To investigate the regulation of KLF7 on the proliferation and apoptosis of lung cancer cells by constructing the KLF7 eukaryotic expression vector，thereby providing novel clues for the discovery of therapeutic targets for non-small cell lung cancer（NSCLC）.
Methods
The entire sequence of KLF7 was cloned through PCR，and the overexpression vector was constructed by means of enzyme digestion，ligation，and sequencing，with the expression efficiency verified.A594 cells were randomly divided into the experimental control group （control group） and the KLF7 overexpression group （KLF7 group）.Changes in the cell cycle，apoptosis，and reactive oxygen species of A594 cells were detected using flow cytometry，and the proliferation of A594 cells was examined by EdU.The expression levels of Proliferating Cell Nuclear Antigen（PCNA），G1/S-specific cyclin-D1 （CyclinD1），B-cell lymphoma-2 （Bcl-2，Bcl-2），Bcl-2-associated X protein （Bax） mRNA and protein were detected by real-time quantitative PCR and Western blotting.
Results
The total length of the CDS region of KLF7 was cloned to 693 bp and linked to the pCDNA3.1 vector to construct the KLF7 overexpression vector，which could significantly enhance the expression level of KLF7 in HEK293T and A594 cells （P＜0.01）.Compared with the control group，the percentage of cells in the G1 phase decreased，the percentage of cells in the G2 phase increased，the proliferation index （PI） significantly increased，and the percentage of EdU-positive cells significantly increased in the KLF7 overexpression group（P＜0.01）.Compared with the control group，the ROS level was inhibited and the apoptosis rate decreased in the KLF7 overexpression group （P＜0.01）.Compared with the control group，the relative expression levels of PCNA，CyclinD1，and Bcl-2 mRNA and protein increased in the KLF7 overexpression group，while the relative expression levels of Bax mRNA and protein decreased （P ＜0.01）.
Conclusion
In this study，the KLF7 overexpression vector was successfully constructed.In lung cancer cells，KLF7 overexpression can significantly promote cell proliferation and inhibit cell apoptosis，and participate in the occurrence of lung cancer，which may serve as a new biomarker of NSCLC.
To analyze the role of IR-780 in idiopathic pulmonary fibrosis （IPF） and its relationship with glycolysis.
Methods
Transforming growth factor-β （TGF-β） -induced fibrosis model was constructed using human type Ⅱalveolar epithelial cells （A549） and human embryonic lung fibroblasts（HELF）.They were divided into control group，TGF-β group，2-deoxy-D-glucose （2-DG） group and IR-780 group.The control group was treated with DMEM，and the TGF-β group was treated with TGF-β（10μg/ml）.2-DG group use TGF-beta （10 mu g/ml） ＋2 DG （5 tendency/L） processing，IR-780 group with TGF-beta （10 mu g/ml） ＋IR-780 mu （1 mol/L）.Immunofluorescence was used to detect the expression of pulmonary fibrosis markers，and RT-PCR and Western blot were used to detect the expression of fibrosis markers and glycolysis markers.
Results
Immunofluorescence detection showed that the expressions of Collagen I and α-SMA in TGF-β group were increased compared with those in control group （P＜0.05）.RT-PCR and Western blot showed that mRNA Collagen I （3.17±0.06） and （1.74±0.03） of A549 and HFLF cells in TGF-β group，α-SMA （2.26±0.08） and （1.65±0.00），GLUT1 （2.11±0.16），（1.57±0.08），PKM2 （2.66±0.19），（1.51±0.06），HK2 （2.84±0.10），（1.75±0.12） and Collagen protein expression Ⅰ（4.71±0.07），（1.76±0.02） and alpha SMA （4.11 ±0.04），（1.57±0.03），GLUT1 （4.06±0.10），（1.51±0.04），PKM2 （4.78±0.15），（1.35±0.01），HK2 （4.07±0.07），（1.69±0.06） were higher than those of A549 and HFLF cells mRNA CollagenⅠ（1.00±0.05），（0.57±0.05），α-SMA （1.00±0.05），（0.71±0.01），GLUT1 （1.00±0.06），（0.72±0.04），PKM2 （1.00±0.04），（0.64±0.01），HK2 （1 ±0.04），（0.67±0.01） and protein expression CollagenⅠ（1.00±0.02），（0.21±0.01），α-SMA（1.00±0.02），（0.23±0.02），GLUT1 （1.00± 0.01），（0.20±0.00），PKM2 （1.00±0.06），（0.22±0.01），HK2 （1.00±0.04），（0.29±0.02） respectively（P＜0.05）.The protein and mRNA expressions of CollagenⅠand α-SMA in A549 and HFLF cells of 2-DG and IR-780 groups were lower than those of TGF-β group （P＜0.05）.There were no significant differences in the expressions of Collagen I and α-SMA in A549 and HFLF cells between 2-DG group and IR-780 group （P＞0.05）.The expressions of GLUT1，PKM2，HK2 in A549 and HFLF cells of TGF-β group were increased，and the expressions of GLUT1，PKM2，HK2 in 2-DG and IR-780 groups were lower than those in TGF-β group （P＜0.05）.There was no significant difference in glycolytic protein expression between 2-DG group and IR-780 group （P ＞0.05）.
