BACKGROUND:Radiation-induced lung injury (RILI) is a common and dose-limiting complication in patients with non-small cell lung cancer (NSCLC) receiving radiotherapy, especially in combination with chemotherapy and/or immunotherapy. RILI encompasses acute radiation pneumonitis (RP) and chronic pulmonary fibrosis, significantly impacting patients' quality of life and treatment outcomes. Preclinical and clinical evidence suggests that nintedanib, a tyrosine kinase inhibitor approved for idiopathic pulmonary fibrosis (IPF), may have preventive effects against RILI due to shared fibrotic pathways. However, prospective data on its prophylactic use remain limited. METHODS:This is a randomized, multicenter, unblinded, controlled trial designed to evaluate the efficacy and safety of nintedanib in preventing RILI. A total of 66 patients with unresectable stage II-III NSCLC scheduled to receive CCRT will be enrolled from three centers in China. Eligible participants will be randomized 1:1 to either the nintedanib group or the control group. Randomization is stratified by concurrent chemotherapy regimen (etoposide-based vs. taxane-based vs. pemetrexed-based). The nintedanib group will receive oral nintedanib 150 mg twice daily, initiated 1-2 weeks before radiotherapy and continued for 12 weeks, followed by a voluntary treatment period from week 13 to week 24. The control group will receive CCRT alone without nintedanib. All patients will undergo standardized CCRT comprising platinum-based doublet chemotherapy (cisplatin or carboplatin combined with etoposide, taxanes, or pemetrexed) and radiotherapy (60 Gy/30 fractions). Immunotherapy consolidation is permitted as a viable treatment option per guideline recommendations. Primary endpoint: The incidence of grade ≥2 RILI (according to CTCAE v5.0) within 6 months after radiotherapy initiation. Secondary endpoints: Time to radiological lung injury; changes in pulmonary function (FVC%, FEV1%, DLco%); tumor response outcomes (OS, PFS, ORR); safety and tolerability; and patient-reported outcomes. This trial will provide the first prospective evidence on the efficacy of nintedanib for preventing RILI in patients with unresectable stage II-III NSCLC undergoing CCRT. The results may inform clinical practice and guide future prophylactic strategies for RILI. TRIAL REGISTRATION:This study was registered on April 16, 2025, at the Chinese Clinical Trial Registry (No. ChiCTR2500100845). REPORTING GUIDELINE:This protocol was developed in accordance with the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) guidelines.

Abstract Background: Idiopathic pulmonary fibrosis (IPF) has an insidious onset, no apparent symptoms in the early stage, and is easily combined with lung cancer in the late stage with a poor prognosis. Previous studies have found an overlap between the pathogenesis of IPF and lung cancer (LC), and immune infiltration plays an essential role in the development. But there are still no immune-related markers associated with IPF that have an impact on lung squamous cell carcinoma (LUSC) tumor infiltration. Methods: The IPF-related datasets GSE53845, GSE107797, and GSE110147 were acquired from the GEO database. WGCNA analyses of the GSE53845 dataset to identify the most relevant modules and candidate hub genes associated with CD8+ T cells. GO and KEGG analysis were performed on all genes within the module. Next, GSE107797 and GSE110147 were used to verify the relationship between candidate hub genes and CD8+ T cells to identify hub genes. The TIMER database was used to analyze the relationship between hub genes and CD8+ T cells in different cancers. UALCAN was used for the pan-cancer analysis of hub genes. And the mRNA expression levels, prognosis, and gene interrelationships of hub genes in LUSC i dentified by GEPIA, TIMER, TarBase v8, OncoLnc, and starBase to construct a ceRNA regulatory network. The role of hub gene expression in tumor immune infiltration was studied using the TIMER and GEPIA. Finally, we performed single-gene GSEA analysis of the hub genes, methylation analysis of the hub genes using the DiseaseMeth database, and protein expression analysis of the hub gene determined by the Human Protein Analysis (HPA) online database. Results: WGCNA identified the pink module as the most relevant module for CD8+ T cells and selected seven candidate hub genes. GO analysis and KEGG analysis further validated the IPF and immune correlation. Three hub genes (CCL5, CXorf65, and RASAL3) significantly associated with CD8+ T cells were validated and identified using the GSE107797 and GSE110147 datasets. Hub genes were positively associated with CD8+ T cells in various cancers. In the pan-cancer analysis, low expression of CXorf65 and RASAL3 was associated with poor prognosis in LUSC. In addition, we found that CXorf65 and RASAL3 were significantly and positively correlated with LUSC immune infiltration, immune cell biomarkers and immune checkpoint expression. We successfully constructed the ceRNA network of CXorf65 and RASAL3. CXorf65, RASAL3 methylation levels, and protein expression levels differed in LUSC and normal tissues. Single-gene GSEA analysis further confirmed the involvement of CXorf65 and RASAL3 in multiple immune responses. Conclusion: CXorf65 and RASAL3 were significantly associated with CD8+ T cells in IPF and play an impact on LUSC Immune infiltration.

