Clinical Respiratory Journal最新文献

Immunotherapy Improves the Survival of Stage 4 Non–Small Cell Lung Cancer Patients at the US Population Level: The Real-World Evidence 免疫疗法提高了美国非小细胞肺癌 4 期患者的生存率：真实世界的证据

IF 1.9 4区医学 Q3 RESPIRATORY SYSTEM

Clinical Respiratory Journal

Pub Date : 2024-09-14 DOI: 10.1111/crj.70000

Yuxuan Wei, Rui Zhang, Ruikang Yin, Shijie Wang, Jianglong Han, Ruyan Chen, Zhenming Fu

Introduction

Immunotherapy has revolutionized the management of lung cancer and improved lung cancer survival in trials, but its real-world impact at the population level remains unclear.

Methods

Using data obtained from eight Surveillance, Epidemiology, and End Results (SEER) registries from 2004 through 2019, we addressed the long-term trends in the incidence, incidence-based mortality (IBM), and survival of lung cancer patients in the United States.

Results

The incidence and IBM of both non–small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) all significantly decreased steadily from 2004 to 2019. The 1-year survival (1-YS) of both NSCLC and SCLC improved over time, with the best improvement observed for Stage 4 NSCLC. Two significant turning points of Stage 4 NSCLC 1-YS were observed over the years: 0.63% (95% confidence interval [CI]: 0.33%–0.93%) from 2004 to 2010, 0.81% (95% CI: 0.41%–1.21%) from 2010 to 2014 and a striking 2.09% (95% CI: 1.70%–2.47%) from 2014 to 2019. The same two turning points in 1-YS were pronounced for Stage 4 NSCLC in women, which were coincident with the introduction of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) and immunotherapy. However, for Stage 4 NSCLC in men, only one significant turning point in the 1-YS starting in 2014 was found, which might only correspond to immunotherapy. Significant period effects in reduced IBM were also observed for both Stage 4 AD and Stage 4 SQCC during the period.

Conclusion

This SEER analysis found that immunotherapy improved the survival of Stage 4 NSCLC patients at the population level in the United States. This real-world evidence confirms that immunotherapy has truly revolutionized the management of lung cancer.

引言免疫疗法在肺癌治疗方面带来了革命性的变化，并在试验中提高了肺癌的生存率，但其在人群中的实际影响仍不清楚。方法我们利用从 2004 年到 2019 年的 8 个监测、流行病学和最终结果（SEER）登记处获得的数据，研究了美国肺癌患者的发病率、基于发病率的死亡率（IBM）和生存率的长期趋势。结果从 2004 年到 2019 年，非小细胞肺癌（NSCLC）和小细胞肺癌（SCLC）的发病率和 IBM 均显著稳步下降。随着时间的推移，非小细胞肺癌和小细胞肺癌的 1 年生存率（1-YS）都有所提高，其中第 4 期非小细胞肺癌的提高幅度最大。多年来，NSCLC 四期的 1 年生存率出现了两个重要转折点：2004年至2010年为0.63%（95%置信区间[CI]：0.33%-0.93%），2010年至2014年为0.81%（95%置信区间：0.41%-1.21%），2014年至2019年为惊人的2.09%（95%置信区间：1.70%-2.47%）。1-YS的两个转折点同样明显地出现在女性NSCLC四期患者中，这两个转折点与表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKIs）和免疫疗法的引入相吻合。然而，在男性 NSCLC 4 期患者中，只发现了一个从 2014 年开始的 1-YS 显著转折点，这可能只与免疫疗法有关。在此期间，4 期 AD 和 4 期 SQCC 也观察到了 IBM 降低的显著时期效应。结论 SEER 的这项分析发现，在美国，免疫疗法在人群水平上提高了 NSCLC 4 期患者的生存率。这一真实世界的证据证实，免疫疗法确实为肺癌的治疗带来了革命性的变化。

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引用次数: 0

Atezolizumab-Induced Immune-Related Pneumonia on Rounded Atelectasis 阿特珠单抗诱发的圆形气胸免疫相关肺炎

IF 1.9 4区医学 Q3 RESPIRATORY SYSTEM

Clinical Respiratory Journal

Pub Date : 2024-09-03 DOI: 10.1111/crj.70008

Satoru Yanagisawa, Takaya Yui, Hiroki Takechi, Satoshi Wasamoto

<p>Dear editor:</p><p>An 82-year-old man with a heavy smoking history (35 pack-years) was diagnosed with right upper lung small cell lung cancer (extensive-disease, cT1cN3M1c: cStage IVB, LYM, OSS, HEP) in June 2023. He was a retired electrician who had been exposed to construction dust and asbestos fibers for decades. Chest computed tomography (CT) revealed partially calcified pleural plaques and posterior left lower lobe rounded atelectasis (RA) with “comet tail sign” [<span>1</span>] (Figure 1A,B). Retrospectively, the RA appeared to remain the same shape and size since 2017. Positron emission tomography revealed <sup>18</sup>F-fluorodeoxyglucose uptake in the right upper lobe primary tumor, but not in the pleural plaque or RA (Figure 1C–E). Subsequently, the patient was treated with carboplatin/etoposide plus atezolizumab as first-line chemotherapy in July 2023. Soon after atezolizumab infusion, he developed a transient fever; thereafter, he gradually complained of worsening dyspnea on exertion, with mild desaturation. On day 9 after chemotherapy induction, chest CT showed a new-onset consolidative shadow on the left lower lung that appeared around the preexisting RA (Figure 2A,B). The laboratory test results, including infectious serology and culture results, were unremarkable. Additional inflammatory serologies (antinuclear and antineutrophil cytoplasmic antibodies) were negative. Due to hypoxemia, further diagnostic studies, such as bronchoscopy, could not be conducted. We suspected that the lesion was consistent with atezolizumab-induced interstitial lung disease (immune-related adverse event [irAE]) and started intravenous prednisolone (40 mg daily). After the initiation of steroid treatment, his hypoxemia and lung shadow were almost completely cleared (Figure 2C,D), which supported the diagnosis of irAE pneumonia in RA. We decided to refrain from atezolizumab treatment and continued carboplatin/etoposide therapy alone without recurrence of irAEs.</p><p>RA [<span>2</span>], also known as “folded lung” or “Blesovsky's syndrome,” is a subtype of lung atelectasis caused by invagination of the redundant visceral pleura [<span>3</span>]. Although most RA are believed to be associated with asbestos lung exposure [<span>4</span>], it is sometimes difficult to differentiate RA from other asbestos exposure-associated malignant diseases such as lung cancer and malignant pleural mesothelioma [<span>5</span>]. RA usually maintains the same volume and even shrinks on serial scans [<span>4-6</span>], which supports the benign feature of the lesion and justifies careful follow-up without intervention. However, there are some reports of RA that gradually enlarge and eventually necessitate surgical biopsy or excision [<span>7</span>]. Although the precise mechanism of RA enlargement is yet to be elucidated, persistent chronic pleural inflammation may be associated. In our case, subpleural consolidation around the RA expanded after the initiation of atezo

