Objective

MicroRNAs （miRNAs） play a key role in the post-transcriptional regulation of gene expression and have emerged as important regulators of cancer onset，progression and metastasis. The aim of this study was to evaluate the expression profiles of mir-21，mir-671-5p，mir-937-3p，and mir-611 in preoperative and three-month postoperative serum samples from patients with early-non-small cell lung caner（NSCLC） in order to explore their biomarker potential.

Methods

A total of 62 blood samples from early-NSCLC patients （pre- and post-surgery） were collected. The relative expression levels of mir-21，mir-671-5p，mir-937-3p and mir-611 in serum were quantified using quantitative real-time PCR.

Results

Our results showed that comparing preoperative and postoperative 3 months，patients'postoperative serum miR-21 decreased 0.2584-fold （95% CI：0.05664 ～0.4601），miR-671-5p decreased 0.2213-fold （95% CI：0.02188 ～0.4207），miR-937-3p decreased 0.2182-fold （95% CI：0.05234～0.3840） and miR-611 decreased 0.6224-fold （95% CI：0.4426～0.8021），and the expression levels of the above molecules were significantly lower than those before surgery （P=0.0039，0.0154，0.0031，＜0.0001）. Receiver operating characteristic curve （ROC） analysis showed that miR-21 （AUC=0.6942，P =0.0004） and miR-937-3p （AUC=0.6522，P =0.0059） were able to differentiate with relatively high accuracy between the preoperative and postoperative levels in early-NSCLC patients. However，no significant correlation was found between the serum levels of the studied genes and the clinical characteristics of the patients.

Conclusion

Serum miR-21 and miR-937-3p are expected to be potential biomarkers for diagnosis and prognosis in early-NSCLC patients.

Objective

To analyze the safety and efficacy of diagnosis of single photon emission computed tomography （SPECT） lung perfusion imaging/low-dose computed tomography （CT） in patients with chronic obstructive pulmonary disease （COPD） complicated by pulmonary embolism （PE）.

Methods

Eighty COPD patients suspected of PE admitted to our hospital from January 2014 to December 2024 were selected as subjects. The patients underwent SPECT lung perfusion imaging and low-dose lung CT examination （samemachine examination），followed by image post-processing fusion. Adverse reactions during imaging were recorded. Using the final discharge results as the gold standard，the diagnostic results and value of SPECT，lowdose CT，and SPECT/CT were analyzed and compared. The detection rates and imaging characteristics of different imaging techniques for lesion locations were recorded.

Results

Among the 80 COPD patients suspected of PE，the gold standard confirmed 43 cases of PE and 37 cases of non-PE. The diagnostic results of SPECT/CT fusion，SPECT，and low-dose CT were 40 positive cases，30 positive cases，and 35 positive cases，and 35 negative cases，25 negative cases，and 28 negative cases，respectively. The diagnostic consistency of SPECT/CT fusion （Kappa=0.843） was higher than that of SPECT and low-dose CT. The diagnostic sensitivity（93.02%），specificity （94.59%），positive predictive value （95.24%），negative predictive value （92.11%），and accuracy （93.75%） of SPECT/CT fusion were higher than those of SPECT （69.77%，67.57%，71.43%，65.79%，68.75%） and low-dose CT （81.40%，75.68%，79.55%，77.78%，78.75%） （P＜0.05）. Among the 43 PE cases diagnosed by the gold standard，there were 91 segmental lesions and 97 subsegmental lesions. The detection rates of segmental lesions by different imaging techniques （92.31% vs. 83.52% vs. 85.71%） showed no statistically significant difference （P＞0.05）. However，the detection rate of subsegmental lesions by SPECT/CT fusion （95.88%） was higher than that by SPECT （76.29%） and low-dose CT （81.44%） （P＜0.05）. In PE patients，SPECT lung perfusion imaging showed single or multiple radioactive sparse defect area，with uniform or uneven radioactive distribution. Low-dose CT images revealed filling defects in the pulmonary vascular pathways，increased lung translucency，and sparse lung texture. In SPECT/CT fusion images，the radioactive sparse defect area in the lung of PE patients matched the filling defects in the pulmonary vascular pathways.

Conclusion

Low-dose SPECT/CT lung perfusion fusion imaging is effective and safe for diagnosing COPD complicated with PE，providing accurate information for clinical PE diagnosis.

Objective

To analyze the effect of interleukin-10（IL-10） on the balance of T helper cell 17 （Th17）/regulatory T cell （Treg） and its effect on mice with transfusion-related acute lung injury （TRALI）.

Methods

Sixty mice were divided into a control group，a transfusion-related acute lung injury （TRALI）group，an interleukin-10 low-dose （IL-10-L） group，and an interleukin-10 high-dose （IL-10-H） group，with 15 mice in each group. Calculate the arterial partial pressure of oxygen （PaO₂），the partial pressure of carbon dioxide （PaCO₂），the oxygenation index （OI），and the wet/dry weight ratio（W/D） of lung tissues. Use the enzyme-linked immunosorbent assay （ELISA） to detect the levels of inflammatory factors in bronchoalveolar lavage fluid （BALF），including interleukin-6 （IL-6），interferon-γ （INF-γ），tumor necrosis factor-α （TNF-α），and interleukin-17A （IL-17A）. Detect the total number of cells and the proportion of neutrophils in BALF.Measure the activity of myeloperoxidase （MPO）. Use flow cytometry to detect the number of helper T cell 17（Th17） and regulatory T cell （Treg） cells in peripheral blood. Use reverse transcription-quantitative polymerase chain reaction （RT-qPCR） and Western blotting （WB） to detect the mRNA and protein levels of Th17/Treg cell-related markers in lung tissues，including IL-17A，retinoic acid-related orphan receptor γt（RORγt），forkhead box protein P3 （Foxp3），glucocorticoid-induced tumor necrosis factor receptor-related protein （GITR），and cytotoxic T lymphocyte-associated protein 4 （CTLA-4）.

