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Acute kidney injury (AKI) may develop in patients with coronavirus disease 2019 (COVID‐19) and is associated with in‐hospital death. We investigated the incidence of AKI in 223 hospitalized COVID‐19 patients and analyzed the influence factors of AKI. The incidence of cytokine storm syndrome and its correlation with other clinicopathologic variables were also investigated. We retrospectively enrolled adult patients with virologically confirmed COVID‐19 who were hospitalized at three hospitals in Wuhan and Guizhou, China between February 13, 2020, and April 8, 2020. We included 124 patients with moderate COVID‐19 and 99 with severe COVID‐19. AKI was present in 35 (15.7%) patients. The incidence of AKI was 30.3% for severe COVID‐19 and 4.0% for moderate COVID‐19 (p

Rationale: Pulmonary alveolar proteinosis (PAP) is a rare lung disorder characterized by the abnormal accumulation of alveolar surfactant protein in alveolar spaces. Secondary PAP can result from myelodysplastic syndrome (MDS). Patient concerns: But most reports described a single case; here we reported 2 cases of PAP secondary to MDS. One case developed secondary PAP at the same time as MDS, and the other developed during the course of MDS. Diagnoses: The diagnosis of PAP was made by bronchoalveolar lavage and based on the identification of periodic acid-Schiff-positive proteinaceous material. Chest high resolution CT (HRCT) scans showed variable distribution of ground glass opacities, but crazy-paving appearance was not seen in our 2 cases. Interventions: Because the patients’ general conditions were poor, whole lung lavage was not used in the 2 cases. Outcomes: And the 2 cases’ prognoses were poor. Lessons: In conclusion, pulmonary physicians should suspect the possibility of secondary PAP when they encounter unexplained pulmonary infiltrates with some hematologic or infectious disease that shows diffuse bilateral GGO on an HRCT scan.

Although the serum granulocyte-macrophage colony stimulating factor autoantibody (GMAb) levels have been recognised as a diagnostic marker in primary pulmonary alveolar proteinosis (PAP), their role in PAP with occupational inhalational exposure (PAPo) remains unclear.Forty-five consecutive patients with PAP were enrolled. Each patient with PAP was assessed for baseline clinical characteristics, chest high-resolution CT (HRCT), serum GMAb and occupational exposure. Fifty healthy controls were included to define normal ranges for GMAb levels. Ninety-seven hospital controls with other respiratory diseases were included to establish prevalence of a history of occupational inhalation exposure.According to the serum GMAb cut-off value of 2.39 μg/mL, 84.4% of the recruited patients with PAP had positive serum GMAb with a median level of 28.7 μg/mL, defined as autoimmune PAP, and the remaining 15.6% had negative serum GMAb with a median level of 0.16 μg/mL, defined as non-autoimmune PAP. Also, 34.2% of patients with autoimmune PAP had a history of occupational inhalational exposure, which was not significantly higher than that of hospital controls (34.2% vs 19.6%, p=0.072). Four patients with PAPo showed negative GMAb. Their arterial oxygen tension, pulmonary function parameters and chest HRCT features were significantly different when compared with patients with autoimmune PAP (p0.05). These four non-autoimmune occupational lung disease cases culminated in 3 deaths and a lung transplant.A number of patients with PAP who may have occupational inhalational exposure and negative serum GMAb represent a high possibility of silicoproteinosis and very poor survival.

Recent evidence haas indicated that meningioma-associate protein (MAC30) exhibits different expression patterns in various tumors. However, little is known about the value of MAC30 in human squamous cell carcinoma of lung (SQCLC). The purpose of our study was to investigate the expression of MAC30 and to explore its clinical significance in SQCLC patients. A total of 156 Chinese patients diagnosed with SQCLC were selected for this study. The expression of MAC30 in all tissues was confirmed by immunohistochemical staining. Quantitative real-time PCR was performed to analyze MAC30 mRNA expression in 32 cases of SQCLC patients with corresponding non-tumor lung tissues. We observed enhanced mRNA expression of MAC30 in SQCLC as compared to control samples. Further, elevated MAC30 protein expression was strongly associated with poor tumor differentiation, TNM stage, and lymph node metastasis. In addition, we observed that patients with increased MAC30 expression demonstrated poor overall survival. Multivariate analysis explicated that increased MAC30 expression was a valuable independent predictable factor for poor tumor differentiation and short survival in SQCLC patients. Our present study suggests that MAC30 may serve as a biomarker for poor tumor differentiation and outcomes of patients with SQCLC.