亲爱的编辑：一位有严重吸烟史（35 包年）的 82 岁男性于 2023 年 6 月被诊断为右上肺小细胞肺癌（广泛病变，cT1cN3M1c：c IVB 期，LYM，OSS，HEP）。他是一名退休电工，数十年来一直接触建筑粉尘和石棉纤维。胸部计算机断层扫描（CT）显示部分钙化胸膜斑块和左下叶后部圆形脑积水（RA），并伴有 "彗尾征"[1]（图 1A、B）。回想起来，自2017年以来，RA的形状和大小似乎保持不变。正电子发射断层扫描显示右上叶原发肿瘤摄取18F-氟脱氧葡萄糖，但胸膜斑块或RA未摄取18F-氟脱氧葡萄糖（图1C-E）。随后，患者于2023年7月接受了卡铂/依托泊苷加阿特珠单抗的一线化疗。输注阿特珠单抗后不久，他出现了一过性发热；此后，他逐渐主诉劳累时呼吸困难加重，并伴有轻度饱和度降低。化疗诱导后第9天，胸部CT显示左下肺出现新发合并影，出现在原有RA周围（图2A,B）。实验室检查结果，包括感染血清学和培养结果，均无异常。其他炎症血清学检查（抗核抗体和抗中性粒细胞胞浆抗体）均为阴性。由于低氧血症，无法进行进一步的诊断检查，如支气管镜检查。我们怀疑该病变与阿特珠单抗诱发的间质性肺病（免疫相关不良事件[irAE]）一致，并开始静脉注射泼尼松龙（每天40毫克）。开始类固醇治疗后，他的低氧血症和肺部阴影几乎完全消失（图2C,D），这支持了RAirAE肺炎的诊断。RA[2]又称 "折叠肺 "或 "Blesovsky综合征"，是由多余的内脏胸膜内陷引起的肺大泡的一种亚型[3]。虽然大多数 RA 被认为与石棉肺暴露有关[4]，但有时很难将 RA 与其他与石棉暴露有关的恶性疾病（如肺癌和恶性胸膜间皮瘤）区分开来[5]。在连续扫描中，RA 的体积通常保持不变，甚至会缩小[4-6]，这支持了病变的良性特征，因此有理由在不进行干预的情况下进行仔细随访。不过，也有一些 RA 逐渐增大，最终需要手术活检或切除的报道[7]。虽然 RA 扩大的确切机制尚未阐明，但持续的慢性胸膜炎症可能与此有关。在我们的病例中，开始使用阿特珠单抗治疗后，RA 周围的胸膜下合并症扩大，可能是 RA 周围的胸膜损伤导致了虹膜急性外膜炎肺炎的发生。Sakata 等人报道了滑石粉胸膜穿刺术后发生的 nivolumab 诱导的严重间质性肺炎[8]。他们推测，nivolumab 可能夸大了滑石粉诱导的胸膜间皮细胞损伤，化学炎症最终导致了严重的间质性肺炎。尽管石棉相关的RA通常被认为是一种陈旧性炎症改变，但它可能是一种潜伏期，有可能在使用免疫检查点抑制剂（ICIs）后发作。总之，这是一例阿特珠单抗诱发的irAE肺炎，发生在一名RA患者身上。由于石棉暴露与 RA 相关，因此适当诊断药物诱导的肺炎非常重要，因为这可能会夸大已存在的 RA。此外，在接受 ICIs 治疗后，与 RA 相关的胸膜炎症可能会变得明显。所有作者均审阅了本稿件，并同意提交本稿件。

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引用次数: 0

Bronchoscopic Interventional Therapy Combined With Pembrolizumab in the Treatment of Pulmonary Large Cell Neuroendocrine Carcinoma: A Case Report 支气管镜介入疗法联合 Pembrolizumab 治疗肺大细胞神经内分泌癌：病例报告。

IF 1.9 4区医学 Q3 RESPIRATORY SYSTEM

Clinical Respiratory Journal

Pub Date : 2024-09-03 DOI: 10.1111/crj.70009

Yingyi Fan, Yingying Wang, Yanrong Ji, Shuang Li, Jian Zhang, Xingliang Hao

This study reports a significant clinical outcome following the use of bronchoscopic interventional therapy combined with pembrolizumab for treating pulmonary large cell neuroendocrine carcinoma (LCNEC), showcasing a novel approach in managing this aggressive cancer.