Results

Compared with the control group，the levels of PaO₂ and OI in the TRALI group decreased （t=5.921，8.216，P＜0.001），and the levels of PaCO₂，the （W/D） of lung tissues，and the activity of MPO increased （t=10.257，7.843，3.987，P＜0.001）. Except for the control group，the lung tissues of the other groups were damaged to varying degrees.Red blood cells and inflammatory cells in the alveolar septa and alveolar cavities showed varying degrees of thickening and infiltration. The proportion of Th17 cells in peripheral blood and the Th17/Treg ratio increased（t=9.836，7.125，P＜0.05），and the proportion of Treg cells decreased （t=6.254，P＜0.05）. The mRNA and protein levels of IL-17A and RORγt in lung tissues increased （t=4.850，8.966，6.401，3.248，P＜0.05），while the mRNA and protein levels of Foxp3，GITR，and CTLA-4 decreased （t=3.567，10.190，7.632，4.610，8.789，t=2.436，P＜0.05）. The levels of IL-6，INF-γ，TNF-α，IL-17A，the total number of cells，and the percentage of neutrophils in BALF increased （t=7.802，2.331，6.208，7.127，3.709，7.540，P＜0.05）.Compared with the TRALI group，the levels of PaO₂ and OI in the IL-10-L group and the IL-10-H group increased （P ＜0.001），and the levels of PaCO₂，the （W/D） of lung tissues，and the activity of MPO decreased （P ＜0.001）. Slight structural damage could be seen in the lung tissues，accompanied by less bleeding and inflammatory reactions. The proportion of Th17 cells in peripheral blood and the Th17/Treg ratio decreased，and the proportion of Treg cells increased （P＜0.05）. The mRNA and protein levels of IL-17A and RORγt in lung tissues decreased，while the mRNA and protein levels of Foxp3，GITR，and CTLA-4 increased（P＜0.05）. The levels of IL-6，INF-γ，TNF-α，IL-17A，the total number of cells，and the percentage of neutrophils in BALF decreased （P＜0.05）.

Conclusion

IL-10 modulates the Th17/Treg cell balance，thereby mitigating TRALI in murine models，highlighting its potential as a therapeutic strategy.

Objective

To analyze the mechanism of secoisolariciresinol diglucoside （SDG） affecting apoptosis and ferroptosis of non-small cell lung cancer A549 cells through circular RNA homeodomain interacting protein kinase 3 （circRNA HIPK3）.

Methods

Lung cancer A549 cells were divided into A549 group，SDG-L group，SDG-M group，SDG-H group，SDG-H+oe-NC group，SDG-H+oe-circRNA HIPK3 group.Each experiment was repeated 6 times. The 3-（4，5-dimethylthiazol-2-yl）-2，5-diphenyltetrazolium bromide assay was used to detect the cell viability. The mRNA expressions of circRNA HIPK3，nicotinamide adenine dinucleotide phosphate oxidase 1 （NOX1），glutathione peroxidase 4 （GPX4），ferritin heavy chain 1 （FTH1），and solute carrier family 7 member 11 （SLC7A11）. Kits were used to detect the levels of Fe²⁺，malondialdehyde （MDA），and glutathione （GSH）. The 2'，7'-dichlorofluorescin diacetate staining method was used to detect the level of reactive oxygen species （ROS）. Western blot was used to determine the expression changes of NOX1，GPX4，FTH1，SLC7A11，nuclear factor erythroid 2-related factor 2 （Nrf2），and heme oxygenase-1 （HO-1）. The Transwell assay and terminal deoxynucleotidyl transferase dUTP nick end labeling assay were used to detect cell invasion and apoptosis.

Results

SDG at different concentrations had no significant effect on the survival rate of human bronchial epithelial cells HBE1，but it decreased the survival rate of A549 cells. The cell viability in the SDG-H group ［（55.29±10.05） %］ decreased most significantly，and 40 μmol/L of SDG was selected for subsequent experiments. Circular RNA HIPK3 was highly expressed in the cells of the A549 group （2.36±0.33） and lowly expressed in the cells of the SDG-H group （1.72±0.26）.The levels of Fe²⁺，MDA，ROS and the cell apoptosis rate in the SDG-H group were higher than those in the A549 group （P＜0.01）. The mRNA and protein expressions of NOX1 were higher than those in the A549 group（P＜0.01）. The levels of GSH and the number of cell invasions （P＜0.05）. The mRNA and protein expressions of GPX4，FTH1，SLC7A11，and the protein levels of Nrf2 and HO-1 were lower than those in the A549 group（P＜0.05）. The levels of Fe²⁺，MDA，ROS and the cell apoptosis rate in the cells of the SDG-H+oe-circRNA HIPK3 group were lower than those in the SDG-H+oe-NC group （P＜0.05）. The mRNA and protein expressions of NOX1 were lower than those in the SDG-H+oe-NC group （P＜0.05）. The levels of GSH and the number of cell invasions were higher than those in the SDG-H+oe-NC group（P＜0.05）. The mRNA and protein expressions of GPX4，FTH1，SLC7A11，and the protein levels of Nrf2 and HO-1 were higher than those in the SDG-H+oe-NC group （P ＜0.05）.

Conclusion

SDG promoted apoptosis of non-small cell lung cancer A549 cells and inhibited cell invasion by regulating circRNA HIPK3. This might be related to inhibiting the activation of the Nrf2/HO-1 antioxidant pathway and activating ferroptosis in cells.

Objective

To investigate the effects and mechanisms of ten-eleven translocation methylcytosine dioxygenase 2 （TET2） on hypoxia-induced injury in human umbilical vein endothelial cells（HUVECs）.

Methods

Human umbilical vein endothelial cells （HUVECs） were treated as follows：HUVECs treated with normal saline under normoxia were defined as the Norm-C group； HUVECs treated with thrombin under normoxia were defined as the Norm-M group； HUVECs treated with normal saline under hypoxia were defined as the Hypo-M group； HUVECs treated with hypoxia and thrombin were also defined as the Hypo-M group. Additionally，HUVECs treated with hypoxia，thrombin，and an adenovirus empty vector without TET2 were defined as the empty vector group； HUVECs treated with hypoxia，thrombin，and a recombinant adenovirus carrying the TET2 gene were defined as the AdTET2 group； HUVECs treated with hypoxia，thrombin，and H₂O₂ were defined as the H₂O₂ group； HUVECs treated with hypoxia，thrombin，a recombinant adenovirus carrying the TET2 gene，and H₂O₂ were defined as the AdTET2+H₂O₂ group. The ultrastructure of the cells was observed，and the levels of tissue plasminogen activator （t-PA），thrombomodulin （TM），vascular endothelial growth factor （VEGF），vascular cell adhesion molecule （VCAM），von Willebrand factor（vWF），plasminogen activator inhibitor-1 （PAI-1），reactive oxygen species （ROS），superoxide dismutase（SOD），and malondialdehyde （MDA） were monitored.