Multifocal Micronodular Pneumocyte Hyperplasia (MMPH) is a rare and histologically, distinctive pulmonary manifestation of tuberous sclerosis complex (TSC) characterized by numerous and extensive proliferative lesions of type II pneumocytes similar to atypical adenomatous hyperplasia (AAH) or non-mucinous adenocarcinoma in situ (AIS). We reported MMPH in a 38-year-old Chinese man with TSC masquerading for 16 months as miliary tuberculosis and discussed the differential diagnosis.

The purpose of this study was to determine the diagnostic and prognostic values of serum KL-6 levels in Chinese patients with interstitial lung disease (ILDs).A total of 1084 subjects including 373 cases of ILDs, 584 cases of non-ILD pulmonary diseases, and 127 healthy individuals were recruited from three clinical centers in China between January 2011 and December 2013. A total of 106 patients undergoing treatments for ILDs in Shanghai Pulmonary Hospital between January 2011 and December 2013 were enrolled. Baseline and posttreatment serum KL-6 levels were determined.Serum KL-6 levels in patients with ILDs were significantly higher than those in patients with non-ILD pulmonary diseases or in healthy individuals (1492.09 ± 2230.08 U/mL vs 258.67 ± 268.73 U/mL or 178.73 ± 71.17 U/mL, all P 0.05). At the cut-off value of 500 U/mL, the sensitivity and specificity of serum KL-6 as a diagnostic marker for ILDs was 77.75% and 94.51%, respectively. The Kappa value was 0.743 (P 0.001). The area below the receiver operating characteristic curve was 0.922 with a 95% Confidence interval of 0.904-0.941 (P 0.001). The posttreatment serum KL-6 levels significantly reduced in patients with improved ILDs, whereas markedly increased in patients with exacerbated ILDs (All P 0.05).Serum KL-6 levels might be a promising diagnostic biomarker for ILDs in Chinese patients. The prognostic value of serum KL-6 levels for ILDs remains to be verified by large-scaled studies.

In addition to the typical size, Cryptococcus neoformans can enlarge its size to form titan cells during infection, and its diameter can reach up to 100 μm. Clinical reports about cryptococcal titan cells are rare. Most studies focus on aspects of animal models of infection with titan cells. Herein, we report the clinical and imaging characteristics and histopathologic features of 3 patients with titan cells and 27 patients with pathogens of typical size, and describe the morphological characteristics of titan cells in details. Histologically, 3 patients with titan cells show necrosis, fibrosis and macrophage accumulation. The titan cells appear in necrotic tissue and between macrophages, and have thick wall with unstained halo around them and diameters range from 20 to 80 μm with characteristic of narrow-necked single budding. There are also organisms with typical size. All 27 patients with normal pathogens show epithelioid granulomatous lesions. There is no significantly difference in clinical and imaging feature between the two groups. Cryptococcus neoformans exhibits a striking morphological change for the formation of titan cells during pulmonary infection, which will result in misdiagnosis and under diagnosis. The histopathological changes may be new manifestation, which need to be further confirmed by the study with animal models of infection and the observation of more clinical cases. Careful observation of the tissue sections is necessary.