这项研究报告了使用支气管镜介入疗法联合 pembrolizumab 治疗肺大细胞神经内分泌癌（LCNEC）后取得的显著临床疗效，展示了一种治疗这种侵袭性癌症的新方法。

引用次数: 0

Analysis of Depression and Anxiety Scores Following Initiation of Elexacaftor/Tezacaftor/Ivacaftor in Adults With Cystic Fibrosis 囊性纤维化成人患者开始使用 Elexacaftor/Tezacaftor/Ivacaftor 后的抑郁和焦虑评分分析

IF 1.9 4区医学 Q3 RESPIRATORY SYSTEM

Clinical Respiratory Journal

Pub Date : 2024-08-29 DOI: 10.1111/crj.70007

Harish Pudukodu, Margret Z. Powell, Agathe Ceppe, Scott H. Donaldson, Jennifer L. Goralski, Nathaniel A. Sowa

Objective

Elexacaftor/tezacaftor/ivacaftor (E/T/I) has provided life-changing pharmacotherapy for many people with cystic fibrosis (CF), but conflicting literature exists regarding the effect on mental health. While some reports suggest E/T/I may induce adverse psychiatric symptoms, others report improvements in mental health symptoms. To add to this growing body of knowledge, we retrospectively analyzed depression and anxiety symptoms before and after E/T/I initiation in adults with CF at a single large US CF center.

Method

Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scores recorded in a database were studied. Patients with scores collected before and after E/T/I initiation were included. Regression analyses described associations between score changes and age, race, ethnicity, sex, CFTR variant, and prior depression and/or anxiety diagnoses. Secondary analyses examined possible confounding effects of the COVID-19 pandemic.

Results

There was no change in mean GAD-7 (0.5 ± 5.3, p = 0.41) or PHQ-9 (−0.02 ± 6.0, p = 0.97) scores following initiation of E/T/I (N = 86). A trend between a prior diagnosis of depression and worsening in PHQ-9 post-E/T/I was observed (OR 3.58; p = 0.054).

Conclusions

Treatment with E/T/I does not lead to changes in depression or anxiety symptoms at the population level in this single center cohort study. A prior diagnosis of depression trended towards an increased odds of worsening PHQ-9 scores after E/T/I initiation.

目的 Elexacaftor/tezacaftor/ivacaftor（E/T/I）为许多囊性纤维化（CF）患者提供了改变生活的药物治疗，但关于其对心理健康的影响，存在相互矛盾的文献。一些报告显示 E/T/I 可能会诱发不良精神症状，而另一些报告则显示精神健康症状有所改善。为了增加这方面的知识，我们在美国一家大型 CF 中心对成年 CF 患者开始使用 E/T/I 前后的抑郁和焦虑症状进行了回顾性分析。方法对数据库中记录的患者健康问卷-9（PHQ-9）和广泛性焦虑症-7（GAD-7）评分进行研究。研究对象包括在使用 E/T/I 之前和之后收集到分数的患者。回归分析描述了分数变化与年龄、种族、民族、性别、CFTR 变体以及既往抑郁和/或焦虑诊断之间的关联。二次分析研究了 COVID-19 大流行可能造成的混杂影响。结果在开始使用 E/T/I 后，GAD-7（0.5 ± 5.3，p = 0.41）或 PHQ-9 （-0.02 ± 6.0，p = 0.97）平均得分没有变化（N = 86）。E/T/I治疗后，先前的抑郁症诊断与PHQ-9恶化之间存在趋势（OR 3.58; p = 0.054）。结论在这项单中心队列研究中，E/T/I 治疗不会导致人群抑郁或焦虑症状发生变化。既往诊断为抑郁症的患者在开始使用 E/T/I 后 PHQ-9 评分恶化的几率呈上升趋势。

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引用次数: 0

A methylation-related lncRNA-based prediction model in lung adenocarcinomas 基于甲基化相关 lncRNA 的肺腺癌预测模型

IF 1.9 4区医学 Q3 RESPIRATORY SYSTEM

Clinical Respiratory Journal

Pub Date : 2024-08-26 DOI: 10.1111/crj.13753

Kun Yang, Hao Liu, Jun Hai Li

Background

The collaboration between methylation and the lung adenocarcinoma (LUAD) occurrence and development is closes. Long noncoding RNA (lncRNA), as a regulatory factor of various biological functions, can be used for cancer diagnosis. Our study aimed to construct a robust methylation-related lncRNA signature of LUAD.

Methods

In the Cancer Genome Atlas (TCGA) dataset, we download the RNA expression data and clinical information of LUAD cases. To develop the best prognostic signature based on methylation-related lncRNAs, Cox regression analyses were utilized. Using Kaplan–Meier analysis, overall survival rates were compared between risk category included both low- and high-risk patients. To categorize genes according to their functional significance, GSEA (Subramanian et al, 2005) was used. Single-sample gene set enrichment analysis (ssGSEA) was used to further reveal the potential molecular mechanism of the methylation-related lncRNA prognostic model in immune infiltration. Using TRLnc (http://www.licpathway.net/TRlnc) and lncRNASNP to analyse the SNP sites and TRLnc of these 18 lncRNAs. LncSEA website was used to analyse 18 lncRNA in the process of tumour development and development. Go was used to analyse the enriched pathways enriched by TFs (transcription factors), Cerna networks, and proteins bound to each other of these 18 lncRNAs. The ‘prophetic’ package was used to analyse the value of this prognostic model in guiding personalized immunotherapy.

Results

In this study, we identified 18 methylation-related lncRNAs (AP002761.1, AL118558.3, CH17-340M24.3, AL353150.1, AC004687.1, LINC00996, AF186192.1, HSPC324, AC087752.3, FAM30A, AC106047.1, AC026355.1, ABALON, LINC01843, AL606489.1, NKILA, AP001453.2, GSEC) to establish a methylation-related lncRNA signature that can detect patients prognosis in LUAD. The enriched pathways enriched by proteins interacting with 18 lncRNAs are mainly EMT, hypoxia, stemness and proliferation, among which LINC00996 and AF186192.1 are regulated by multiple tumour associated transcription factors, such as TP53 and TP63, and fam30a and mRNA form a Cerna network. There are 2319 SNP loci in LINC00996, 36 of which are risk SNP loci and 205 SNP loci in af186192.1; AF186192.1 affects 95 conserved miRNAs and 123 non-conserved miRNAs, promotes the binding of 149 pairs of miRNAs: lncRNAs and inhibits the binding of 95 pairs of miRNAs: lncRNAs. The ROC curve demonstrated that the established methylation-related lncRNA signature was more effective in predicting the prognosis of patients in LUAD than the clinicopatholog