Results

Compared with the Norm-C group，the Hypo-C group exhibited swollen and vacuolated organelles in the cytoplasm，but the cell membranes remained intact.In contrast，the Norm-M and Hypo-M groups showed ruptured cell membranes and cytoplasmic leakage. In the Hypo-M group，the levels of t-PA （2.03±0.04） ng/ml，TM （1.04±0.06）ng/ml，SOD activity （12.97±1.79）U/mg，and TET2 mRNA （0.45±0.04） were lower than those in the Norm-C group t-PA （3.29±0.25）ng/ml，TM （1.45±0.11）ng/ml，SOD activity （19.66±2.15）U/mg，TET2 mRNA （1.00±0.07）. Conversely，the levels of VEGF （435.03±18.27） pg/ml，VCAM （74.14±4.47）ng/ml，vWF （87.22±6.57）ng/ml，PAI-1（12.32±0.28）pg/ml，ROS （81 911.90±3 011.78），and MDA （0.87±0.10） nmol/mg were higher in the Hypo-M group than in the Norm-C group VEGF （328.55±21.02）pg/ml，VCAM （56.74±3.95）ng/ml，vWF（66.27±4.91）ng/ml，PAI-1 （8.07±0.43）pg/ml，ROS （46 424.60±2 040.93），MDA（0.55±0.06）nmol/mg.Compared with the model group or the empty vector group，the AdTET2 group showed increased levels of t-PA，TM，and SOD activity，while VEGF，VCAM，vWF，PAI-1，ROS，and MDA were decreased. In the AdTET2+H₂O₂ group，the levels of TM and t-PA were higher than those in the H₂O₂ group，while VEGF，VCAM，vWF，PAI-1，ROS，and MDA were lower than those in the H₂O₂ group.

Conclusion

Hypoxia and thrombin induce injury in HUVECs，while overexpression of TET2 alleviates oxidative stress and exerts a protective effect.

Objective

To investigate the expression of tumor necrosis factor-like cell weak apoptosis factor （TWEAK） in induced sputum and its association with asthma severity.

Methods

A total of 50 asthma patients were recruited from March 2022 to September 2022，and induced TWEAK in sputum were determined using enzyme-linked immunosorbent assay. According to the TWEAK value，asthma patients were divided into TWEAK high expression group （≥0.70 ng/ml） and TWEAK low expression group （＜0.70 ng/ml），with 25 cases in each group. Spearman was used to analyze the correlation between TWEAK and lung function indexes，inflammation markers and M1 macrophages.

Results

The interferon （IFN）-γ in the TWEAK high expression group were significantly lower than those in the low expression group （P ＜0.05），and the percentages of interleukin （IL）-17A，CD45⁺/CD68⁺ macrophages%，M1 type （CD11c⁺/CD86⁺） macrophages % in the TWEAK high expression group were significantly higher than those in the low expression group （P＜0.05）.According to Spearman analysis，induced sputum TWEAK was significantly negatively correlated with the percentage of forced expiratory volume （FEV₁） in 1 second （r_s=-0.476），FEV₁/forced vital capacity （r_s=-0.394），and induced sputum IFN-γ （r_s=-0.346）（P＜0.05）. The induced sputum TWEAK was significantly positively correlated with tumor cell necrosis factor-α （r_s=0.315），IL-6 （r_s=0.286），IL-17A （r_s=0.320），M1 type （CD11c⁺/CD86⁺） macrophage % （r_s =0.470），neutrophil % （r_s =0.293） and peripheral blood neutrophil % （r_s=0.351）（P＜0.05）. The expression of induced sputum TWEAK in patients with a family history of allergies was significantly lower than that in patients without a family history of allergies（P＜0.05）.

Conclusion

There was a significant correlation between induced sputum TWEAK overexpression and inflammation progression and disease flare-up in asthma patients，and induced TWEAK in sputum may be a marker of asthma severity.

Objective

To explore the risk of acute exacerbation in patients with chronic obstructive pulmonary disease （COPD） based on interpretable machine learning model.

Methods

A total of 80 patients with COPD in stable phase admitted to our hospital from January 2021 to December 2024 were selected. Patients were divided into a observation group 23 cases and an control group 57 cases based on whether they experienced acute exacerbations. LASSO regression was used to screen for the best predictors of acute exacerbations. Four machine learning algorithms-logistic regression （logistic regression，LR），K-nearest neighbors classification（K-Nearest Neighbor Classification，KNN），and extreme gradient boosting （eXtreme Gradient Boosting，xGBoost）-were employed to develop predictive models and evaluate their performance. The SHAP method was used to analyze the interpretability of the optimal model and record the prognosis of patients.

Results

Univariate analysis showed that there were statistically significant differences between the observation group and the control group in age，body mass index，COPD course，smoking，FEV₁/FVC，FEV1%pred，procalcitonin，fibrinogen，heparin binding protein，and IL-6 （P＜0.05）. The regression results show that the risk factors affecting acute exacerbations in COPD patients include IL-6，age，heparin-binding protein，and body mass index. Among the four ML models constructed based on these four characteristics，Model AUC of xgboost model was the highest at 0.979，with an accuracy rate of 91.70% and a precision rate of 98.00%. The SHAP results indicate that the top four contributing features are IL-6，age，heparin-binding protein，and body mass index. During the follow-up period，68（85.00%） of the 80 patients survived and 12 died（15.00%）.

Conclusion

This study developed an efficient and interpretable machine learning model to predict acute exacerbation of COPD patients，which is helpful for clinical identification of high-risk patients with acute exacerbation of COPD.

Objective

To analyze the correlation between dynamic variability in red blood cell distribution width （RDW） and the risk of readmission in patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD）.

Methods

A total of 96 AECOPD patients admitted to our hospital from January 2021 to December 2023 were enrolled and divided into three groups based on dynamic RDW changes on day 1 and day 4 of admission：normal group （30 cases），decreased group （32 cases），and elevated group（34 cases）. Clinical parameters，including comorbidities and white blood cell （WBC） levels，were collected.Logistic regression was used to analyze risk factors for 30 day readmission after discharge，and receiver operating characteristic curve（ROC） were employed to predict prognosis.

Results

Compared to the normal and decreased groups，the elevated group had 12 cases （35.29%） of 30 day readmission，higher WBC levels（8.26±1.95 ）×10⁹/L，higher C-reactive protein （CRP） levels （30.76±6.31 ）mg/L，and lower hemoglobin（Hb） levels （116.18±21.47 ） g/L （P＜0.05）. Univariate logistic regression analysis revealed that pH＜7.35（OR=4.364，95% CI：1.435～13.269），WBC （OR=1.456，95% CI：1.020～2.077），CRP（OR=1.139，95% CI：1.006～1.291），and dynamic RDW elevation （OR=10.263，95% CI：2.081 ～50.619） were significant predictors of 30 day readmission （P＜0.05）. Multivariate logistic regression analysis identified pH＜7.35 （OR=9.610，95% CI：1.799～51.340），CRP（OR=1.249，95% CI：1.050 ～1.486），and dynamic RDW elevation（OR=27.417，95% CI：3.385～222.054） as independent risk factors for 30-day readmission （P＜0.05）. ROC curve analysis showed that pH ＜7.35，CRP levels，and dynamic RDW changes had areas under the curve（AUC） of 0.639（0.489 ～0.790），0.597（0.431 ～0.763），and 0.733（0.609 ～0.857），with sensitivities of 42.10%，31. 60%，and 68. 40%，and specificities of 85. 70%，96. 10%，and 74. 00%，respectively.