Conclusion
IR-780 inhibits fibrosis and glycolysis of A549 and HFLF cells induced by TGF-β.The mechanism of action is similar to that of 2-DG.IR-780 can inhibit pulmonary fibrosis by regulating glycolysis metabolism.
To study the mechanism of doxycycline combined with levofloxacin in regulating high temperature requirement factor A2 （HtrA2） for the treatment of rats with pneumonia caused by Carbapenem-resistant Acinetobacter Baumannii（CRAB）.
Methods
Sixty SD rats were randomly divided into control group，model group，doxycycline group，levofloxacin group，combination group and overexpressed（oe）-HtrA2 group，with 10 rats in each group.In the model group，100 μl 1×1011 cfu/L AB5075 bacteria were dropped into the nasal cavity of rats； Doxycycline group was given 20 mg/kg doxycycline intragastric administration on the basis of model group.Levofloxacin group was given 30 mg/kg levofloxacin by gavage on the basis of model group.Based on the model group，the combined group was given 20 mg/kg doxycycline ＋30 mg/kg levofloxacin by intragastric administration；In group oe-HtrA2，HtrA2 lentivirus was injected into SD rats through the tail vein at 200 μl and 1×109 IFU/L each time.Real-time fluorescence quantitative polymerase chain reaction was used to detect the expression of HtrA2 mRNA.The colony-forming unit method was employed to measure the bacterial content in lung tissues.Kits were utilized to detect white blood cell count，the percentage of neutrophils，the levels of inflammatory factors and oxidative stress.Western blotting was adopted to detect the levels of proteins related to the Toll-like receptor （TLR） signaling pathway.
Results
The expressions of HtrA2 mRNA in the control group，model group，doxycycline group，levofloxacin group，combination group and oe-HtrA2 group were （1.00±0.16），（2.31±0.29），（1.76±0.17），（1.81±0.26），（1.37±0.14） and （3.89±0.58） respectively.The protein levels of TLR2 in these groups were （1.00±0.20），（3.65±0.60），（2.88±0.43），（2.74±0.65），（1.87±0.21） and （2.92±0.49） respectively.The protein levels of TLR4 were （1.00±0.17），（3.92±0.71），（2.77±0.54），（2.81±0.43），（2.06±0.28） and （3.11±0.44）respectively.The protein levels of myeloid differentiation factor 88 （MyD88） were （1.00±0.15），（2.94±0.45），（2.21±0.39），（2.25±0.23），（1.44±0.16） and （2.41±0.27） respectively.There were statistically significant differences in the above indicators （all P＜0.05）.Compared with the model group，the expressions of HtrA2，white blood cell counts，percentages of neutrophils，levels of inflammation and oxidative stress，and protein levels of the TLR signaling pathway in the doxycycline group and the levofloxacin group were all decreased.The combination group showed further improvement.Compared with the combination group，the results in the oe-HtrA2 group were the opposite.
Conclusion
The combination of doxycycline and levofloxacin can improve lung injury in rats with CRAB pneumonia，which may be related to the regulation of HtrA2 and the inhibition of the activation of the TLR2/4-MyD88 signaling pathway.
This study aimed to analyze the serum levels of cysteine-rich 61 （CCN1），eosinophil cationic protein （ECP），and glutathione peroxidase （GSH-Px） in patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD），exploring their correlation with pulmonary and immune function，as well as their potential diagnostic value in AECOPD.