To evaluate and compare the predictive value of short-term risk of death of global registry of acute coronary events (GRACE) risk scores, acute physiology and chronic health evaluation II (APACHEII) scores and rapid emergency medicine score (REMS) in patients with acute myocardial infarction (AMI).A retrospective review of clinical data of 390 patients with AMI admitted from October 2012 to March 2013 in emergency department and cardiology care unit (CCU) in Guizhou People's Hospital were performed. The lowest scores within 24 hours of GRACE risk score, APACHEII risk score, and REMS risk score, respectively, for each patient were recorded. Mortality rate within 30 days after onset was calculated. Prediction of the mortality rate of AMI within 30 days as made in three scoring systems was compared.A total of 54 patients died from cardiovascular disease within 30 days. GRACE risk scores, APACHEII scores, and REMS risk scores were higher in non-survivors as compared with that of survivors (GRACE: 206.09±24.67 vs. 150.17±25.72, t=-4.349, P=0.000; APACHEII: 15.81±7.60 vs. 7.50±2.83, t=-4.182, P=0.000; REMS: 7.11±2.70 vs. 5.38±2.59, t=-2.345, P=0.020). Area under the receiver operator characteristic curve (ROC curve) for GRACE risk scores, APACHEII risk scores and REMS in patients with AMI died from cardiac vascular disease in 30 days were 0.862 [95% confidence interval (95%CI) 0.76-0.95, P=0.000], 0.825 (95%CI 0.71-0.93, P=0.002) and 0.615 (95%CI 0.46-0.77, P=0.192), sensitivity of three kinds of scoring system was 92.32%, 76.91%, 69.26%, respectively, with specificity of 66.23%, 77.84%, 54.02% respectively.GRACE and APACHEII scores for patients with AMI risk of short-term death showed more accurate in predicting early than GRACE scores, and REMS for AMI risk of short-term death did not have predictive value.

Serum expression of cytokines may provide information about the clinical outcome of advanced non-small cell lung cancer (NSCLC) patients. This study aimed to investigate the relationship between serum cytokine levels and the clinical outcome of erlotinib treatment in a second or third line setting in patients with advanced NSCLC.A total of 162 patients with advanced NSCLC who received erlotinib as either second or third line therapy were enrolled in this study. Blood samples were collected before the initiation of erlotinib treatment, and the levels of IL-1, IL- 2R, IL-6, and tumor necrosis factor (TNF)-α were assessed by enzyme-linked immunosorbent assay (ELISA). Cutoff points were defined as the median levels of IL-1 (low (≥26.5 pg/ml) and high (26.5 pg/ml)), IL-2R (low ( = 115 pmol/L) and high (15 pmol/L)), IL-6 (low (≤49.5 pg/ml) and high (49.5 pg/ml)), and TNF-α (low (≤48.5 pg/ml) and high (48.5 pg/ml)). Kaplan-Meier analysis was used to estimate the survival time, and Cox regression analyses were used to correlate cytokines and baseline clinical characteristics with clinical outcomes, including time to progression (TTP) and overall survival (OS).Between January 2007 and May 2011, 162 patients were enrolled. Their median age was 58 years. In this group, 109 were males and 53 were females, 74 were former or current smokers and 88 were non-smokers. A total of 122 patients had adenocarcinoma, 27 had squamous cell carcinoma, and 13 had tumors with other types of histology. And 139 patients had an Eastern cooperative oncology group (ECOG) performance status of 0-1, while 23 scored at 2-3. Expression of IL-1, IL-2R, and IL-6 was not significantly associated with age, gender, ECOG performance status, smoking status, or histology and stage of tumor. Only TNF-α was associated with smoking status (P = 0.045). Survival analysis showed that patients with low levels of either IL-6 or TNF-α had a statistically longer TTP and OS than patients with high expression (P0.05). These cytokines remained significant upon multivariate analysis (P0.05).IL-6 or TNF-α may serve as potential predictive biomarker for the efficacy of erlotinib.