背景：甲基化与肺腺癌（LUAD）的发生和发展之间的关系已接近尾声。长非编码 RNA（lncRNA）作为多种生物功能的调控因子，可用于癌症诊断。我们的研究旨在构建与甲基化相关的LUAD lncRNA特征：在癌症基因组图谱（TCGA）数据集中，我们下载了LUAD病例的RNA表达数据和临床信息。为了建立基于甲基化相关lncRNA的最佳预后特征，我们采用了Cox回归分析。通过Kaplan-Meier分析，比较了不同风险类别（包括低风险和高风险患者）的总生存率。为了根据基因的功能意义对其进行分类，采用了 GSEA（Subramanian 等人，2005 年）。单样本基因组富集分析（ssGSEA）被用来进一步揭示甲基化相关lncRNA预后模型在免疫浸润中的潜在分子机制。利用TRLnc（http://www.licpathway.net/TRlnc）和lncRNASNP分析这18个lncRNA的SNP位点和TRLnc。利用 LncSEA 网站分析肿瘤发生和发展过程中的 18 个 lncRNA。Go 用于分析这 18 个 lncRNA 的 TF（转录因子）、Cerna 网络和相互结合的蛋白质所富集的通路。预言 "软件包用于分析这一预后模型在指导个性化免疫疗法方面的价值：在这项研究中，我们发现了18个与甲基化相关的lncRNA（AP002761.1、AL118558.3、CH17-340M24.3、AL353150.1、AC004687.1、LINC00996、AF186192.1、HSPC324、AC087752.3、FAM30A、AC106047.1、AC026355.1、ABALON、LINC01843、AL606489.1、NKILA、AP001453.2、GSEC）来建立一个甲基化相关的lncRNA特征，以检测LUAD患者的预后。与18个lncRNA相互作用的蛋白质所富集的通路主要是EMT、缺氧、干性和增殖，其中LINC00996和AF186192.1受TP53和TP63等多种肿瘤相关转录因子调控，fam30a与mRNA形成Cerna网络。LINC00996中有2319个SNP位点，其中36个为风险SNP位点，af186192.1中有205个SNP位点；AF186192.1影响95个保守miRNA和123个非保守miRNA，促进149对miRNA：lncRNA的结合，抑制95对miRNA：lncRNA的结合。ROC曲线显示，已建立的甲基化相关lncRNA特征在预测LUAD患者预后方面比临床病理参数更有效。我们的研究证实，基于甲基化相关lncRNA的风险评分模型分出的高危组患者的OS较短。根据GSEA，高危组主要富集了肿瘤和免疫相关通路。ssGSEA显示，LUAD患者的预测特征与免疫状态之间存在明显关联。此外，主成分分析（PCA）证明了我们的特征具有预后和预测价值。甲基化相关lncRNA预测特征与常规化疗药物IC50之间的相关性可为LUAD患者提供个性化的化疗方案。甲基化相关lncRNA特征能有效预测LUAD患者的DFS。

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引用次数: 0

Increased Frequency of Angiotensin-Converting Enzyme D Allele in Asian Patients With Chronic Obstructive Pulmonary Disease: An Updated Meta-Analysis 亚洲慢性阻塞性肺病患者血管紧张素转换酶 D 基因频率增加：最新的 Meta 分析。

IF 1.9 4区医学 Q3 RESPIRATORY SYSTEM

Clinical Respiratory Journal

Pub Date : 2024-08-26 DOI: 10.1111/crj.70002

Xiaozheng Wu, Wen Li, Zhenliang Luo, Yunzhi Chen

At present, the angiotensin-converting enzyme (ACE) I/D polymorphism was considered to be associated to the pathogenesis of chronic obstructive pulmonary disease (COPD). However, the association between it and the risk of COPD in different ethnic groups is still unclear. The purpose of this study is to conduct an updated meta-analysis of the association between them; collect literatures published before 10 February 2023 by searching PubMed, Embase, MEDLINE, CBM, CNKI, Wanfang, and VIP Chinese scientific databases; and display the analysis results by drawing forest plots. At the same time, publication bias, sensitivity analysis, and trial sequential analysis (TSA) were performed to evaluate the stability and reliability of the results. In the overall population, the result of the DD versus II model showed the association with the risk of COPD ([OR] = 1.30, 95% CI [1.08, 1.56]), and there were no associations in other genetic models (p > 0.05). In Caucasians, the results of all genetic models showed no associations (p > 0.05). In Asians, the results of D versus I, DD versus II, and DD versus II + ID models showed the associations with the risk of COPD (D vs. I: [OR] = 1.48, 95% CI [1.14, 1.93]; DD vs. II: [OR] = 2.04, 95% CI [1.53, 2.72]; DD vs. II + ID: [OR] = 2.19, 95% CI [1.45, 3.29]), while the results of ID versus II and DD + ID versus II models showed no associations (p > 0.05). Therefore, the D allele and “DD” genotype variation of the ACE I/D gene polymorphism are associated with susceptibility to COPD in Asians but not in Caucasians.