Conclusion

Dynamic elevation of RDW，pH＜7.35，and CRP levels are risk factors for 30 day readmission in AECOPD patients. Monitoring dynamic RDW changes can help predict readmission risk，identify high-risk populations early，and guide personalized interventions to reduce short-term readmission rates and improve prognosis.

Objective

To analyze the clinical analysis between the severity of sleep apnea and the risk of cognitive decline in patients with chronic obstructive pulmonary disease （COPD）.

Methods

A total of 118 COPD patients admitted to our hospital from January 2022 to August 2024 were enrolled. They were divided into four groups based on the apnea hypopnea index （AHI）：control group 38 cases （AHI＜5 events/h），mild group 38 cases （5 events/h≤AHI＜15 events/h），moderate group 30 cases （15 events/h≤AHI＜30 events/h），and severe group12 cases （ AHI≥30 events/h）. General data，pulmonary function，and cognitive function were compared among the groups. Pearson correlation analysis and multiple linear regression were used to assess the correlation between sleep apnea severity and cognitive function in COPD patients.

Results

Significant differences were observed among the groups in forced expiratory volume in the first second/forced vital capacity（FEV₁/FVC） and forced expiratory volume in the first second as a percentage of predicted value （FEV₁%Pred）. The FEV₁/FVC values for the control，mild，moderate，and severe groups were （61.25±4.09）%，（58.64±5.17）%，（52.65±6.22）%，and （48.97±4.19）%，respectively. FEV₁%Pred values were （75.33±2.75）%，（72.61±4.86）%，（62.64±5.44）%，and （58.67±4.59）%，respectively. The severe group had significantly lower FEV₁/FVC and FEV₁%Pred compared to the control，mild，and moderate groups （P ＜0.05）. Significant differences were also observed in visuospatial/executive function，attention，memory，and total Montreal Cognitive Assessment Scale （MoCA） scores among the groups （P＜0.05）. The severe group scored （3.31±0.67），（4.66±0.15），（3.52±0.29），and （24.18±2.01） in these domains，respectively，while the control group scored （4.58±0.12），（5.61±0.27），（4.39±0.24），and （28.33±1.17） （P＜0.05）. Pearson correlation analysis revealed a negative correlation between AHI and MoCA scores （r=-0.616，P =0.001）.Multiple stepwise regression analysis indicated that AHI negatively impacted cognitive function in COPD patients （P ＜0.05）. Among 118 patients with OSA and CODP who had cognitive decline，98（83.05%）survived after treatment，and 20（16.95%） died due to poor treatment efficacy.

Conclusion

The severity of sleep apnea is associated with the risk of cognitive decline in COPD patients. Assessing sleep apnea in COPD patients and implementing early interventions may help reduce the risk of cognitive impairment.

Objective

To analyze the predictive significance of circulating tumor DNA （ctDNA） in the risk of early recurrence of non-small cell lung cancer （NSCLC） after radical surgery.

Methods

All of 81 patients with NSCLC admitted to our hospital from February 2020 to December 2023 were selected. Radical resection was completed，tumor specimens and blood samples were collected. ctDNA analysis was performed using circulating single-molecule amplification and resequencing technology （cSMART） based on liquid biopsy.Relapse-free survival （RFS） and overall survival （OS） were recorded，and the relationship between ctDNA and RFS and OS was analyzed.

Results

81 cases had an average of （1.73±0.65） gene mutations，50 cases（61.73%） were positive ctDNA before surgery，and 33 of 76 cases （43.42%） were positive ctDNA at least one point after surgery. Among the 50 patients with positive ctDNA before surgery，26 patients had positive ctDNA after surgery. During a median follow-up of 44.0 months，Among the 81 NSCLC patients，55 survived（67.90%），37 cases （45.68%） relapsed and 26 cases （32.10%） died. The median RFS stage was 19.0 months （log rank=12.531，P＜0.001） and OS stage was 34.89 months （log rank=11.028，P =0.001） in ctDNA-positive patients before surgery，and the median RFS stage was 42.0 months and OS stage was 46.65 months in ctDNA-negative patients. Among the 33 ctDNA positive patients，21 casses （63.64%） relapsed and 15 cases（45.45%） died. The median RFS duration of 25.79 months （log rank=10.796，P =0.001） and OS duration of 34.21 months （log rank=7.384，P =0.007） in ctDNA-positive patients were shorter than those in ctDNA-negative patients （39.0 months of RFS and 43.15 months of OS）. The imaging results of 43 patients with negative ctDNA after surgery showed complete resection of the lesions，and 21 cases of them were positive ctDNA before surgery. The median RFS duration of those with negative ctDNA was 38.05 months （log rank=5.139，P =0.023），which was longer than that of those without negative ctDNA. 31 patients with negative ctDNA before surgery，7 cases（22.58%） had positive ctDNA conversion after surgery. Among the 33 ctDNA positive cases，21 cases had positive ctDNA after surgery （11.12±5.21） months earlier than the average results of imaging or clinical symptoms，and 17 cases had positive ctDNA within 2 weeks after surgery. Multifactor analysis showed that clinical stage and preoperative ctDNA status had statistical significance for RFS and OS（P＜0.05）. The risk of recurrence or death from high stage （stage Ⅲ） and low stage （stage Ⅰ/Ⅱ） NSCLC was 3.082 times or 3.577 times，respectively. Preoperative ctDNA-positive NSCLC had 3.889 times or 3.139 times increased risk of recurrence or death compared with ctDNA-negative NSCLC. Positive ctDNA was a factor affecting RFS after operation （P＜0.05），and the risk of recurrence was increased by 3.333 times.

Conclusion

Advanced stage and preoperative ctDNA positive are the factors affecting RFS and OS in patients with radical resection of NSCLC. The detection of ctDNA after surgery can help to detect recurrence in time.

Objective

To analyze the correlation between serum soluble growth stimulation expressed gene 2 protein （sST-2） and the risk of pulmonary hypertension complicating acute pulmonary embolism（APE）.

Methods

Seventy-two APE patients treated in our hospital from January 2021 to January 2024 were selected. Sixteen patients with concurrent pulmonary hypertension were assigned to the observation group，and 56 patients without pulmonary hypertension served as the control group. General data，serum sST-2 levels，forced expiratory volume in one second （FEV₁），interleukin-6 （IL-6），red cell distribution width （RDW），and mean platelet volume （MPV） were compared between the two groups. Logistic regression was used to analyze influencing factors of pulmonary hypertension in APE patients. The predictive value of these factors for pulmonary hypertension in APE patients was assessed using receiver operating characteristic （ROC） curves.

