To explore SMARCA4-deficient non-small cell lung cancer in the chest Clinical characteristics, imaging manifestations, histopathological features and treatment prognosis of patients with SMARCA4-dNSCLC and SMARCA4-deficient undifferentiated tumors (SMARCA4-UT) To enhance the understanding of the disease.

A retrospective analysis was conducted on 37 patients with SMARCA4-deficient tumors (SMARCA4-DT) in the chest admitted to the Second Affiliated Hospital of Army Medical University from November 2022 to April 2025. They were divided into 10 cases of SmarCA4-deletion non-small cell lung cancer (SMARCA4-dNSCLC) and 27 cases of SmarCA4-deletion undifferentiated tumor (SMARCA4-UT). The gender, age, smoking history, clinical symptoms, Eastern Cooperative Oncology Group (ECOG) performance status score, tumor CT location, tumor size, tumor density, uniformity of tumor enhancement, metastasis site, stage, histopathological characteristics and prognosis of the patients were compared.

Compared with SMARCA4-dNSCLC, SMARCA4-UT has a larger tumor diameter, extremely irregular tumor density and enhancement uniformity, a later clinical stage, more common mediastinal lymph node metastasis, and a higher Ki-67 index. The Overall Survival (OS) is short. The difference was statistically significant (P<0.05); There was no statistically significant difference in clinical manifestations, ECOG performance status score, and distant metastasis sites (P>0.05). The histological morphology of SMARCA4-dNSCLC presents various poorly differentiated NSCLC morphologies. The histological morphology of SMARCA4-UT is poorly differentiated and has lost the morphological characteristics of epithelial carcinoma, presenting as rhabdoid morphology. Surgery is the main treatment for early-stage tumors, while chemotherapy combined with immunotherapy is the core regimen for advanced-stage tumors. However, the Overall prognosis of both types of tumors is extremely poor, and the Median Overall Survival (mOS) is relatively short. The median survival period of SMARCA4-dNSCLC patients in this article was 14 months, while that of SMARCA4-UT was 5 months, and the difference was statistically significant (P<0.05).

Both SMARCA4-dNSCLC and SMARCA4-UT have the characteristics of high invasiveness, rapid disease progression and poor prognosis. However, SMARCA4-UT has a higher degree of malignancy, faster progression and worse prognosis. There are differences between the two in terms of imaging manifestations, histopathological features and prognosis. SMARCA4 can be routinely incorporated into the immunohistochemical detection of poorly differentiated and undifferentiated thoracic tumors in clinical practice. Early identification and accurate classification are of great clinical significance for evaluating the condition and guiding treatment.

To systematically dissect the molecular mechanisms underlying the transcriptional regulatory network governing malignant proliferation of lung adenocarcinoma cells through integrated analysis of multiple public human lung cancer single-cell transcriptomic datasets, and to identify core genes and transcription factors driving tumor proliferation, thereby providing a theoretical basis for early diagnosis and targeted therapy of lung cancer.

Four public lung cancer scRNA-seq datasets (GSE131907, GSE149655, GSE148071, and E-MTAB-6149) were integrated and processed. After quality control, normalization, and batch correction using Harmony, a total of 199 489 high-quality cells were retained. Cell clustering was performed using the Louvain algorithm, and cell types were annotated using canonical marker genes. InferCNV combined with Gaussian mixture modeling (GMM) was applied to accurately distinguish tumor epithelial cells from normal epithelial cells based on copy number variation (CNV) profiles. Differentially expressed genes (DEGs) were identified using the Wilcoxon rank-sum test. Weighted gene co-expression network analysis (WGCNA) was performed to identify key functional modules, and the GENIE3 algorithm was used to construct transcription factor regulatory networks. Finally, HMGB2 was knocked down in A549 cells via siRNA transfection, and the expression changes of core transcription factors and their downstream target genes were validated by qRT-PCR.

After batch correction, cells from different datasets were uniformly mixed. A total of 20 cell clusters were identified and classified into four major lineages: immune cells (65.18%), epithelial cells (27.43%), endothelial cells (4.60%), and fibroblasts (2.79%). Using CNV-based GMM analysis, 23 505 tumor cells were successfully identified (44.90% of all epithelial cells), among which 80.59% were classified as high-confidence malignant cells. WGCNA identified the blue module as the key module highly associated with the cell cycle, whose activity was markedly elevated in S and G2/M phases, with all hub genes being canonical cell cycle drivers. Transcriptional regulatory network analysis uncovered a tightly interacting regulatory circuit consisting of seven core transcription factors, including FOXM1, E2F7, and HMGB2. Functional cell experiments confirmed that knockdown of HMGB2 significantly downregulated the expression of key genes including FOXM1, E2F7, and TOP2A.

This study successfully integrated multiple lung cancer single-cell transcriptomic datasets and established a comprehensive single-cell atlas of lung cancer epithelial cell heterogeneity. We elucidated the molecular mechanism by which the core transcriptional regulatory axis centered on HMGB2-FOXM1/E2F7/HMGA1-cell cycle genes drives malignant proliferation of lung cancer epithelial cells. These findings provide a novel theoretical basis and potential molecular targets for the identification of early diagnostic biomarkers and the development of targeted therapeutic strategies for lung cancer.

To identify robust pulmonary arterial hypertension (PAH)-associated genes through multi-cohort transcriptomic integration and single-cell resolution analyses, and to elucidate their cellular origins and potential links to immune microenvironment remodeling.

Differential expression analysis of PAH and control was conducted on three independent transcriptome cohorts (GSE217438, GSE117261, GSE33463) respectively, and the intersection was taken to obtain consistent candidate genes across cohorts. Build a protein-protein interaction (PPI) network based on STRING to locate key nodes; The co-expression network was constructed using WGCNA and module-trait association and functional enrichment were carried out. Further analyze the single-cell transcriptome data of lung tissue to clarify the cellular origin of RGS1 and conduct quasi-temporal analysis in the mononuclear macrophage lineage. At the same time, compare the differences in cell communication between the control and PAH and screen the key ligand-receptor axes. Finally, a rat PAH model induced by MCT (60 mg/kg) was constructed. The expression changes of RGS1 were verified by RT-qPCR of alveolar macrophages, Western blot and immunohistochemistry of lung tissue.

