A rare case of Interstitial lung disease complicated by overlapping syndrome with obstructive ventilatory dysfunction as the first symptom

Interstitial lung disease is often a serious complication of connective tissue disease（CTD）, representing the first cause of death in CTD. However, there are few reports of SSc-RA overlap-associated interstitial pneumonia. Respiratory dysfunction as the first clinical manifestation is even rarely reported. We herein described a case of a male patient who developed significant respiratory dysfunction as the principal clinical sign for the past 6 months, plus newly developed skin thickening in bilateral upper limbs and pain and swelling of multiple joints for the past 6 weeks. Extensive immunological screening showed high titer of antinuclear antibodies(ANA), rheumatoid factor(RF), anti-cyclic peptide containing citrulline (anti-CCP)，and positive anti-Scl-70 antibody. Chest high resolution computed tomography(HRCT) was performed and hence ILD was confirmed. Pulmonary function test (PFT) revealed obstructive ventilatory dysfunction rather than restrictive ventilatory dysfunction. So bronchodilation test was performed and asthma was considered. Finally, after a multidisciplinary team (MDT) discussion, the diagnosis of asthma and ILD associated with SSc-RA overlap was established. It is important to note that CTD associated pulmonary interstitial fibrosis must be considered as the differential diagnosis of any newly diagnosed interstitial pulmonary disease. In addition, if patient with dyspnea is highly suspicious of pulmonary interstitial fibrosis, bronchodilation test is still needed to exclude asthma in order to avoid misdiagnosis.

An unusual tracheal foreign body in a middle-aged male with a 15-year history of coal use: a case report

Background Long-term exposure to coal dust causes respiratory disease. In chest computer tomography (CT), pulmonary nodules, pulmonary interstitial fibrosis and emphysema manifest themselves. However, tracheal foreign bodies caused by coal dust are rarely reported. In this study, we report a special case of a tracheal coal foreign body, in which the patient has neither a history of coal work nor foreign body inhalation. Case presentation A 49-year-old man was diagnosed with chronic obstructive pulmonary disease (COPD) due to chronic cough and exertional dyspnoea. His symptoms gradually worsened despite treatment for COPD. Chest radiograph and CT images showed an irregular high-density nodule inserting fromthe trachea into the right thyroid at approximately the level of the 7th cervical vertebra. Fiberoptic bronchoscopy revealed that the tracheal lumen was mostly blocked. After the surgery, the energy spectrum CT quantitative analysis showed that the foreign body was likely that of a bituminous coal specimen. Conclusions For cases in which a foreign body in the airway is highly suspected, early fiberoptic bronchoscopy and radiographic examinations should be performed as soon as possible to avoid misdiagnosis and ensure timely treatment.

SARS-CoV-2 triggers inflammatory responses and cell death through caspase-8 activation

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can lead to respiratory illness and multi-organ failure in critically ill patients. Although the virus-induced lung damage and inflammatory cytokine storm are believed to be directly associated with coronavirus disease 2019 (COVID-19) clinical manifestations, the underlying mechanisms of virus-triggered inflammatory responses are currently unknown. Here we report that SARS-CoV-2 infection activates caspase-8 to trigger cell apoptosis and inflammatory cytokine processing in the lung epithelial cells. The processed inflammatory cytokines are released through the virus-induced necroptosis pathway. Virus-induced apoptosis, necroptosis, and inflammation activation were also observed in the lung sections of SARS-CoV-2-infected HFH4-hACE2 transgenic mouse model, a valid model for studying SARS-CoV-2 pathogenesis. Furthermore, analysis of the postmortem lung sections of fatal COVID-19 patients revealed not only apoptosis and necroptosis but also massive inflammatory cell infiltration, necrotic cell debris, and pulmonary interstitial fibrosis, typical of immune pathogenesis in the lung. The SARS-CoV-2 infection triggered a dual mode of cell death pathways and caspase-8-dependent inflammatory responses may lead to the lung damage in the COVID-19 patients. These discoveries might assist the development of therapeutic strategies to treat COVID-19.

