Immune-related pneumonitis is an uncommon but potentially fatal immune-related adverse event in advanced non-small cell lung cancer (NSCLC) patients during treatment with anti-programmed cell death 1 (PD-1) and programmed cell death-ligand 1 (PD-L1). Underlying emphysema, interstitial lung disease (ILD), and previous radiation therapy for lung cancer might be factors precipitating immune-related pneumonitis. The incidence of immune-related pneumonitis is reported to be higher in those treated with PD-1 inhibitors than in those treated with anti-PD-L1 inhibitors. Early detection and diagnosis and appropriate management according to the severity are critical to improving the prognosis. The first-line physicians, including the primary responsible oncologists, family doctors, emergency physicians and NSCLC patients should be trained to identify and report symptoms of immune-related pneumonitis as early as possible. Multidisciplinary treatment teams involving clinicians (including ILD specialists and lung cancer specialists), radiologists and pathologists are recommended for the treatment of immune-related pneumonitis.

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Objectives Few studies have investigated the prognostic factors for idiopathic inflammatory myopathy-associated interstitial lung disease (IIM-ILD) across different clinical/serological phenotypes. Methods We conducted a retrospective analysis of patients diagnosed with IIM between January 2012 and December 2017. Results Of the 760 IIM cases registered, 679 adult cases were included in this study. ILD was present in 508 cases, and the presence of ILD in the clinically amyopathic DM, DM and PM groups was 92.7, 73.6 and 55.1%, respectively (P < 0.01). The prevalence of ILD in the anti-synthetase antibody (ASA)+-IIM group was higher than that in ASA–-IIM group (95.2 vs 72.4%, P < 0.01); no such difference was found between the anti-histidyl-tRNA synthetase (Jo-1)+-IIM and Jo-1–ASA+-IIM groups (93.0 vs 98.5%, P > 0.05). The prevalence of ILD in the melanoma differentiation-associated protein-5 (MDA-5)+-IIM group was higher than that in MDA-5–-IIM group (97.8 vs 72.1%, P < 0.01). Among adults with IIM, men with concurrent ILD, who were older than 50 years, were most likely to die. No significant difference was found in the all-cause mortality rates between DM-ILD and clinically amyopathic DM-ILD groups (33.3 vs 23%, P > 0.05), although both were higher than that in PM group (13.2%, P = 0.01 and P < 0.05, respectively). No difference was found in the all-cause mortality rates between MDA5–ASA–-IM-ILD and MDA5–ASA+-IM-ILD groups (17.2 vs 12.8%, P > 0.05), and both were lower than that in MDA5+ASA–-IM-ILD group (33.7%, P < 0.05). Conclusion The prevalence of ILD in IIM and the prognosis of IIM-ILD patients may vary depending on the statuses of the ASA and MDA-5 antibodies.

Although a strong association between idiopathic inflammatory myositis (IIM) and malignancy has been widely reported, few studies have solely focused on the concurrence of dermatomyositis (DM) and malignancies (DM-malignancy). We conducted a retrospective analysis of 37 DM-malignancy cases among 363 DM patients admitted to our hospital between January 2012 and December 2017. (1) The mean age at DM diagnosis was higher for DM-malignancy patients than for DM-non-malignancy patients [(54.76 ± 9.77) years vs (48.57 ± 12.82) years, t = 2.84, P = .005]. (2) Gynecological malignancies (35.90%/14 cases) were the most common malignancies. Malignancies were diagnosed before DM for 7 DM-malignancy patients. The interval between the DM and malignancy diagnoses for the remaining 32 DM-malignancy patients was less than 6 months for 18 patients (46.15%), less than 1 years for 23 patients (58.9%), and less than 2 years for 29 patients (74.26%). (3) There was no significant difference either in antinuclear antibody or anti-Ro-52 positivity between the 2 groups ( P > .05). (4) Multivariate analysis demonstrated that DM onset age ≥50 years and concurrence with ILD increased the risk of death for DM patients [hazard ratio (HR): 1.62 and 2.72; 95% confidence interval (CI): (1.08–2.43) and (1.47–5.02); P = .02 and 0.001, respectively], and male gender decreased the risk of death [HR 0.66, 95% CI (0.44–0.98), P = .04]. DM-malignancy patients were older than DM-non-malignancy patients. Gynecological malignancies were the most common malignancies among these patients. A DM onset age ≥50 years, female sex and the presence of ILD were independent risk factors for death.

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Purpose: To explore the effects of unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) on traumatic disseminated intravascular coagulation (DIC). Methods: A total of 77 cases of severe trauma (APACHE II score: 5-10) with DIC were collected and randomly assigned to one of three groups: LMWH treatment-26 cases were subcutaneously injected with LMWH (75-150 units/kg/d); UFH treatment-25 cases were subcutaneously injected with UFH (100-250 units/kg/d); control-26 cases supplemented with blood coagulation factor only. Daily mortality in the intensive care unit (ICU), hospitalization time, bleeding rate, thrombin time, prothrombin time, activated partial thromboplastin time, and levels of fibrinogen, antithrombin III (ATIII), and D-dimer were recorded and analyzed. Results: In ICU, LMWH and UFH treatments resulted in lower mortality than in the control group. In addition, hospitalization time was longer in patients treated with LMWH and UFH than in control patients. No significant differences were found between LMWH-treated and control patients in terms of bleeding rate, but UFH-treated patients had lower bleeding rates than control patients. Multifactor analysis indicate a strong relationship between ATIII levels and bleeding rate. Conclusion: The results indicate that low-dose UFH and LMWH are effective options for the treatment of DIC.

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