape, unmet needs, patient experiences and quality of life. Understanding these aspects through the patient journey is essential for developing patient-centred therapeutic strategies. Therefore, this study aims to explore the status of diagnosis, treatment, the unmet needs and patient experiences of IPF in China through an analysis of the patient journey using mixed methods research. The findings in this study provide valuable insights to guide drug development, optimise clinical decision-making and support health technology assessments.Methods and analysis An exploratory sequential mixed methods design will be used in two phases. In the qualitative phase, 50 patients with IPF and 15 experienced physicians will be recruited to complete in-depth interviews. Patient journey and unmet medical needs will be the focus of data collection. Based on the findings of the qualitative study, a structured questionnaire will be developed for the subsequent quantitative study. Data will be collected from 245 patients with IPF to quantitatively analyse critical points in the patient journey, quality of life, unmet needs and treatment expectations. The integration of patient experience data into the drug/intervention development lifecycle in this mixed methods research will enhance the relevance of IPF interventions, optimising disease management strategies and improving patient health outcomes.Ethics and dissemination The study has been approved by the Peking University Third Hospital Medical Science Research Ethics Committee (2024-188-02). Prior to the study, study information will be provided, and consent will be obtained. Findings in this study will be disseminated in peer-reviewed publications and conferences.Trial registration number NCT06629623.

BACKGROUND: Idiopathic pulmonary fibrosis is a progressive disease that profoundly impacts patients’ psychosocial well-being. Social isolation is a significant but often overlooked challenge in this population. This study aimed to explore the lived experiences of social isolation among patients with idiopathic pulmonary fibrosis. METHODS: A secondary qualitative analysis was conducted on semi-structured interview data from a parent study involving patients with idiopathic pulmonary fibrosis. The dataset was analyzed via conventional content analysis to systematically interpret patients’ experiences of social isolation. RESULTS: Three core themes (antecedents, consequences and coping strategies) emerged from the analysis. The antecedents of social isolation include physical decline, the repercussions of medical interventions, external environmental barriers, and strained interpersonal dynamics. The consequences included reduced social ties and compromised psychological well-being, which coexisted with an emergent desire for social reconnection. Patient coping strategies were centered on the strategic management of finite energy and the proactive pursuit of alternative forms of social support. CONCLUSION: Social isolation in patients with idiopathic pulmonary fibrosis is a complex phenomenon shaped by the interplay of physiological and sociocultural factors. The “antecedent-consequence-coping” framework developed herein offers a nuanced lens to understand the predicament of this group and provides a valuable scaffold for designing robust patient support systems.

SARS-CoV-2 viremia is associated with disease severity and high risk for in-hospital mortality. However, the impact of SARS-CoV-2 viremia on long-term outcomes in hospitalized patients with COVID-19 is poorly understood. We conducted a prospective cohort study and recruited a group of older adult patients with COVID-19 admitted to pulmonary intermediate care units of Peking University Third Hospital during December 2022 and January 2023. The plasma level of SARS-CoV-2 RNA was determined by a standardized RT-PCR technique, and SARS-CoV-2 RNAemia was defined as a plasma viral load ≥ 50 copies/ml. In-hospital and follow-up (180-day) outcome data were collected. A total of 101 patients with an average of 80.4 years were recruited, and 63.4

患者男性，16岁，入院前1年反复气胸、咯血、呼吸困难，于外院先后行5次胸腔闭式引流术，胸部CT示胸膜下肺大疱、右下肺团片状实变伴厚壁空洞形成，体检双手掌指关节、近端指关节、远端指关节可见过度活动，左侧踝部可见最大径1.5 cm淤血斑，基因检测结果显示COL3A1 c1816-2A>G剪切突变阳性。最终诊断为血管型Ehlers-Danlos 综合征。

