Two patients, a 76-year-old woman and 66-year-old woman, presented to our hospital with symptoms of lower respiratory tract infection. Both patients showed chest imaging findings of bilateral ground-glass opacities and consolidations. We initially suspected these patients of having influenza-associated pneumonia and cryptogenic organizing pneumonia, respectively, and performed bronchoalveolar lavage, but only human parainfluenza virus-1 infection was detected by multiplex polymerase chain reaction testing. These findings suggest that pneumonia due to human parainfluenza virus-1 should be included in the differential diagnosis of such cases.

Objective To clarify what future problems must be resolved and how clinical findings of SARS-CoV-2 infection differ from those of cHCoV infection. Methods Patients and Methods Clinical characteristics of 14 patients with laboratory-confirmed Coronavirus disease 2019 (COVID-19) and 5 patients with cHCoV pneumonia admitted to our institution and treated up to March 8, 2020, were retrospectively analyzed. Results On admission, 10 patients had pneumonia, 5 of whom had pulmonary shadows detectable only via computed tomography (CT). During hospitalization, another patient with no pulmonary shadows on admission developed pneumonia. In total, 11 (78.6%) of the 14 patients developed pneumonia, indicating its high prevalence in COVID-19. During hospitalization, the patients' symptoms spontaneously relapsed and resolved, and gastrointestinal symptoms were frequently found. C-reactive protein values showed correlation with the patients’ clinical courses. Ritonavir/lopinavir were administered to 5 patients whose respiratory conditions worsened during admission, all of whom improved. However, the pneumonia in the 6 other patients improved without antivirals. None of the 14 patients died, whereas 5 other patients with cHCoV pneumonia were in respiratory failure on admission, and one patient (20%) died. Conclusion Both SARS-CoV-2 and cHCoV can cause severe pneumonia. Problems for future resolution include whether antiviral agents administered in cases of mild or moderate severity can reduce the number of severe cases, and whether antivirals administered in severe cases can reduce mortality.

Background Combination immunotherapy (immune checkpoint inhibitors and cytotoxic anticancer agents) is widely used as first‐line treatment for advanced non‐small cell lung cancer (NSCLC). However, the therapeutic effect of combination immunotherapy has not been fully investigated. C‐reactive protein, performance status, lactate dehydrogenase, albumin, and derived neutrophil‐to‐lymphocyte ratio (C‐PLAN) are useful biomarkers for predicting the prognosis of NSCLC; however, there are no reports examining the C‐PLAN index, which combines these five factors in a single prognostic factor. Methods We retrospectively collected data from 178 patients with previously untreated advanced NSCLC who received combination immunotherapy at multicenter institutions in Nagano Prefecture between December 2018 and April 2022. We investigated the utility of the C‐PLAN index as a prognostic factor using Cox regression analysis and correlated it with survival. Results The good and poor C‐PLAN index groups included 85 and 93 patients, respectively. The good C‐PLAN index group had a longer median progression‐free survival (PFS) (10.7 vs. 6.0 months; p = 0.022) and overall survival (OS) (25.3 vs. 16.5 months; p = 0.003) than the poor C‐PLAN index group. The C‐PLAN index was an independent favorable prognostic factor that correlated with PFS and OS in multivariate analysis. The good C‐PLAN index group had a higher proportion of never‐smokers (16.5 vs. 4.3%; p = 0.007) and stage III disease/postoperative recurrence (32.9 vs. 15.1%; p = 0.005) than the poor C‐PLAN index group. Conclusion The C‐PLAN index is a useful prognostic factor for patients with previously untreated advanced NSCLC undergoing combination immunotherapy.

The effects of pulmonary vasodilator therapy for patients with pulmonary hypertension associated with chronic lung diseases (CLD-PH) remain controversial. This is mainly because different etiologies are included in CLD. In the 6 th World Symposium on Pulmonary Hypertension, the haemodynamic definitions of PH have been reconsidered and the strategy of CLD-PH may also change in the future. Objectives: To assess the treatment and long-term outcomes of patients with CLD-PH. Methods: Over about 10-year period from 2009 April through 2019 May, medical records of 39 patients diagnosed with CLD-PH at our institution in Nagano, Japan, were retrospectively analyzed. In the present study, patients with mean pulmonary arterial pressure [mPAP] values of 21 mmHg or higher were included as PH. Measurements and Main Results: Of the 57 patients diagnosed with PH through right heart catheterization in our institution, 39 (68.4%) patients were CLD-PH. Median patient age was 71.0 years, and male was 82.1%. Median mPAP was 29 mmHg (range 21 to 64 mmHg), and pulmonary vascular resistance was 4.19 WU (range 1.26-13.78 WU). Respiratory comorbidities were chronic obstructive disease (COPD): 15 (38.5%) patients; interstitial lung disease (ILD): 9 (23.1%) patients; COPD and ILD: 10 (25.6%) patients; others: 5 (12.8%) patients. Mild comorbidity (COPD with FEV1 ≥ 60% of predicted, IPF with FVC ≥ 70% of predicted, CT: absence of or only very modest airway or parenchymal abnormalities) was 6 (15.4%) patients, mild PH (mPAP values of 21-24 mmHg) was 13 (33.3%), moderate PH (mPAP values of 25-34 mmHg) was 17 (43.6%), and severe PH (mPAP values of 35 mmHg or higher) was 9 (23.1%) patients. Of the 39 patients, 22 (56.4%) patients were treated with pulmonary vasodilator medications; phosphodiesterase-5 (PDE-5I) alone in 13 (59.1%) patients, and combination therapy in 9 (40.9%) patients. Three-year survival rates for total, subjects with treatment and without treatment were 68.3%, 73.6% and 60.9%, respectively. There were no significance between those with treatment and without treatment (p=0.922), among respiratory comorbidities (p=0.399), and the severity of PH (p=0.345). Conclusions: Pulmonary vasodilator therapy for patients with CLD-PH did not show the improvement of mortality, as previous studies showed. The number of total patients and those with mild ventilatory impairment were small, and early therapeutic intervention before respiratory comorbidities progression had not been fully achieved and evaluated in this study.

Two patients, a 60-year-old man and 43-year-old woman, presented to our hospital with symptoms of respiratory tract infection. These patients showed imaging findings of multiple small nodules, ground-glass opacities, and consolidations. In case 1, although antibiotics were started, bilateral shadows spread widely, which made us suspect interstitial pneumonia. The condition improved after steroid administration, and there has been no recurrence since completing this treatment. In case 2, the patient recovered rapidly with antibiotics only. In both cases, we performed bronchoalveolar lavage, in which only human rhinovirus infection was detected by multiplex polymerase chain reaction testing, and primary rhinovirus pneumonia was diagnosed.