Characterization of immunomodulatory factors and cells in bronchoalveolar lavage fluid for immune checkpoint inhibitor-related pneumonitis.

As immune checkpoint inhibitors (ICIs) are widely used, a series of immune-related adverse events (irAEs) have been reported, including immune checkpoint inhibitor-related pneumonitis (ICI-pneumonitis). The incidence of ICI-pneumonitis is higher in reality than in clinical trials. The diagnosis is challenging, mainly based on clinical and imaging features, and requires the exclusion of other causes. The data on the biological mechanisms of ICI-pneumonitis are scarce, resulting in little knowledge of the best treatment for ICI-pneumonitis. Bronchoalveolar lavage (BAL) may be helpful to identify the biological differences or find predictive biomarkers, and may in turn help to develop phenotype-specific targeted drugs to treat ICI-pneumonitis. Herein, we outline the characterization of immunomodulatory factors and cells in bronchoalveolar lavage fluid for ICI-pneumonitis. Through careful sorting and literature review, we find crosstalk between pathogenic Th17/Th1 cells (i.e., Th17.1) and pro-inflammatory monocytes, and activation of Th17(/Th1)/IL-17A (/IFN-γ) pathways may play a key role in the pathogenesis of ICI-pneumonitis. Disruption of the interaction between pathogenic Th17/Th1 cells and pro-inflammatory monocytes (such as, anti-IL-23) may be a potential treatment for ICI-pneumonitis. We first describe the possible pathophysiological mechanisms of ICI-pneumonitis, hoping to contribute to the optimization of diagnosis and treatment, as well as provide readers with research inspiration.

Myositis-myasthenia gravis overlap syndrome complicated with myasthenia crisis and myocarditis associated with anti-programmed cell death-1 (sintilimab) therapy for lung adenocarcinoma.

Immune checkpoint inhibitors (ICIs) have improved clinical outcomes with a number of advanced malignancies. However, diverse immune-related adverse events (iRAEs) occurred with the widespread use of ICIs, some of which are rarely and life-threatening. Here we report a 66-year-old patient with lung adenocarcinoma who received two doses of sintilimab, a human monoclonal antibody against programmed cell death-1 (PD-1), experienced a fatal storm of iRAEs. He was admitted to the intensive care unit (ICU) by immune induced-myositis/myocarditis and rhabdomyolysis. Despite immediate immunosuppressive therapy with methylprednisolone (MP) and immunoglobulin intravenously, he developed into myositis-myasthenia gravis (MG) overlap syndrome complicated with myasthenia crisis. We commenced plasma exchange (PLEX), mechanical ventilation, immunosuppressive therapy, as well as other supportive therapies. Three months later, the patient's serum creatine phosphate kinase (CPK) and anti-acetylcholine receptor antibody (anti-AChR-Ab) returned to normal despite tumor progression. Herein we discuss the incidence, operating mechanism and management strategies of the fatal iRAEs. Early admission to the ICU and multidisciplinary collaborative treatment for unstable patients with iRAEs could help to achieve a favorable outcome.

A comprehensive health classification model based on support vector machine for proseal laryngeal mask and tracheal catheter assessment in herniorrhaphy.

Purpose: In order to classify different types of health data collected in clinical practice of hernia surgery more effectively and improve the classification performance of support vector machine (SVM). Methods: A prospective randomized study was conducted. Sixty patients undergoing hernia repair under general anesthesia were randomly divided into two groups, PLMA group (n = 30) and ETT group (n = 30), for airway management. Heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, respiratory parameters and the incidence of complications related to ProSeal laryngeal mask airway (PLMA) and endotracheal tube (ETT) were collected in clinical experiments in order to evaluate the operation condition. On the basis of this experiment, at first, expert credibility is introduced to process the index value; secondly, the classification weight of the index is objectively determined by the information entropy output of the index itself; finally, a comprehensive classification model of support vector machine based on key sample set is proposed and its advantages are evaluated. Result: After classifying the experimental data, we found that SVM can accurately judge the effect of surgery by data. In this experiment, PLMA method is better than ETT method in xenon repair operation. Discussion: SVM has great accuracy and practicability in judging the outcome of xenon repair operation. Conclusion: The proposed index classification weight model can deal with the uncertainties caused by uncertain information and give the confidence of the uncertain information. Compared with the traditional SVM method, the proposed method based on SVM and key sample set greatly reduces the number of samples that misjudge the effect of samples, and improves the practicability of SVM method. It is concluded that PLMA is superior to the ETT technique to hernia surgical. The idea of constructing classification model based on key sample set proposed in this paper can also be used for reference in other data mining methods.