BACKGROUND Drug reaction with eosinophilia and systemic symptoms（DRESS） syndrome is an uncommon yet serious adverse drug hypersensitivity reaction with the presentations including rash, fever, lymphadenopathy, and internal organ involvement. Sarcoidosis is a systematic granulomatous disease with unknown etiology. We herein report a case of pulmonary sarcoidosis secondary to allopurinol-induced DRESS.CASE SUMMARY A 37-year-old man with a history of hyperuricemia was treated with allopurinol for three weeks at a total dose of 7000 milligrams before developing symptoms including anorexia, fever, erythematous rash, and elevated transaminase. The patient was diagnosed with DRESS and was treated with prednisone for 6 mo until all the symptoms completely resolved. Three months later, the patient presented again because of a progressively worsening dry cough. His chest computed tomography images showed bilateral lung parenchyma involvement with lymph node enlargement, which was confirmed to be nonnecrotizing granuloma by pathological examination. Based on radiologic and pathological findings, he was diagnosed with sarcoidosis and was restarted on treatment with prednisone, which was continued for another 6 mo. Reexamination of chest imaging revealed complete resolution of parenchymal lung lesions and a significant reduction in the size of the mediastinal and hilar lymph nodes. Following a 6-month follow-up of completion of treatment, the patient’s clinical condition remained stable with no clinical evidence of relapse.CONCLUSION This is the first case in which pulmonary sarcoidosis developed as a late complication of allopurinol-induced DRESS. The case indicated that the autoimmune reaction of DRESS may play an important role in the pathogenesis of sarcoidosis.

BackgroundInterstitial lung disease (ILD) seriously influences patient’s quality of life (QOL) due to an abnormally repaired lung structure and damaged lung function, as well as its many complications. Osteoporosis is a systemic bone disease characterized by low bone mineral density (BMD) and may impair QOL and increase mortality in ILD patients. We conducted this study to investigate osteoporosis in Chinese ILD patients.MethodsWe performed a cross-sectional survey of 179 Chinese ILD patients. BMD levels were evaluated, and the clinical variables of the patients were recorded. The physical activity and QOL of patients were evaluated by a questionnaire when enrolled. Regression analysis was used to identify factors affecting BMD in ILD patients.ResultsIn total, 68.2% of the included patients had an abnormal BMD, 24.6% had osteoporosis, and 43.6% had osteopenia. Decreased of BMD in ILD patients was associated with multiple factors, of which sex, height, weight, ILD subtypes and serum parathyroid hormone (PTH) were most significantly. The QOL of ILD patients with osteoporosis is dramatically declining.ConclusionsOsteoporosis and osteopenia have high prevalence rates in ILD patients and seriously affect patients’ QOL. The development of osteoporosis and low BMD in ILD patients are influenced by multiple factors. Early identification and interventions are expected to benefit the QOL of ILD patients.

Introduction Interstitial lung diseases (ILDs) include a wide variety of chronic progressive pulmonary diseases characterized by lung inflammation, fibrosis and hypoxemia and can progress to respiratory failure and even death. ILDs are associated with varying degrees of quality of life impairments in affected people. Studies on the quality of life in patients with ILDs are still limited, and there are few studies with long-term follow-up periods in these patients. Methods Data from patients who were clinically diagnosed with ILDs in the Respiratory Department, Beijing Chaoyang Hospital, Capital Medical University from January 2017 to February 2018 were collected. Clinical status and HRQoL were assessed at baseline and subsequently at 6- and 12-month intervals with the LCQ, mMRC, HADS, SF-36, and SGRQ. Multivariate linear regression was used to evaluate the determinants of the decline in HRQoL. Results A total of 139 patients with idiopathic interstitial pneumonia (IIP) and 30 with connective tissue disease-associated ILD (CTD-ILD) were enrolled, 140 of whom completed the follow-up. The mean age was 63.7 years, and 92 patients were men. At baseline, the decline in HRQoL assessed by the SF-36 and SGRQ was significantly associated with the mMRC, LCQ and HADS depression score. In the follow-up, changes in FVC%, DLco%, mMRC and LCQ were significantly associated with changes in HRQoL. Conclusions HRQoL in both IIP and CTD-ILD patients deteriorates to varying degrees, and the trend suggests that poor HRQoL in these patients is associated with many determinants, primarily dyspnea, cough and depression. Improving HRQoL is the main aim when treating patients living with ILDs.