The intersection of differentially expressed genes across three cohorts indicates candidate genes exhibit strong cross-cohort stability, with the immune-regulatory gene RGS1 further identified. In all three independent cohorts, RGS1 was significantly upregulated in the PAH group (P<0.05). Protein interaction network analysis revealed RGS1 occupies a central position within the network and interacts with multiple G protein signaling and immune-related molecules, suggesting its potential involvement in GPCR-mediated immune pathways. WGCNA analysis revealed that the dark gray module containing RGS1 was highly correlated with the PAH phenotype (cor=0.43, P=5e-5). Genes in this module were enriched in pathways including adaptive immune response, immunoglobulin-mediated response, and lymphocyte-mediated immunity. Single-cell analysis revealed that RGS1 is predominantly highly expressed in immune cells. The proportion of macrophages significantly increased in the PAH group, accompanied by enrichment of inflammation-related pathways (P<0.05). The results of pseudotime series showed that monocyte-macrophage migration occurred in a continuous state along the trajectory, and the expression of RGS1 changed dynamically with pseudotime. Cell communication analysis showed that the number and intensity of overall communication were increased in PAH group, and the probability of ligand-receptor pair PPIA-BSG communication was significantly increased in PAH group, suggesting that the signal network was remodled. The expressions of RGS1 mRNA and protein in alveolar macrophages in the experimental group were significantly up-regulated in the MCT animal model (P<0.01), and the positive signal of RGS1 in lung tissue was enhanced by IHC.

RGS1 may be involved in the remodeling of the immune microenvironment in PAH and serve as an immune-related biomarker and potential therapeutic target.

To investigate the predictive value of intratumoral heterogeneity (ITH) quantified by computed tomography (CT)-based habitat radiomic features for the response to immune checkpoint inhibitors (ICIs) in patients with non-small cell lung cancer (NSCLC).

A total of 148 NSCLC patients scheduled to receive pembrolizumab plus platinum-based doublet chemotherapy at our hospital from June 2022 to June 2025 were enrolled as the training cohort, and another 98 patients treated during the same period served as the validation cohort. Pre-treatment CT images were acquired and habitat radiomic features were extracted. LASSO regression was used to select core features for constructing the ITHscore model. After treatment completion, treatment response was assessed according to RECIST criteria. In the training cohort, patients with complete response or partial response were classified as the response group (n=79), while those with stable disease or progressive disease were classified as the nonresponse group (n=69). Clinical data were compared between the two groups. Univariate and multivariate logistic regression analyses were performed to identify independent factors associated with ICI response. Predictive performance was evaluated using receiver operating characteristic (ROC) curves and decision curve analysis (DCA).

In the training cohort, significant differences were observed between the response and nonresponse groups in age, sex, clinical stage, and programmed deathligand 1 (PDL1) expression level (all P<0.05). LASSO regression selected 8 core features with nonzero coefficients from 1, 524 radiomic features to construct the ITHscore. Multivariate logistic regression showed that age (OR=1.145, 95%CI: 1.031~1.272, P=0.011), sex (OR=2.447, 95%CI: 1.079~5.550, P=0.032), clinical stage (OR=3.555, 95%CI: 1.581~7.992, P=0.002), PDL1 expression (OR=0.887, 95%CI: 0.847~0.929, P=0.007), and ITHscore (OR=1.895, 95%CI: 1.261~2.848, P=0.002) were independent predictors of ICI response. ROC analysis showed that the AUC of the ITHscore model was 0.818 (95%CI: 0.737~0.882), and that of the clinical feature model was 0.793 (95%CI: 0.710~0.862) (P>0.05). The combined model achieved an AUC of 0.896 (95%CI: 0.827~0.944), with a sensitivity of 75.61% and specificity of 91.23%, outperforming either single model. In the validation cohort, the combined model yielded an AUC of 0.879(95%CI: 0.807~0.931), sensitivity of 70.73%, and specificity of 92.41%. DCA demonstrated that at a threshold probability of 0.25, the net benefit of the combined model (0.27) was higher than that of the ITHscore model (0.23) and the clinical feature model (0.11).

The ITHscore combined with clinical features, constructed from CTbased intratumoral heterogeneity radiomic features, demonstrates good discriminative ability and clinical net benefit for predicting ICI response in NSCLC patients, and may facilitate early identification of patients likely to benefit from immunotherapy.

The present study explores the incidence of treatment-related pneumonitis (TRP) in patients with locally advanced non-small cell lung cancer (NSCLC) undergoing radiotherapy combined with immunotherapy, and its association with systemic immune-inflammation index (SII).

A retrospective analysis of the clinical data of patients with unresectable locally advanced NSCLC patients who were treated at the hospital from January 2021 to December 2024 was conducted. The patients were divided into two groups according to whether they received immunotherapy: a combined group (radiotherapy + immunotherapy) and a radiotherapy group (radiotherapy only). The primary research objective was to make a comparison between the incidence and severity of TRP in the two groups, and the secondary research objective was to explore the relationship between pre-treatment SII and TRP in the combined group.

The study population comprised 89 patients, predominantly male 82 patients(92.13%), with 41 patients (46.07%) aged ≥65 years. The incidence of TRP in the combination group was 27 cases (61.36%), which was higher than that in the radiotherapy group 16 cases (35.56%)(P<0.05). The incidence of grade ≥3 TRP in the combination group was 7 cases (15.91%), higher than the radiotherapy group 2 cases(4.44%)(P>0.05). In the combined group, among the 27 patients with TRP, ground-glass opacities occurred in 23 cases (85.18%), consolidation in 15 cases (55.56%), reticular opacities in 10 cases (37.04%), and bilateral lung involvement in 10 cases (37.04%). In the radiotherapy group, among the 16 patients with TRP, ground-glass opacities occurred in 12 cases (75.00%), consolidation in 7 cases (43.75%), reticular opacities in 5 cases (31.25%), and bilateral lung involvement in 4 cases (25.00%). The incidence rates in the combination group were higher than those in the radiotherapy group, but the differences were not statistically significant (P>0.05). Higher pre-treatment SII values[1 035.1 (568.8, 1 727.5)] than those without TRP[472.0(336.4, 851.3)] (χ²=7.35, P=0.01). Multivariate logistic regression analysis confirmed that elevated SII was an independent risk factor for TRP in the combination group(OR=1.01, 95%CI: 1.01~1.01, P<0.05), with consistent results across different adjustment models.

In comparison with radiotherapy administered in isolation, the combination of radiotherapy and immunotherapy has been observed to result in an elevated probability of TRP. Consequently, it is imperative that caution is exercised when formulating combined treatment plans in clinical practice. The increase in SII prior to treatment may be associated with the occurrence of TRP, suggesting that SII may serve as a potential biomarker.