Risk factors for pulmonary interstitial fibrosis in patients with systemic sclerosis

Background Pulmonary interstitial fibrosis (PIF) is a frequent manifestation of systemic sclerosis (SSc). However, there is a lack of good clinical indicators for predicting PIF. Here, we evaluated autoantibodies and clinical phenotypes to predict the involvement of PIF in SSc. Methods Peripheral blood was collected from the 86 SSc patients enrolled in this study to detect autoantibodies. PIF, lung function, and heart function were analyzed by lung high-resolution computed tomography, pulmonary function test, and standard transthoracic echocardiography, respectively. The correlation between autoantibodies, clinical phenotype, and internal organ involvement were summarized. Results PIF occurred in 68.4% anti-SCL-70 antibody positive SSc patients (p = 0.0045), 59.8% anti-centromere antibody negative SSc patients (p = 0.0013), and 71.4% anti-SSA antibody positive SSc patients (p = 0.0107). PIF occurred in 94.1% anti-SCL-70 antibody and anti-SSA antibody double positive SSc patients, which was higher than in anti-SCL-70 antibody single positive patients, p = 0.0452. More SSc patients with digital ulcers had PIF (73.5%) than SSc patients without digital ulcers (p = 0.0008). Conclusion These data suggest that SSc patients with double positive for anti-SCL-70 and anti-SSA antibodies are more prone to develop PIF. In addition, digital ulcers are an important and convenient predictor for PIF in SSc patients.

Analysis of 4 imaging features in patients with COVID-19

Background : The aim of this was to analyze 4 chest CT imaging features of patients with coronavirus disease 2019 (COVID-19) in Shenzhen, China so as to improve the diagnosis of COVID-19. Methods: Chest CT of 34 patients with COVID-19 confirmed by the nucleic acid test (NAT) were retrospectively analyzed. Analyses were performed to investigate the pathological basis of four imaging features(“feather sign”,“dandelion sign”,“pomegranate sign”, and “rime sign”) and to summarize the follow-up results. Results: There were 22 patients (65.2 %) with typical “feather sign”and 18 (52.9%) with “dandelion sign”, while few patients had “pomegranate sign” and “rime sign”. The “feather sign” and “dandelion sign” were composed of stripe or round ground-glass opacity(GGO), thickened blood vessels, and small-thickened interlobular septa. The “pomegranate sign” was characterized as follows: the increased range of GGO, the significant thickening of the interlobular septum, complicated with a small amount of punctate alveolar hemorrhage. The “rime sign” was characterized by numerous alveolar edemas. Microscopically, the wall thickening, small vascular proliferation, luminal stenosis, and occlusion, accompanied by interstitial infiltration of inflammatory cells, as well as numerous pulmonary interstitial fibrosis and partial hyaline degeneration were observed. Repeated chest CT revealed the mediastinal lymphadenectasis in one patient. Re-examination of the NAT showed another positive anal swab in two patients. Conclusion: “Feather sign” and “dandelion sign” were typical chest CT features in patients with COVID-19; “pomegranate sign” was an atypical feature, and “rime sign” was a severe feature. In clinical work, accurate identification of various chest CT signs can help to improve the diagnostic accuracy of COVID-19 and reduce the misdiagnosis or missed diagnosis rate.

Analysis of 4 imaging features in patients with COVID-19

Background: The aim of this was to analyze 4 chest CT imaging features of patients with coronavirus disease 2019 (COVID-19) in Shenzhen, China so as to improve the diagnosis of COVID-19.Methods: Chest CT of 34 patients with COVID-19 confirmed by the nucleic acid test (NAT) were retrospectively analyzed. Analyses were performed to investigate the pathological basis of four imaging features(“feather sign”,“dandelion sign”,“pomegranate sign”, and “rime sign”) and to summarize the follow-up results.Results: There were 22 patients (65.2 %) with typical “feather sign”and 18 (52.9%) with “dandelion sign”, while few patients had “pomegranate sign” and “rime sign”. The “feather sign” and “dandelion sign” were composed of stripe or round ground-glass opacity(GGO), thickened blood vessels, and small-thickened interlobular septa. The “pomegranate sign” was characterized as follows: the increased range of GGO, the significant thickening of the interlobular septum, complicated with a small amount of punctate alveolar hemorrhage. The “rime sign” was characterized by numerous alveolar edemas. Microscopically, the wall thickening, small vascular proliferation, luminal stenosis, and occlusion, accompanied by interstitial infiltration of inflammatory cells, as well as numerous pulmonary interstitial fibrosis and partial hyaline degeneration were observed. Repeated chest CT revealed the mediastinal lymphadenectasis in one patient. Re-examination of the NAT showed another positive anal swab in two patients.Conclusion: “Feather sign” and “dandelion sign” were typical chest CT features in patients withCOVID-19; “pomegranate sign” was an atypical feature, and “rime sign” was a severe feature. In clinical work, accurate identification of various chest CT signs can help to improve the diagnostic accuracy of COVID-19 and reduce the misdiagnosis or missed diagnosis rate.

