Backgrounds: Hypersensitivity pneumonitis (HP) is an immune-mediated interstitial lung disease (ILD) that develops in response to the inhalation of various antigens. The clinical pathologies are very complex and undetermined. The clinical features and outcomes of HP have not been fully elucidated. The aim of this study was to analyze the incidence, clinical features, and outcomes of HP patients and construct a simple clinical model for diagnosing chronic HP (CHP). Methods: The cohort study included 101 patients with HP admitted to the Nanjing Drum Tower Hospital from January 2009 to December 2017. The patients were categorized into acute HP (AHP, n = 72) and CHP ( n = 29) groups according to the updated international criteria. The clinical, imaging, treatment, and follow-up data were retrospectively reviewed. All patients were followed up until December 31, 2017. Statistical analysis was performed, and a clinical scoring system for CHP was constructed by SPSS 20.0 software. Results: The incidence of HP was 2.4% in ILD inpatients in our center. Patients in the CHP group were older ( t = −2.212, P = 0.029), had more smokers ( χ 2 = 8.428, P = 0.004), and longer duration of symptoms ( t = −4.852, P < 0.001) than those in the AHP group. Weight loss, crackles, digital clubbing, and cyanosis were more common in the CHP group than those in the AHP group ( χ 2 = 5.862, P < 0.001; χ 2 = 8.997, P = 0.003; χ 2 = 11.939, P = 0.001; and χ 2 = 4.025, P = 0.045, respectively). On chest high-resolution computed tomography (HRCT), reticular patterns, traction bronchiectasis, and accompanying honeycombing were more common in CHP cases than those in AHP cases ( χ 2 = 101.000, P < 0.001; χ 2 = 32.048, P < 0.001; and χ 2 = 36.568, P < 0.001, respectively). The clinical scoring system for CHP was established based on the clinical variables (age [A], duration of symptoms [D], smoking history [S], unidentified exposure [U], and chest HRCT [C]; ADSUC) (area under the curve 0.935, 95% confidence interval: 0.883–0.987, P < 0.001). Eleven patients (15.3%) in the AHP group developed CHP, and unidentified exposure was an independent risk factor for the progression of disease ( P = 0.038). The s...

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α1-antitrypsin (AAT) has been recognized to be associated with lung adenocarcinoma metastasis. However, the mechanisms by which AAT promotes tumor metastasis remain to be investigated. Herein, we first examined AAT expression in a panel of formalin-fixed paraffin-embedded tumor tissues from 88 lung adenocarcinoma patients undergoing curative resection, using immunohistochemical methods. Lung adenocarcinoma patients with high AAT expression showed a significantly shorter overall survival compared to those with low AAT expression by Kaplan-Meier method (P=0.008). High AAT expression was also identified as an independent prognostic factor by Cox regression analysis (adjusted hazard ratio: 2.05; P=0.04). Second, the role of AAT in lung adenocarcinoma cell migration was evaluated in vitro using wound healing and Transwell assays, by transfecting the lentivirus vector with interfering sequence or coding sequence of AAT. The migration property of A549 and SPC-A1 cells was significantly diminished by downregulating AAT expression. Conversely, the migration of both cell lines was significantly increased through upregulating AAT. Furthermore, AAT could increase the expression of fibronectin (FN). FN downregulation reversed AAT-induced promotion of adenocarcinoma cell migration. Third, a cancer cell/endothelial cell co-culture model was established to investigate the effect of AAT on adenocarcinoma cell adhesion using immunofluorescence examination. The results showed that downregulation of AAT inhibited adhesion between lung adenocarcinoma cells and human umbilical vein endothelial cells whereas upregulation of AAT promoted adhesion, which may attribute to interactions between FN and integrin α5. Finally, AAT also showed the regulation effect on the metastatic behavior of lung adenocarcinoma cells in a mouse model, which may be through regulating FN expression. This study suggested that high AAT expression might be a negative prognostic marker for lung adenocarcinoma. AAT promoted lung adenocarcinoma metastasis, whose functional target may be FN. Our findings provide new insight into the mechanisms of lung adenocarcinoma metastasis.

Rationale:Azygos and hemiazygos continuation of the inferior vena cava (IVC) is uncommon. It is rare especially when it is not associated with congenital heart disease or deep venous thrombosis.Patient concerns:We report an interesting case of an interstitial lung disease with an interrupted IVC with azygous and hemiazygos continuation. A 67-year-old man suffered from cough and shortness of breath.Diagnoses:Computed tomography revealed absence of the hepatic segment of the IVC with azygos and hemiazygos continuation. The patient did not have congenital anomalies of the remaining thoracoabdominal vasculature and viscera. The diagnosis of azygos and hemiazygos continuation of IVC was made by inferior venacavography.Interventions:There was no significant association between interstitial lung disease and expanded azygos and hemiazygos veins. The patient was treated with corticosteroids.Outcomes:After 6 months of follow-up, the patient was asymptomatic.Lessons:It is important to recognize the enlarged azygos vein at the confluence with the superior vena cava and in the retrocrural space to avoid misdiagnosis as a right-sided paratracheal mass or retrocrural adenopathy.

Although associations between thioredoxin interacting protein (TXNIP) and cancers have been recognized, the effects of TXNIP on non-small cell lung cancer (NSCLC) prognosis remained to be determined in detail. In addition, while hypoxia is a key characteristic of tumor cell growth microenvironment, the effect of hypoxia on TXNIP expression is controversial. In this study, formaldehyde fixed and paraffin embedded (FFPE) samples of 70 NSCLC patients who underwent resection between January 2010 and December 2011 were obtained. Evaluation of TXNIP and hypoxia inducible factor-1α (HIF-1α) protein expression in FFPE samples was made by immunohistochemistry. By Kaplan-Meier method, patients with high TXNIP expression demonstrated a significantly shorter progression free survival (PFS) compared with those with low TXNIP expression (18.0 months, 95%CI: 11.7, 24.3 versus 23.0 months, 95%CI: 17.6, 28.4, P=0.02). High TXNIP expression level was also identified as an independent prognostic factor by Cox regression analysis (adjusted hazard ratio: 2.46; 95%CI: 1.08, 5.56; P=0.03). Furthermore, TXNIP expression was found to be significantly correlated with HIF-1α expression (Spearman correlation=0.67, P=0.000). To further confirm correlations, we established a tumor cell hypoxic culture model. Expression of TXNIP was up-regulated in all three NSCLC cell lines (A549, SPC-A1, and H1299) under hypoxic conditions. This study suggests that hypoxia induces increased TXNIP expression in NSCLC and high TXNIP expression could be a poor prognostic marker.