To improve understanding of the clinical, radiological and pathological characteristics of acute fibrinous and organizing pneumonia (AFOP).The clinical data of 5 AFOP patients were retrospectively analyzed. AFOP was diagnosed via percutaneous lung biopsy guided by chest computerized tomography (CT) in the Affiliated Drum Tower Hospital of Nanjing University Medical School during March 2011 to June 2012. The clinical, radiological and pathological characteristics of those patients were summarized.Among the 5 patients, 2 were male and 3 were female, aging 43-61 years. They were all subacute onset. The main clinical manifestations were dyspnea, productive cough, fever and chest pain with hypoxemia via blood gas analysis. Bilateral infiltrates with diffuse and pathy distribution were the predominant features in chest HRCT. The pathological examination revealed slightly widened alveolar septa, 1ymphocyte and plasma cell infiltration and the presence of intra-alveolar fibrin in the form of fibrin "balls" (organization) within the alveolar spaces. No neutrophil, and eosinophil infiltration and hyaline membrane formation were detected, which was different from other well-recognized histologic patterns of acute lung injury, such as diffuse alveolar damage, cryptogenic organizing pneumonia and eosinophilic pneumonia. All patients were treated by corticosteroids and showed significant clinical and radiological improvement.AFOP has nospecific features, and its diagnosis depends on pathological examination. Treatment with corticosteroids is optimal. However, whether it is a unique interstitial disease needs to be further clinically investigated.

Congenital cystic adenomatoid malformation (CCAM), also named congenital pulmonary airway malformation (CPAM), is a congenital abnormality of lung which is uncommon in adults. Here we present 2 adult cases of CCAM with unusual clinical and pathologic findings. One case was complicated with aspergillosis which was seldom reported. The other case was suffered bilateral lesions and the patient's mother had been previously radiographically discovered bilateral cystic lesions that CCAM could not be ruled out. A review of currently published related literatures has also been provided. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/6406766736634578.

to improve understanding of the novel influenza A (H1N1) virus infection complicated with pneumonia.clinical presentations, radiological data, laboratory data and treatments of 2 patients with pneumonia caused by the novel influenza A (H1N1) virus were retrospectively analyzed.one patient was a middle-aged woman, and the other was a young man with a history of asthma. Both patients had fever (temperatures more than 39 degrees C), cough, and dyspnea. At the time of admission, both patients had hypoxemia. Chest computed tomography (CT) scan showed patchy distribution of consolidation and ground-glass opacity mainly in peripheral subpleural regions, as well as peribrochovascular lesions with air-bronchogram. The decreased and lymphocytes, elevated lactate dehydrogenase and creatine kinase were found in both patients. After admission, the patients received oseltamivir with a dose of 75 mg twice a day for a minimum of 5 days. Other treatments included antibiotics and methylprednisolone. One patient needed intermittent non-invasive ventilation for respiratory distress. Both patients recovered and the opacities on their chest CT were almost absorbed. WBC counts increased to normal and the levels of LDH and CK decreased.patients with the novel influenza A (H1N1) virus infection may develop pneumonia. The manifestations are non-specific. Chest CT scan reveals patchy distribution of consolidation and ground-glass opacity. In addition to antiviral therapy, glucocorticoids may have some effects on the pulmonary lesions and be useful for improving the clinical conditions.

To highlight the clinical, radiological and pathological characteristics of Objective To highlight the clinical, radiological and pathological characteristics of giant cell interstitial pneumonia (GIP) associated with Hard metals.The clinical, radiological and pathological data of a patient with hard metal lung disease confirmed by video-assisted thoracoscopic biopsy of the right lung were presented, and relevant literatures were reviewed.A 30-year-old female patient presented with cough and dyspnea on exertion for more than 40 days. She had worked for grinding tungsten rod, with exposure to metal dusts containing cobalt and tungsten for more than 3 years. Chest radiographs and CT demonstrated bilateral ground-glass attenuations and ill-defined small nodules. Lung function studies showed the mixed type of ventilation dysfunction with a low diffusion capacity (DLCO of 39% of predicted). Lung biopsy specimens showed desquamative interstitial pneumonia like reaction with alveolar macrophages and numerous large multinucleated histiocytes that ingested inflammatory cells in alveolar spaces, which was characteristics of GIP. The lung parenchyma also showed patchy chronic inflammatory-cell infiltrates centered predominantly around the bronchioles and interstitial fibrosis. Considering the exposure history and the histological findings of the lung, the diagnosis of hard metal lung disease and GIP associated with hard metals was made. Her cough, dyspnea, and radiological changes showed marked improvement after corticosteroid therapy and avoidance of further exposure to hard metals.GIP is almost pathognomonic for hard metal lung disease. Meticulous history taking on occupational exposure is important for the diagnosis and differential diagnosis of suspected interstitial lung disease.

