To investigate the risk, risk factors, and dynamic changes in lymphocyte subsets and peripheral inflammatory cytokines of Pneumocystis jirovecii(PJ) infection in patients with advanced non-small cell lung cancer (NSCLC) receiving immune checkpoint inhibitors (ICIs) therapy.

This retrospective study included 34 patients with advanced NSCLC diagnosed with pulmonary PJ infection and treated with ICIs at our hospital between January 2019 and December 2024. Patients without pulmonary PJ infection during the same period served as the control group 47 patients. Peripheral blood mononuclear cells (PBMCs) were analyzed by cytometry by time-of-flight(CyTOF), including CD4⁺ and CD8⁺ T cell subsets and the expression of exhaustion markers T cell immunoglobulin and mucin domain-3 (TIM-3⁺ ), lymphocyte activation gene 3 (LAG-3⁺ ), and programmed death receptor 1 (PD-1⁺ ). Flow cytometry was used to detect peripheral blood T lymphocyte subsets at baseline (T0) and after one cycle of treatment (T1) in all subjects, and a series of serum cytokines were detected by enzyme-linked immunosorbent assay (ELISA).

Compared with the control group, the observation group exhibited significantly higher white blood cell counts [(6.50±2.10) × 109/L vs. (5.21±1.14) ×10⁹/L; t=3.249, P=0.002] and neutrophil-to-lymphocyte ratios (NLR) [(5.17±2.58) vs. (3.53±2.07); t=3.210, P=0.002]. Conversely, the observation group showed significantly lower lymphocyte counts [(1.28±0.56) ×10⁹/L vs. (1.55±0.67)×10⁹/L; t=-1.915, P=0.049], CD4⁺ T-cell counts [(420.54±102.65)×10⁶/L vs. (552.76±120.23)×10⁶/L; t=-5.170, P<0.001], and CD4⁺ /CD8⁺ T-cell ratios [(1.10±0.18) vs. (1.38±0.25); t=-5.910, P<0.001]. Multivariate analysis demonstrated that immunotherapy combined with chemotherapy (OR=1.910, P=0.011), negative PD-L1 expression (OR=2.333, P=0.033), NLR(OR=2.010, P=0.020), and a CD4⁺ /CD8⁺ T-cell ratio ≤1.0 (OR=2.578, P=0.036) were independent factors associated with an increased risk of pulmonary PJ infection. CyTOF analysis revealed that the relative abundances of exhausted CD8⁺ T cells and total CD8⁺ T cells in the control group were significantly higher than those in the observation group (Z-score difference of approximately 1.5~2.0), accompanied by the upregulated expression of CD366 (TIM-3), CD223 (LAG-3), and CD279 (PD-1) (Log2FC>1.0, P<0.1). Flow cytometry analysis demonstrated that PD-1⁺ CD8⁺ T-cell counts in the observation group significantly increased at T1 compared with T0 [(298.50±48.25)/μl vs. (418.29±67.43)/μl; t=-2.621, P=0.013]. Conversely, in the control group, significant decreases from T0 to T1 were observed in both LAG-3⁺ CD4⁺ T-cell counts [(685.50±104.83)/μl vs. (229.35±34.26)/μl; t=2.825, P=0.007] and PD-1⁺ CD8⁺ T-cell counts [(383.21±41.65)/μl vs. (108.21±37.43)/μl; t=2.083, P=0.043]. Analysis of cytokine levels revealed significant upward trends at T1 compared with T0 for serum interleukin-2 (IL-2) [(45.23±15.01) pg/ml vs. (135.12±20.21)pg/ml; t=-2.698, P=0.045], tumor necrosis factor-α(TNF-α) [(60.56±9.18) pg/ml vs. (186.25±53.47) pg/ml; t=-3.240, P=0.021], and interferon-γ(IFN-γ) [(50.56±10.34) pg/ml vs. (201.23±20.56) pg/ml; t=-3.274, P=0.019]. The fold changes (T1/T0) of these cytokines in the control group were significantly higher than those in the observation group. In contrast, interleukin-6 (IL-6) levels exhibited a downward trend, with a significantly smaller fold change observed in the control group compared with the observation group. With a median follow-up of 7.79 months, the median survival time of the observation group was significantly shorter than that of the control group (7.23 months vs. 14.12 months; P=0.047).

Reducing the number of exhausted T cells and increasing TNF-α may be potential mechanisms by which ICIs decreases susceptibility to pulmonary PJ infection. Exhausted T cells have potential predictive value for the risk of pulmonary PJ infection in patients with advanced NSCLC.

To investigate the impact of distinct clinical progression patterns on progression-free survival (PFS) in patients with anaplastic lymphoma kinase (ALK) fusion gene-positive non-small cell lung cancer (NSCLC) following treatment with first-generation, first-line and sequential second-line second-generation ALK tyrosine kinase inhibitors (ALK-TKIs), to analyze whether baseline patient characteristics can predict progression patterns, and to evaluate survival differences among various treatment strategies after second-generation ALK-TKI resistance.

A retrospective analysis was conducted on ALK-positive advanced NSCLC patients who experienced disease progression after ALK-TKI therapy between January 1, 2017, and September 30, 2025, across four centers (Eastern Theater Command General Hospital, Hunan Cancer Hospital, Shanxi Bethune Hospital, and Nanjing Chest Hospital). Patients were divided into first-generation ALK-TKI resistance cohort and second-generation ALK-TKI resistance cohort based on the targeted agent and treatment line at the time of drug resistance. The second-generation ALK-TKI resistance cohort included two subgroups: patients progressed after first-line second-generation ALK-TKI treatment, and patients progressed after sequential second-generation ALK-TKI treatment (second-line) following first-generation ALK-TKI. Progression patterns (oligoprogression vs. systemic progression; primary site progression vs. distant site progression) were assessed according to RECIST 1.1 criteria. Kaplan-Meier method was used for PFS analysis, and Firth regression was applied to identify predictive factors for systemic progression after second-generation ALK-TKI resistance.

The first- and second-generation TKI resistance cohorts included 53 and 56 patients, respectively. The median PFS for patients with oligoprogression after second-generation TKI resistance (17.7 months; 95%CI: 12.5~22.8 months) was significantly longer than for those with systemic progression (9.0 months; 95%CI: 4.5~13.5 months, P<0.001). Subgroup analysis showed that patients with oligoprogression had significantly better PFS than those with systemic progression, regardless of first-line or sequential second-line second-generation TKI treatment (all P<0.05). Patients presenting with oligometastatic disease before second-generation TKI treatment were less likely to develop systemic progression (OR=0.18, 95%CI: 0.03~0.87, P=0.033). After second-generation TKI resistance, no significant difference in PFS was observed among patients who continued the original drug, switched to another second-generation TKI, or initiated a third-generation TKI (P=0.979).