To compare the anesthetic effects of ciprofol and propofol in Da Vinci robotassisted lung cancer lobectomy.

A total of 113 patients who underwent Da Vinci robotassisted lung cancer lobectomy in our hospital from May 2022 to February 2025 were enrolled and randomly divided into a ciprofol group 57 cases and a propofol group 56 cases. The ciprofol group received a loading dose of 0.3~0.4 mg/kg ciprofol followed by continuous intravenous infusion at 0.8 mg/(kg·h) for maintenance, while the propofol group received a loading dose of 1.5~2.5 mg/kg propofol followed by continuous infusion at 5.0 mg/(kg·h). The two groups were compared in terms of intraoperative heart rate (HR), mean arterial pressure (MAP), systolic blood pressure (SBP), diastolic blood pressure (DBP), regional cerebral oxygen saturation (rSO₂), postoperative recovery time, orientation recovery time, MiniMental State Examination (MMSE) scores, and perioperative adverse reactions.

At 5 min after induction, MAP, SBP, and DBP in the ciprofol group were higher than those in the propofol group (P<0.05). At 15 min after anesthesia, there was no significant difference in rSO₂ between the two groups [(75.54±2.57)% vs. (75.84±2.62)%, P=0.565]; at 10, 30, and 60 min of onelung ventilation and at 20 min after resumption of twolung ventilation, rSO₂ in the ciprofol group was higher than that in the propofol group [(71.67±2.42)% vs. (69.54±2.37)%, (70.37±2.87)% vs. (68.29±4.35)%, (70.27±3.68)% vs. (66.31±2.13)%, (74.45±3.76)% vs. (71.21±2.71)%, all P<0.001]. The induction success time [(1.41±0.42) min vs. (1.59±0.58) min], spontaneous breathing recovery time [(10.96±1.57) min vs. (13.28±2.02) min], postoperative recovery time [(9.34±1.58) min vs. (11.57±1.82) min], and orientation recovery time [(16.35±2.53) min vs. (18.98±2.42) min] in the ciprofol group were shorter than those in the propofol group (all P<0.001). The MMSE scores at 3 h and 72 h after surgery in the ciprofol group were higher than those in the propofol group [(19.31±1.52) vs. (17.54±1.37), (25.90±1.04) vs. (23.31±1.13), P<0.001]; at 24 h after surgery, there was no significant difference between the two groups (P=0.711). There were no statistically significant differences between the two groups in the incidence of nausea and vomiting, intraoperative hypertension, hypotension, tachycardia, bradycardia, injection site pain, or postoperative delirium (POD) (P>0.05), POD 3 cases (5.36%) in the propofol group.

In Da Vinci robotassisted lung cancer lobectomy, ciprofol can better maintain intraoperative hemodynamic stability, increase cerebral oxygen saturation during onelung ventilation, shorten postoperative recovery and orientation recovery time, improve early cognitive function, and does not increase the risk of adverse reactions compared with propofol, demonstrating clinical significance.

To investigate the efficacy and safety of different doses of bevacizumab combined with pemetrexed and platinum-based chemotherapy as first-line treatment for advanced non-squamous non-small cell lung cancer (NSCLC).

Data from 76 patients with advanced non-squamous NSCLC treated with bevacizumab combined with pemetrexed and platinum-based regimens admitted to our hospital between September 2021 and December 2025 were selected. Among them, 45 patients received the low-dose group (7.5 mg/kg) and 31 patients received the high-dose group (15 mg/kg). Propensity score matching (PSM) was used to randomly assign 28 patients to each group at a 1︰1 ratio. Objective response rate (ORR), disease control rate (DCR), overall survival (OS), and adverse reactions were compared between the two groups. Survival curves were plotted using the Kaplan-Meier method, and survival differences were compared using the Log-rank test. Cox regression was used for subgroup analysis.

Baseline characteristics were balanced between the two groups after PSM (P>0.05). ORR was 53.57% vs. 35.71% in the low-dose group (P=0.179), and DCR was 78.57% vs. 60.71% (P=0.146) in the high-dose group. Median OS was 24.5 months (95%CI: 19.324~29.676) vs. 22.8 months (95%CI: 17.512~28.088) in the low-dose group (HR=1.167, 95%CI: 0.540~2.519, Log-rank P=0.695). Subgroup analysis showed no significant interaction between baseline characteristics such as age, sex, Eastern Cooperative Oncology Group Performance Status (ECOG PS), smoking history, pathological subtype, hypertension, chronic obstructive pulmonary disease (COPD), and KRAS mutation and dose-response relationship (P>0.05). Adverse reactions were predominantly grade 1~2 in both groups; there was no statistically significant difference in the incidence of grade ≥3 serious hematologic and non-hematologic toxicities between the groups (P>0.05). The incidence of grade 1~2 nausea/vomiting was higher in the low-dose group than in the high-dose group (42.86% vs. 17.86%, P=0.042), but no increase in grade ≥3 gastrointestinal toxicities (7.14% vs. 3.57%, P=0.553).

The efficacy of low-dose bevacizumab (7.5 mg/kg) combined with pemetrexed and platinum-based chemotherapy as first-line treatment for advanced non-squamous NSCLC is non-inferior to the standard dose (15 mg/kg), with similar adverse reaction risks and good safety profile.

To investigate the correlation of pan-immune-inflammation value (PIV), platelet-to-lymphocyte ratio (PLR), D-dimer (D-D) and cardiac troponin I (cTnI), as well as their combined index, with the risk stratification of acute pulmonary embolism (APE).

A total of 123 APE patients admitted to Tongxiang Hospital of Traditional Chinese Medicine (Zhejiang Province) and Punan Hospital of Pudong New Area (Shanghai) from January 2021 to October 2025 were enrolled. According to pulmonary embolism severity index (PESI) scores, patients were divided into low-risk group (39 cases) and intermediate-high-risk group (84 cases). The influencing factors of APE risk stratification were analyzed, and the predictive value of single and combined indicators for APE severity was evaluated.