To describe the clinical and pathological features of primary NK/T cell lymphoma of the lung.Two cases of primary NK/T cell lymphoma of the lung were reported, and the clinical, radiological and pathological characteristics of the disease were discussed with literature review of 3 cases.Most patients presented with fever, cough and dyspnea, and antibiotics were ineffective. Radiographic findings included solitary or multiple nodules and consolidation, unilateral orbilateral pleural effusions (4/5), without hilar or mediastinal adenopathy. Ebstein-Barr virus was positive in cases patients (3/5). Histopathology revealed a great deal of abnormal lymphocyte infiltration, which were angio-centric with marked tissue putrescence and angio-destruction. Immunophenotyping showed CD56(+), CD3(+), perform (+), T-cell intracytoplasmic antigen-1(+) and/or GranB(+), but CD20(-). Most patients died of respiratory failure in half a year (4/5).Primary NK/T cell lymphoma of the lung is rare, but should be considered when patients present with lung shadows and fever non-responsive to antibiotics, decreased WBC and increased LDH.

To describe the characteristics of high-resolution CT(HRCT) findings of nonspecific interstitial pneumonia (NSIP) and the correlation with pathological changes.The HRCT features of 9 cases (3 men and 6 women) of histopathologically confirmed NSIP were retrospectively analyzed and correlated with the pathological findings.The predominant HRCT features, found in all the cases, were bilaterally patchy areas of ground-glass opacity with or without areas of consolidation. Irregular linear opacities, traction bronchiectasis, and thickening of bronchovascular bundles were also frequently seen. The abnormalities were distributed over the peripheral zones of the middle and lower lungs in most cases. Honeycombing was not a feature in all the cases. Areas of ground-glass opacity with or without irregular linear opacity or traction bronchiectasis corresponded pathologically to areas of interstitial thickening caused by varying degrees of interstitial inflammation and fibrosis showing temporal uniformity. Areas of consolidation were associated with extensive collagen-type interstitial fibrosis and mild interstitial inflammation at the biopsy sites, and occasionally represented the areas of bronchiolitis obliterans organizing pneumonia, foamy cell collections in alveolar spaces, or microscopic honeycombing with mucin stasis.The HRCT manifestations of NSIP are characteristic though not specific. In patients with consistent clinical features, the diagnosis of NSIP can be suspected by typical HRCT findings.

To investigate the expression of granulocyte-macrophage colony-stimulating factor (GM-CSF), GM-CSF/IL-3/IL-5 receptor common beta chain (GM-CSFbetacR), surfactant protein (SP)-A and SP-D in adult patients with idiopathic pulmonary alveolar proteinosis (PAP), so as to demonstrate the possible association of GM-CSF, GM-CSFbetacR, SP-A and SP-D with human PAP.The protein expression of GM-CSF, GM-CSFbetacR, SP-A and SP-D in the alveolar macrophages and alveolar type II epithelial cells was detected by immunohistochemical staining.The age was 51.8 +/- 9.5 years old for patients with idiopathic PAP (6; males 4, females 2) and 48.8 +/- 12.6 years old for the control adult individuals (6; males 4, females 2). There was no difference in the expression of GM-CSF (P = 0.818) and SP-D (P = 0.24) in alveolar macrophages between patients with idiopathic PAP and the controls. The expression of GM-CSFbetacR (P = 0.002) and SP-A (P = 0.004) in alveolar macrophages of patients with idiopathic PAP was less than that in the controls. There was no expression of GM-CSF in alveolar type II epithelial cells of patients with idiopathic PAP and the controls. There was a little expression of GM-CSFbetacR in alveolar type II epithelial cells of the controls. There was no expression of GM-CSFbetacR in alveolar type II epithelial cells of patients with idiopathic PAP. There was no difference in the expression of SP-A (P = 0.818) and SP-D (P = 0.485) in alveolar type II epithelial cells between patients with idiopathic PAP and the controls.The decreased protein expression of GM-CSFbetacR in alveolar macrophages may be one of the mechanisms causing dysfunction of the macrophages in adult patients with idiopathic PAP.