Methods
A retrospective analysis was conducted on 55 AECOPD patients admitted to the Second Affiliated Hospital of Soochow University from January 2019 to June 2024 （observation group）.Forty-three stable COPD patients during the same period were selected as the control group.Serum CCN1，ECP，and GSH-Px levels were measured using enzyme-linked immunosorbent assay （ELISA）.Pulmonary function was assessed by measuring the percentage of predicted forced expiratory volume in one second （FEV1%pred），FEV1/forced vital capacity （FEV1/FVC） ratio，and the percentage of predicted maximal mid-expiratory flow （MMEF%pred）.Immune function was evaluated by assessing CD4＋and CD8＋T-cell counts，as well as immunoglobulin A （IgA） and immunoglobulin M （IgM）levels.Pearson correlation analysis was used to evaluate the relationship between serum CCN1，ECP，and GSHPx levels and pulmonary and immune function.The diagnostic value of these biomarkers for AECOPD was assessed using receiver operating characteristic （ROC） curve analysis.
Results
The observation group had higher CCN1 （173.15±35.63 ng/ml） and ECP （30.16±4.25 ng/ml） levels compared to the control group（CCN1： 153.27±27.86 ng/ml； ECP： 19.23±2.84 ng/ml， P＜0.05），while GSH-Px levels （29.14±3.16）U/L were significantly lower than in the control group （46.36±3.77 U/L， P＜0.05）.Pulmonary function parameters in the observation group，including FEV1%pred （58.43±5.13%），FEV1/FVC （58.28±7.35%），and MMEF%pred （26.27±5.13%），were significantly lower than those in the control group （FEV1%pred：74.18±10.04%；FEV1/FVC： 67.41±7.90%； MMEF%pred： 40.07±5.79%， P ＜0.05）.Additionally，CD4＋T-cell levels（29.93±3.12%） in the observation group were lower than in the control group （38.24±2.76%， P＜0.05），whereas CD8＋T-cell levels （35.16±4.07%），IgA （264.72±17.49 mg/dl），and IgM （126.94±14.37 mg/dl）were higher than those in the control group （CD8＋： 27.29±2.25%； IgA： 195.83±15.21 mg/dl； IgM： 95.57±10.94 mg/dl， P＜0.05）.Pearson correlation analysis revealed that serum CCN1 and ECP levels were negatively correlated with FEV1%pred，FEV1/FVC，and MMEF%pred （r＜0， P＜0.05） but positively correlated with CD8＋，IgA，and IgM （r＞0，P＜0.05）.Conversely，GSH-Px levels were positively correlated with FEV1%pred，FEV1/FVC，and MMEF%pred （r＞0，P＜0.05） and negatively correlated with CD8＋，IgA，and IgM （r＜0，P＜0.05）.ROC analysis demonstrated that combined detection of serum CCN1，ECP，and GSH-Px achieved the highest diagnostic efficacy for AECOPD，with an area under the curve （AUC） of 0.973 （95%CI： 0.944-0.999），a sensitivity of 97.1%，a specificity of 97.8%，and a Youden index of 0.949.
Conclusion
Changes in serum CCN1，ECP，and GSH-Px levels in AECOPD patients are closely related to pulmonary and immune function，highlighting their diagnostic value as biomarkers for AECOPD.These findings support their potential application as predictive and monitoring tools in clinical practice.
To evaluate the protective effect of pterostilbene （PTER） on acute lung injury（ALI） in septic mice.
Methods
Forty SPF-grade male C57BL/6J mice，6-8 weeks old，weighing 20-25 g，were categorized into four groups （n＝10） using a randomized numeric table method：control group （group C），PTER group （group P），LPS group，and LPS＋PTER group （group LPS＋P）.Septic acute lung injury （ALI）model was induced by intraperitoneal injection of LPS 15 mg/kg，with the groups of C and P receiving an equivalent volume of saline.PTER 30 mg/kg were injected in the contralateral peritoneal cavity 2 h and 6 h post-LPS injection in LPS＋P group and at the corresponding time in group P.Mice were anesthetized 24 h after modeling，blood was collected via heart injection，bronchoalveolar lavage fluid （BALF） was obtained through bronchial-alveolar lavage，and lung tissues were harvested post-euthanasia.Mouse blood samples were analyzed for IL-1β，IL-6，TNF-α，and cell-free DNA （cf-DNA）using the LEGENDplex multifactor assay kit，and the PicoGreen dsDNA quantification kit.RT-qPCR was utilized for the assessment of IL-1β，IL-6，and TNF-α mRNA expression in mouse lung tissues.HE staining was conducted to evaluate pathological alterations in mouse lung tissues，with subsequent calculation of lung injury （LI） scores and wet/dry weight （W/D） ratios；immunofluorescence staining was employed to assess the amount of neutrophil extracellular traps （NETs） in mouse lung tissues.