目前，血管紧张素转换酶（ACE）I/D 多态性被认为与慢性阻塞性肺病（COPD）的发病机制有关。然而，该多态性与不同种族人群罹患慢性阻塞性肺病的风险之间的关系仍不明确。本研究旨在通过检索PubMed、Embase、MEDLINE、CBM、CNKI、万方和VIP中文科学数据库，收集2023年2月10日之前发表的文献，并通过绘制森林图显示分析结果，从而对二者之间的相关性进行最新的荟萃分析。同时，还进行了发表偏倚、敏感性分析和试验序列分析（TSA），以评估结果的稳定性和可靠性。在总体人群中，DD 与 II 模型的结果显示与慢性阻塞性肺病的风险有关（[OR] = 1.30，95% CI [1.08，1.56]），其他遗传模型中没有相关性（P > 0.05）。在白种人中，所有遗传模型的结果都显示没有关联（P > 0.05）。在亚洲人中，D 与 I、DD 与 II 和 DD 与 II + ID 模型的结果显示与慢性阻塞性肺病的风险有关（D 与 I：[OR] = 1.48，95% CI [1.14，1.93]；DD 与 II：[OR] = 2.04，95% CI [1.53，2.72]；DD vs. II + ID：[OR] = 2.19，95% CI [1.45，3.29]），而 ID vs. II 和 DD + ID vs. II 模型的结果显示没有关联（P > 0.05）。因此，ACE I/D 基因多态性的 D 等位基因和 "DD "基因型变异与亚洲人的慢性阻塞性肺病易感性有关，但与白种人无关。

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引用次数: 0

Whole-Exome Sequencing and Experimental Validation Unveil the Roles of TMEM229A Q200del Mutation in Lung Adenocarcinoma 全基因组测序和实验验证揭示 TMEM229A Q200del 突变在肺腺癌中的作用

IF 1.9 4区医学 Q3 RESPIRATORY SYSTEM

Clinical Respiratory Journal

Pub Date : 2024-08-26 DOI: 10.1111/crj.70006

Yi-Xian Liang, Yan-Ping Xie, Huan-Ming Yu, Wen-Juan Zhu, Cheng-Yi Yin, Zhao-Hui Dong, Xi-Lin Zhang

Introduction

Lung adenocarcinoma (LUAD) is one of the major histopathological types of non-small cell lung cancer (NSCLC), including solid, acinar, lepidic, papillary and micropapillary subtypes. Increasing evidence has shown that micropapillary LUAD is positively associated with a higher percentage of driver gene mutations, a higher incidence of metastasis and a poorer prognosis, while lepidic LUAD has a relatively better prognosis. However, the novel genetic change and its underlying mechanism in the progression of micropapillary LUAD have not been exactly determined.

Methods

A total of 181 patients with LUAD who underwent surgery at the First Affiliated Hospital of Huzhou University from January 2020 to December 2022 were enrolled. Three predominant lepidic and three predominant micropapillary LUAD tissue samples were carried out using whole-exome sequencing. Comprehensive analysis of genomic variations and the difference between lepidic and micropapillary LUAD was performed. In addition, the TMEM229A Q200del mutation was verified using our cohort and TCGA-LUAD datasets. The correlations between the TMEM229A Q200del mutation and the clinicopathological characteristics of patients with LUAD were further analyzed. The functions and mechanisms of TMEM229A Q200del on NSCLC cell proliferation and migration were also determined.

Results

The frequency of genomic changes in patients with micropapillary LUAD was higher than that in patients with lepidic LUAD. Mutations in EGFR, ATXN2, C14orf180, MUC12, NOTCH1, and PKD1L2 were concomitantly detected in three predominant micropapillary and three predominant lepidic LUAD cases. The TMEM229A Q200del mutation was only mutated in lepidic LUAD. Additionally, the TMEM229A Q200del mutation had occurred in 16 (8.8%) patients, and not found TMEM229A R76H and M346T mutations in our cohort, while TMEM229A mutations (R76H, M346T, and Q200del) occurred only in 1.0% of the TCGA-LUAD cohort. Further correlation analysis between the TMEM229A Q200del mutation and clinicopathological characteristics suggested that a lower frequency of the Q200del mutation was significantly associated with positive lymph node metastasis, advanced TNM stage, positive cancer thrombus, and pathological features. Finally, overexpression of TMEM229A Q200del suppressed NSCLC cell proliferation and migration in vitro. Mechanistically, overexpression of TMEM229A and TMEM229A Q200del both reduced the expression level of phosphorylated (p)-ERK a

简介肺腺癌（LUAD）是非小细胞肺癌（NSCLC）的主要组织病理学类型之一，包括实性、尖锐性、鳞状、乳头状和微乳头状亚型。越来越多的证据表明，微乳头状 LUAD 与较高比例的驱动基因突变、较高的转移发生率和较差的预后呈正相关，而鳞状 LUAD 的预后相对较好。然而，微乳头状 LUAD 进展过程中的新型基因变化及其内在机制尚未确切确定：方法：选取2020年1月至2022年12月在湖州大学附属第一医院接受手术治疗的181例LUAD患者为研究对象。采用全外显子组测序技术，对 3 例优势鳞状上皮细胞和 3 例优势微乳头状上皮细胞 LUAD 组织样本进行了测序。对鳞状上皮癌和微乳头状上皮癌的基因组变异和差异进行了全面分析。此外，还利用我们的队列和TCGA-LUAD数据集验证了TMEM229A Q200del突变。研究还进一步分析了TMEM229A Q200del突变与LUAD患者临床病理特征之间的相关性。研究还确定了TMEM229A Q200del对NSCLC细胞增殖和迁移的功能和机制：结果：微乳头状 LUAD 患者的基因组变化频率高于鳞状 LUAD 患者。在三例占优势的微乳头状LUAD和三例占优势的鳞状LUAD病例中，同时检测到了表皮生长因子受体（EGFR）、ATXN2、C14orf180、MUC12、NOTCH1和PKD1L2的突变。TMEM229A Q200del突变仅在鳞状LUAD中出现。此外，TMEM229A Q200del突变发生在16例（8.8%）患者中，在我们的队列中未发现TMEM229A R76H和M346T突变，而在TCGA-LUAD队列中，TMEM229A突变（R76H、M346T和Q200del）仅发生在1.0%的患者中。TMEM229A Q200del突变与临床病理特征之间的进一步相关性分析表明，较低频率的Q200del突变与淋巴结转移阳性、TNM分期晚期、癌栓阳性和病理特征显著相关。最后，体外过表达 TMEM229A Q200del 可抑制 NSCLC 细胞的增殖和迁移。从机理上讲，过表达TMEM229A和TMEM229A Q200del都会降低磷酸化（p）-ERK和p-AKT（Ser473）的表达水平，而且与TMEM229A组相比，TMEM229A Q200del组p-ERK蛋白水平的降低更为明显：我们的研究结果表明，TMEM229A Q200del突变体可能通过使ERK通路失活而在LUAD的进展过程中发挥保护作用，为LUAD提供了一个潜在的治疗靶点。