The neutrophil count in the intermediate-high risk group was 5.31(3.95, 7.95)×10⁹/L, monocyte count 0.64(0.47, 0.81)×10⁹/L, PIV 565.55 (373.41, 1030.36), D-dimer 7.62(4.08, 15.18)mg/L, cTnI 20.52(8.29, 36.91)ng/ml, SII 992.30(696.69, 1 828.96), NLR 4.46(3.10, 9.44), and PLR 181.56(131.90, 281.31), which were higher than those in the low-risk group [4.46 (3.12, 5.91)×10⁹/L, 0.44 (0.35, 0.51)×10⁹/L, 171.77(127.51, 333.45), 4.31(1.54, 6.89)mg/L, 5.35(2.88, 11.94)ng/ml, 494.21 (295.97, 840.78), 2.67(1.66, 4.39), and 109.03(91.24, 144.61), respectively]; while the lymphocyte count in the intermediate-high risk group was 1.14(0.76, 1.38), lower than that in the low-risk group [1.84 (1.27, 2.12)], and the differences between groups were statistically significant (P<0.05). Multivariate binary Logistic regression analysis confirmed that high levels of PIV, PLR, D-D and cTnI were independent risk factors for intermediate-high-risk APE. Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) of PIV, PLR, D-D and cTnI for predicting intermediate-high-risk APE was 0.827 (95%CI: 0.743~0.911), 0.769(95%CI: 0.681~0.857), 0.694 (95%CI: 0.598~0.790) and 0.735 (95%CI: 0.634~0.835), respectively, while the combined index had an AUC of 0.884 (95%CI: 0.817~0.951). At the optimal cut-off value of 0.560, the sensitivity, specificity and Youden index were 89.29%, 74.26% and 0.636, respectively.

PIV, PLR, D-D and cTnI are influencing factors for the occurrence of intermediate-high risk pulmonary embolism. Elevated levels of PIV, PLR combined with D-D and cTnI are closely correlated with the risk stratification of APE. Combined detection can effectively improve the early identification ability of intermediate-high risk APE and facilitate clinical evaluation.

To investigate the clinical significance of pulmonary artery distensibility (PAD) monitored by electrocardiogram-gated computed tomography pulmonary angiography (CTPA) in the prognostic risk stratification of patients with acute pulmonary embolism (APE).

A total of 109 APE patients who underwent electrocardiogram-gated CTPA in our hospital from February 2021 to December 2025 were enrolled. According to the prognosis, 23 patients with poor prognosis were assigned to the observation group and 86 patients with good prognosis to the control group. Serum high-sensitivity cardiac troponin I (hs-cTnI), D-dimer, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were compared between the two groups. The simplified Pulmonary Embolism Severity Index (sPESI), simplified Wells score, and Pulmonary Embolism Rule-out Criteria (PERC) score were calculated. The right ventricle/left ventricle transverse diameter ratio (RV/LV), pulmonary artery obstruction index (PAOI), and PAD were measured by CTPA. The predictive value was assessed by receiver operating characteristic (ROC) curves. Multivariate logistic regression analysis was used to identify prognostic risk factors, and a nomogram model was constructed.

Compared with the control group, the observation group showed significantly higher serum hs-cTnI[96.50 (28.79, 269.32) pg/ml vs. 43.85 (24.22, 90.76) pg/ml], NT-proBNP [2 147.00 (422.05, 5 687.15) pg/ml vs. 140.60 (45.21, 614.20) pg/ml], sPESI [2.00(1.00, 3.00) points vs. 1.00(0.00, 1.00) points], and PERC score [2.00(2.00, 3.00) points vs. 1.00(1.00, 2.00) points], and lower systolic blood pressure [135.50 (119.75, 150.25) mmHg vs. 139.50 (124.50, 150.00) mmHg] (P<0.05). The observation group also had higher RV/LV [1.33 (1.08, 1.56) vs. 0.95 (0.90, 1.15)], a higher proportion of RV/LV>1.0 (89.66% vs. 49.65%), and higher PAOI [35.25% (31.03%, 40.73%) vs. 29.00% (25.93%, 34.23%)], while PAD was significantly lower [2.95 (2.22, 4.97)×10^-3/mmHg vs. 5.98(4.37, 7.31)×10^-3/mmHg] (P<0.05). ROC curve analysis showed that the area under the curve (AUC) of PAD for predicting poor short-term prognosis was 0.859 [95%CI: 0.803~0.904], with a sensitivity of 84.48% and a specificity of 80.14%. The AUC of RV/LV was 0.757 (95%CI: 0.691~0.815), with a sensitivity of 89.66% and a specificity of 54.61% at the cutoff value>1.0. The AUC of PAOI was 0.766 (95%CI: 0.700~0.823), with a sensitivity of 84.48% and a specificity of 70.21% at the cutoff value >30%. Multivariate logistic regression analysis revealed that NT-proBNP>125 pg/ml (OR=5.396, 95%CI: 1.822~15.978), RV/LV>1.0 (OR=7.562, 95%CI: 2.397~23.860), PAOI>30% (OR=13.784, 95%CI: 3.912~48.567), and PAD>4.28×10^-3/mmHg (OR=0.086, 95%CI: 0.028~0.270) were risk factors for the prognosis of APE (P<0.05). The AUC of the combined prediction was 0.94 (95%CI: 0.90~0.98), which was superior to that of any single indicator (P<0.05).

PAD measured by electrocardiogram-gated CTPA can reflect the mechanical changes of pulmonary vasculature in APE patients, and its predictive performance is superior to RV/LV and PAOI. The combination of PAD, RV/LV, PAOI, and NT-proBNP can improve the accuracy of risk stratification in APE patients, demonstrating clinical significance.

To investigate the predictive value of peripheral blood inflammatory markers for major pathological response (MPR) in patients with locally advanced nonsmall cell lung cancer (NSCLC) receiving neoadjuvant immunochemotherapy.

A total of 104 patients with locally advanced NSCLC who received neoadjuvant immunochemotherapy at our hospital from February 2022 to January 2025 were retrospectively enrolled. Based on postoperative pathological findings, MPR were divided into the observation group (63 cases) and non MPR were the control group (41 cases). Clinical data, as well as pre and posttreatment neutrophiltolymphocyte ratio (NLR), platelettolymphocyte ratio (PLR), systemic immuneinflammation index (SII), and prognostic nutritional index (PNI), were collected. The change values (Δ=posttreatment-pretreatment) were calculated. LASSO regression was used for variable selection, and multivariate Logistic regression was performed to identify independent factors associated with MPR and to construct a nomogram. The association between dynamic inflammation score and eventfree survival (EFS) was analyzed using the KaplanMeier method with the Logrank test.