在过去的50余年里,人类战胜疾病的能力大大提高.但是,随着医药学科的不断进步,包括药物、放射性治疗、器官移植等在内的治疗因素,已经逐步成为人类肺脏损伤的重要原因之一.这些治疗因素既可直接破坏肺脏结构导致肺功能异常,也可通过损害神经肌肉系统导致人无法呼吸,通过减低身体抵抗力诱发肺部感染的发生.这些损害的发生,可表现为隐匿起病、缓慢进展,但也常常表现为急进的快速发展,有时甚至在短期内出现致死性的呼吸功能破坏,提醒大家要充分重视.

患者女，26岁，因“干咳2个月”入院。因外院影像学表现为双肺多发结节影，以间质性肺疾病查因进行筛查，以“贫血”作为线索，完善腹部相关检查、正电子发射计算机断层显像（PET-CT）及胃镜、骨髓穿刺、气管镜病理，最终病理证实均为胃腺癌，印戒细胞癌，并伴有骨质破坏、血行转移、淋巴结转移。患者出院当月去世。

Objective: To investigate the accuracy of bedside transthoracic lung ultrasonography (TLU) in different typical high resolution computed tomography (HRCT) signs of interstitial lung diseases (ILDs). Methods: Fifty patients first diagnosed with ILDs were enrolled from January 2016 to December 2018. There were 21 males and 29 females. The mean age was (56±14) years(rang 42-73 years). TLU was performed in inspiration for the characters of A-lines and B-lines as well as pleural at anterior, lateral and dorsal chest walls, respectively. HRCT was selected at three levels according to the upper, middle, and lower lung fields. The range of each level needing to be evaluated corresponded to the TLU scanning field one by one, and recording the signs of HRCT. Early change of ILDs was definite as the HRCT score was no more than 1 and no honeycomb was present. The correlation between A-lines, B-lines, pleural abnormal and HRCT signs was evaluted. Spearman's correlation coefficient was used to evaluate the relationship between B-lines and HRCT score. Results: The sensitivity and specificity of A-lines for HRCT normality were 83.9% and 84.9%, respectively. Coincidence rate was 84.6%. The sensitivity and specificity of B-lines for HRCT abnormality were 84.9% and 83.9%, respectively. Coincidence rate was 84.6%. Interlobular septal thickening shadow had fewer B-lines and narrower interval than other HRCT signs, while the other HRCT signs had no differences in B-lines. And the sensitivity and specificity of B-lines for detection the early change of HRCT in ILDs were 89.5% and 89.2%, respectively. Coincidence rate was 89.3%. A positive correlation was found between the number of B-lines and HRCT scores (R=0.827, P<0.001), and the width of B-lines and HRCT score (R=0.951, P<0.001). Meanwhile, a negative correlation was found between the interval of B-lines and HRCT score (R=-0.831, P<0.001). The sensitivity and specificity of TLU for HRCT pleural abnormality were 100.0% and 90.0%, respectively. Coincidence rate was 93.6%. Conclusions: TLU showed high sensitivity and specificity in finding interstitial changes of the lung. It gives a new view on the diagnostic possibilities of ILDs and may be used to evaluate the severity and the therapeutic effect of treatment. However, TLU could not differentiate HRCT signs of ILDs.

Interstitial lung disease (ILD) is a group of chronically and progressively fibrotic diseases of lung parenchyma.The etiology and course,as well as the treatment and prognosis of different types of ILD are different.Current measures cannot still improve the progress of these patients with most types of ILD.Improving the quality of life is a challenge urgently needed to be solved for these patients.At present,the studies about the quality of life of ILD patients mainly focus on idiopathic pulmonary fibrosis and sarcoidosis.The degree of dyspnea,fatigue,depression and anxiety are the main factors affecting the quality of life of patients with such disease.This article reviews the advances in the field of quality of life in order to raise the awareness of the quality of life in these patients.