Results

The FEV₁ of the observation group was （52.78±5.33）L，lower than that of the control group （58.25±6.35）L. The serum sST-2 （133.15±8.34）ng/ml，IL-6 （56.83±5.88）mg/ml，RDW（15.64±3.67）%，and D-dimer （3.13±0.77） mg/L of the observation group were higher than those of the control group sST-2 （122.62±5.77）ng/ml，IL-6 （51.57±1.36）mg/ml，RDW （12.72±1.48）%，D-dimer （2.82±0.32）mg/L （P＜0.05）.Logistic regression analysis showed that high serum sST-2 （OR=1.613，95% CI：1.043～2.493），IL-6（OR=3.002，95% CI：1.276～7.060），and RDW （OR=4.029，95% CI：1.135～14.305） were risk factors for acute pulmonary embolism （APE）-related pulmonary hypertension，while FEV₁（OR= 0.692，95% CI：0.484 ～0.988） was a protective factor （P＜0.05）. Receiver operating characteristic （ROC） curve results showed that the area under the curve （AUC） of FEV₁，serum sST-2，IL-6，and RDW for diagnosing APE-related pulmonary hypertension were 0.733，0.853，0.828，and 0.771，respectively （P＜0.05）.

Conclusion

FEV₁，serum sST-2，IL-6，and RDW are influencing factors for pulmonary hypertension complicating APE，and serum sST-2 can predict the occurrence of pulmonary hypertension in APE patients.

Objective

To analyze the influencing factors of recurrence in retreatment multidrugresistant/rifampicin-resistant tuberculosis.

Methods

A total of 78 patients with retreatment-sensitive tuberculosis who developed multidrug-resistant/rifampicin-resistant tuberculosis at our hospital from June 2018 to December 2023 were selected and treated with the Bedaquiline regimen for 12 months. Among them，31 patients with recurrence after discharge were assigned to the observation group，and 47 patients without recurrence served as the control group. Clinical data were collected，and univariate and multivariate regression analyses were performed to identify factors influencing post-discharge recurrence. A nomogram model was constructed.

Results

It was higher diabetes history 18 cases （58.06%），pulmonary cavities 25 cases（80.65%），and irregular treatment （26 cases，83.87%） in the observation group compared to the control group 13 cases （27.66%），10 cases （21.27%），and 9 cases （19.15%），respectively； χ²=7.211，26.615，31.632，P＜0.05. Diabetes （OR=1.957，95% CI：1.403 ～2.729），pulmonary cavities （OR=1.302，95% CI：1.111～1.526），and irregular treatment （OR=1.197，95% CI：1.112～1.288） were identified as independent risk factors for recurrence （P＜0.05）. Variance inflation factor （VIF） analysis showed no multicollinearity among the three indicators （VIF = 1.022，1.046，1.053）. The 78 patients were split into a training set（54 cases and a validation set （24 cases） by 7∶3 ratio. The area under the receiver operating characteristic（ROC） curve （AUC） （95%CI） for predicting 1-year recurrence post-discharge was 0.83 （0.73～0.94） in the training set and 0.90（0.79～1.00） in the validation set. At 6-month follow-up，67 patients （85.90%） survived，while 11 cases（14.10%） died due to severe pulmonary lesions （4 cases），recurrent drug-resistant infections（4 cases），and hemoptysis （3 cases）. Decision curve analysis （DCA） indicated high net benefit for nomogram probability thresholds of 20% ～100%.

Conclusion

Retreatment multidrug-resistant/rifampicin-resistant tuberculosis has a high recurrence rate，with diabetes，pulmonary cavities，and irregular treatment as key influencing factors. The nomogram model demonstrates significant predictive value.

Objective

To evaluate the value of AI-based CT quantitative analysis on pulmonary nodules.

Methods

A total of 182 patients with lung cancer confirmed by surgery and pathology in Xinqiao Hospital from September 2021 to May 2022 were retrospectively analyzed，including 63 cases of invasive adenocarcinoma （MIC），104 cases of minimally invasive adenocarcinoma （MIA） and 15 cases of carcinoma in situ （AIS）. All patients underwent CT quantitative analysis of AI. The diagnostic efficacy of pathology and AI-assisted CT examination for the nature and infiltration degree of pulmonary nodules was compared. At the same time，the AI analysis parameters of solid pulmonary nodules and ground glass pulmonary nodules and different infiltration degree of pulmonary nodules were compared.

Results

Surgical pathology showed that 95 cases were solid nodules，87 were ground glass nodules；15 cases were in situ pulmonary nodules，106 were microinvasive pulmonary nodules and 63 were invasive pulmonary nodules. The sensitivity，specificity，accuracy，positive predictive value and negative predictive value of the gold standard，No statistical difference （P＞0.05）；Comparison of CT parameters between solid nodules and ground glass nodules showed that：The mass of solid nodules was （448.34±60.05） g，the 3D long diameter was （16.88±0.80） mm，the average length and short diameter was （12.99±0.63）mm，the average CT value was （-453.29±15.17）Hu，and the CT variance was（107 460.12±17 115.26） Hu. The maximum value of CT was （401.03±32.37） Hu，and the entropy value was（9.09±0.88），which were higher than those of ground glass nodules，and there were differences between the groups （P＜0.05）. The CT parameters of lung nodules with different degrees of invasion showed that the weight and volume of lung nodules in situ were （238.04±163.23） g and （716.66±479.08） cm³，which were higher than those of invasive carcinoma，but lower than those of minimally invasive carcinoma，and the 3D long diameter and CT average were lower than those of minimally invasive carcinoma and invasive carcinoma （P＜0.05）. Compared with carcinoma in situ，microinvasive carcinoma had a higher mean length of meridian and invasive carcinoma had a lower mean length of meridian （P ＜0.05）.

Conclusion

The AI-assisted CT examination can accurately diagnose the nature and infiltration degree of pulmonary nodules，and the quantitative analysis of relevant parameters can provide a basis for disease evaluation.

Objective

Explore the significance of neutrophil/lymphocyte ratio （NLR） in patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD） with different blood eosinophil （EOS）levels.

Methods

A total of 205 AECOPD patients hospitalized in the Department of Pulmonary and Critical Care Medicine of Xi'an Ninth Hospital from December 2020 to October 2023 were collected and divided into high blood EOS group （blood EOS≥3%） and low blood EOS group （blood EOS＜3%） according to blood EOS level. The patients were divided into high NLR subgroup （NLR≥3.35） and low NLR subgroup （NLR＜3.35）.The clinical data，pulmonary function and immune inflammatory indexes were collected，and the differences between groups were compared.