Results
Compared to group C，the LPS group mice exhibited increased LI scores，lung W/D ratios，and BALF protein levels （P＜0.05），as well as upregulated expression of plasma IL-1β，IL-6，and TNF-α proteins，lung tissue IL-1β，IL-6，and TNF-α mRNA （P＜0.05），and elevated plasma cf-DNA，lung tissue myeloperoxidase （MPO） activity and NETs levels.The differences in the above parameters in group P were not statistically significant （P＞0.05）.Compared to LPS group，group LPS＋P mice displayed decreased LI scores，lung W/D ratios，and BALF protein concentrations （P＜0.05），along with downregulated plasma IL-1β，IL-6，TNF-α levels，lung tissue IL-1β，IL-6，TNF-α mRNA expression （P＜0.05），and reduced plasma cf-DNA，lung tissue MPO activity and NETs levels.
Conclusion
PTER ameliorates ALI in septic mice by inhibiting inflammatory responses and NETs accumulation.
To investigate the curative effect of Qingfei Huatan Zhuyu Decoction，a traditional Chinese medicine，on acute exacerbation of chronic obstructive pulmonary disease（AECOPD）patients and its influence on CXC chemokine ligand 8 （CXCL8），CXC chemokine receptors 1 （CXCR1） and CXC chemokine receptors 2 （CXCR2）.
Methods
A total of 86 patients with COPD admitted to our hospital from January 2020 to December 2023 were selected and divided into control group 45 cases and observation group 41 cases according to the treatment method.The control group was inhaled indacaterol maleate and glycopyrronium bromide inhalation powder，once a day.On the basis of the control group，the observation group took oral Qingfei Huatan Zhuyu Decoction，a traditional Chinese medicine，one dose per day，divided into 2 times in the morning and evening，and both groups were treated for 12 weeks.The clinical efficacy，lung function，inflammatory factor levels，CXCL8-CXCR1/CXCR2 pathway protein levels，modified medical research council （mMRC） and COPD assessment test （CAT） scores，and the incidence of side effects was contrasted between the two groups.
Results
The total effective rate of the observation group was 36 cases（87.80%），which was higher than the 31 cases （68.89%） in the control group （P ＜0.05）.No notable disparity emerged in the frequency of adverse events between the two groups （P＞0.05）.After treatment，the observation group forced expiratory volume in one second （FEV1） （1.66±0.34） L，maximal voluntary ventilation （MVV） （56.35±7.86） L/min，peak expiratory flow （PEF） （4.02±0.78） L/s，partial pressure of oxygen （PaO2） （84.32±17.62） mmHg，arterial oxygen saturation （SaO2） （95.76±18.75） % were higher than control group （1.50±0.31）L，（52.86±6.89）L/min，（3.63±0.71）L/s，（78.43±15.37）mmHg，（91.89±16.34）%.The observation group partial pressure of carbon dioxide （PaCO2） （42.39±6.85） mmHg，surfactant associated protein D （SP-D） （88.42±13.75） ng/ml，von willebrand factor （vWF） （9.79±1.35）pg/ml，matrix metalloproteinase 9 （MMP-9） （208.25±56.27） ng/ml，CXCL8 （272.49±45.24）ng/L，CXCR1（269.72±67.83） ng/L，CXCR2 （257.64±71.78） ng/L，mMRC （1.71±0.26） scores，CAT （19.46±3.15）scores were lower than control group（46.45±8.65）mmHg，（92.95±15.62）ng/ml，（10.16±0.65）pg/ml，（217.38±73.25）ng/ml，（283.65±57.21）ng/L，（288.56±85.26）ng/L，（278.36±82.91）ng/L，（1.88±0.32）scores，（21.37±3.23）scores.
Conclusions
The traditional Chinese medicine Qingfei Huatan Zhuyu Decoction has proven effective in treating patients with COPD by improving pulmonary function，reducing inflammatory responses，and inhibiting the expression of CXCL8，CXCR1，and CXCR2，demonstrating clinical significance.
To analyze the expression of miR-150-5p in the serum of Mycobacillus tuberculosis patients in Qinghai Province and its relationship with macrophage polarization.