After second generation ALK-TKI resistance, oligoprogression pattern is associated with longer PFS regardless of treatment line, and pre-treatment metastatic status may serve as an independent predictor for the progression pattern. No significant difference in efficacy was found among different subsequent TKI strategies following second-generation TKI resistance, and this result is only an exploratory analysis, which needs to be further verified by prospective studies

To investigate the expression characteristics and clinical significance of STE20 family genes in lung squamous cell carcinoma (LUSC), and to explore their association with immune infiltration and their potential as prognostic biomarkers and therapeutic targets.

Transcriptomic data from TCGA, GTEx, and GEO databases (GSE229509, GSE268175) comprising 85 normal lung tissues and 559 LUSC tissues were integrated to analyze the differential expression of STE20 family members. ESTIMATE and TIMER databases were used to evaluate the correlation between STE20s and immune cell infiltration. LASSO regression was employed to construct a prognostic risk model, and random forest model was used to assess the prognostic value of MST4. GO and KEGG enrichment analyses were performed to explore the potential functions of MST4. qRT-PCR and Western blotting were used to validate the expression of key genes in LUSC cell lines (NCIH520, H-1703, SK MES 1).

Among STE20 family members, SPAK, PAK1, PAK6, and MST4 were significantly upregulated in LUSC tissues (P<0.05), while MST1, OSR1, TAO2, MINK, TNIK, and LOK were significantly downregulated (P<0.05). Immune infiltration analysis revealed that MST3, MYO3B, and TNIK were positively correlated with immune scores, whereas MST1, MST4, PAK1, and PAK6 were negatively correlated. TIMER analysis showed that MST4 expression was significantly negatively correlated with infiltration of CD8⁺ T cells (r=-0.23, P<0.001), CD4⁺ T cells (r=-0.19, P<0.01), and macrophages (r=-0.21, P<0.001). LASSO regression identified five prognosis-related genes (PAK1, PAK6, MST1, OSR1, MST4). The risk score model indicated that the high-risk group had significantly shorter overall survival than the low-risk group (HR=2.34, 95%CI: 1.78~3.08, P<0.001). The random forest model predicting 1-, 3-, and 5-year survival achieved AUC values of 0.71, 0.75, and 0.75, respectively. High MST4 expression was associated with poor prognosis (HR=1.89, 95%CI: 1.42~2.51, P<0.001). GO/KEGG enrichment analysis revealed that MST4 is involved in cell cycle, ECM-receptor interaction, and EMT-related pathways. qRT-PCR and Western blotting confirmed that mRNA and protein levels of PAK1, PAK6, and MST4 were significantly higher in LUSC cell lines than in normal lung epithelial cells (BEAS-2B) (P<0.01), while MST1 and OSR1 were significantly lower (P<0.01).

STE20 family genes are aberrantly expressed in LUSC and are closely associated with immune infiltration and prognosis. MST4, as a key member, may promote LUSC progression by regulating cell cycle and ECM remodeling, highlighting its potential as a prognostic biomarker and therapeutic target.

To analyze the effectiveness and safety of electromagnetic navigation bronchoscopy (ENB)-guided methylene blue localization in thoracoscopic surgery for pulmonary nodules, compare it with computed tomography (CT)-guided percutaneous localization, and explore its clinical feasibility and influencing factors.

A retrospective study was conducted on 248 patients who underwent pulmonary nodule localization and video-assisted thoracoscopic surgery at our hospital from October 2022 to October 2024. Propensity score matching at a 1︰1 ratio resulted in 124 cases in the ENB localization group and 124 cases in the CT localization group. Localization time, localization success rate, and complications were recorded. LASSO regression and logistic regression were used to analyze factors affecting ENB localization time.

The proportion of solid nodules (12.10% vs. 4.03%, P=0.048) and the proportion of bronchus sign (15.32% vs. 7.26%, P=0.045) were higher in the ENB localization group than in the CT localization group. Localization time (15.00 min vs. 16.15 min, P=0.086) and thoracoscopic surgery time (81.50 min vs. 90.00 min, P=0.068) were lower in the ENB localization group compared to the CT localization group (P>0.05). Successful localization of pulmonary nodules was achieved in 122 cases (98.39%) in the ENB localization group, which was higher than the 121 cases (97.58%) in the CT localization group (P=0.651). The rates of hemopneumothorax (0.00% vs. 4.84%, P=0.013) and overall complications (4.84% vs. 17.74%, P=0.001) were lower in the ENB localization group than in the CT localization group. In the ENB localization group, there were 6 cases (4.84%) of complications, with no cases of hemopneumothorax or hemoptysis. Multivariate logistic regression analysis showed that pulmonary nodule location (OR=4.084, P=0.005), pulmonary nodule diameter (OR=2.452, P=0.032), and operator experience (OR=3.227, P=0.005) were risk factors affecting ENB localization time.

ENB-guided methylene blue localization has a success rate comparable to CT-guided localization, with a lower risk of complications. Clinical optimization of ENB localization outcomes should consider pulmonary nodule location, pulmonary nodule diameter, and operator experience.

To construct a single-cell dynamic atlas of pulmonary microvascular endothelial cells (PMVECs) in acute lung injury (ALI) by analyzing single-cell RNA sequencing (scRNA-seq) data, and to decipher cellular heterogeneity and communication characteristics during the injury progression.

The single-cell RNA sequencing dataset (GSE148499) was retrieved from the Gene Expression Omnibus (GEO) database. Quality control, dimensionality reduction, clustering, and cell annotation were performed using the Seurat package. Differential gene enrichment analysis was conducted through Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG). Pseudotemporal trajectory inference and intercellular communication analysis were carried out using the Monocle3 and CellChat packages, respectively. Validation was performed using the GSE207651 dataset and in vitro cellular experiments.

PMVECs were classified into five functional subpopulations, among which innate immune aerocytes (IIAerocytes) and proliferative capillary(PCap) were identified as key regulatory subpopulations. During the early phase of ALI (6 h~24 h), IIAerocytes highly expressing Car4, Prx, Sox9, and Ptgse rapidly expanded, reaching peak abundance on day 1 (13.4% of total cells). This subpopulation exhibited 338 differentially expressed genes (adj. P<0.05, |log2FC|>1), significantly enriched in pathways associated with innate immune activation and pathogen response. Functionally, IIAerocytes may enhance endothelial junctions through ESAM signaling, thereby regulating inflammatory responses and vascular permeability. Entering the repair phase of ALI (3 d), PCap highly expressing Gpihbp1, Tm4sf1, Cdk1, E2f1, and Cdk4 dramatically expanded to 32.7% of total cells. This subpopulation exhibited 441 differentially expressed genes (adj. P<0.05, |log2FC|>1), significantly enriched in cell cycle and DNA repair pathways. Pseudotime analysis revealed that IIAerocytes originated from the differentiation trajectory of Aerocytes, whereas PCap derived from GCap. In a sepsis model, a similar IIAerocyte subpopulation (highly expressing Car4, Prx, Ltbp2, and Higd1b) was also identified; however, its functions were more concentrated on chemokine signaling, leukocyte migration regulation, and neutrophil recruitment. In vitro LPS stimulation experiments demonstrated that Cdk4 protein expression in human PMVECs peaked on day 1 post-stimulation (P<0.0001), while E2f1 peaked on day 2 (P<0.0001). Immunofluorescence staining results were highly consistent with Western blot analysis trends, with intracellular fluorescence intensities of Cdk4 and E2f1 reaching peaks on day 1 and day 2 post-stimulation, respectively (P<0.0001), consistent with the temporal expression characteristics of PCap proliferative markers.