Results

①The high blood EOS group exhibited significantly higher FeNO levels ［23.0（16.5，37.5） vs. 18.0（12.3，23.0），P＜0.05］ but lower systemic inflammation markers，including WBC［5.7（4.8，6.9） vs. 6.6（5.3，8.2）］，NEU% （61.6±10.9 vs. 71.0±10.7），NLR［2.6（1.8，3.7） vs. 3.6（2.4，6.5）］，hsCRP［3.1（1.9，7.0） vs. 4.0（2.6，14.1）］，and Fib ［3.3（2.7，4.0） vs. 3.6（3.0，4.6）］，compared to the low blood EOS group （P＜0.05）. ②In the low blood EOS group，compared with the low NLR group，the high NLR subgroup had higher mMRC grade，degree of inflammation （WBC，hsCRP），pulse concussion resistance （Z5，R5，R5-R20，X5，AX） （P＜0.05），lower PaO₂，traditional pulmonary function（FEV1%，FEV₁/FVC，FEF50%，MMEF，MVV%），immune index （IgG，IgM，lymphocyte，CD3⁺ T cell and CD4⁺ T cell count） （P＜0.05）. ③In the high blood EOS group，compared with the low NLR subgroup，the degree of inflammation （hsCRP） and pulse concussion resistance （Fres） in the high NLR subgroup were higher（P＜0.05），while the traditional pulmonary function （FEV1%） and immune indexes （IgG，IgM，lymphocyte，CD3⁺ T cell，CD8⁺ T cell and B cell count） were lower （P＜0.05）. ④In AECOPD patients stratified by blood EOS levels，NLR showed weak negative correlations with FEV₁（the low blood EOS group：r=-0.219，P =0.008； the high blood EOS group：r=-0.302，P =0.020） and FEV1% （the low blood EOS group：r=-0.217，P=0.009； the high blood EOS group：r=-0.258，P =0.049）.

Conclusion

The inflammatory reaction，pulmonary function and immune function of the high EOS subgroup of the AECOPD patients with different blood EOS levels were more severe than those of the low NLR subgroup，especially in the group with blood EOS＜3%，and accompanied by more severe dyspnea. Monitoring blood Eos level，MLR and pulmonary function is clinically significant.

Objective

To analyze the molecular characteristics，resistance patterns，virulence factors，and pathogenic mechanisms of carbapenem-resistant Klebsiella pneumoniae（CRKP）.

Methods

Eighty CRKP strains isolated from our hospital between January 2018 and December 2023 were selected，and clinical data were collected. Thirty-five strains were randomly chosen for antimicrobial susceptibility testing using the disk diffusion method. Metagenomic next-generation sequencing （mNGS） was performed for sequencing CRKP isolates，and capsular serotyping was conducted for strain classification.

Results

Among the 80 CRKP strains，capsular serotypes included K1 12 strains（ 15.00%），K2 3 strains（ 3.75%），K35 1 strain（1.25%），K57 1 strain（1.25%），and 63 strains （78.75%） were untypeable. Resistance rates to ciprofloxacin and tetracycline were 77.50% and 61.25%，respectively，while resistance to common antimicrobial agents exceeded 90%.Carbapenemase genes identified were KPC-2（60.00%），NDM（20.00%），and OXA-48（8.57%）； one strain co-produced OXA-48 and NDM. Aminoglycoside-modifying enzyme genes included aac（6'）-Ⅰb（28.57%）；one strain carried aac（6'）-Ⅰb and aac（3）-Ⅰa，and two strains carried aac（6'）-Ⅰb and aac（3）-Ⅳa. No methyltransferase genes were detected. Capsular antigen molecular typing predominantly identified KL1 and KL2. O-antigen types included O1/O2v1 16 strains （45.71%），O1/O2v2 12 strains（34.28%），O3b 2 strains（ 5.71%），and O4 1 strain（2.85%）. Virulence genes with high detection rates were entB（100.00%），mrkD（97.14%），ybtS（94.28%），and rmpA（11.43%）. GO gene functions were related to metabolic processes （P＜0.001）. CRKP primarily carried ColRNAI and IncFIB（K） plasmids，with sdiA present in most conjugative plasmids.

Conclusion

CRKP exhibits high resistance to common antimicrobials，predominantly mediated by carbapenemase genes and aminoglycoside-modifying genes. High positivity rates were observed for virulence genes entB，mrkD，and ybtS. An OXA-48-producing K1 capsular hypervirulent strain was identified.

Objective

To analyze the role of a digital patient profiling （P-P） dynamic symptom model in postoperative management of lung cancer.

Methods

A total of 227 lung cancer surgery patients admitted to our hospital from July 2021 to September 2024 were selected. Among them，112 patients receiving digital software combined with routine postoperative care were assigned to the observation group，while 115 patients receiving routine care alone served as the control group. Postoperative outcomes at one month were recorded，including forced vital capacity （FVC），forced expiratory volume in 1 second （FEV₁），quality of life scores（EORTC QLQ-C30 covering functional，global health，and symptom domains），and lung cancer-specific symptom scores （EORTC QLQ-LC13，including cough，hemoptysis，dyspnea，chest pain，shoulder/back pain，sore throat，insomnia，dysphagia，and numbness in hands/feet）.

Results

At one month post-surgery，the observation group showed significantly higher FVC （2.90±0.66） L，FEV₁（2.31±0.55） L，and FEV₁/FVC ratio （78.90±14.77） %compared to the control group （2.58±0.72） L，（1.88±0.66） L，（73.97±18.72）%，respectively（P＜0.05）. For the EORTC QLQ-C30，the observation group scored better in symptom domain（18.95±6.80 vs. 30.41±7.52），functional domain （85.63±9.41 vs. 71.52±10.21），and global health domain（77.82±6.92 vs. 64.23±7.13）（P＜0.05）. Similarly，the EORTC QLQ-LC13 scores for cough （29.44±8.22 vs.41.72±9.34），hemoptysis （22.14±7.6 vs. 30.34±8.026），dyspnea （21.23±8.91 vs. 37.52±8.73），chest pain（24.81±7.14 vs. 38.31±7.22），shoulder/back pain （22.92±8.02 vs. 30.82±8.61），sore throat （20.32±9.13 vs. 33.44±8.52），insomnia （11.52±7.83 vs. 16.23±7.61），dysphagia （18.01±7.57 vs. 26.41±7.92），and numbness in hands/feet （20.12±7.73 vs. 34.01±8.22） were significantly lower in the observation group （P＜0.01）.

Conclusion

The application of a digital patient profiling dynamic symptom model in postoperative management of lung cancer improves lung function，alleviates clinical symptoms，and enhances quality of life.