Background Bronchiectasis was reported in 2%-40% of patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV), but there were no studies on the prevalence, risk factors and impact of AAV-associated bronchiectasis in Chinese patients. Research design and methods AAV patients were retrospectively enrolled. The clinical, laboratory and imaging features and the prognosis were analyzed and compared between those with and without bronchiectasis. Results Bronchiectasis was present in 48/212 (22.6%) of our AAV patients, among whom 41 were confirmed in 210 patients (19.5%) who received chest HRCT at the initial diagnosis of AAV. There were more women and fewer smokers in those with bronchiectasis as compared to those without. Cases with positive anti-MPO were more likely to have bronchiectasis (26.2%), and those with bronchiectasis were more likely to be anti-MPO positive (93.8%). Patients who had a diagnosis of bronchiectasis before AAV were more likely to have nervous system involvement, while patients without bronchiectasis had higher 24h proteinuria. The presence of bronchiectasis showed no significant effect on the 1, 3, 5-year survival. Conclusions Nearly 20% of patients showed bronchiectasis on chest HRCT at the initial diagnosis of AAV, and positivity of anti-MPO was associated with bronchiectasis in a Chinese cohort of AAV patients.

Background: Several large randomized clinical trials (RCTs) have assessed the efficacy and safety of inhaled corticosteroid (ICS) combination regimens versus non-ICS therapy in patients with chronic obstructive pulmonary disease (COPD) at increased risk of exacerbation risk with mixed results. Methods: We performed a systematic literature review and meta-analysis of RCTs comparing the effect of ICS-containing combination therapy and non-ICS regimen in patients with COPD. Results: A total of 54 RCTs (N = 57,333) reported treatment effects on various outcomes and were eligible for inclusion. Overall, the number of patients experiencing moderate/severe exacerbations was significantly lower for ICS-containing combination therapy versus non-ICS therapy (RR: 0.86 [95% CI: 0.80-0.93]). The annual rate of exacerbations was also significantly reduced by 22% (0.78 [0.72- 0.86]) with ICS-containing versus non-ICS therapy. The annual rate of exacerbations requiring hospitalisation was reduced by 31% versus non-ICS therapy (0.69 [0.54-0.88]); similar reduction was observed for exacerbations requiring oral steroids (0.69 [0.66-0.73]). Overall, the effect on trough FEV1 was comparable between ICS-containing and non-ICS therapies (follow-up: 6-52 weeks); however, a significant improvement in lung function (trough FEV1) was observed for ICS/LABA versus LABA (MD: +0.04 L [0.03-0.05]) and ICS/LABA/LAMA versus LAMA (MD: +0.09 L [0.05-0.13]) regimens. In addition, a significant improvement in QoL was observed with ICS-containing versus non-ICS therapy (MD in SGRQ score: -0.90 [-1.50, -0.31]). Conclusion: This meta-analysis demonstrated that a wide range of patients with COPD could benefit from dual and triple ICS containing therapy.

Background COPD at high altitude may have different risk factors and unique clinical and radiological phenotypes. We aimed to investigate the demographic data, clinical and radiological features of COPD patients permanently residing at the Tibet Plateau (≥3000 meters above sea level). Methods We conducted an observational cross-sectional study which consecutively enrolled COPD patients visiting the outpatient of Respiratory Medicine at Tibet Autonomous Region People’s Hospital from January 2018 to March 2021. All patients were Tibetan permanent residents aging ≥40 years and met the diagnosis of COPD according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Data including demographic characteristics, altitude of residence, risk factors, respiratory symptoms, comorbidities and medications, as well as computed tomography (CT) measurements were collected. Results Eighty-four patients with definite COPD were enrolled for analysis. Their mean age was 64.7 (±9.1) years. All patients lived at ≥3000 m above sea level and 34.5% of them lived at ≥4000 m. About 8.3% of the patients were current smokers and 44.0% were ex-smokers. Up to 88.1% of the patients reported long-term exposure to indoor biomass fuels. Most of the patients were classified as having mild-to-moderate (GOLD I: 27.4%; GOLD II: 51.2%) COPD, while 89.3% had a CAT score ≥10. Only 36.9% of the patients received regular long-term medications for COPD in the past year, in whom ICS/LABA and oral theophylline were the most common used pharmacological therapy. On CT scanning, the majority of our patients (70.7%) showed no or minimal emphysema, while signs of previous tuberculosis were found in 45.1% of the patients. Conclusion COPD patients living at the Tibet Plateau had a heavy respiratory symptom burden, but most of them did not receive adequate pharmacological treatment. Indoor biomass fuel exposure and previous tuberculosis were prevalent, while the emphysema phenotype was less common in this population.