The effect of Wogonoside on the expression of pulmonary fibrosis factor in Mycoplasma pneumoniae pneumonia

BACKGROUND Mycoplasma pneumoniae pneumonia (MPP) is an acute respiratory infectious pneumonia with pulmonary interstitial fibrosis. TGF-β1 is well accepted as the central mediator for fibrosis which promotes the formation of tissue fibrosis factor. Qinbaiqingfei pellet (Qinbai) has already been approved as the first effective new traditional Chinese medicine which can delay activities of Mycoplasma pneumoniae (M.pneumoniae) and protect lung epithelial cells in clinical trials. However, the mechanism of Qinbai inhibiting the expression of TGF-β1 is still unclear. METHODS The Chinese herbs in Qinbai were screened by surface plasmon resonance (SPR) and it was deteimined that Scutellaria baicalensis extracts in Qinbai showed the best binding with TGF-β1. Then the active ingredient whicn can be bound with TGF-β1 protein in the solution of Qinbai and Scutellaria baicalensis was isolated and analyzed by UPLC-Q-TOF-MS, which proved the active ingredient was Wogonoside. The affinity constant of Wogonoside and TGF-β1 protein was measured by SPR affinity analysis. A549 cells infected with M.pneumoniae were intervened by Wogonoside, and then the expression of TGF-β1 and Smad3 in A549 cells were analyzed by PCR and western blotting. RESULTS The results showed the bound effect of Scutellaria baicalensis and TGF-β1 was effective. The active ingredients which can be bound with TGF-β1 in the solution of Scutellaria baicalensis and Qinbai were obtained and analyzed to investigate the mechanism of Qinbai inhibiting the expression of TGF-β1. UPLC-Q-TOF-MS results showed that the active ingredients was Wogonoside. SPR affinity analysis showed that the affinity constant was 21.71 µM. Pharmacological experiments revealed that Wogonoside strongly inhibited the expression of TGF-β1 and Smad3 in A549 cells infected by M.pneumoniae. CONCLUSION Wogonoside in Qinbai can be bound with TGF-β1 and down-regulate the expression of lung fibrosis factors TGF-β1 and Smad3. The finding may improve our understanding the molecular mechanism of Qinbai mediating MPP and provide new sights into the future pharmacological investigation of Qinbai.

The effect of Wogonoside on the expression of pulmonary fibrosis factor in Mycoplasma pneumoniae pneumonia

BACKGROUND Mycoplasma pneumoniae pneumonia (MPP) is an acute respiratory infectious pneumonia with pulmonary interstitial fibrosis. TGF-β1 is well accepted as the central mediator for fibrosis which promotes the formation of tissue fibrosis factor. Qinbaiqingfei pellet (Qinbai) has already been approved as the first effective new traditional Chinese medicine which can delay activities of Mycoplasma pneumoniae (M.pneumoniae) and protect lung epithelial cells in clinical trials. However, the mechanism of Qinbai inhibiting the expression of TGF-β1 is still unclear. METHODS The Chinese herbs in Qinbai were screened by surface plasmon resonance (SPR) and it was deteimined that Scutellaria baicalensis extracts in Qinbai showed the best binding with TGF-β1. Then the active ingredient whicn can be bound with TGF-β1 protein in the solution of Qinbai and Scutellaria baicalensis was isolated and analyzed by UPLC-Q-TOF-MS, which proved the active ingredient was Wogonoside. The affinity constant of Wogonoside and TGF-β1 protein was measured by SPR affinity analysis. A549 cells infected with M.pneumoniae were intervened by Wogonoside, and then the expression of TGF-β1 and Smad3 in A549 cells were analyzed by PCR and western blotting. RESULTS The results showed the bound effect of Scutellaria baicalensis and TGF-β1 was effective. The active ingredients which can be bound with TGF-β1 in the solution of Scutellaria baicalensis and Qinbai were obtained and analyzed to investigate the mechanism of Qinbai inhibiting the expression of TGF-β1. UPLC-Q-TOF-MS results showed that the active ingredients was Wogonoside. SPR affinity analysis showed that the affinity constant was 21.71 µM. Pharmacological experiments revealed that Wogonoside strongly inhibited the expression of TGF-β1 and Smad3 in A549 cells infected by M.pneumoniae. CONCLUSION Wogonoside in Qinbai can be bound with TGF-β1 and down-regulate the expression of lung fibrosis factors TGF-β1 and Smad3. The finding may improve our understanding the molecular mechanism of Qinbai mediating MPP and provide new sights into the future pharmacological investigation of Qinbai.