After treatment, the observation group showed significantly lower ΔNLR[-0.65(-1.71, -0.27) vs. 0.58 (0.22, 1.94), Z= -5.053, P<0.001], ΔPLR[-48.13 (-102.80, -12.83) vs. 26.22 (-16.87, 60.70), Z=-4.660, P<0.001], and ΔSII[-225.54 (-411.09, -83.77) vs. 380.83 (104.52, 538.33), Z=-5.768, P<0.001], and significantly higher ΔPNI[0.98(-1.80, 3.71) vs. -1.63 (-7.15, 0.79), Z=-5.236, P<0.001] than the control group. Multivariate Logistic regression revealed that pathological subtype (adenocarcinoma vs. squamous cell carcinoma: OR=0.127, 95%CI: 0.021~0.769, P=0.025), histological differentiation (poorly differentiated vs. moderately differentiated: OR=0.022, 95%CI: 0.002~0.294, P=0.004), ΔNLR(OR=0.518, 95%CI: 0.299~0.898, P=0.019), ΔSII (OR=0.996, 95%CI: 0.993~0.998, P=0.002), and ΔPNI (OR=1.514, 95%CI: 1.146~2.001, P=0.004) were independent factors for MPR. The nomogram model yielded an AUC of 0.95 (95%CI: 0.91~0.99) for predicting MPR. The HosmerLemeshow test indicated good model calibration (χ²=6.610, P=0.579), and the decision curve analysis demonstrated a high net clinical benefit within the risk threshold range of 0.10~0.92. Using the median dynamic inflammation score of 0.76 as the cutoff, the lowscore group (52 cases) had a significantly shorter median EFS of 22 months compared with 36 months in the highscore group (52 cases) (Logrank χ²= 30.989, P<0.001).

Dynamic changes in ΔNLR, ΔSII, and ΔPNI before and after neoadjuvant immunochemotherapy are predictive biomarkers for postoperative MPR in patients with locally advanced NSCLC. The nomogram combining these markers with pathological subtype and histological differentiation exhibits excellent discriminative ability, calibration, and clinical net benefit, which may help preoperatively predict pathological response to neoadjuvant immunochemotherapy and provide a reference for longterm recurrence risk stratification.

To explore predictive biomarkers for the efficacy of firstline immune checkpoint inhibitors (ICIs) combined with chemotherapy in patients with advanced non-small cell lung cancer (NSCLC) and to construct a prognostic scoring model.

A total of 125 patients with advanced NSCLC who received firstline ICIs plus chemotherapy in our hospital from October 2023 to October 2025 were enrolled, and treatment responses were analyzed. Variables were screened by LASSO regression, and the NLAL scoring system was constructed based on neutrophiltolymphocyte ratio (NLR), lactate dehydrogenase (LDH), albumin (ALB), and liver metastasis. Patients were divided into a lowrisk group (0-1 point, 95 cases) and a highrisk group (2–5 points, 30 cases). Patients were divided into the observation group (NLR>3.25) and the control group (NLR<3.25). Progressionfree survival (PFS) was analyzed using receiver operating characteristic (ROC) curves, multivariate Cox proportional hazards regression, and KaplanMeier curves.

The disease control rate (DCR) in the lowrisk group was 84.21%, significantly higher than that in the highrisk group (60.00%) (χ²=7.892, P=0.005); the objective response rate (ORR) was also higher in the lowrisk group [40.00% (38/95) vs. 10.00% (3/30), χ²=9.310, P=0.002]. The area under the curve (AUC) of the NLAL score for predicting DCR was 0.797 (95%CI: 0.665~0.872), which was superior to single indicators including NLR (AUC=0.735), LDH (AUC=0.752), ALB (AUC=0.718), liver metastasis (AUC=0.689), and PDL1 expression (AUC=0.578) (all P<0.05). Multivariate Cox regression showed that liver metastasis (HR=1.524, 95%CI: 1.032~2.248, P=0.034), NLR>3.25 (HR=1.854, 95%CI: 1.247~2.766, P=0.003), LDH>225 U/L (HR=1.654, 95%CI: 1.114~2.452, P=0.013), and ALB<36.52 g/L(HR=1.416, 95%CI: 1.005~1.996, P=0.046) were risk factors for shorter PFS. The median PFS was longer in the lowrisk group than in the highrisk group (15.31 months vs. 6.78 months, logrank P<0.001). The AUC of the NLAL score for predicting PFS was 0.763 (95%CI: 0.689~0.821), superior to single indicators (P<0.05). With a median followup of 19 months, 72 patients (57.60%) survived and 53 (42.40%) died.

The NLAL score based on NLR, LDH, ALB, and liver metastasis can predict ORR, DCR, and PFS in advanced NSCLC patients receiving firstline ICIs combined with chemotherapy, and it is superior to single peripheral blood biomarkers and PDL1 expression, demonstrating clinical utility.

To analyze the clinical, radiological, laboratory, and histopathological characteristics of indeterminate pulmonary nodules that were highly suspected of malignancy preoperatively but were confirmed as benign by postoperative pathology, and to provide evidence for improving the accuracy of preoperative diagnosis and reducing unnecessary surgical intervention.

A total of 271 patients with pulmonary nodules who were preoperatively suspected of having malignant lesions, underwent surgical resection, and were pathologically confirmed to have benign pulmonary nodules after surgery at our hospital, between January 2020 and December 2024 were retrospectively included. Their clinical baseline characteristics, radiological findings, laboratory results, and pathological data were systematically analyzed.