Based on scRNA-seq, this study reveals that PMVECs undergo a functional transition from pro-inflammatory to pro-angiogenic phenotypes during ALI, providing novel insights into the pathological mechanisms and targeted therapeutic interventions for ALI.

To analyze the clinical characteristics and prognosis of patients with acute respiratory distress syndrome (ARDS).

The clinical data of 75 patients with ARDS admitted to the Second Affiliated Hospital of Army Medical University from December 2020 to January 2024 were retrospectively collected. They were grouped according to prognosis. 41 cases survived as the control group and 34 cases died as the observation group. Compare the basic information, laboratory indicators, lung injury prediction score (LIPS) and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)of the two groups. Logistic regression was used to analyze the prognostic risk factors of ARDS, and the prognosis of ARDS was predicted by the receiver operating characteristic (ROC) curve.

Among 75 patients with ARDS, severe pulmonary infection in 46 cases (61.33%), severe acute pancreatitis in 19 cases (25.33%), sepsis in 5 cases (6.67%), and severe trauma in 5 cases (6.67%). Forty-one cases (54.67%) survived and 34 cases (45.33%) died. The age of the observation group was (63.06±13.52) years old, and APACHE The Ⅱ score (14.82±5.83) points, LIPS score (6.28±1.72) points, and oxygenation index (145.76±72.24) were statistically different from those of the control group (54.20±13.59) years old, (7.22±3.24) points, (4.63±1.36)points, and (205.27±61.30) (P<,0.05). Logistic regression analysis showed that age (OR: 1.080, 95%CI: 1.011~1.153), LIPS score (OR: 2.245, 95%CI: 1.252~4.027), APACHE Ⅱ score (OR: 1.263, 95%CI: 1.067~1.496) and oxygenation index (OR: 0.988, 95%CI: 0.977~1.000) were risk factors for the prognosis of ARDS. the area under the ROC curve (AUC) showed that the AUC of the APACHE Ⅱ score combined with the oxygenation index was 0.888, the Youden index was 0.707, the sensitivity was 0.853, and the specificity was 0.854.

The APACHE Ⅱ score combined with the oxygenation index can predict the prognosis of ARDS patients, which is helpful for the early identification of high-risk patients and provides a basis for targeted intervention.

To investigate the relationship between the D-dimer to albumin ratio (DAR), chest computed tomography (CT) parameters, and pulmonary function in acute exacerbation of chronic obstructive pulmonary disease (AECOPD).

A retrospective analysis was conducted on 83 patients with AECOPD (observation group) and 82 patients with COPD (control group) admitted to our hospital from March 2019 to December 2024. Pulmonary function, DAR, and CT parameters were compared between the two groups. Spearman′s rank correlation analysis was used to evaluate the relationships among DAR, chest CT parameters, and pulmonary function.

The DAR in the observation group was significantly higher than that in the control group [17.90 (12.17, 38.93) vs. 8.39 (6.27, 13.73), P<0.001]. The area under the receiver operating characteristic (ROC) curve (AUC) for DAR in diagnosing AECOPD was 0.827, which was higher than that of C-reactive protein (AUC 0.803), neutrophil count (AUC 0.647), lymphocyte count (AUC 0.639), and monocyte count (AUC 0.637). The lung volume in the observation group was significantly lower than that in the control group [(3.58±0.93)L vs. (4.77±1.14)L, t=7.351, P<0.001], while the emphysema index (EI) [19.36(10.62, 30.46)% vs. 6.03(3.83, 12.08)%, Z=-6.965, P<0.001] and air trapping index (ATI) [0.97±0.02 vs. 0.91±0.02, t=19.270, P<0.001] were significantly higher. The forced expiratory volume in one second (FEV₁) [53.00 (42.00, 69.00)% vs. 62.50 (50.00, 74.00)%, Z=-2.259, P=0.024], FEV₁/forced vital capacity (FVC) [58.22 (51.87, 65.48)% vs. 63.71 (55.23, 68.77)%, Z=-2.720, P=0.007], maximum mid-expiratory flow (MMEF) [25.00 (15.25, 34.50)% vs. 29.55 (21.05, 41.00)%, Z=-2.030, P=0.042], and carbon monoxide diffusing capacity (DL_CO) [63.00 (45.50, 77.50)% vs. 75.00 (55.25, 89.00)%, Z=-3.222, P=0.001] were significantly lower in the observation group compared to the control group (P<0.05). Spearman′s rank correlation and multiple linear regression analyses showed that DAR was negatively correlated with FEV₁ (Rho=-0.287, P<0.001), FEV₁/FVC (Rho=-0.264, P<0.001), and MMEF (Rho=-0.267, P<0.001). Lung volume was positively correlated with FEV₁(Rho=0.336, P<0.001), FEV₁/FVC (Rho=0.281, P<0.001), MMEF (Rho=0.215, P=0.001), and DL_CO (Rho=0.195, P=0.011). ATI was negatively correlated with FEV₁ (Rho=-0.311, P<0.001), FEV₁/FVC (Rho=-0.309, P<0.001), MMEF (Rho=-0.286, P<0.001), and DL_CO (Rho=-0.299, P<0.001). EI was negatively correlated with FEV₁ (Rho=-0.281, P<0.001), FEV₁/FVC (Rho=-0.289, P<0.001), and DL_CO (Rho=-0.162, P=0.038). The AUC of DAR for predicting readmission or death in AECOPD was 0.783 (95%CI: 0.575~0.992), with an optimal cutoff value of 16.448. Kaplan-Meier survival curve analysis showed that the event-free survival rate of AECOPD patients with DAR<16.448 (n=18) was significantly higher than that of patients with DAR ≥16.448(n=19) (88.89% vs. 47.37%, χ²=6.973, P=0.008).

DAR, lung volume, EI, and ATI in AECOPD patients are correlated with pulmonary function parameters.

