Pneumocystis pneumonia in stage IIIA lung adenocarcinoma with immune-related acute kidney injury and thoracic radiotherapy:A case report

BACKGROUND Immune checkpoint inhibitors(ICIs)are therapeutic agents for advanced and metastatic non-small cell lung cancer(NSCLC)with high clinical antitumor efficacy.However,immune-related adverse events occur in 20%of these patients and often requiring treatment with immunosuppressive agents,such as corticosteroids.Consequently,this may increase the risk of patients to opportunistic infections.Pneumocystis jirovecii pneumonia(PJP),a rare but serious opportunistic infection typically observed in patients with human immunodeficiency virus,can also occur in cancer patients undergoing long-term glucocorticoid treatment.CASE SUMMARY We report a case of a 56-year-old male with squamous NSCLC treated with triplimab combined with paclitaxel,carboplatin,and radical thoracic radiation therapy.Following this regimen,he developed acute kidney injury(AKI)with elevated creatinine levels.After concurrent radical chemoradiotherapy ended,he developed a grade 3 immune-related AKI.High-dose corticosteroids were administered to treat AKI,and renal function gradually recovered.Corticosteroids were reduced to a dose of 10 mg prednisone equivalent daily eight weeks later;however,he developed severe pneumonia with spontaneous pneumothorax.Next-generation sequencing of the bronchoscopic lavage revealed PJP co-infection with herpes simplex virus 1 and cytomegalovirus.The inflammation was more severe in areas exposed to radiation.Piperacillin-tazobactam,acyclovir,sulfamethoxazole,and trimethoprim were used to control the infection.The patient recovered,and immunotherapy was terminated.CONCLUSION PJP is rare but can occur in patients with ICI adverse events and should be differentiated from tumor progression or immune-related adverse events.Thoracic radiation may increase risk,necessitating careful monitoring and prevention.

Moiréflat bands of twisted few-layer graphite

We report that the twisted few layer graphite(tFL-graphite)is a new family of moiréheterostructures(MHSs),which has richer and highly tunable moiréflat band structures entirely distinct from all the known MHSs.A tFL-graphite is composed of two few-layer graphite(Bernal stacked multilayer graphene),which are stacked on each other with a small twisted angle.The moiréband structure of the tFL-graphite strongly depends on the layer number of its composed two van der Waals layers.Near the magic angle,a tFL-graphite always has two nearly flat bands coexisting with a few pairs of narrowed dispersive(parabolic or linear)bands at the Fermi level,thus,enhances the DOS at EF.This coexistence property may also enhance the possible superconductivity as been demonstrated in other multiband superconductivity systems.Therefore,we expect strong multiband correlation effects in tFL-graphite.Meanwhile,a proper perpendicular electric field can induce several isolated nearly flat bands with nonzero valley Chern number in some simple tFL-graphites,indicating that tFL-graphite is also a novel topological flat band system.

Topological flat bands in twisted trilayer graphene

Twisted trilayer graphene(TLG)may be the simplest realistic system so far,which has flat bands with nontrivial topology.Here,we give a comprehensive calculation about its band structures and the band topology,i.e.,valley Chern number of the nearly flat bands,with the continuum model.With realistic parameters,the magic angle of twisted TLG is about 1.12°,at which two nearly flat bands appears.Unlike the twisted bilayer graphene,a small twist angle can induce a tiny gap at all the Dirac points,which can be enlarged further by a perpendicular electric field.The valley Chern numbers of the two nearly flat bands in the twisted TLG depends on the twist angleθand the perpendicular electric field E⊥.Considering its topological flat bands,the twisted TLG should be an ideal experimental platform to study the strongly correlated physics in topologically nontrivial flat band systems.And,due to its reduced symmetry,the correlated states in twisted TLG should be quite different from that in twisted bilayer graphene and twisted double bilayer graphene.

Metabolic Dysfunction-associated Fatty Liver Disease is Associated with Greater Impairment of Lung Function than Nonalcoholic Fatty Liver Disease

Background and Aims:We compared lung function parameters in nonalcoholic fatty liver disease(NAFLD)and metabolic dysfunction-associated fatty liver disease(MAFLD),and examined the association between lung function parameters and fibrosis severity in MAFLD.Methods:In this cross-sectional study,we randomly recruited 2,543 middle-aged individuals from 25 communities across four cities in China during 2016 and 2020.All participants received a health check-up including measurement of anthropometric parameters,biochemical variables,liver ultrasonography,and spirometry.The severity of liver disease was assessed by the fibrosis(FIB)-4 score.Results:The prevalence of MAFLD was 20.4%(n=519)and that of NAFLD was 18.4%(n=469).After adjusting for age,sex,adiposity measures,smoking status,and significant alco-hol intake,subjects with MAFLD had a significantly lower predicted forced vital capacity(FVC,88.27±17.60%vs.90.82±16.85%,p<0.05)and lower 1 s forced expiratory volume(FEV1,79.89±17.34 vs.83.02±16.66%,p<0.05)than those with NAFLD.MAFLD with an increased FIB-4 score was significantly associated with decreased lung function.For each 1-point increase in FIB-4,FVC was diminished by 0.507(95%CI:-0.840,-0.173,p=0.003),and FEV1 was diminished by 0.439(95%CI:-0.739,-0.140,p=0.004).The results remained unchanged when the statistical analyses was performed separately for men and women.Conclusions:MAFLD was significantly asso-ciated with a greater impairment of lung function param-eters than NAFLD.