目的 分析肺癌血清肿瘤标志物与病理特征及转移的关系.方法 选取2018年1月-2019年6月成都市第三人民医院、北京大学第三医院收治的肺癌患者(n=100,肺癌组)、肺部良性病变者(n=80,良性组)、同期健康体检者(n=40,对照组),测定三组入院时神经元特异性烯醇化酶(NSE)、细胞角蛋白19片段(CYFRA21-1)、鳞状细胞癌抗原(SCC-Ag)、胃泌素释放肽前体(ProGRP)、糖类抗原125(CA125)、糖类抗原153(CA153)水平,分析上述6种血清肿瘤标志物与病理类型、TNM分期、转移的关系及对肺癌转移的预测价值.结果 肺癌组入院时血清NSE、CYFRA21-1、SCC-Ag、ProGRP、CA125、CA153水平明显高于良性组和对照组(P＜0.05),良性组、对照组各指标比较差异亦有统计学意义(P＜0.05).肺癌患者中,腺癌CYFRA21-1、CA125、CA153水平高于鳞癌和小细胞肺癌,鳞癌SCC-Ag水平高于腺癌和小细胞肺癌,小细胞肺癌NSE、ProGRP水平高于鳞癌和腺癌(P＜0.05).随肺癌患者TNM分期增加,血清NSE、CYFRA21-1、SCC-Ag、ProGRP、CA125、CA153水平有增加趋势(P＜0.05);肺癌转移患者血清NSE、CYFRA21-1、SCC-Ag、ProGRP、CA125、CA153水平高于未转移者,肝转移患者NSE、CYFRA21-1表达水平最高,骨转移患者SCC-Ag、CA125表达水平最高,脑转移患者ProGRP表达水平最高(P＜0.05).ROC曲线分析显示,血清NSE、CYFRA21-1、SCC-Ag、ProGRP、CA125、CA153联合预测肺癌转移的曲线下面积为0.871,高于各指标单独预测.结论 肺癌患者血清NSE、CYFRA21-1、SCC-Ag、ProGRP、CA125、CA153呈高表达,且其表达水平均与肺癌病理类型、转移类型有一定关联,血清NSE、CYFRA21-1、SCC-Ag、ProGRP、CA125、CA153联合对肺癌转移有较高预测价值.

肉芽肿性血管炎是一种以坏死性血管炎、肉芽肿病变为特点的系统性疾病，临床常表现为鼻窦炎、中耳炎、肺实质病变、蛋白尿、血尿等多脏器病变。胸部高分辨率CT常见的影像学改变为多发结节或团块影，可伴有大小不等的中央型空洞改变，易与其他空洞病变相混淆。评估患者是否多系统受累，应进行血清中性粒细胞胞质抗体检测，血清或痰液病原学及肿瘤相关检查，评估对抗生素或抗结核等药物治疗的反应，对鉴别诊断有提示意义，并应及早争取病理活检确诊。