During the 5-year study period, a total of 13, 201 surgical resections for pulmonary nodules were performed at our hospital, including 961 preoperatively indeterminate pulmonary nodules (7.28%). The 271 patients included in this study were pathologically confirmed to have benign lesions after surgery, accounting for 2.05% of all pulmonary nodule resections during the same period and 28.20% of all preoperatively indeterminate pulmonary nodules. Among the 271 patients, pulmonary nodules were mainly detected during routine health examinations in 166 patients (61.25%), followed by symptom-related detection in 58 patients (21.40%) and incidental detection during evaluation for other diseases in 47 patients (17.34%). Radiologically, multiple nodules were observed in 213 patients (78.60%) and solitary nodules in 58(21.40%); solid nodules were found in 240 patients (88.56%), whereas mixed ground-glass and pure ground-glass nodules were found in 31 patients (11.44%). Nodules were located in the right lung in 165 patients (60.89%) and in the left lung in 106(39.11%). The maximum nodule diameter was >1.0 cm in 162 patients (59.78%) and ≤1.0 cm in 109 patients (40.22%). Among radiological signs suggestive of malignancy, lobulation was the most common, occurring in 101 patients (37.27%), followed by spiculation in 86 patients (31.73%), pleural adhesion in 78 patients (28.78%), and the vascular penetration sign in 68 patients (25.09%). Lymphadenopathy was present in 87 patients (41.83%). PET/CT showed an increased SUVmax in 195 patients (71.96%); among them, 81 patients had an SUVmax ≥2.5 (41.54%), and 114 patients had an SUVmax <2.5 (58.46%). Postoperative pathology showed inflammatory lesions in 184 patients (67.89%), among which granulomatous inflammation accounted for 116 cases; confirmed tuberculosis and fungal infection accounted for 39 cases (33.62%)and 15 cases (12.93%), respectively. Among benign tumors, hamartoma was the most common type, with 36 cases (55.38%), followed by pulmonary sclerosing pneumocytoma in 18 cases (27.69%). Elevated fasting blood glucose was identified in 88 of the 271 patients, with an overall incidence of 32.47%. The incidence of elevated blood glucose was significantly higher in the inflammatory lesion group than in the non-inflammatory lesion group(38.59%比19.54%, P=0.002).Surgical procedures included thoracoscopic wedge resection in 151 patients (55.72%), segmentectomy in 70 patients (25.83%), and lobectomy in 50 patients (18.45%).

Benign pulmonary nodules surgically resected due to preoperative suspicion of malignancy were predominantly solid and multiple, and frequently exhibited imaging features suggestive of malignant nodules. Postoperative pathology most commonly revealed inflammatory lesions, particularly granulomatous inflammation. Abnormal glycemic status was not uncommon in this patient population, suggesting that, in addition to routine imaging assessment and follow-up, glycemic status should also be considered during the preoperative differential diagnosis. Comprehensive evaluation may help optimize clinical decision-making and reduce unnecessary surgical intervention.

To clarify the epidemiological characteristics, viral subtype distribution and population infection patterns of influenza in Ya′an City during surveillance years 2019-2024, so as to provide scientific evidence for targeted prevention and control strategies.

Influenza surveillance data from March 2019 to February 2025 were collected from two national sentinel hospitals in Ya′an City, with zero-positive data generated during epidemic prevention and control in 2020 excluded. Reverse transcription-polymerase chain reaction (RT-PCR) was performed for viral subtyping identification. The chi-square (χ²) test was adopted to compare differences in positive detection rates across different years, seasons and populations.

A total of 13, 454 samples were included, with 2, 535 positive cases (18.84%). The annual differences were significant (P<0.001), and 803 positive cases (29.82%) were detected in 2023. Virus typing was dominated by seasonal influenza A(H3N2) subtype (seasonal H3) with 1, 411 cases (55.66%), followed by influenza B virus Victoria lineage (BV lineage) with 1, 725 cases (28.60%) and 2009 pandemic influenza A(H1N1) virus (novel H1N1) with 399 cases (15.74%); influenza B virus Yamagata lineage (BY lineage) was not detected. The seasonal distribution showed a bimodal pattern, with 1, 020 cases (27.54%) in autumn and 792 cases (24.00%) in winter, and the lowest number of 255 cases (7.93%) in summer; the difference was statistically significant (P<0.001). The 5-14 years age group had 1, 303 positive cases (30.23%); the positive rates among 1, 207students(33.07%) and15 teachers (37.50%) were significantly higher than those in other occupations (P<0.001). The positive rate in the school setting 1, 711 cases( 25.76%) was significantly higher than that outside school 824 cases(12.09%) (P<0.001).

Influenza epidemics in Ya′an City prevail in autumn, winter and spring, with the most prominent peak occurring in autumn. Alternating circulation of seasonal H3, BV and pdm09 A/H1N1 strains is identified, and students and teachers constitute high-risk populations. It is recommended to prioritize influenza vaccination for school-aged children aged 5-14 years, teachers and preschool children, strengthen morning and afternoon temperature checks as well as absence tracking due to illness in key settings such as schools, and establish a two-dimensional early warning system covering viral subtype and seasonal dynamics.

To evaluate the diagnostic value of metagenomic nextgeneration sequencing (mNGS) in non-tuberculous Mycobacterial pulmonary disease (NTMPD) and to analyse its clinical characteristics.

Clinical data of 93 patients with suspected NTMPD admitted to our hospital from January 2020 to January 2024 were retrospectively reviewed. All patients underwent mycobacterium culture and mNGS testing. Using the final clinical diagnosis as the gold standard, the diagnostic performances of the two methods were compared. The mycobacterial species distribution, infection types, clinical manifestations, and prognosis of confirmed NTMPD patients were analysed.

Among the 93 suspected patients, 65 cases (69.89%) were definitively diagnosed with NTMPD. Compared with the confirmed diagnosis, the diagnostic accuracy of mycobacterium culture was 76.34%, with a Kappa value of 0.470 (P<0.05), indicating moderate agreement; the diagnostic accuracy of mNGS was 94.62%, with a Kappa value of 0.873 (P<0.05), indicating excellent agreement. Among the 65 confirmed patients, 43 cases (66.15%) had single NTM infection and 22 cases (33.85%) had mixed NTM infection, of which 11 cases had 2 species, 9 had 3 species, and 2 had 4 species. A total of 7 species were identified: Mycobacterium intracellulare in 29 cases (44.62%), Mycobacterium avium in 17 cases (26.15%), Mycobacterium abscessus in 14 cases (21.54%), Mycobacterium fortuitum in 10 cases (15.38%), Mycobacterium paraintracellulare in 9 cases (13.85%), Mycobacterium massiliense in 7 cases (10.77%), and Mycobacterium chubuense in 5 cases (7.69%). ROC curve analysis showed that the AUC for mycobacterium culture in diagnosing NTMPD was 0.607 (95%CI: 0.477~0.736, P=0.104), with a sensitivity of 78.46% and specificity of 74.42%; the AUC for mNGS was 0.923 (95% CI: 0.850~0.997, P<0.001), with a sensitivity of 95.38% and specificity of 92.85%. The difference in AUC between the two methods was statistically significant (Z=4.176, P<0.001). Of the 65 confirmed patients, 64 responded well to antimycobacterial treatment, while 1 patient, who had underlying comorbidities including COPD, cor pulmonale, and bronchiectasis, died of septic shock and multiple organ dysfunction syndrome.

mNGS demonstrates superior sensitivity and specificity over traditional mycobacterium culture in diagnosing NTMPD. It accurately identifies mycobacterial species and distinguishes mixed infections, offering high diagnostic efficacy and significant clinical utility.