目的 评价人工冬虫夏草治疗慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)、间质性肺疾病(interstitial lung diseases,ILDs)随机和半随机对照试验的质量.方法 计算机检索PubMed、Cochrane Library、中国生物医学文献数据库、中国知网CNKI数据库、万方数据库和维普中文期刊数据库,收集人工冬虫夏草治疗COPD和ILDs的随机对照试验和半随机对照试验.按照Cochrane协作网推荐的评价方法对纳入的研究进行方法学质量评价,按照随机对照试验报告统一标准(consolidated standards of reporting trials,CONSORT)清单进行研究报告质量评价,按照临床指南对纳入研究的疾病诊断标准、干预措施和严重程度评价及结局指标设定进行专业评价.结果 检索相关文献,入组126篇文献,其中涉及COPD的研究112篇,涉及间质性肺疾病或矽肺合并COPD的研究14篇.入组文献的研究方法学质量(COPD正确率0％ ～35.7％;ILDs正确率9.1％～18.2％)和报告质量亟待提高.入选文献在诊断的确认(COPD合理率42.3％;ILDs合理率78.6％)、治疗方案设定(COPD合理率28.8％;ILDs合理率14.3％)和疗效评价指标及治疗终点设计(COPD合理率50％;ILDs合理率64.3％)上也有很大缺陷.结论 由于研究质量较差,目前的证据不能证实联合使用发酵的虫草粉对改善COPD和ILDs的疗效有肯定作用,仍需要进一步研究以证实其临床价值.

临床资料 患者女,22岁,学生,因"间断咳嗽伴胸闷2 年余,加重2个月"于2016年7月23日收入北京朝阳医院呼吸科.患者自2年多前"感冒"后经常出现咳嗽,为干咳,无喘息及胸闷,对症治疗后症状缓解. 10个月前受凉后再次出现咳嗽、咳痰,为黄色脓痰,伴喘息,呼吸困难,于当地医院"抗炎、平喘"治疗(具体药物不详),症状有所缓解,为进一步诊治于2015年11月13日第一次收入我院.体检:意识清、精神可,双肺呼吸音粗,可闻及呼气相哮鸣音.余查体未见明显异常.入院后完善相关检查,血气分析(未吸氧): pH 值为7.46,动脉血氧分压( PaO2)为66 mmHg (1 mmHg ＝0.133 kPa).血常规:白细胞为14.5×109/L,嗜酸粒细胞 为8.23 ×109/L (占0.57). ESR为16 mm/1 h.过敏原总IgE 为691 kU/L,白色念珠菌特异性过敏原IgE为1.01 kU/L,余过敏原特异性IgE均为阴性.呼出气一氧化氮为59 ppb.寄生虫、自身抗体、抗中性粒细胞胞质抗体( anti-neutrophil cytoplasmic antiboclies,ANCA)均为阴性. BALF 常规:细胞总数为16.8×106/L,巨噬细胞占0.40,淋巴细胞占0.05,中性粒细胞占0.53,嗜酸粒细胞占0.02.骨髓涂片嗜酸粒细胞占0.26,基因检测不支持血液系统恶性肿瘤.胸部高分辨率CT示双肺散在多发斑片状磨玻璃影,左上肺前段、左舌叶可见小条片状实变影(图1～3).纵隔淋巴结未见明显增大,胸膜未见增厚.副鼻窦轴位、冠状位CT平扫示双侧上颌窦、筛窦、右侧额窦炎症(图4,5).

Backgroud: As a fast and non-invasive tool, transthoracic lung ultrasonography (TLU) has shown the value of diagnose some kinds of pulmonary diseases, such as Interstitial lung diseases (ILDs). There are no studies exam the accuracy of TLU for each ILDs’ high resolution computed tomography (HRCT) characters, such as honeycomb, ground-glass opacity, consolidation, interlobular interstitial thickening and reticulation. In this study, we try to investigate the TLU characters of each HRCT signs of ILDs. Methods: Twenty-nine ILDs patients were involved in the study. Eighty-seven HRCT scanning planes were studied and totally 423 spots were investigated. A-lines and B-lines were recorded and B-lines’ interval, width and quantity were calculated. HRCT characters were also recorded for each spots. Results: The sensitivity and specificity of B-lines for all kinds of HRCT abnormalities of ILDs was 87.6% (95% CI 83.3, 90.9) and 84.2% (95% CI 75.0, 90.6), respectively. There was a significant difference of B-lines’ interval between consolidation and ground glass, interlobular septal thickening as well as grid shadow. There were no differences of B lines’ width and quantity for each HRCT signs. ILDs’ pleural change was rough and uneven on ultrasonic scanning. Conculsions: TLU is a sensitive and specific tool in the diagnosis of ILDs but has its shortage in differential diagnosis of each HRCT signs of ILDs.