Objective

To investigate the risk factors of he progression of fibrotic connective tissue disease-associated interstitial lung disease （CTD-ILD） and constructing predictive models.

Methods

The baseline clinical data of patients with fibrosing CTD-ILD who were hospitalized in the Department of Pulmonary and Critical Care Medicine of the Fourth，Sixth and Eighth Medical Centers of the PLA General Hospital from January，2019 to December，2023 were collected. The patients were divided into a stable group and a progressive group （PPF group） based on whether progression occurred during follow-up，The variables were preliminarily screened by four different methods including LASSO regression，random forest，gradient boosting machine，and one-way analysis of variance. The screened covariates were incorporated into multivariate stepwise Logistic regression for three analysis to identify the risk factors for the progression of fibrotic. Based on multivariate stepwise regression，a predictive model for the progression of CTD-ILD was constructed and evaluated.

Results

The multivariate stepwise regression results demonstrated that a history of novel coronavirus infection（OR=8.735，95% CI：2.754 ～27.711，P＜0.001），DLCO%pred （OR=0.962，95% CI：0.930 ～0.995，P＜0.001），DLCO%pred ≥60%（OR=0.07，P =0.016），honeycomb shadow on HRCT（OR=7.685，95% CI：2.399～24.613，P＜0.001） ，combined pulmonary hypertension （OR=19.812，95% CI：4.152 ～94.534，P＜0.001）were independently related to the progression of fibrotic CTD-ILD. The area under the ROC curve （AUC） of the predictive model constructed based on stepwise regression was 0.92 in the training set，and the corresponding sensitivity，specificity，and 95%CI were 0.81，0.89，and 0.87～0.97，respectively； the AUC of the predictive model was 0.95 in the test set，and the corresponding sensitivity，specificity，and 95%CI were 0.82，0. 75，and 0. 88 ～1. 00，respectively. These results indicated that the model had an excellent discrimination ability. The calibration curves plotted based on the training set and the test set were basically consistent with the standard curves，which suggested that the model had a favorable calibration ability. The decision curve analysis （DCA） revealed that the model had a higher clinical net benefit within a large threshold in both the training set and the test set，which indicated that the model had favorable clinical utility.

Conclusion

A history of novel coronavirus infection，low level of DLCO%pred at baseline，combined pulmonary hypertension，and honeycomb shadow on HRCT are closely related to the progression of pulmonary fibrosis in patients with fibrotic CTD-ILD. The model constructed based on the above factors can accurately predict the progression of progressive fibrotic CTD-ILD and has certain clinical utility and generalization potency.

Objective

to explore the analysis of factors affecting the occurrence of complications after lung cancer surgery.

Methods

The clinical data of 68 patients who underwent thoracoscopic general anesthesia for radical lung cancer treatment in the hospital from January 2023 to December 2023 were retrospectively analyzed，and the postoperative complications of thoracoscopic general anesthesia for radical lung cancer were evaluated by using unifactorial and multifactorial logistic regression analysis.

Results

In the observation group，there were 11 cases （52.38%） with ASA grade Ⅲ，19 cases with hypotension （90.48%），19 cases with diabetes （90.48%），19 cases with stroke （90.48%），17 cases with CHD （80.95%） and 19 cases with age≥70 years （There were 19 cases （90.48%） with FEV1%≤60% and 18 cases （85.71%） with DLCO%≥80%，compared with 8 cases （17.02%） with ASA grade Ⅲin the control group，27 cases with hypotension（57.45%） and 22 cases with diabetes mellitus （46.81%）. There were 28 cases （49.57%） of FEV₁≥1.5 L，30 cases （63.83%） of FEV1%≤60% and 29 cases （61.70%） of DLCO%≥80%，and there was no statistical significance （P ＜0.05）. ASA grade Ⅲ，hypotension，diabetes，stroke，CHD，age，FEV₁，FEV1% and DLCO% were the influencing factors of postoperative complications of lung cancer （P ＜0.05）. Multivariate Logistic regression analysis showed that age≥70 years old （OR=1.054，95% CI：1.012～1.119），CHD （OR=1.354，95% CI：1.159～1.629），FEV₁%≤60% （or：1）.

Conclusion

Age≥70 years old，CHD and FEV1%≤60% are the risk factors of complications after thoracoscopic lung cancer radical surgery.

Objective

To analyze the risk of ventilator-associated pneumonia （VAP） in patients with mechanical ventilation based on an interpretable machine learning model.

Methods

All of 77 patients with mechanical ventilation in our hospital from January 2022 to December 2024 were selected. 19 cases with VAP were divided into the observation group and 58 cases without VAP were divided into the control group. Clinical data were collected，and the features related to VAP were screened by LASSO regression analysis. Logistic regression （LR） and support vector machine were used. SVM，multi-layer perceptron （MLP） and eXtreme Gradient Boosting （xGBoost） were four machine learning（ML） algorithms to construct the prediction model，and SHAP was used to analyze the interpretability of the model.

Results

Univariate analysis showed that acute physiology and chronic health evaluation Ⅱ，APACHEⅡ） （21.53±2.50） minutes and mechanical ventilation time （10.37±3.30） d were higher than those of control group （18.59±2.80） minutes and mechanical ventilation time （8.38±2.55） d. Glasgow score （10.79±2.07） and albumin level （30.08±3.79） g/L in the observation group were lower than those in the control group （12.14±1.94） and albumin level （34.22±5.20） g/L. There were significant differences in age，chronic obstructive pulmonary disease，diabetes，sedative use and antibiotic type between observation group and control group （P ＜0.05）. LASSO regression results showed that age，APACHE Ⅱscore，mechanical ventilation time and albumin were risk factors for VAP in patients with mechanical ventilation. Four ML models were constructed based on the above four risk factors，and the area under the curve（AUC） of xGBoost model was 0.882，the accuracy was 81.30%，the sensitivity was 84.00%，and the specificity was 82.00%. SHAP results showed that the top 4 characteristics of VAP risk contribution were APACHE Ⅱscore，age，mechanical ventilation time and albumin.

Conclusion

xGBoost model has high sensitivity and specificity，which can be used as an auxiliary diagnostic tool to quickly and accurately determine the risk of VAP in patients with mechanical ventilation，and provide reference for clinical decision-making.

Objective

To analyze the correlation between cognitive level and cancer-related fatigue in patients with non-small cell lung cancer （NSCLC），and to improve the quality of life in patients with NSCLC.

Methods

All of 75 patients with NSCLC admitted to the First Affiliated Hospital of Air Force Medical University from January 2021 to December 2023 were selected as subjects. Clinical data questionnaire and minimental status examination （MMSE）and revised Piper fatigue scale （RPFS） were used to investigate MMSE score and RPFS score of NSCLC patients，and to analyze the cognitive level and cancer-related fatigue status of NSCLC patients. Pearson correlation was used to analyze the correlation between the cognitive scores of NSCLC patients in each dimension （orientation，immediate memory，attention and computation，recall ability，language ability and total score） and the behavioral dimension，emotional dimension，sensory dimension，cognitive dimension and fatigue score of cancer-related fatigue.

