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Neoadjuvant PD-(L)1 inhibitors may be promising for locally advanced non-small cell lung cancer (NSCLC) with potential pathological and survival benefits. But severe immune-related adverse events (irAEs) may cause fatal consequences which require early identification and timely intervention. The basis for most of these adverse events is a reactive hyperactivated T-cell response to normal tissues that results in the production of high levels of CD4 T-helper cell cytokines or increased migration of cytolytic CD8 T cells in normal tissues. It is recommended that all patients receiving PD-(L)1 inhibitors routinely have thyroid function studies, complete blood counts, and liver function and metabolic panels at each treatment and at intervals of 6 to 12 weeks for the first 6 months after finishing treatment. Herein, we report a rare case who had two grade 3–4 irAEs consecutively occurring after PD-1 induction therapy and surgery. A 59-year-old man with stage IIIA squamous cell lung cancer receiving 3 cycles of neoadjuvant nab-paclitaxel, carboplatin, and nivolumab was reevaluated for resectability. The patient experienced acute serum transaminase elevation right after induction therapy. Seven days after surgery he had severe pneumonia. These two serious complications were both eventually relieved by a month long treatment of corticosteroids but not regular medicine which verified the diagnosis of irAEs. Although results of clinical trials of neoadjuvant immunotherapy are worth expecting, our case calls attention to careful surveillance and timely management of irAEs during the perioperative use of PD-(L)1 inhibitors. We also further discuss the standard use of corticosteroids for irAEs based on a review of literature.

Background The incidence of dry eye is high after a cataract surgery. However, the clinical efficacy of sodium hyaluronate combined with conventional eye drops for dry eye after cataract surgery remains unclear. The currently available studies were based on small sample sizes, and no systematic review on this topic has been conducted. Thus, a meta-analysis was performed to systematically and accurately evaluate the clinical value of sodium hyaluronate in the treatment of dry eye after cataract surgery. Methods English-language databases including PubMed, Cochrane, and Web of Science, and Chineselanguage databases including (CNKI), Wanfang Database, and CQVIP were systematically searched for relevant articles published up to December 31, 2019. The pooled effect size of qualitative data was evaluated with relative risk (RR) and 95% confidence interval (CI), and the overall effect of the quantitative data was estimated by using weighted mean difference (WMD) or standard mean difference (SMD) and 95% CI. Randomized controlled clinical trials concerning the use of sodium hyaluronate combined with conventional treatment for dry eye after cataract surgery were included. The quality of the included literature was evaluated by RevMan5.3 software, and the rest of the statistical data were analyzed using the "meta" package of the R3.5.1 software. Results A total of 24 articles including 2,177 eyes (1,088 eyes in the combination group and 1089 eyes in the control group) were included. Twelve articles reported the total effective rate after 1 month of treatment (I2 =71%), and the random effects model was used to estimate RR. The total effective rate in the combination group was 1.33 times that of the control group (95% CI: 1.21, 1.47). Ten articles reported the dry eye symptom score after 1 month of treatment (I2 =92%). The SMD was estimated using the random effects model. The dry eye symptom score in the combination group was significantly lower than that in the control group, with an SMD of -2.98 (95% CI: -3.69, -2.27). Seventeen articles reported the tear film break-up time (BUT) after 1 month of treatment. As shown in the random effects model, BUT was significantly longer in the combination group than in the control group, with an MD of 2.06 (95% CI: 1.63, 2.49). Sixteen articles described the scores of a fluorescein (FL) eye stain test after 1 month of treatment. As shown in the random effects model, FL score was significantly lower in the combination group than in the control group, with an SMD of -2.52 (95% CI: -3.23, -1.81). Eight articles reported the results of Schirmer I test (SIt) after 1 month of treatment. As estimated by the random effects model, the wetting length in SIt was significantly higher in the combination group than in the control group, with an MD of 1.50 (95% CI: 0.53, 2.48). In the elderly population, BUT was significantly higher in the combined group than in the control group, with an MD of 2.97 (95%CI: 2.47, 3.47); however, the FL score and SIt showed no such significant difference. Conclusions For the patients with dry eye after cataract surgery, sodium hyaluronate on the basis of conventional anti-inflammatory treatment is highly effective as it can improve the dry eye symptom score and the results of 3 tests for dry eye. However, high-quality studies are warranted to further investigate the safety of sodium hyaluronate.