Post-infectious cough (PIC) is a kind of disease that patients complain of a persistent cough after experiencing the acute symptoms of an upper respiratory tract infection.It is a common disease. This paper aims to guide the therapy by concluding the studies on the pathogenesis and treatment for PIC in recent years.

分子靶向治疗是指在细胞分子水平上,针对已经明确的致癌位点设计相应的小分子化合物、单克隆抗体、多肽等物质,特异性干预调节肿瘤细胞生物学行为的信号通路,从而使肿瘤细胞特异性死亡,而不会杀伤正常组织细胞[1].自1997年单克隆抗体利妥昔单抗(美罗华)和曲妥珠单抗(赫赛汀)首次被美国食品药品监督管理局(FDA)批准应用于临床治疗弥漫性大B细胞淋巴瘤和转移性乳腺癌开始,分子靶向治疗逐渐在临床实践中取得显著成绩,已成为临床治疗恶性肿瘤不可或缺的手段之一.肺癌是全球发病率和死亡率最高的恶性肿瘤,非小细胞肺癌(NSCLC)占肺癌发病率的80％[2].目前,靶向治疗在NSCLC,尤其是晚期患者的治疗中占有重要地位.

1 病历资料 患者女,31岁,因“活动后呼吸困难2年余,加重3个月”主诉于2014-05-07入院.患者2年余前始出现活动后呼吸困难,休息后可好转,无发热、咳嗽、咳痰、咯血、胸痛、关节肿痛、反复口腔溃疡、脱发、光过敏等,症状进行性加重.于3个月前平路步行100 m即出现呼吸困难,1周余前活动后“晕倒”,数分钟后自行好转,于外院行心脏彩超提示肺动脉高压(PAH).

Objective:To analyze the clinical characteristics and enhance the understanding of Takayasu's arteritis (TA) with pulmonary vascular involvement.Methods:The clinical data of 9 TA patients diagnosed with pulmonary thromboembolism previously, who were administrated into Beijing Chaoyang Hospital from 2005 to 2012 due to the poor efifcacy of anticoagulant therapy.Results: Totally 9 cases were included. The main clinical manifestations included fever (5 cases), fatigue (3 cases), sweating (2 cases), dizziness/syncope (5 cases), cold/numbness (2 cases); respiratory symptoms included dyspnea (8 cases), cough (5 cases), chest pain (5 cases) and hemoptysis (5 cases). CT examination showed pulmonary vascular disease mainly presenting as stenosis, occlusion and expansion.Conclusion:The clinical manifestations of TA with pulmonary vascular involvement are diverse. CT pulmonary vascular screening is a better method to relfect the characteristics and the extent of disease. Treatment should be based on activity of the disease and steroid and immunosuppressants are still the main medicine in the treatment of active TA.

BACKGROUND:No data on the incidence of pleural effusion (PE) in Chinese patients with pulmonary embolism are available to date. The aim of the current study was to investigate the frequency of PE in a Chinese population of patients with pulmonary embolism.METHODS:This was a retrospective observational single-center study. All data of computed tomography pulmonary angiography (CTPA) performed over 6-year period on adult patients with clinically suspected pulmonary embolism were analyzed.RESULTS:From January 2008 until December 2013, PE was identified in 423 of 3141 patients (13.5%) with clinically suspected pulmonary embolism who underwent CTPA. The incidence of PE in patients with pulmonary embolism (19.9%) was significantly higher than in those without embolism (9.4%) (P < 0.001). Majority of PEs in pulmonary embolism patients were small to moderate and were unilateral. The locations of emboli and the numbers of arteries involved, CT pulmonary obstruction index, and parenchymal abnormalities at CT were not associated with the development of PE.CONCLUSIONS:PEs are present in about one fifth of a Chinese population of patients with pulmonary embolism, which are usually small, unilateral, and unsuitable for diagnostic thoracentesis.