To investigate the factors influencing the efficacy of non-invasive positive pressure ventilation (NIPPV) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with obstructive sleep apnea (OSA), and to evaluate the clinical value of different nocturnal ventilation strategies.

A retrospective analysis was conducted on 138 patients with AECOPD complicated by OSA admitted to our hospital from April 2022 to December 2025. Based on the therapeutic effect of NIPPV during hospitalization, patients were divided into two groups: 93 cases in the observation group (effective treatment) and 45 cases in the control group (ineffective treatment). General data, arterial blood gas parameters, sleep monitoring data, and ventilation parameters were collected from both groups. Univariate and multivariate logistic regression analyses were used to identify factors influencing the therapeutic effect.

Univariate analysis showed that body mass index (BMI), arterial partial pressure of carbon dioxide (PaCO₂), positive end-expiratory pressure (PEEP), NIPPV initiation delay time, nocturnal ventilation strategy, apnea-hypopnea index (AHI), and minimum pulse oxygen saturation (miniSpO₂) were associated with the efficacy of NIPPV (P<0.05). Multivariate logistic regression analysis revealed that BMI (OR=0.87, P=0.024), PaCO₂ (OR=0.94, P=0.006), and AHI (OR=0.91, P=0.005) were negative predictors; whereas ΔPEEP increment (OR=1.88, P=0.004), shorter NIPPV delay time (OR=0.78, P=0.019), active nocturnal PEEP up-titration (OR=4.26, P=0.002), and higher miniSpO₂ (OR=1.12, P=0.009) were protective factors. The area under the receiver operating characteristic (ROC) curve (AUC) was 0.839.

High BMI, PaCO₂, and AHI, moderate nocturnal increase in PEEP, early initiation of NIPPV, and high oxygen saturation can improve the therapeutic effect of NIPPV in patients with AECOPD combined with OSA. Optimizing ventilation parameters and intervention timing has clinical significance for enhancing ventilation efficiency and sleep quality in these patients.

To establish a 5-year all-cause mortality risk predicting model for patients with chronic obstructive pulmonary disease (COPD) based on quantitative CT assessment of imaging features across six major thoracic anatomic units, thereby informing precision diagnosis and treatment.

A total of 733 COPD patients who were hospitalized in our department for the first time from December 2012 to September 2023 were selected. Clinical data were collected. Chest CT was used to quantify imaging features across six thoracic anatomic units, and the six-feature model (with a total score of 0~10 points) was established. Discrimination was evaluated using the receiver operating characteristic (ROC) curve. Unsupervised K-Means clustering was used to stratify patients by model scores, and Kaplan-Meier survival analysis assessed 5-year all-cause mortality.

Among 733 COPD patients, 575 were male (78.44%) and 158 were female (21.56%), aged from 41 to 93 years, with a median age of 73 (65, 80) years. With the first admission as the baseline, a total of 278 patients (37.93%) died before the 5-year follow-up point. Comparisons of quantified features of thoracic anatomic units revealed statistically significant differences between non-survivors and survivors (P<0.05): pulmonary artery diameter [30.10 (26.72, 33.36) vs. 28.00 (24.90, 31.77)mm], modified Reiff score [1(0, 3) vs. 0(0, 2)], Weston score [3(0, 7) vs. 0(0, 3)], erector spinae muscle density [30.80(20.07, 37.92) vs. 35.22(28.72, 41.94)HU], visual score of emphysema [(2.91±0.37) vs. (2.56±0.86)], average density of the 4th, 7th, and 10th thoracic vertebrae [121.39(94.65, 150.56) vs. 132.42(105.55, 163.15)HU], patient proportion coexisting thoracic vertebral fracture [57(20.50%) vs. 67(14.73%)], and the six-feature model score [6(5, 7) vs. 5(4, 6)]. The area under the ROC curve (AUC value) of the six-feature model for predicting 5-year all-cause mortality risk in COPD patients was 0.70. K-Means clustering analysis separated patients into four score groups, and Kaplan-Meier curves indicated that the higher score, the higher 5-year all-cause mortality risk of COPD patients. The 5-year all-cause mortality of patients at the high score group (with a score of 8 to 10) reached 65%.

Quantitative CT assessment of imaging features across six major thoracic anatomic units enables effective prediction of 5-year all-cause mortality in COPD. The six-feature model can effectively predict the 5-year all-cause mortality risk of COPD patients, which may facilitate early identification of patients at high risk of death, supporting precision management in COPD.

To investigate the clinical efficacy of adjuvant therapy with rhubarb in patients with secondary acute lung injury (ALI) after multiple trauma, and its effects on inflammatory factors and oxidative stress indicators.

A total of 89 patients with secondary ALI after multiple trauma admitted to our hospital from June 2022 to June 2024 were enrolled and divided into a control group 37 cases and an observation group 52 cases. The control group received conventional treatment, while the observation group received rhubarb decoction in addition to conventional treatment. Respiratory function indicators [partial pressure of oxygen in arterial blood (PaO₂)/ fraction of inspired oxygen (FiO₂), maximal mid-expiratory flow (MMEF), forced vital capacity (FVC), forced expiratory volume in 1 second (FEV₁)], inflammatory factors [tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6)], oxidative stress indicators [superoxide dismutase (SOD), nitric oxide (NO)], as well as ICU stay, total hospital stay, and survival status were compared between the two groups before and after treatment.

After treatment, the observation group showed significantly higher values of PaO₂/FiO₂ (375.78±84.59 mmHg), MMEF (2.32±0.57 L/s), FVC (3.69±0.42 L), and FEV1 (76.23±8.33%) than the control group [PaO₂/FiO₂ (323.45±73.45 mmHg), MMEF (1.85±0.42 L/s), FVC (3.16±0.38 L), FEV1 (70.48±9.47%)] (all P<0.05). After treatment, serum levels of TNF-α (21.36±6.91 ng/L), IL-6 (39.52±9.36 ng/L), and NO (22.01±6.08 μmol/L) in the observation group were significantly lower than those in the control group [TNF-α(34.66±8.06 ng/L), IL-6 (60.60±10.03 ng/L), NO (30.12±8.12 μmol/L)] (all P<0.05); the SOD level in the observation group (142.33±36.06 mU/L) was higher than that in the control group (125.02±33.23 mU/L) (P<0.05). The observation group had shorter ICU stay (9.02±3.26 d) and total hospital stay (17.02±6.14 d) than the control group (11.21±4.36 d and 20.16±8.33 d, respectively) (both P<0.05). During hospitalization, 43 patients (82.69%) survived and 9 (17.31%) died in the observation group, compared with 26 survivors (70.27%) and 11 deaths (29.73%) in the control group (P>0.05).

Adjuvant therapy with rhubarb can improve pulmonary ventilation and oxygenation function, reduce inflammatory factor levels, enhance antioxidant capacity, and shorten hospital stay in patients with secondary ALI after multiple trauma.