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引用次数: 0

TFAP2A Activates S100A2 to Mediate Glutamine Metabolism and Promote Lung Adenocarcinoma Metastasis TFAP2A激活S100A2介导谷氨酰胺代谢并促进肺腺癌转移

IF 1.9 4区医学 Q3 RESPIRATORY SYSTEM

Clinical Respiratory Journal

Pub Date : 2024-08-26 DOI: 10.1111/crj.13825

Tao Zeng, Wangsheng Ren, Hang Zeng, Dachun Wang, Xianyu Wu, Guo Xu

Background

Lung adenocarcinoma (LUAD) is a fatal disease with metabolic abnormalities. The dysregulation of S100 calcium-binding protein A2 (S100A2), a member of the S100 protein family, is connected to the development of various cancers. The impact of S100A2 on the LUAD occurrence and metastasis, however, has not yet been reported. The functional mechanism of S100A2 on LUAD cell metastasis was examined in this article.

Methods

The expression of TFAP2A and S100A2 in LUAD tissues and cells was analyzed by bioinformatics and qRT-PCR, respectively. The enrichment pathway analysis was performed on S100A2. Bioinformatics analysis determined the binding relationship between TFAP2A and S100A2, and their interaction was validated through dual-luciferase and chromatin immunoprecipitation experiments. Cell viability was determined using cell counting kit-8 (CCK-8). A transwell assay was performed to analyze the invasion and migration of cells. Immunofluorescence was conducted to obtain vimentin and E-cadherin expression, and a western blot was used to detect the expression of MMP-2, MMP-9, GLS, and GLUD1. The kits measured the NADPH/NADP ratio, glutathione (GSH)/glutathione disulfide (GSSG) levels, and the contents of glutamine, α-KG, and glutamate.

Results

S100A2 was upregulated in LUAD tissues and cells, and S100A2 mediated glutamine metabolism to induce LUAD metastasis. Additionally, the transcriptional regulator TFAP2A was discovered upstream of S100A2, and TFAP2A expression was upregulated in LUAD, which indicated that TFAP2A promoted the S100A2 expression. The rescue experiment found that upregulation of S100A2 could reverse the inhibitory effects of silencing TFAP2A on glutamine metabolism and cell metastasis.

Conclusion

In conclusion, by regulating glutamine metabolism, the TFAP2A/S100A2 axis facilitated LUAD metastasis. This suggested that targeting S100A2 could be beneficial for LUAD treatment.

背景：肺腺癌（LUAD）是一种代谢异常的致命疾病。S100 蛋白家族成员 S100 钙结合蛋白 A2（S100A2）的失调与多种癌症的发生有关。然而，S100A2对LUAD发生和转移的影响尚未见报道。本文研究了S100A2对LUAD细胞转移的功能机制：方法：通过生物信息学和 qRT-PCR 方法分别分析了 TFAP2A 和 S100A2 在 LUAD 组织和细胞中的表达。对 S100A2 进行了富集通路分析。生物信息学分析确定了TFAP2A和S100A2之间的结合关系，并通过双荧光素酶和染色质免疫共沉淀实验验证了它们之间的相互作用。使用细胞计数试剂盒-8（CCK-8）测定细胞活力。采用转孔试验分析细胞的侵袭和迁移。免疫荧光法检测波形蛋白和 E-cadherin 的表达，Western 印迹法检测 MMP-2、MMP-9、GLS 和 GLUD1 的表达。试剂盒检测了NADPH/NADP比率、谷胱甘肽（GSH）/二硫化谷胱甘肽（GSSG）水平以及谷氨酰胺、α-KG和谷氨酸的含量：结果：S100A2在LUAD组织和细胞中上调，S100A2介导谷氨酰胺代谢诱导LUAD转移。此外，还发现了S100A2上游的转录调节因子TFAP2A，TFAP2A在LUAD中表达上调，表明TFAP2A促进了S100A2的表达。拯救实验发现，S100A2的上调可以逆转沉默TFAP2A对谷氨酰胺代谢和细胞转移的抑制作用：总之，通过调节谷氨酰胺代谢，TFAP2A/S100A2轴促进了LUAD的转移。结论：通过调节谷氨酰胺代谢，TFAP2A/S100A2轴促进了LUAD的转移，这表明靶向S100A2可能有利于LUAD的治疗。

{"title":"TFAP2A Activates S100A2 to Mediate Glutamine Metabolism and Promote Lung Adenocarcinoma Metastasis","authors":"Tao Zeng, Wangsheng Ren, Hang Zeng, Dachun Wang, Xianyu Wu, Guo Xu","doi":"10.1111/crj.13825","DOIUrl":"10.1111/crj.13825","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Lung adenocarcinoma (LUAD) is a fatal disease with metabolic abnormalities. The dysregulation of S100 calcium-binding protein A2 (S100A2), a member of the S100 protein family, is connected to the development of various cancers. The impact of S100A2 on the LUAD occurrence and metastasis, however, has not yet been reported. The functional mechanism of S100A2 on LUAD cell metastasis was examined in this article.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The expression of TFAP2A and S100A2 in LUAD tissues and cells was analyzed by bioinformatics and qRT-PCR, respectively. The enrichment pathway analysis was performed on S100A2. Bioinformatics analysis determined the binding relationship between TFAP2A and S100A2, and their interaction was validated through dual-luciferase and chromatin immunoprecipitation experiments. Cell viability was determined using cell counting kit-8 (CCK-8). A transwell assay was performed to analyze the invasion and migration of cells. Immunofluorescence was conducted to obtain vimentin and E-cadherin expression, and a western blot was used to detect the expression of MMP-2, MMP-9, GLS, and GLUD1. The kits measured the NADPH/NADP ratio, glutathione (GSH)/glutathione disulfide (GSSG) levels, and the contents of glutamine, α-KG, and glutamate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>S100A2 was upregulated in LUAD tissues and cells, and S100A2 mediated glutamine metabolism to induce LUAD metastasis. Additionally, the transcriptional regulator TFAP2A was discovered upstream of S100A2, and TFAP2A expression was upregulated in LUAD, which indicated that TFAP2A promoted the S100A2 expression. The rescue experiment found that upregulation of S100A2 could reverse the inhibitory effects of silencing TFAP2A on glutamine metabolism and cell metastasis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In conclusion, by regulating glutamine metabolism, the TFAP2A/S100A2 axis facilitated LUAD metastasis. This suggested that targeting S100A2 could be beneficial for LUAD treatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55247,"journal":{"name":"Clinical Respiratory Journal","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142074607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