Results

The total score of NSCLC patients' cognitive level was （24.68±4.17），and the average score was （0.85±0.12）. The incidence of cancer-related fatigue in 75 patients was 100%，and RPFS score was behavioral dimension （10.68±2.17） ，emotional dimension（12.44±2.12），ensory dimension（15.31±2.88），cognitive dimension，（15.44±3.52） and total fatigue（53.78±8.45）. Pearson correlation analysis showed that the cognitive scores of NSCLC patients in each dimension（orientation，immediate memory，attention and computation，recall ability，language ability，total score） were negatively correlated with the behavioral dimension，emotional dimension，cognitive dimension，and total fatigue score （P＜0.001）. In the 75 patients with NSCLC，6 cases（8%） died in 6 months after discharge，among which the causes of death were pulmonary infection in 4 cases （66.62%），respiratory failure in 1 case（16.67%） and brain metastasis in 1 case （16.67%）.

Conclusion

The cognitive level of NSCLC patients is closely related to cancer-related fatigue，and improving the cognitive level of NSCLC patients has clinical significance in alleviating cancer-related fatigue.

Objective

To analyze the risk factors for acute exacerbation in patients with bronchiectasis.

Methods

Clinical data of 300 patients admitted to Longhua Hospital affiliated with Shanghai University of Traditional Chinese Medicine from September 2021 to June 2023 due to acute exacerbation of bronchiectasis were collected. Divide patients into two groups based on whether acute exacerbation of bronchiectasis occurs again within 6 months after discharge. Analyze patient general information，laboratory test results，imaging data，etc.，and explore the risk factors for acute exacerbation of bronchiectasis.

Results

The survival analysis results showed that patients with age ≥70，concomitant chronic obstructive pulmonary disease（COPD），Pseudomonas aeruginosa （PA） infection，involvement of ≥ 3 lobes of the lungs，severe bronchiectasis severity index（BSI），and severe exacerbations，FEV₁，age，chronic colonization，extension，dyspnea（E-FACED） had a low cumulative survival rate without acute exacerbation within 6 months of discharge（P＜0.05）； The results of multiple regression analysis showed that age ≥70 years old （HR=2.51，95% CI：1.67～3.78，P＜0.001），concomitant COPD （HR=2.92，95% CI：1.91～4.46，P＜0.001），and PA infection（HR = 2.03，95% CI：1.30 ～3.18，P = 0.002） were independent risk factors for acute exacerbation of bronchiectasis.

Conclusions

Acute exacerbation of bronchiectasis is associated with multiple risk factors，and early identification of risk factors is of great significance for improving patient prognosis and optimizing disease management.

Objective

To analyze a case of pulmonary sarcomatoid carcinoma （PSC） presented as spontaneous pneumothorax （SP） in our hospital and review the literature，and enhance clinical awareness to reduce the rates of missed diagnosis and misdiagnosis.

Methods

A retrospective analysis was conducted on the clinical data of a patient with PSC who presented with SP as the initial manifestation at our hospital on August 26，2022，and it was explored that the clinical manifestations，pathological characteristics，diagnostic points and treatment strategies of PSC，and relevant literature was analyzed.

Results

A 74-year-old male presented with SP. Preoperative chest CT showed right pneumothorax and right lung compression of about 30%；Soft tissue nodular shadow in the upper lobe of the right lung，about 2.0 cm×1.8 cm in size，and another thick-walled cavity shadow was seen around the lesion. Right upper lobectomy and systematic lymph node dissection were performed with single port thoracoscopic surgery. Postoperative pathological examination：PSC. TNM stage was pT1bN0M0 IA2. The whole gene detection results based on second-generation sequencing：microsatellite stability （MSS） and tumor mutation burden low （TMB-L）. Targeted drug use related mutation results：TP53 splice region mutation，NF1 nonsense mutation，NF1 missense mutation，ATR missense mutation，ALK missense mutation，SDHA missense mutation，KMT2C missense mutation. The patient died after 2 months of follow-up with progressive disease.

Conclusion

PSC progresses rapidly and has a poor prognosis. PSC with SP as the first manifestation is extremely rare. The combination of SP may be one of the risk factors for poor prognosis of PSC.

Objective

To explore the effectiveness of using 3D reconstruction technology to guide single port thoracoscopic wedge resection for the treatment of pulmonary ground glass nodules ≤2 cm.

Methods

A total of 69 patients with ground glass nodules measuring ≤2 cm，who received surgical treatment in hospitals between January 2021 and June 2024，were enrolled in the study. These patients were divided into two groups based on the treatment method：37 patients in the observation group and 32 patients in the control group. The control group underwent single port thoracoscopic wedge resection，while the observation group underwent single port thoracoscopic wedge resection under the guidance of three-dimensional reconstruction technology. Compare the surgical indicators，stress indicators ［cortisol，norepinephrine，and heat stress protein（HSP） 70］，postoperative lung function ［forced expiratory volume in the first second （FEV₁），maximum ventilation volume （MVV），and residual gas volume］，postoperative pain level，and incidence of complications between the two groups.

Results

The observation group had shorter surgical time，intraoperative blood loss，postoperative 24-hour chest drainage volume，and chest drainage tube retention time compared to the control group （P＜0.05）. After surgery，serum cortisol，norepinephrine，and HSP70 levels increased in both groups compared to preoperative levels，with the observation group being lower than the control group （P＜0.05）. On postoperative day 1，72 hours，and 1 week，the pain scores of both groups gradually decreased （P＜0.05），with the observation group being lower than the control group （P＜0.05）. After surgery，FEV1 and MVV decreased in both groups，with the observation group being higher than the control group （P＜0.05）； The residual gas volume of both groups increased，and the observation group was lower than the control group （P＜0.05）. On postoperative day 1，72 hours，and 1 week，the pain scores of both groups gradually decreased （P＜0.05），with the observation group being lower than the control group （P ＜0.05）. There was no statistically significant difference in the total incidence of pleural effusion，pulmonary leakage，subcutaneous hematoma，and pneumothorax between the two groups （P＞0.05）. The 1-year cumulative survival rate of two groups has statistically significant.

Conclusion

Guided by three-dimensional reconstruction technology，single port thoracoscopic wedge resection is used to treat pulmonary ground glass nodules ≤2 cm，which helps to shorten the surgical time and postoperative recovery time less traumatic stress，reduce postoperative lung function damage，and minimize the occurrence of postoperative complications.