To analyze the relationship between serum levels of glycan antigen 6 (KL-6) and pulmonary surfactant protein D (SP-D) in patients with connective tissue disease-related interstitial lung disease (CTD-ILD) and the diagnosis and severity of chest high-resolution computed tomography (HRCT), in order to investigate their clinical significance.

A total of 221 patients with CTD admitted to our hospital from January 2022 to December 2025 were retrospectively enrolled, comprising 81 patients with CTD-ILD and 140 patients with CTD alone. Based on whether they had received anti-CTD medication within the preceding 3 months, the patients were stratified into the following subgroups: the untreated CTD-ILD group 39 cases and the treated CTD-ILD group 42 cases; the untreated CTD group 70 cases and the treated CTD group 70 cases. Enzyme linked immunosorbent assay was used to measure serum KL-6 and SP-D levels. The diagnostic efficacy of serum KL-6 and SP-D were evaluated to predict CTD-ILD using binary logistic regression and receiver operating characteristic (ROC) curves. Spearman correlation analysis was used to explore the relationship between KL-6, SP-D and pulmonary function and HRCT scores.

Compared with the CTD group, the serum levels of KL-6 [855.39 (419.03, 1 281.28) U/ml vs. 182.71 (138.83, 231.68)U/ml], SP-D[64.56(61.10, 68.36) ng/ml vs. 49.27 (46.94, 52.50)ng/ml], and red blood cell distribution width-standard deviation (RDW-SD) [48.30(45.00, 51.40) fL vs. 44.40 (42.00, 48.10) fL] were significantly higher in the CTD-ILD group (P<0.05). Multivariate logistic regression analysis demonstrated that SP-D (OR=1.085, P<0.001), KL-6 (OR=1.009, P<0.001), and RDW-SD (OR=1.061, P=0.014) were independent risk factors for the development of CTD-ILD. ROC curve analysis indicated that the combination of KL-6, SP-D, and RDW-SD yielded the optimal predictive performance for CTD-ILD. The areas under the curve in the untreated and treated groups were 0.975 and 0.951, respectively, with corresponding sensitivity and specificity reaching 100.00% and 94.31% in the untreated group, and 76.89% and 95.12% in the treated group. Spearman correlation analysis showed that in both treated and untreated CTD-ILD patients, KL-6 and SP-D were significantly negatively correlated with pulmonary function parameters (r=-0.618~-0.278, P<0.05), and positively correlated with HRCT scores (untreated group: r=0.356 and 0.478; treated group: r=0.331 and 0.412; all P<0.05).

KL-6 and SP-D could be more promising biomarkers for diagnosing CTD-ILD and assessing its severity, and their diagnostic value is not affected by CTD disease subtypes and drug interference.

To investigate the clinical efficacy of butorphanol combined with remimazolam in single-port thoracoscopic lobectomy for non-small cell lung cancer (NSCLC).

A total of 78 patients with NSCLC undergoing lobectomy in our hospital from July 2020 to December 2024 were selected and divided into a control group 41 cases and an observation group 37 cases according to different anesthesia protocols. All patients received an intravenous bolus of butorphanol 30 μg/kg 15 minutes before anesthesia induction. For induction, the control group received intravenous propofol 1.5~2.5 mg/kg, sufentanil 0.2~0.4 μg/kg, and cisatracurium 0.15~0.2 mg/kg; the observation group received intravenous remimazolam 0.2~0.3 mg/kg, sufentanil 0.2~0.4 μg/kg, and cisatracurium 0.15~0.2 mg/kg. For anesthesia maintenance, the control group received continuous intravenous infusion of propofol 5~10 mg/kg/h and remifentanil 0.05~0.2 μg/kg/min, combined with inhalation of 1.7%~2.5% sevoflurane and intermittent intravenous boluses of cisatracurium 0.06~0.12 mg/kg for muscle relaxation. The observation group received continuous intravenous infusion of remimazolam 0.4~1.2 mg/kg/h and remifentanil 0.05~0.2 μg/kg/min, combined with inhalation of 1.7%~2.5% sevoflurane and intermittent intravenous boluses of cisatracurium 0.06~0.12 mg/kg. Surgical parameters, hemodynamics, respiratory function recovery, postoperative analgesia, serum biomarkers, and postoperative complications were compared between the two groups.

The intraoperative remifentanil consumption in the observation group [(1 729.81±181.22) μg vs. (1 854.43±198.95) μg] was lower than that in the control group (P<0.05). At 5 minutes after tracheal intubation (T1), heart rate (HR) [(75.28±6.76) beats/min vs. (69.36±7.38) beats/min] and mean arterial pressure (MAP) [(75.16±6.42) mmHg vs. (69.97±6.68) mmHg] were higher in the observation group than in the control group (P<0.05). At 60 minutes after one-lung ventilation (T2), HR[(75.34±6.87) beats/min vs. (72.49±7.22) beats/min] and MAP [(76.28±6.06) mmHg vs. (73.23±6.03) mmHg] were higher in the observation group than in the control group (P<0.05). At 1 week postoperatively, forced expiratory volume in the first second (FEV₁) [(2.11±0.37) L vs. (1.94±0.33) L], maximum voluntary ventilation (MVV) [(60.87±8.49) L/min vs. (56.84±8.11) L/min], and PaO₂/FiO₂ [(329.34±31.39) vs. (314.59±28.47)] were higher in the observation group than in the control group (P<0.05). Visual analogue scale (VAS) scores at 12 h, 24 h, and 48 h postoperatively [(3.02±0.35) vs. (3.36±0.57); (2.78±0.36) vs. (2.98±0.39); (2.39±0.31) vs. (2.55±0.34)] were lower in the observation group than in the control group (P<0.05). Immediately after surgery, cortisol (Cor) [(289.47±36.72) nmol/L vs. (308.48±35.29) nmol/L] and S100 calcium-binding protein B (S100β) [(1.87±0.43) μmol/L vs. (2.11±0.47) μmol/L] were lower in the observation group than in the control group (P<0.05). At 24 h postoperatively, Cor [(254.65±36.29) nmol/L vs. (274.37±35.14) nmol/L] and S100β [(0.74±0.13) μmol/L vs. (0.81±0.16) μmol/L] were lower in the observation group than in the control group (P<0.05). There was no statistically significant difference in the incidence of postoperative complications between the observation group 6 cases (16.22%) and the control group 7 cases (17.07%)(P>0.05).

Butorphanol combined with remimazolam for single-port thoracoscopic lobectomy in NSCLC patients provides effective analgesia, stabilizes hemodynamics, improves serum biomarker levels, and promotes postoperative recovery of respiratory function, demonstrating clinical significance.