An Accuracy Assessment: Responses to Mycoplasma Pneumoniae Pneumonia-Related Questions by Different Artificial Intelligence Tools 准确性评估：不同人工智能工具对肺炎支原体肺炎相关问题的回答。

IF 1.9 4区医学 Q3 RESPIRATORY SYSTEM

Clinical Respiratory Journal

Pub Date : 2024-08-26 DOI: 10.1111/crj.70005

Shuang Li

With the rapid development of socio-economic technology, artificial intelligence (AI) is increasingly applied in daily life. When discussing AI, it is inevitable to mention ChatGPT, a language model based on AI technology. Pretrained on extensive language data, ChatGPT can perform various natural language processing tasks, including dialog generation. In addition, similar large language models include the intelligent assistant Kimi launched by Beijing Lunar Tech and the chatbot ERNIE developed by Baidu, among others.

Mycoplasma pneumoniae pneumonia, caused by infection with Mycoplasma pneumoniae, refers to inflammation of the lungs that can affect the bronchi, bronchioles, alveoli, and interstitial tissue. It can occur at any age but is more common in children aged 5 and above, as well as in immunocompromised individuals (such as the elderly, immunodeficient individuals, or patients undergoing immunosuppressive therapy). The course of Mycoplasma pneumoniae pneumonia is generally 1–2 weeks, with a favorable prognosis and no sequelae in most cases. However, a small number of cases can develop into severe conditions, primarily presenting with symptoms of respiratory distress and respiratory failure. These severe cases are often associated with acute respiratory distress syndrome, plastic bronchitis affecting the large airways, diffuse bronchiolitis, and severe pulmonary embolism. In rare instances, severe extrapulmonary complications may be the main manifestations. Given the prevalence of Mycoplasma pneumoniae infection in China, we sought to understand whether ChatGPT could contribute to a better understanding of Mycoplasma pneumoniae pneumonia. We selected 13 questions that are most commonly asked by patients in clinical practice and posed them to ChatGPT-3.5, ChatGPT-4.0, Kimi, and ERNIE. Each question was run five times. Then we invited nine experts with extensive clinical experience and knowledge of Mycoplasma pneumonia to rate the accuracy of the answers. Among them, there were four respiratory specialists and five pediatric specialists, with five from our hospital and four from other hospitals. The scoring criteria were as follows: score = 0: completely incorrect; score < 6: inaccurate; 6 ≤ score < 8: mostly accurate; 8 ≤ score < 10: very accurate; score = 10: completely accurate. The final results were ChatGPT 3.5 8.46 ± 0.80, ChatGPT 4.0 7.05 ± 1.16, Kimi 8.62 ± 0.68, and ERNIE 9.33 ± 0.30. In descending order of accuracy, they were ERNIE, Kimi, ChatGPT 3.5, and ChatGPT 4.0.

We compared the answers provided by ChatGPT versions 3.5 and 4.0, ERNIE, and Kimi regarding Mycoplasma pneumonia and found that their accuracy ranked from the highest to the lowest as ERNIE, Kimi, ChatGPT 3.5, and ChatGPT 4.0, with ERNIE achieving the highest accuracy. Although ERNIE performed the best among the four AI models with more comprehensive answers, it still exhibited some answers with noticeable error