Methods
Active lung tuberculosis patients diagnosed by clinical diagnosis in the Affiliated Hospital of Qinghai University and the Fourth People′s Hospital of Qinghai Province from August 2022 to August 2023 were selected.35 cases of tuberculosis （ALTB） were treated as observation group and 26 cases of latent tuberculosis infection （LTBI） as control group.Serum interleukin-10 （IL-10），tumor necrosis factor-α （TNF-α），inducible nitric oxide synthase（iNOS） were detected by ELISA； The expressions of CD80 and CD206 were detected by flow cytometry.The expression of miR-150-5p was detected by qRT-PCR assay.
Results
The expressions of miR-150-5p （28.11±5.41），TNF-α （19.91±2.95），iNOS （40.00±4.32），CD80 （30.02±4.19） in observation group were lower than those in control group （38.37±3.51） and TNF-α （31）.24±3.17），iNOS （46.74±3.75），CD80 （40.65±2.88） （P＜0.05）； The expressions of IL-10 （100.92±5.83，81.05±9.34） and CD206 （56.33±6.10，33.72±7.65） in observation group were higher than those in control group （81.05±9.34） and CD206 （33.72±7.65）（P＝0.000）.The expression of miR-150-5p in the observation group was positively correlated with IL-10 （r ＝0.385， P＜0.05），but had no correlation with TNF-α and iNOS.In control group，the expression of miR-150-5p was positively correlated with TNF and iNOS （r＝0.558， P＜0.05； r＝0.509， P＜0.05），was not correlated with IL-10 （r＝-0.194，P＞0.05）.In the observation group，the expression of miR-150-5p was negatively correlated with CD80 （r＝-0.395，P＜0.05），and positively correlated with CD206 （r ＝0.457， P＜0.05）.In the control group，the expression of miR-150-5p was positively correlated with CD80 （r＝0.475，P＜0.05），and negatively correlated with CD206 （r ＝-0.614， P＜0.05）.
Conclusion
miR-150-5p is highly expressed in ALTB and LTBI，and may be a biomarker of early tuberculosis infection.In the state of tuberculosis infection，the expression of inflammatory factors TNF-α，IL-10 and iNOS is high，and the differential expression of ALTB and LTBI can judge the condition and curative effect of tuberculosis.Macrophages in latent tuberculosis infection were polarized to M1 type，and in active tuberculosis macrophages were polarized to M2 type.
To investigate the relationship between eosinophil （EOS） to neutrophil （NEU）ratio （ENR） and bacterial infection and in-hospital death in patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD） in intensive care.
Methods
A total of 115 cases AECOPD patients admitted to the intensive care unit （ICU） between January 2020 and January 2024 were selected as study subjects.The percentage of EOS and NEU at admission was measured by blood cell analyzer，and the ratio ENR was calculated.Within 24 hours after admission，all patients underwent laboratory tests，culture tests and PCR to detect pathogen infection status.The primary outcome was survival during hospitalization，and patients were divided into death and survival according to the prognosis.
Results
According to the results of bacterial or viral identification at admission，all the patients were divided into four groups： 30 cases of bacterial infection only，36 cases of viral infection only，21 cases of mixed bacteria-virus infection，and 28 cases of no infection.The ENR （H＝56.407，P＜0.001） and EOS counts （H＝42.010，P＜0.001） were significantly lower in patients with bacterial infection alone or with a combination of bacterial and viral infections.According to ROC curve analysis，ENR had higher identification value for bacterial infection only/bacteria-virus mixed infection，with an AUC value of 0.821 （95%CI： 0.754 ～0.888），which was higher than that of EOS （AUC ＝0.779）.The inhospital mortality rate of ICU patients was 18.26%.Admission ENR was significantly lower in deceased patients compared with survivors ［1.69 （0.45，2.94） vs. 0.21 （0.11，0.33）， Z ＝-5.365， P＜0.001］.Multivariate COX regression analysis revealed that admission ENR was one of the independent risk factors associated with inhospital mortality （HR＝0.179， P ＝0.003）.During the 28-day follow-up period，patients with low ENR had lower survival rates compared with patients with high ENR ［98.25% （56/57） vs.65.52% （38/58）］ and a shorter median survival time （log rank χ2 ＝17.376， P＜0.001）.
Conclusion
Low ENR on admission was associated with an increased risk of bacterial infection and 28-day hospitalization death in older AECOPD patients admitted to the ICU.ENR may be an important indicator to evaluate the bacterial infection status and hospitalization prognosis of patients with AECOPD.
To analyze the epidemiological changes and clinical characteristics of severe Mycoplasma pneumoniae pneumonia （MPP） in children，and to explore potential factors influencing the rising trend of M.pneumoniae （MP） infections post-2023，providing insights for optimizing treatment strategies.