Background: Multiple myeloma (MM) is a hematologic malignancy of plasma cell origin. Multiple myeloma with pleural effusion (PE) is not uncommon. The existing literature on MM with PE in China and abroad is limited to case reports. Thus, it is necessary to investigate the characteristics of MM with PE and the associated prognosis to achieve early recognition and treatment. Method: Patients diagnosed with MM from January 2000 to December 2019 at Peking University Third Hospitals were assessed retrospectively. We summarized and analyzed the clinical manifestations, laboratory examinations, diagnosis and prognoses of patients by using clinical data and a literature review. Result: A total of 490 patients with MM were included. 272 patients (55.5%) had PE. Confirmed by pathology, there were 45 myelomatous pleural effusion (MPE) patients and 28 non-MPE patients. The total protein, albumin, calcium and complement C3 levels were lower and the β2-MG levels were higher in the PE group than in the non-PE group (P <0.05). Low total protein and low albumin levels were independent risk factors for PE. The levels of nucleated cells, total protein, LDH, and ADA were higher in the MPE group than the non-MPE group (P <0.05). There were no significant differences in the specific gravity or the levels of protein, glucose and CEA. Multivariate regression analysis suggested that low LDH levels and high levels of nucleated cell counts, total protein and ADA in PE were independent risk factors for MPE. Conclusions: PE is a complication of MM, and it is likely to be malignant. Low serum total protein and albumin levels are independent risk factors for MM with PE. Hypocomplement C3emia (activation of the complement bypass pathway) may affect the formation of PE in patients with MM. High nucleated cell counts, total protein and ADA levels as well as low LDH levels in PE were independent risk factors for MPE.

Objective To evaluate the impact of body mass index (BMI) on survival of a Chinese cohort of medical patients with sepsis. Design A single-centre prospective cohort study conducted from May 2015 to April 2017. Setting A tertiary care university hospital in China. Participants A total of 178 patients with sepsis admitted to the medical intensive care unit (ICU) were included. Main outcome measures The primary outcome was 90-day mortality while the secondary outcomes were in-hospital mortality, length of ICU stay and length of hospital stay. Results The median age (IQR) was 78 (66-84) years old, and 77.0% patients were older than 65 years. The 90-day mortality was 47.2%. The in-hospital mortality was 41.6%, and the length of ICU stay and hospital stay were 12 (5-22) and 15 (9-28) days, respectively. Cox proportional hazard regression analysis identified that Sequential Organ Failure Assessment score (HR=1.229, p<0.001), Acute Physiology and Chronic Health Evaluation II score (HR=1.050, p<0.001) and BMI (HR=0.940, p=0.029) were all independently associated with the 90-day mortality. Patients were divided into four groups based on BMI (underweight 33 (18.5%), normal 98 (55.1%), overweight 36 (20.2%) and obese 11 (6.2%)). The 90-day mortality (66.7%, 48.0%, 36.1% and 18.2%, p=0.015) and in-hospital mortality (60.6%, 41.8%, 30.6% and 18.2%, p=0.027) were statistically different among the four groups. Differences in survival among the four groups were demonstrated by Kaplan-Meier survival analysis (p=0.008), with the underweight patients showing a lower survival rate. Conclusions BMI was an independent factor associated with 90-day survival in a Chinese cohort of medical patients with sepsis, with patients having a lower BMI at a higher risk of death.

Objective: To analyze the clinical features, diagnosis and differential diagnosis of diffuse pulmonary meningotheliomatosis (DPM), a rare subtype of minute pulmonary meningothelial-like nodules (MPMN), so as to improve the understanding of this disorder. Methods: The clinical data of a patient diagnosed as DPM admitted in department of Respiratory Medicine, Peking University Third Hospital in August 2016 were reported and the related literatures were reviewed. With "pulmonary meningothelial-like nodules" , "minute pulmonary meningothelial-like nodules" or "diffuse pulmonary meningotheliomatosis" as the search terms, and the search time before November 1st 2017 for Wanfangdata, China National Knowledge Infrastructure (CNKI), and PubMed.Twenty-five articles were retrieved, among which 6 English (all case reports) articles were found with the search term "diffuse pulmonary meningotheliomatosis" involving 10 cases, and the other 19 articles (1 Chinese, 18 English) about MPMN mainly discussed non-DPM cases,including 13 case reports and 6 pathological/genetic studies. Results: A 68-year old female was admitted to the hospital because of intermittent cough and expectoration for more than 3 years and aggravation for 3 weeks. Her pulmonary CT showed diffuse minute nodules distributed randomly throughout both lungs, and did not improve after treatment with oral Moxifloxacin for 2 weeks. A video-assisted thoracoscopic biopsy was performed. The specimens showed MPMN and no other lesions, which confirmed the final diagnosis of DPM. She was followed without any medication therapy and her pulmonary CT showed stabilization of the lesions one year later. DPM was considered as a rare type of MPMN. A total of 11 cases were analyzed, including 10 cases reported in the literature. The patients included 1man and 10 women, aged 51 to 75 years, with an average age of (64±8) years. Among the 11 patients, 8 denied a history of smoking or of occupational exposure, 7 presented with dyspnea, shortness of breath, or fatigue, and 8 had mild abnormalities of pulmonary function test. The pulmonary CT of all the patients showed randomly distributed, diffuse bilateral small solid or ground-glass nodules, with the diameters less than 5 millimeters, some of which were cavitated. Only 1 patient had pulmonary thromboembolism, while the other 10 did not have any other lung diseases. All the patients were histologically diagnosed, 8 by open lung biopsies, 2 by transbronchial lung biopsy, and 1 by CT-guided fine needle aspiration. Three patients were followed for 12-92 months and the lung lesions were all stable. Conclusions: As a rare subtype of MPMN, DPM lacks specificity of clinical manifestations, and presents with diffuse bilateral small solid or ground-glass nodules, distributed randomly throughout both lungs. An early correct diagnosis depends on biopsy.