随着社会经济技术的飞速发展，人工智能（AI）越来越多地应用于日常生活中。说到人工智能，就不得不提到基于人工智能技术的语言模型 ChatGPT。经过大量语言数据的预训练，ChatGPT 可以执行包括对话生成在内的各种自然语言处理任务。此外，类似的大型语言模型还包括北京朗能科技推出的智能助手Kimi、百度开发的聊天机器人ERNIE等。"肺炎支原体肺炎 "是由肺炎支原体感染引起的肺部炎症，可累及支气管、支气管、肺泡和肺间质组织。肺炎支原体肺炎可发生于任何年龄，但更常见于 5 岁及以上的儿童和免疫力低下的人群（如老年人、免疫缺陷者或接受免疫抑制治疗的患者）。肺炎支原体肺炎的病程一般为 1-2 周，预后良好，大多数病例不会留下后遗症。但少数病例可发展为重症，主要表现为呼吸窘迫和呼吸衰竭症状。这些严重病例通常伴有急性呼吸窘迫综合征、影响大气管的塑性支气管炎、弥漫性支气管炎和严重肺栓塞。在极少数情况下，严重的肺外并发症可能是主要表现。鉴于肺炎支原体感染在中国的流行情况，我们试图了解 ChatGPT 是否有助于更好地了解肺炎支原体肺炎。我们选择了临床实践中患者最常问到的 13 个问题，并将其分别提交给 ChatGPT-3.5、ChatGPT-4.0、Kimi 和 ERNIE。每个问题都运行了五次。然后，我们邀请了九位具有丰富临床经验和支原体肺炎相关知识的专家对答案的准确性进行评分。其中有四位呼吸科专家和五位儿科专家，五位来自本院，四位来自其他医院。评分标准如下：得分=0：完全不正确；得分< 6：不准确；6≤得分< 8：基本准确；8≤得分< 10：非常准确；得分=10：完全准确。最终结果为 ChatGPT 3.5 8.46 ± 0.80、ChatGPT 4.0 7.05 ± 1.16、Kimi 8.62 ± 0.68 和 ERNIE 9.33 ± 0.30。我们比较了 ChatGPT 3.5 和 4.0 版、ERNIE 和 Kimi 对支原体肺炎的回答，发现准确率从高到低依次为 ERNIE、Kimi、ChatGPT 3.5 和 ChatGPT 4.0，其中 ERNIE 的准确率最高。虽然 ERNIE 在四种人工智能模型中表现最好，答案也更全面，但它仍有一些答案存在明显错误。例如，在问题 11 "支原体肺炎的治疗方案 "中，ERNIE 认为青霉素类抗生素对支原体肺炎有一定疗效。众所周知，肺炎支原体缺乏细胞壁，因此除非存在细菌合并感染，否则针对细胞壁的抗生素无效。另一个例子是在问题 2 "肺炎支原体如何传播 "中，ERNIE 的答案建议通过性传播，但这并没有在相关的 PubMed 文献中找到证据支持。令人惊讶的是，当我们比较 ChatGPT 3.5 和 4.0 版本时，我们发现尽管 OpenAI 声称 ChatGPT 4.0 在语言理解、生成能力和性能方面超过了 ChatGPT 3.5，但在我们提出的有关支原体肺炎的问题上，ChatGPT 3.5 始终获得了更高的分数。显然，在准确性方面，ChatGPT 3.5 优于 ChatGPT 4.0。此外，我们还注意到，与 ChatGPT 3.5 相比，ChatGPT 4.0 虽然更生动，使用的专业术语更少，但提供的答案往往不够全面和具体，偶尔会导致误解。例如，在问题 1 "什么是支原体肺炎 "中，ChatGPT 4.0 的答案中包含了有关胸部 X 光片的事实错误。此外，在将四款人工智能工具的答案与最新指南进行比较后，我们发现除了上述问题外，人工智能的答案还存在不准确或不完整的情况。例如，关于问题 8，四种人工智能工具关于肺炎支原体肺炎并发症的答案并不全面。肺炎支原体肺炎的病程一般为 1-2 周，预后良好，大多数病例不会留下后遗症。然而，少数病例可发展为重症，主要表现为呼吸窘迫和呼吸衰竭症状。

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引用次数: 0

Clinical Characteristics of Overweight Patients With Acute Exacerbation Chronic Obstructive Pulmonary Disease (AECOPD) 体重超标的急性加重期慢性阻塞性肺病 (AECOPD) 患者的临床特征。

IF 1.9 4区医学 Q3 RESPIRATORY SYSTEM

Clinical Respiratory Journal

Pub Date : 2024-08-26 DOI: 10.1111/crj.70001

Yuxin Gong, Fawang Du, Yu Yao, Hanchao Wang, Xiaochuan Wang, Wei Xiong, Qin Wang, Gaoyan He, Linlin Chen, Heng Du, Juan Yang, Brent A. Bauer, Zhongruo Wang, Huojin Deng, Tao Zhu

Introduction

Low body weight in patients with COPD is associated with a poor prognosis and more comorbidities. However, the impact of increased body weight in patients with COPD remains controversial. The aim of this study was to explore the clinical features of overweight patients with AECOPD.

Methods

In this multicenter cross-sectional study, a total of 647 AECOPD patients were recruited. Finally, 269 normal weight and 162 overweight patients were included. Baseline characteristics and clinical and laboratory data were collected. The least absolute shrinkage and selection operator (LASSO) regression was performed to determine potential features, which were substituted into binary logistic regression to reveal overweight-associated clinical features. The nomogram and its associated curves were established to visualize and verify the logistic regression model.

Results

Six potential overweight-associated variables were selected by LASSO regression. Subsequently, a binary logistic regression model identified that the rates of type 2 diabetes (T2DM) and hypertension and levels of lymphocytes (LYM)%, and alanine aminotransferase (ALT) were independent variables of overweight in AECOPD patients. The C-index and AUC of the ROC curve of the nomogram were 0.671 and 0.666, respectively. The DCA curve revealed that the nomogram had more clinical benefits if the threshold was at a range of 0.22~0.78.

Conclusions

Collectively, we revealed that T2DM and hypertension were more common, and LYM% and ALT were higher in AECOPD patients with overweight than those with normal weight. The result suggests that AECOPD patients with overweight are at risk for additional comorbidities, potentially leading to worse outcomes.

导言：慢性阻塞性肺病患者体重过轻与预后不良和合并症增多有关。然而，体重增加对慢性阻塞性肺病患者的影响仍存在争议。本研究旨在探讨超重的 AECOPD 患者的临床特征：在这项多中心横断面研究中，共招募了 647 名 AECOPD 患者。最后，纳入了 269 名正常体重和 162 名超重患者。研究人员收集了基线特征、临床和实验室数据。通过最小绝对收缩和选择算子（LASSO）回归确定潜在特征，并将其代入二元逻辑回归以揭示与超重相关的临床特征。建立了提名图及其相关曲线，以直观显示和验证逻辑回归模型：结果：通过 LASSO 回归筛选出六个潜在的超重相关变量。随后，二元逻辑回归模型发现，2 型糖尿病（T2DM）和高血压发病率、淋巴细胞（LYM）% 和丙氨酸氨基转移酶（ALT）水平是 AECOPD 患者超重的独立变量。提名图 ROC 曲线的 C 指数和 AUC 分别为 0.671 和 0.666。DCA曲线显示，如果阈值在0.22~0.78之间，提名图的临床获益更大：综上所述，我们发现超重的 AECOPD 患者比体重正常者更常见 T2DM 和高血压，LYM% 和 ALT 也更高。这一结果表明，超重的 AECOPD 患者有可能出现更多合并症，从而导致更差的预后。

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