To evaluate the effect of comprehensive airway intervention strategies on prognosis in mechanically ventilated patients and to analyze the mediating roles of pulmonary ventilation function and airway microbiota.

A total of 199 mechanically ventilated patients admitted to our hospital from August 2022 to December 2025 were enrolled and randomly divided into an observation group (n=102) and a control group (n=97). The control group received routine airway management, while the observation group received additional comprehensive airway interventions, including dynamic airway assessment, individualized humidification, precise sputum suction, artificial airway maintenance, and airway clearance. Pulmonary dynamic compliance (Cdyn), airway resistance (Raw), oxygenation index (PaO₂/FiO₂), airway microbiota diversity (Chao1 index, Shannon index), and clinical outcomes were compared between the two groups before and after treatment. Pearson correlation analysis, multiple linear hierarchical regression, and PROCESS macro model 4 were used for mediation analysis.

After treatment, the observation group showed significantly higher Cdyn [(58.62±9.47) ml/cmH₂O vs. (48.35±8.66) ml/cmH₂O, t=7.869, P<0.001] and PaO₂/FiO₂[(289.62±41.53) mmHg vs. (231.47±36.82) mmHg, t=9.905, P<0.001], and lower Raw [(12.15±3.12) cmH₂O/(L·s) vs. (15.36±3.57) cmH₂O/(L·s), t=-6.772, P<0.001] compared with the control group. The Chao1 index [(689.25±72.36) vs. (542.16±65.82), t=14.869, P<0.001] and Shannon index [(5.86±0.72) vs. (4.23±0.65), t=16.392, P<0.001] were also significantly higher in the observation group. The observation group had shorter duration of mechanical ventilation [(7.82±2.15) d vs. (11.36±3.42) d, t=-8.976, P<0.001], shorter ICU stay[(10.15±3.26) d vs. (14.72±4.15) d, t=-8.403, P<0.001], and lower mortality (10.78% vs. 24.74%, χ²=6.189, P=0.013) than the control group. Hierarchical regression showed that the final model had an R² of 0.685, and airway intervention strategy, Cdyn, PaO₂/FiO₂, and Shannon index were independent influencing factors for mechanical ventilation duration. Mediation analysis revealed that the mediating effect of pulmonary ventilation function and airway microbiota was -0.315 (95%CI: -0.390 to -0.249), accounting for 47.37% of the total effect.

Comprehensive airway intervention strategies can effectively improve pulmonary ventilation function and airway microbiota homeostasis, shorten mechanical ventilation duration and ICU stay, and reduce mortality in mechanically ventilated patients.

To analyze the correlation between diffusing capacity for carbon monoxide (DLCO) and pulmonary ventilation function in elderly patients with chronic obstructive pulmonary disease (COPD), and to evaluate the diagnostic performance of DLCOrelated indicators with emphasis on sexspecific differences.

In this casecontrol study, 535 elderly patients (age ≥60 years) who underwent pulmonary function tests and chest CT between June 2022 and June 2024 were enrolled and classified into a COPD group 275 cases and a control group 260 cases according to the GOLD criteria. Collected data included demographics, spirometric parameters (FEV₁, FEV1%pred, FVC, FEV₁/FVC), DLCOrelated measures (DLCO, DLCO%pred, DLCO/VA), and CTderived emphysema index (LAA%). Pearson correlation and multivariate linear regression were used to assess associations and independent predictors of DLCO%pred. Diagnostic performance was evaluated using receiveroperatingcharacteristic (ROC) curves.

Compared with controls, the COPD group showed significantly lower values in all DLCOrelated and spirometric indices (all P<0.05). DLCO%pred was strongly correlated with FEV1%pred (r=0.708, P<0.01). Multivariate analysis identified age, FEV1%pred, and LAA% as independent determinants of DLCO%pred (all P<0.01). The overall AUC of DLCO%pred for diagnosing COPD was 0.844 (95%CI: 0.799~0.889). Sexspecific cutoffs improved diagnostic accuracy: in males, DLCO%pred ≤59.75% yielded an AUC of 0.883 (95%CI: 0.842~0.924); in females, ≤65.50% yielded an AUC of 0.861 (95%CI: 0.778~0.943).

DLCOrelated indices correlate closely with ventilatory impairment and emphysema severity in elderly COPD patients and provide valuable diagnostic information. Sexstratified thresholds can enhance screening accuracy and support a more individualized assessment approach.

To investigate the correlation between preoperative sleep monitoring parameters and serum neurofilament light polypeptide (NfL) with postoperative delirium (POD) in patients with chronic obstructive pulmonary disease (COPD) complicated with lung cancer.

A total of 87 patients with COPD and lung cancer who underwent thoracoscopic lung resection in our hospital from January 2021 to August 2025 were enrolled. Among them, 19 patients who developed POD were assigned to the observation group, and 68 patients without POD were assigned to the control group. Clinical data, laboratory indicators, preoperative polysomnographic parameters, and intraoperative parameters were collected. Multivariate logistic regression was used to identify independent risk factors for POD, and receiver operating characteristic (ROC) curves were constructed to evaluate the predictive value of each parameter and their combination.

The observation group had significantly higher age, proportion of American Society of Anesthesiologists (ASA) grade Ⅲ, intraoperative onelung ventilation time [(97.85±16.37) min vs. (88.14±16.05) min, P=0.001], propofol dosage [(790.34±68.34) mg vs. (648.14±68.91) mg, P<0.001], and serum NfL level [(77.45±22.36) pg/ml vs. (61.34±10.02) pg/ml, P<0.001] than the control group. The rates of REM sleep absence (73.68% vs. 47.06%, P<0.05) and atypical sleep (47.37% vs. 17.65%, P<0.05) were also significantly higher in the observation group. Multivariate logistic regression showed that intraoperative onelung ventilation time (OR=1.063, 95%CI: 1.035~1.093, P<0.001), propofol dosage (OR=1.006, 95%CI: 1.003~1.009, P<0.001), serum NfL (OR=1.397, 95%CI: 1.182~1.652, P<0.001), rapid eye movement (REM )sleep absence (OR=2.294, 95%CI: 1.164~4.519, P=0.016), and atypical sleep (OR=1.178, 95%CI: 1.050~1.635, P=0.008) were independent risk factors for POD. ROC curve analysis revealed that the area under the curve (AUC) values for serum NfL, REM sleep absence, propofol dosage, atypical sleep, and onelung ventilation time were 0.757, 0.602, 0.762, 0.778, and 0.763, respectively. The combined model incorporating sleep parameters, NfL, onelung ventilation time, and propofol dosage yielded an AUC of 0.939 (95%CI: 0.898~0.981) with a Youden index of 0.758.