OBJECTIVE:To investigate the etiological and clinical characteristics of immunocompetent patients with candidemia. METHODS:The clinical and microbiological data of patients diagnosed as candidemia admitted in Peking University Third Hospital from January 2010 to June 2016 were retrospectively analyzed. Underlying diseases, Candida spp. colonization, clinical manifestations, microbiological data, treatment and the outcome were compared between the HIV-negative immunocompromised (IC) and nonimmunocompromised (NIC) patients. RESULTS:A total of 62 cases diagnosed as candidemia were analyzed including 36 men and 26 women, with 16 to 100 years of age [(66.02±17.65) years]. There were 30 NIC and 32 HIV-negative IC patients respectively. In the NIC patients, there were 19 cases (19/30, 63.33%) with admission in intensive care unit (ICU), 21 (21/30, 70.00%) associated diabetes mellitus or uncontrolled hyperglycemia and 22 (22/30,73.33%) receiving invasive mechanical ventilation, while in the HIV-negative IC patients, there were 8 (8/32, 25.00%), 13 (13/32, 40.63%) and 7 (7/32, 21.88%) respectively (P<0.05). The NIC patients had higher acute physiology and chronic health evaluation (APACHE II) scores and sequential organ failure assessment (SOFA) scores both at admission (19.98±5.81, 6.04±6.14) and candidemia onset (25.61±6.52, 12.75±8.42) than the HIV-negative IC patients (APACHEII 15.09±5.82, 22.15±5.98) and SOFA 2.87±2.73, 7.66±5.64 respectively (P<0.05). In the NIC patients, twenty-one cases (21/30, 70.00%) died in hospital, while 14 cases (14/32, 43.75%) in HIV-negative IC. The crude mortality was significantly different between the two groups (P<0.05). By blood culture, Canidia albicans remained the the most prevalent isolates in all the patients. Clinical manifestation, Candida spp. colonization, etiology and drug susceptibility were also similar between NIC and HIV-negative IC patients (P>0.05). CONCLUSION:Candidemia in NIC patients tends to occur in those who are much more critically ill, more often admitted in ICU, and more frequently have diabetes mellitus or uncontrolled hyperglycemia and receive invasive mechanical ventilation than HIV-negative IC patients. NIC patients also have poorer prognosis than HIV-negative IC patients. Clinical manifestations, and microbiological characteristics are similar between HIV-negative IC and NIC patients.