To observe the clinical efficacy of tumor hyperthermia combined with Yiqi Fuzheng mixture in the treatment of lung cancer with malignant pleural effusion.

A total of 118 patients with lung cancer and malignant pleural effusion admitted to our hospital from January 2022 to January 2025 were selected and randomly divided into Group A 41 cases, Group B 40 cases, and Group C 37 cases. All patients underwent pleural puncture and catheter drainage. Group A received tumor hyperthermia alone, Group B received Yiqi Fuzheng mixture alone, and Group C received tumor hyperthermia combined with Yiqi Fuzheng mixture. The malignant pleural effusion remission rate, tumor marker parameters serum carbohydrate antigen 125 (CA125), carcinoembryonic antigen (CEA), cytokeratin 19 fragment (CYFRA21-1), neuron-specific enolase (NSE), total scores of primary and secondary symptoms in the traditional Chinese medicine (TCM) syndrome score, and adverse reactions were compared among the groups.

After treatment, 37 cases (100.00%) in group C had remission of malignant pleural effusion, which was higher than 35 cases (85.37%) in group A and 32 cases (80.00%) in group B (P<0.05). After treatment, CA125, CEA, CYFRA21-1, and NSE in each group decreased compared with those before treatment. The levels of CA125 (19.97±5.13) U/ml, CEA (24.36±3.18) ng/ml, CYFRA21-1 (3.21±0.43) ng/ml, and NSE (21.23±3.84) ng/ml in group C were lower than those of group A[CA125(25.84±5.61) U/ml, CEA(28.12±4.39) ng/ml, CYFRA21-1(4.67±0.48)ng/ml, NSE(25.06±4.24) ng/ml] and group B[CA125(30.06±7.28) U/ml, CEA(32.11±4.96)ng/ml, CYFRA21-1(5.36±0.54) ng/ml, NSE(32.13±4.72)ng/ml] (P<0.05). The total main symptom score and secondary symptom total score of each group decreased after treatment, and the scores of main symptoms (5.27±1.02) and secondary symptom total score (2.01±0.76) in group C were lower than those of group A main symptoms(7.95±1.09), secondary symptom total score(2.97±0.82) and group B main symptoms(9.23±1.37), secondary symptom total score(3.74±0.91) (P<0.05). There were 13 cases (35.14%) of nausea, vomiting, and chest pain in group C, which were not statistically different from 16 cases (39.02%) in group A and 11 cases (27.50%) in group B (P>0.05). After one year follow up, 14 cases (34.15%) in group A survived, 27 cases (65.85%) died; 12 cases (30.00%) in group B survived, 28 cases (70.00%) died; 18 cases (48.65%) in group C survived, 19 cases (51.35%) died(χ²=3.124, P=0.210).

Tumor hyperthermia combined with Yiqi Fuzheng mixture in the treatment of lung cancer with malignant pleural effusion can effectively control fluid accumulation, reduce the levels of tumor markers CA125, CEA, CYFRA21-1, and NSE, and improve clinical symptoms, and has clinical significance.

To analyze the correlation between the dynamic changes in serum calprotectin (Cal) levels and the prognosis of severe pneumonia (SP).

Sixty-four patients with severe pneumonia admitted to our hospital from January 2023 to January 2025 were selected as subjects. They were grouped according to prognosis: 42 patients in the observation group, and 22 patients in the control group. Serum Cal levels were measured on admission day 1 (T1), day 3 (T3), and day 7 (T7). ΔQ1 (T3-T1), ΔQ2 (T7-T1), ΔQ1%[(T3-T1)/T1], and ΔQ2%[(T7-T1)/T1] were calculated. Multivariate logistic regression analysis was used to identify factors affecting prognosis. The clinical applicability was evaluated using receiver operating characteristic (ROC) curves and decision curve analysis (DCA).

The neutrophil count [(9.31±1.72) ×10⁹/L vs. (8.12±1.27)×10⁹/L], C-reactive protein (CRP) [(38.36±10.52) mg/L vs. (32.59±9.32) mg/L], and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score [(17.53±2.14) points vs. (15.24±2.26) points] in the observation group were higher than those in the control group (P<0.05). The serum Cal in T3 of the observation group [(10.43±1.25) μg/ml vs. (9.25±1.36) μg/ml] and the serum Cal in T7 [(13.83±1.34) μg/ml vs. (10.12±1.78) μg/ml] were higher than those in the control group (P<0.05); the ΔQ2 in the observation group [(8.34 (6.48, 10.03) vs. 4.75 (3.74, 6.45)] and the ΔQ2% [(1.39 (0.90, 2.37) vs. -0.98 (-1.49, -0.59)] were higher than those in the control group (P<0.05). Multivariate Logistic regression showed that neutrophil count (OR=1.069, 95%CI: 1.017~1.124), CRP (OR=1.506, 95%CI: 1.062~2.134), APACHE Ⅱ score (OR=1.318, 95%CI: 1.085~1.600), ΔQ2 (OR=4.358, 95%CI: 2.575~7.374), and ΔQ2% (OR=0.137, 95%CI: 0.053~0.354) were prognostic factors (P<0.05). Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) for predicting prognosis by neutrophil count, CRP, APACHE Ⅱ score, ΔQ2, and ΔQ2% was 0.677, 0.670, 0.733, 0.661, and 0.750, respectively. The combined prediction AUC was 0.940 (95%CI: 0.891~0.971), with a sensitivity of 90.28% and a specificity of 85.87%. DCA showed that the net benefit difference of the prediction model at the threshold probability of 0.1 to 0.8 was 0.05 to 0.15.

The dynamic detection of serum Cal levels in the early stages of admission is associated with the prognosis of patients with severe pneumonia. Elevated neutrophil count, CRP, APACHE Ⅱ score, ΔQ2, and ΔQ2% are prognostic influencing factors.

To evaluate the clinical efficacy and safety of traditional Chinese medicine (TCM) prescriptions in improving the early outcomes and prognosis of severe pneumonia when used in combination with comprehensive treatments such as anti-infection therapy, glucocorticoids, and Xuebijing, and to explore the optimal TCM prescription for early integrated TCM-Western medicine therapy in severe pneumonia to enhance treatment efficacy and prognosis.

A total of 89 patients with early-stage severe pneumonia who met the inclusion criteria were selected and divided into a control group (antibiotic, glucocorticoid, and Xuebijing group, 46 cases) and an observation group (antibiotic, glucocorticoid, Xuebijing, and TCM group, 43 cases) based on their willingness to take TCM. The control group received treatment with levofloxacin, hydrocortisone, and Xuebijing. The observation group received additional TCM prescriptions tailored to their syndrome differentiation on the basis of the control group′s treatment. The serum infection markers [white blood cell count (WBC), high-sensitivity C-reactive protein (hs-CRP), procalcitonin (PCT), amyloid A (SAA), interleukin-6 (IL-6)], oxygenation indicators, treatment efficacy, and incidence of adverse reactions were compared between the two groups.

