Chi Shao

Bio: Chi Shao is an academic researcher from Peking Union Medical College Hospital. The author has contributed to research in topics: Interstitial lung disease & Lung cancer. The author has an hindex of 3, co-authored 12 publications receiving 23 citations.

Prognosis of adult idiopathic inflammatory myopathy-associated interstitial lung disease: a retrospective study of 679 adult cases

Abstract: 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 0.05). 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 0.05), although both were higher than that in PM group (13.2%, P = 0.01 and 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.

Programmed cell death 1 (PD-1)/PD-ligand 1(PD-L1) inhibitors-related pneumonitis in patients with advanced non-small cell lung cancer.

Abstract: 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.

Clinical characteristic analysis of 96 cases of hypersensitivity pneumonitis

Abstract: Objective To improve understanding of the clinical characteristics and diagnosis of hypersensitivity pneumonitis(HP). Methods We retrospectively analyzed the clinical data, including clinical symptoms, laboratory tests, exposure, pulmonary function tests, chest CT imaging and cytological classification of bronchoalveolar lavage(BAL) of 96 patients with HP from Jan 2001 to Jun 2011 in Peking Union Medical College Hospital.We divided the patients into 2 groups: a pathologically-confirmed group and a clinically-suspected group. Results There were 58 females and 41 males.The median age at the diagnosis was 53 years.The most common exposures were low-molecular-weight chemicals (42.7%) and animal proteins (37.5%). Common clinical symptoms included dyspnea on exertion (90.6%) and cough (76.0%). Pulmonary function test showed diffusion abnormality (73.5%) and restrictive ventilatory impairment(59.7%). Chest CT scan revealed patchy or diffuse bilateral ground-glass opacities(64.6%), centrilobular nodules (21.9%), and air trapping (15.6%). Reticulation (45.8%), traction bronchiectasis (21.9%) and honeycombing(9.4%) were present in chronic HP.BAL lymphocyte counts >0.2 and CD4/CD8 <0.9 were more commonly seen in patients with a disease course of less than 1 year. The pathologically-confirmed group and the clinically-suspected group shared many similar characteristics including age at diagnosis, gender, clinical manifestation, pulmonary function impairments and imaging findings, but significant differences existed in certain parameters.In the pathologically-confirmed group, the duration of disease was longer (24 months vs 6 months, Z=-2.492, P=0.013) and clubbed fingers were more common (23.4% vs 8.2%, χ2=4.227, P=0.040). Diffusion abnormality was present in more patients of this group (90.7% vs 44.0%, χ2=35.219, P<0.01). By CT scan, reticulation, traction bronchiectasis and honeycombing (57.5% vs 26.5%, χ2=9.434, P<0.01) were more evident as compared to the clinically-suspected group.The value of transbronchial lung biopsy for diagnosing HP was limited, with a positive result of only 8.2%.Surgical lung biopsy was needed in uncertain cases. Conclusion The diagnosis of HP was difficult.In some cases a clinical diagnosis can be made by combination of history of exposure, CT manifestations and cell classification of BAL.For atypical cases a multi-disciplinary approach including pathologists, radiologists and pulmonologists is needed. Key words: Alveolitis, extrinsic allergic; Retrospective studies; Diagnosis

Myositis specific antibodies are associated with isolated anti-Ro-52 associated interstitial lung disease

Abstract: Objectives Anti-Ro-52 antibody positivity might be associated with the presence of interstitial lung disease (ILD) among patients with autoimmune features. However, the clinical significance of isolated anti-Ro-52 positivity (i.e., the presence of anti-Ro52 antibodies but the absence of anti-Ro60 antibodies; anti-Ro52+-Ro60-) in patients with ILD is not clear. Methods This is a prospective and observational study of Chinese ILD patients with isolated anti-Ro-52 positivity. According to their myositis-specific antibody (MSA) status, patients were split into groups, and their clinical and radiological features were compared. Results Of the 158 enrolled patients with ILD and isolated anti-Ro-52 positivity (isolated anti-Ro-52-ILD), there were 130 patients with a positive MSA status and 28 patients with a negative MSA status. Anti-synthetase antibodies (ASAs) were found in 61.5% of patients with MSA+ ILD, and anti-melanoma differentiated-associated protein 5 (MDA-5) antibodies were found in the remaining 38.5% of patients. The anti-nuclear antibody (ANA) pattern was associated with ASA and anti-MDA-5 positivity (χ2=70.7, P Conclusions Patients with isolated anti-Ro-52-ILD showed high positivity of MSA. Isolated anti-Ro-52 positivity with cytoplasmic ANA positivity was strongly associated with ASA+-ILD, while ANA negativity was associated with anti-MDA-5+-ILD.