Analysis of 4 imaging features in patients with COVID-19

Purpose: This study aimed to analyze 4 chest CT imaging features of patients with coronavirus disease 2019 (COVID-19) in Shenzhen, China in order to improve the diagnosis of COVID-19 . Methods: Chest CT of 34 patients with COVID-19 confirmed by the nucleic acid test (NAT) were retrospectively analyzed. A nalyses were performed to investigate the pathological basis of 4 imaging features ( “feather sign” , “dandelion sign” , “pomegranate sign”, and “rime sign” ) and to summarize the follow-up results. Results: There were 22 patients (65.2 %) with typical “feather sign”, and 18 (52.9 %) with “dandelion sign”; few patients had “pomegranate sign”, and “rime sign”. The“feather sign” and “dandelion sign” were composed of stripe or round ground-glass opacity ( GGO ) , thickened blood vessels, and small-thickened interlobular septa. The “pomegranate sign” can be characterized as follows: the range of GGO further increases, the thickening of the interlobular septum become more significant, complicated with a small amount of punctate alveolar hemorrhage . The “rime sign” is characterized by numerous alveolar edema. Microscopically, the wall thickening, small vascular proliferation, luminal stenosis, and occlusion are seen, accompanied by interstitial infiltration of inflammatory cells, as well as numerous pulmonary interstitial fibrosis and partial hyaline degeneration. Repeated chest CT revealed the mediastinal lymphadenectasis in one patient. Re-examination of the NAT showed another positive anal swab in two patients . Conclusion: “Feather sign” and “dandelion sign” were typical chest CT features of COVID-19; “pomegranate sign” was an atypical feature, and “rime sign” was a severe feature . In clinical work, accurate identification of various chest CT signs in can help to improve the diagnostic accuracy of COVID-19 and reduce the misdiagnosis or missed diagnosis rate.

Exploring the diagnostic value of multilayer spiral computed tomography (MSCT) in thoracogastric airway fistula

Background Thoracostomach-airway fistula is a rare complication of esophageal-cancer resection. We intended to explore the diagnostic value of multilayer spiral computed tomography (MSCT) in thoracostomach-airway fistula, to enhance its clinical understanding; evaluate an effective, convenient, and non-invasive diagnostic method; and provide the fundamentals for subsequent treatment. Methods The MSCT images and complete clinical data of 216 consecutive patients diagnosed with thoracogastric airway fistula were retrospectively analyzed. Results MSCT was able to determine the exact location, size of the fistula, and the adjacent bronchus between the fistula and bronchus in 192 out of 216 patients with thoracogastric airway fistula. All patients had pulmonary lesions including emphysema (n=68), ground glass density (n=25), bronchial wall thickening (n=28), patchy high densities along the lung texture (n=207), pulmonary consolidation (n=104), atelectasis (n=11), pulmonary nodules (n=53), bronchiectasis (n=19), lobular septal thickening (n=5), cavity (n=14), and pulmonary interstitial fibrosis (n=6). Further, 95 cases showed pleural effusion, 184 showed pleural thickening, 4 had pneumothorax, and 2 had subcutaneous pneumothorax. 12 patients with thoracogastric airway fistula had anastomotic wall thickening (mean: 20.63±9.57, range: 9.19–43.37 mm), while 13 patients showed thoracic gastric wall thickening (mean: 22.83(±)5.58 mm, range: 12.32–31.24 mm) on. 23 patients showed distant metastasis on MSCT. Conclusions MSCT can accurately display the location and size of thoracogastric airway fistula, as well as lung lesions, tumor recurrence, and distant metastasis, and provide the basis for the next therapy.