After treatment, serum infection markers (WBC, hs-CRP, PCT, SAA, IL-6) in both groups showed significant improvement compared to pre-treatment levels. The observation group exhibited lower levels of WBC(9.78±0.85)×10⁹/L、hs-CRP(7.23±0.15) mg/L、PCT (0.09±0.00)pg/ml、SAA (10.27±0.25)mg/L、IL-6 9.35 (7.48, 13.32) pg/ml than those of the control group(11.15±0.76)×10⁹/L, (12.73 ± 0.89) mg/L, (0.15±0.00) pg/ml, (24.20±1.32) mg/L, 18.34 (13.54, 21.51) pg/ml. The observation group significantly outperformed the control group in reducing serum inflammatory markers, with statistically significant differences (P<0.05). Notably, IL-6 levels decreased markedly, approaching the normal reference range. After, arterial blood gas oxygenation indicators (PaO₂, SaO₂, oxygenation index PaO₂/FiO₂) in both groups improved significantly compared to pre-treatment levels. The observation group showed higher PaO₂(95.64±8.25) mmHg, SaO₂(98.58±4.41)%、PaO₂/FiO₂(333.27±10.89)mmHg than those of the control group(84.74±5.90) mmHg, (94.63±7.39)%, (240.50±12.01) mmHg. The observation group significantly outperformed the control group in improving arterial oxygenation indicators, with statistically significant differences (P<0.05). The observation group had shorter durations for fever resolution (2.38 days), cough and sputum relief (6.32 days), mechanical ventilation (75.38 hours), chest CT inflammation absorption (8.46 days), and average hospitalization (10.74 days) compared to the control group (5.31 days, 11.88 days, 128.53 hours, 13.25 days, 13.34 days, respectively). The observation group significantly outperformed the control group in reducing these indicators, with statistically significant differences (P<0.05). Both groups showed reduced CPIS scores at D14 compared. The observation group achieved a CPIS score of 4.15, which was significantly lower than the control group′s 6.57. The effective rate in the observation group (79.07%) was slightly higher than that in the control group (76.40%), but the difference was not statistically significant; The mortality rate in the observation group (16.28%) was comparable to that in the control group (17.39%), with no statistically significant difference. The overall incidence of adverse reactions in the observation group (27.91%) was similar to that in the control group (28.26%), showing no statistically significant difference between the two groups. Most adverse reactions were mild, including rashes, slight dizziness, and gastrointestinal symptoms (nausea, vomiting, bloating), with no severe myocardial damage or liver and kidney function impairment observed.

The combined treatment of traditional Chinese and Western medicine (anti infection+ hydrocortisone+ Xuebijing+ Chinese herbal formula) can significantly improve various inflammatory indicators, improve oxygenation, shorten the course of disease, achieve ideal therapeutic effects, and have mild adverse reactions and good safety. It can be used as the preferred early treatment plan for severe pneumonia. (2) Traditional Chinese medicine formulas have certain adjuvant therapeutic value for severe pneumonia, but there is no definite advantage in improving overall efficacy and reducing mortality.

To explore the performance of an interpretable machine learning model for predicting immunotherapy responsiveness in lung cancer based on serum cytokines.

A total of 84 lung cancer patients receiving immunotherapy at our hospital from January 2022 to December 2025 were enrolled. Among them, 58 responders were assigned to the observation group and 26 nonresponders to the control group. Clinical data were collected and compared between the two groups. Least absolute shrinkage and selection operator (LASSO) regression was used to screen core predictive features. Four machine learning models, namely logistic regression (LR), random forest (RF), support vector machine (SVM), and extreme gradient boosting (XGBoost), were constructed. The discriminative performance of the models was evaluated by the area under the receiver operating characteristic curve (AUC). Shapley additive explanations (SHAP) was applied for clinical interpretability analysis of the optimal model.

Compared with the control group, the observation group showed in age [ (59.33±9.12)years vs. (57.82±7.93)years, P=0.445], proportion of smokers (34.48% vs. 61.54%, P=0.021), and ECOG performance status score (score 0: 67.24% vs. 38.46%; score 1: 32.76% vs. 61.54%, P=0.013). Baseline serum levels of interleukin (IL)-6 [(46.78±10.32)pg/ml vs. (56.47±11.23)pg/ml, P=0.001], IL-10[(5.20±1.64) pg/ml vs. (6.48±1.56) pg/ml, P=0.001], tumor necrosis factor α (TNF-α) [(12.33±3.00) pg/ml vs. (14.22±3.34) pg/ml, P=0.017], IL-1β [(11.28±3.21) pg/ml vs. (14.75±2.89) pg/ml, P<0.001], as well as carcinoembryonic antigen (CEA) [(20.53±6.36) ng/ml vs. (25.98±7.15)ng/ml, P=0.002], squamous cell carcinoma antigen (SCC) [(1.65±0.42) ng/ml vs. (1.89±0.51) ng/ml, P=0.042], and cytokeratin 19 fragment (CYFRA21-1) [(7.33±2.15) ng/ml vs. (8.56±2.34)ng/ml, P=0.027] were significantly lower in the observation group than in the control group. No statistically significant difference was observed in IL-8 between the two groups [(7.67±2.10) pg/ml vs. (8.48±2.37) pg/ml, P=0.141]. LASSO screening identified five predictive factors: IL-1β, IL-8, IL-6, TNF-α, and ECOG score. Among the four machine learning models, XGBoost performed best, with an AUC of 0.956, accuracy of 91.2%, recall of 89.0%, precision of 90.5%, and F1 score of 0.896. SHAP analysis revealed that the order of feature contribution was IL-1β, IL-8, IL-6, TNF-α, and ECOG score.

The XGBoost machine learning model based on serum cytokines can efficiently predict immunotherapy responsiveness in lung cancer patients. The SHAP method clarifies the contribution of key features, providing clinical significance.

Bronchoscopy is of clinical significance in the diagnosis of respiratory diseases. This study aims to investigate the consistency between bronchoscopy findings and clinical diagnosis, as well as the change of the associated inflammatory markers.

A retrospective analysis was conducted on 936 patients who underwent bronchoscopy in the Department of Respiratory and Critical Care Medicine of our hospital. Among them, 704 patients with qualified bronchoalveolar lavage fluid (BALF) were divided into a positive group (440 cases) and a negative group (264 cases) for comparison of clinical characteristics.