Elevated preoperative serum NfL, REM sleep absence, atypical sleep, prolonged intraoperative onelung ventilation time, and increased propofol dosage are independent risk factors for POD in elderly COPD patients undergoing thoracoscopic lung cancer surgery. The combined preoperative assessment of sleep parameters and serum NfL demonstrates good predictive value for POD and may facilitate early identification of highrisk patients to guide perioperative brainprotective strategies.

To investigate the predictive value of inflammatory composite indicators for the risk of atrial fibrillation in patients with chronic obstructive pulmonary disease (COPD).

A total of 860 patients with COPD admitted to Jiangyin People′s Hospital and Nanjing Chest Hospital from January 2019 to December 2024 were enrolled and randomly divided into a training set 600 cases and a validation set 260 cases at a 7︰3 ratio. In the training set, patients were categorized into an AF group 128 cases and a non atrial fibrillation group 472 cases according to the presence of atrial fibrillation. The neutrophiltolymphocyte ratio (NLR), platelettolymphocyte ratio (PLR), monocytetohighdensity lipoprotein cholesterol ratio (MHR), and Creactive proteintoalbumin ratio (CAR) were compared between the two groups. Lasso regression was used to select predictive variables for constructing a nomogram. The discriminative ability was assessed by receiver operating characteristic (ROC) curves, calibration was evaluated by the HosmerLemeshow test, and clinical net benefit was determined by decision curve analysis (DCA).

In the training set, the atrial fibrillation group had significantly higher NLR, PLR, MHR, and CAR than the non atrial fibrillation group [(2.18±0.42) vs. (1.58±0.39), (142.07±42.13) vs. (112.81±26.69), (0.42±0.12) vs. (0.34±0.10), (1.28±0.24) vs. (0.76±0.20), all P<0.001]. Lasso regression identified the four variables (NLR, PLR, MHR, CAR) for nomogram construction, with corresponding points of 12.11, 14.51, 6.58, and 44.44, respectively. In the validation set, ROC analysis showed an AUC of 0.902 (95%CI: 0.852~0.952), with a sensitivity of 83.70% and specificity of 82.10%. The calibration curve had a Cindex of 0.909, and the HosmerLemeshow test gave χ²=7.0874, df=8, P=0.5272. DCA demonstrated that the model′s net benefit remained stable above 0.4 across threshold probabilities of 0~0.8, indicating high clinical utility.

The nomogram based on NLR, PLR, MHR, and CAR shows good discriminative ability, satisfactory calibration, and significant clinical net benefit for predicting atrial fibrillation in COPD patients, providing a useful tool for early identification of highrisk individuals in clinical practice.

To investigate the effect of esketamine combined with thoracoscopic-guided thoracic paravertebral block (TTPB) on the quality of recovery and analgesic consumption after lobectomy for lung cancer.

Seventy-two patients with lung cancer who underwent thoracoscopic lobectomy in our hospital from January 2022 to September 2025 were selected. According to the perioperative analgesia regimen, they were divided into an observation group 35 cases and a control group 37 cases. The observation group received continuous intravenous infusion of esketamine combined with thoracoscopic-guided thoracic paravertebral block, while the control group received an equal volume of normal saline combined with thoracoscopic-guided thoracic paravertebral block. The quality of recovery-15 (QoR-15) scores, visual analogue scale (VAS) scores at rest and during activity at different time points after surgery, extubation time, time to first ambulation, length of hospital stay, number of patient-controlled intravenous analgesia (PCIA) bolus attempts within 48 h after surgery, rescue analgesic consumption, and incidence of adverse reactions were compared between the two groups.

At 24 h and 48 h after surgery, the QoR-15 scores in the observation group were higher than those in the control group [(82.36±5.78) vs. (73.12±6.05), (91.45±4.32) vs. (82.67±5.11); t=7.241, 8.604; P<0.001]. At 6, 12, 24, and 48 h after surgery, the resting VAS scores in the observation group were lower than those in the control group [(3.12±0.89) vs. (4.56±0.98), (2.78±0.76) vs. (3.98±0.87), (2.41±0.65) vs. (3.23±0.78), (1.64±0.54) vs. (2.21±0.67); t=7.133, 6.812, 5.296, 4.344; P<0.001]. The VAS scores during activity in the observation group were also lower than those in the control group [(4.23±1.01) vs. (5.89±1.12), (3.78±0.92) vs. (5.12±1.03), (3.32±0.85) vs. (4.34±0.98), (2.51±0.76) vs. (3.12±0.89); t=7.218, 6.363, 5.156, 3.418; P<0.001]. The extubation time [(18.76±4.32) min vs. (25.45±5.11) min; t=6.556, P<0.001], time to first ambulation [(22.34±5.67) min vs. (30.12±6.05) min; t=6.153, P<0.001], and length of hospital stay [(6.89±1.23) d vs. (8.76±1.54) d; t=6.222, P<0.001] in the observation group were shorter than those in the control group. The total number of PCIA bolus attempts at 24 h [(4.32±1.23) vs. (8.98±1.98); t=13.110, P<0.001], the total number at 48 h [(7.89±1.87) vs. (15.67±2.76); t=15.303, P<0.001], the number of effective bolus deliveries [(3.78±1.01) vs. (8.98±1.56); t=18.348, P<0.001], and rescue analgesic consumption [(25.67±8.98) mg vs. (58.98±12.34) mg; t=14.312, P<0.001] were all lower in the observation group than in the control group. The incidence of adverse reactions was 9.30% in the observation group and 13.33% in the control group (P>0.05).

Esketamine combined with thoracoscopic-guided thoracic paravertebral block can improve the quality of recovery after thoracoscopic lobectomy for lung cancer, enhance analgesic efficacy, reduce postoperative opioid analgesic consumption, and accelerate recovery, with a good safety profile and no increase in the incidence of adverse reactions.