Rituximab in severe, treatment-refractory interstitial lung disease

Abstract: Background In a subgroup of patients with severe interstitial lung disease (ILD) progressing despite conventional immunosuppression, rituximab, a B cell-depleting monoclonal antibody, may offer an effective rescue therapy. Methods Retrospective assessment of 50 patients with severe, progressive ILD (34 with connective tissue disease-associated ILD, 7 with fibrotic hypersensitivity pneumonitis, 3 with likely drug-induced ILD, the rest with miscellaneous ILD patterns, excluding idiopathic pulmonary fibrosis) treated with rituximab between 2010 and 2012. At the time of rituximab treatment, mean DLco was 25.5 % (±9.9%), and FVC was 49.1% (±17.6%). Change in pulmonary function tests compared to pre-rituximab levels, was assessed at six to twelve months post-treatment. Changes in lung function before and after treatment were analysed by Wilcoxon signed rank test. Results In contrast with a median decline in forced vital capacity (FVC) and diffusing capacity for carbon monoxide (DLco) of 14.6% and 18.8% respectively in the six to twelve months prior to rituximab, analysis of paired pulmonary function data revealed a median improvement in FVC of 5.7% (p Conclusions In a subgroup of patients with severe, progressive ILD unresponsive to conventional immunosuppression, rituximab may offer a safe and effective therapeutic intervention. Future prospective, controlled trials are warranted to validate these findings.

Immune Checkpoint Inhibitor-Associated Pneumonitis in Non-Small Cell Lung Cancer: Current Understanding in Characteristics, Diagnosis, and Management

Abstract: Immunotherapy that includes programmed cell death-1 (PD-1), programmed cell death- ligand 1 (PD-L1) and cytotoxic T lymphocyte antigen 4 (CTLA-4) inhibitors has revolutionized the therapeutic strategy in multiple malignancies. Although it has achieved significant breakthrough in advanced non-small cell lung cancer patients, immune-related adverse events (irAEs) including checkpoint inhibitor pneumonitis (CIP), are widely reported. As the particularly worrisome and potentially lethal form of irAEs, CIP should be attached more importance. Especially in non-small cell lung cancer (NSCLC) patients, the features of CIP may be more complicated on account of the overlapping respiratory signs compromised by primary tumor following immunotherapy. Herein, we included the previous relevant reports and comprehensively summarized the characteristics, diagnosis, and management of CIP. We also discussed the future direction of optimal steroid therapeutic schedule for patients with CIP in NSCLC based on the current evidence.

Endobronchial Ultrasound-guided Transbronchial Needle Aspiration versus Standard Bronchoscopic Modalities for Diagnosis of Sarcoidosis: A Meta-analysis

Abstract: Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an effective technique used to precisely detect enlarged mediastinal lymph nodes. The efficacy of EBUS-TBNA versus standard modalities for the diagnosis of sarcoidosis remains to be elucidated. In this meta-analysis, we compared the efficacies of these methods. Methods: We searched PubMed, Embase, The Cochrane Library, Wanfang, Cpvip, CNKI, and the bibliographies of the relevant references. We analyzed the data obtained with Revman 5.2 (Nordic Cochrane Center, Copenhagen, Denmark) and Stata 12.0 software (Stata Corporation, College Station, TX, USA). The Mantel-Haenszel method was used to calculate the pooled odds ratio ( OR ) and 95% confidence intervals ( CIs ). Results: Sixteen studies with a total of 1823 participants met the inclusion criteria, and data were extracted regarding the diagnostic yield of each approach. The ORs for EBUS-TBNA versus transbronchial lung biopsy (TBLB) for the diagnosis of sarcoidosis ranged from 0.26 to 126.58, and the pooled OR was 5.89 (95% CI , 2.20–15.79, P = 0.0004). These findings indicated that EBUS-TBNA provided a much higher diagnostic yield than TBLB. The pooled OR for EBUS-TBNA + TBLB + endobronchial biopsy (EBB) versus TBNA + TBLB + EBB was 1.54 (95% CI , 0.61–3.93, P = 0.36), implying that there was no significant difference between their diagnostic yields. However, clinical heterogeneity was reflected in the nature of the studies and in the operative variables. Conclusions: The results of this meta-analysis suggest that EBUS-TBNA + TBLB + EBB could be used for the diagnosis of sarcoidosis, if available. At medical centers without EBUS-TBNA, TBNA + TBLB + EBB could be used instead.