The sensitivity of bronchoscopy was 68.40%, specificity was 97.10%, and the overall concordance rate was 75.70% (P<0.001). There were no statistically significant differences in gender or age between the 704 BALF-positive and BALF-negative patients (P>0.05). Statistically significant differences were observed between the positive group and the negative group in terms of hypersensitive C-reactive protein (hs-CRP)[12.28(2.77, 83.49)mg/L vs. 7.22(1.00, 52.37)mg/L], white blood cell count [(9.33±6.03)×10⁹/L vs. (7.88±3.49)×10⁹/L], lymphocyte count [(1.14±0.63)×10⁹/L vs. (1.37±0.60)×10⁹/L], erythrocyte sedimentation rate (ESR)[31.0(9.0, 70.5)mm1 h vs. 15.0(7.0, 40.0)mm 1 h] and serum amyloid A protein (SAA)[69.69(4.70, 200.02)mg/L vs. 19.68(2.13, 144.48)mg/L] (P<0.05). Among 499 bronchoalveolar lavage results, there were 296 cases of general infection, 127 cases of tuberculosis, 44 cases of malignant tumors, and 32 cases of non-infectious diseases. ROC curve analysis indicated that hs-CRP and white blood cell count had high diagnostic value in positive patients. Analysis of BALF-positive patients with different disease entities revealed that inflammatory markers in tuberculosis and general infection were significantly higher than those in negative patients.

There is a significant difference between bronchoscopy findings and clinical diagnosis, and alterations in inflammatory markers in BALF vary among different respiratory diseases. This suggests that inflammatory markers in BALF may help improve the interpretation of bronchoscopy results and hold clinical significance for the early diagnosis of pulmonary diseases.

To analyze the diagnosis and treatment data of children with community-acquired pneumonia (CAP) from a single-center pediatric department in a general hospital, and to provide a basis for improving the management of pediatric pneumonia.

A retrospective analysis was conducted on 577 children with pneumonia hospitalized in the pediatric ward of Qinhuangdao Hospital of Peking University Third Hospital from July 2019 to January 2024. Data on epidemiological information, clinical characteristics, pathogen detection, chest imaging findings, and the use of antimicrobial agents and glucocorticoids were collected.

Pneumonia accounted for 53.28% (577/1 083) of all pediatric hospitalizations during the same period. The median age of the children was 4 years (3~7), and the median length of hospital stay was 7 days (5~8). Severe pneumonia accounted for 6.07% (35/577), and 1.91% (11/577) were transferred to a higher-level hospital for bronchoscopy treatment. Intravenous antimicrobial agents were administered to 99.31% of the children, with a median treatment duration of 6 days (5~7). Intravenous methylprednisolone was used in 68 cases (11.78%), with a median treatment duration of 4 days (3~5). The overall pathogen detection rate was 25.14% (416/1655). Among pathogens detected by serum IgM antibody testing, Mycoplasma pneumoniae had the highest positivity rate (272/577, 47.14%). Sputum culture was performed in 178 cases (30.74%, 178/579), with a positivity rate of only 1.69%. Pulmonary imaging findings in children with community-acquired pneumonia (CAP) included patchy fuzzy opacities in 280 cases (48.52%), large patchy high-density opacities in 59 cases (10.22%), ground-glass opacities in 8 cases (1.39%), left lung inflammation in 97 cases (16.81%), right lung inflammation in 134 cases (23.22%), bilateral inflammation in 268 cases (46.45%), pleural effusion in 1 case (0.17%), and atelectasis in 3 cases (0.52%). Pathogens were detected in 416 cases (72.10%). Among these, Mycoplasma pneumoniae (MP) was positive in 272 cases (47.14%), Adenovirus (ADV) in 56 cases (9.81%), Influenza B virus (Flu B) in 53 cases (9.28%), and Influenza A virus (Flu A) in 15 cases (4.56%). Sputum culture was performed in 178 cases (30.85%), with positive results in 3 cases (1.69%), all of which were Klebsiella pneumoniae.

Pneumonia is the predominant cause of hospitalization in the pediatric department. The annual number of pneumonia hospitalizations fluctuates significantly, with most cases being mild. Certain issues exist in areas such as precise microbiological detection methods and the application of antimicrobial agents. Efforts should be made to improve the level of etiological detection, strengthen the supervision of antimicrobial use, and promote the prioritization of outpatient management for children with mild pneumonia.

To investigate the development trajectory and influencing factors of frailty in elderly patients with chronic obstructive pulmonary disease (COPD).

A total of 429 elderly COPD patients admitted to our hospital from January 2024 to September 2025 were selected as the study subjects. The frailty screening scale (FSS) was used to assess frailty at admission (T0), 1 month (T1), 3 months (T2), and 6 months (T3) of follow-up. Latent class growth modeling (LCGM) was applied to identify frailty development trajectories, resulting in three groups: a stable group (C1, 205 cases), an increasing group (C2, 70 cases), and a decreasing group (C3, 154 cases). Univariate analysis and multivariate logistic regression were used to analyze the influencing factors of different trajectories.

At T0, 327 patients (76.22%) were frail, and at T3, 346 patients (80.65%) were frail. The correlation coefficients for frailty scores across T0, T1, T2, and T3 ranged from 0.553 to 0.685 (P<0.01). In the C1 group, the frailty score showed little change over the four time points, with an intercept of 2.68 and an average slope of 0.077. In the C2 group, the frailty score gradually increased over time, with an intercept of 0.97 and an average slope of 0.262. In the C3 group, the frailty score gradually decreased, with an intercept of 4.36 and an average slope of -0.257. Univariate analysis showed statistically significant differences in age, BMI, ethnicity, education level, disease duration, number of medication types, living alone, and grip strength among the different trajectory groups (P<0.05). Multivariate logistic regression showed that compared with the C1 group, BMI >24 (OR=6.957, 95%CI: 1.434~33.760, P=0.016), disease duration of 3~6 years (OR=0.335, 95%CI: 0.154~0.728, P=0.006), fear of progression (OR = 1.066, 95% CI: 1.014~1.121, P=0.012), and cognitive impairment (OR=1.068, 95% CI: 1.003~1.137, P=0.039) were factors associated with being in the C2 group. Compared with the C1 group, age ≥ 80 years (OR=2.277, 95%CI: 1.164~4.455, P=0.016), living alone (OR=6.031, 95%CI: 1.981~18.357, P=0.002), and grip strength (OR=1.051, 95%CI: 1.015~1.089, P=0.006) were factors associated with being in the C3 group. After 6 months of follow-up, 414 patients (96.50%) survived and 15 (3.50%) died, with a mortality rate of 8.57% in the C2 group, which was higher than that in the C1 group (2.44%) and the C3 group (2.60%).

The development of frailty in elderly COPD patients follows three distinct trajectories: stable, increasing, and decreasing. BMI, disease duration, fear of progression, cognitive impairment, living alone, grip strength, and age are influencing factors for different frailty trajectories. Dynamic monitoring of frailty trajectories may help identify high-risk individuals early and facilitate personalized interventions.