Objective: To investigate the clinical implications of increased neutrophils in bronchoalveolar lavage fluid (BALF) in sarcoidosis. Methods: A retrospective analysis was performed for 72 cases of histologically diagnosed, treatment-näive sarcoidosis admitted to Peking University Third Hospital from January 2000 to October 2014. The patients included 18 men and 54 women, 26 to 75 years of age [(50±10) years], with the disease course 0.5 month to 12 years (median disease course, 3 months). Results of cell count and differentials of BALF were analyzed and the patients were grouped based on the percentage of neutrophils: those with increased neutrophils (>3%) and those without (≤3%). Clinical manifestations, pulmonary function tests, radiological features, bronchoscopic findings, and other laboratory data were compared between the 2 groups. Finally 67 patients were followed for 6 to 240 months (median 36 months). The subsequent changes of radiological manifestations and relapses after therapy were recorded and compared. Results: There were 72 patients in the study, including 16 with increased BALF neutrophils(stage Ⅰ/Ⅱ/Ⅲ, 4/10/2) and 56 without(stage Ⅰ/Ⅱ/Ⅲ, 9/45/2). Compared with patients without increased neutrophils, those with increased neutrophils had more reticular changes in the lungs(6/16, 8/56), more common diffusion dysfunction (7/13, 11/46) with lower DLCO% [(70±19)% vs (89±23)%], higher percentage of CD8＋ lymphocytes [(19±4)% vs (11±4)%, P<0.05] in BALF. Sixteen (stage Ⅰ/Ⅱ/Ⅲ, 4/10/2) and 51 (stage Ⅰ/Ⅱ/Ⅲ, 9/41/1) patients with and without increased neutrophils were followed respectively. Compared with patients without increased neutrophils, those with increased neutrophils tended to deteriorate and relapse despite corticosteroid therapy. Conclusions: Sarcoidosis patients with BALF neutrophilia had more severe pulmonary fibrosis and diffusion dysfunction, poorer response to corticosteroid therapy and higher relapse rate. These patients, therefore, should be monitored more closely during therapy or follow-up.

Objective To investigate the therapeutic value of caspofun-gin combined with clindamycin for pneumocystis pneumonia ( PCP ).Methods The clinical data of two severe PCP patients treated by caspo-fungin combined with clindamycin regimen in department of respiratory medicine of our hospital were analyzed.Because of definitely sulfame-thoxazole/trimethoprim (SMZ/TMP) allergy history, they were both ini-tially treated with caspofungin single drug , and received mechanical ven-tilation and methylprednisolone treatment.However , clindamycin was added to both patients after 3-4 days because of poor response to caspo-fungin monotherapy.Then they got better gradually , the arterial blood gas and chest CT scan showed that the respiratory failure and lung infil-tration were much improved.Results and Conclusion The courses of caspofungin combined with clindamycin were both 3 weeks, the patients were cured without adverse drug reactions.For PCP patients with limited usage of SMZ/TMP, caspofungin combined with clindamycin may be an effective and safe regimen.

OBJECTIVE:To investigate the clinical significance of anaphylatoxin C3a in induced sputum in patients with asthma.METHODS:The patients with acute exacerbation of asthma treated at our department between September, 2006 and February, 2007 were included in the study. The demographic data, medical history, levels of lung function and C3a levels in induced sputum were assessed.RESULTS:A total of 33 patients were included in the study. The level of C3a in induced sputum was significantly higher in patients with acute exacerbation of asthma (2.24 ng/ml, range 1.68-5.58 ng/ml) than that in patients with asthma remission (0.7 ng/ml, range 0.24-2.31 ng/ml, P<0.05). Sputum C3a levels in the remission patients were significantly higher than those in the healthy controls (0.12 ng/ml, range 0.07-0.39 ng/ml, P<0.05). The levels of C3a in patients with severe exacerbation (4.69 ng/ml, range 2.69-6.59 ng/ml) were significantly higher than those in patients with mild exacerbation (0.25 ng/ml, range 0.09-0.40 ng/ml) and moderate exacerbation (2.21 ng/ml, range 1.16-3.41 ng/ml) (P<0.01), and were significantly higher in patients with moderate exacerbation than in those in mild exacerbation (P<0.01). The level of C3a in induced sputum was positively correlated with the number of total cell count (r=0.718, P<0.05), eosinophils (r=0.495, P<0.05) and macrophages (r=0.600, P<0.05) in patients with acute exacerbation of asthma.CONCLUSION:Induced sputum C3a level can serve as an important clinical biomarker for clinical asthma management.