Methods
A retrospective review of clinical data from children hospitalized with MPP between January 2018 and May 2024 was conducted.Demographic，epidemiological，and clinical features were analyzed，along with differences in imaging，laboratory findings，and treatment between mild and severe cases.
Results
Post-2023，the positive rate of MP-IgM detection significantly increased，reaching 10.61% in 2023 and 18.12% from January to May 2024.Hospitalized MPP cases accounted for 11.16% to 13.73%.The median age of the observed group was 6 years，with higher incidences of fever （86.38%），high fever （47.84%），and antipyretic use （84.39%） compared to the control group （median age 3 years，62.20%，24.39%，and 53.65%，respectively； P＜0.05）.Imaging revealed that the observed group had more cases with multi-lobe involvement（47.84%），high-density lesions （66.45%），and lung consolidation （28.57%） compared to the control group（9.76%，25.00%，and 6.01%，respectively； P＜0.005）.The observed group also had higher CRP （14.62±18.45 mg/L），PCT （0.16±0.38 ng/ml），steroid use （71.10%），and tetracycline use （23.26%） compared to the control group （9.82±13.38 mg/L，0.10±0.14ng/ml，38.41%，and 18.30%，respectively）.Hospital stay duration did not differ，but the observed group had more chest X-ray re-examinations （39.05%） and delayed inflammation resolution （32.23%） compared to the control group （20.73% and 15.24%，respectively； P＜0.001）.
Conclusion
Post-2023，MP infections in children have shown a trend towards severity，characterized by older age，high fever，multi-lobe involvement，and elevated inflammatory markers.Early lung imaging combined with MP nucleic acid and drug resistance gene testing is valuable for identifying severe MPP.The rational use of tetracyclines and steroids should be guided by resistance monitoring and individualized analysis.
To explore the clinical effect of Flex-3D thoracoscopic lobectomy in non-small cell lung cancer （NSCLC）.
Methods
The clinical data of 147 patients with NSCLC admitted from June 2021 to August 2023 were retrospectively analyzed.According to the type of thoracoscopy used during surgery，the patients were divided into observation group 78 cases and control group 69 cases.Patients in the observation group received Flex-3D thoracoscopic lobectomy，and patients in the control group received traditional 2D thoracoscopic lobectomy，and were followed up by outpatient follow-up within 6 month after surgery.The data of the two groups were recorded at different time points before and after operation，including indicators of surgical indexes ，operation time，postoperative extubation time，postoperative hospitalization time，number of lymph node dissection，surgical stress indexes ［prostaglandin E2（PGE2），substance P （SP），heat shock protein 70（HSP70）］，blood gas indexes ［partial pressure of oxygen in arterial blood （PaO2），partial pressure of carbon dioxide in arterial blood （PaCO2）］，pulmonary function indicators ［diaphragm activity，forced vital capacity（FVC），forced expiratory volume in 1 second （FEV1）］，postoperative complications，recurrence and metastasis.
Results
The operation time of observation group and control group was （166.26±38.57） min and（182.38±33.05） min，and the postoperative extubation time was （5.64±1.28） d and （6.73±1.56） d，respectively.Postoperative hospitalization time was （7.37±1.66） d，（8.22±1.05） d，and the number of lymph nodes were （13.25±3.01） and （11.89±1.77），respectively，with statistical significance （P＜0.05）.On the 2nd day after surgery，the levels of PGE2（123.06±21.52） pg/ml，SP （5.33±1.74）μg/ml and HSP70（31.03±6.25 ）ng/ml in the observation group were lower than those in the control group（131.74±22.38 ）pg/ml，（6.28±2.09）μg/ml，（33.28±6.34 ）ng/ml （P＜0.05）； On the 1st and 5th day after surgery，the PaO2 level in the observation group was higher than that in the control group，and the PaCO2 level was lower than that in the control group （P＜0.05）.There were no significant differences in FVC，FEV1 levels and diaphragmatic activity between the two groups at 3 and 6 months after surgery （P＞0.05）.Postoperative complications of the patients included pneumonia，pulmonary embolism，atelectasis，subcutaneous emphysema，arrhythmia，chylothorax.There was no statistical significance in the occurrence of complications between the two groups （P＞0.05）.No distant metastasis or death occurred in patients 6 month after surgery，Local recurrence occurred in 3 cases（3.85%） in the observation group and 6 cases （8.70%） in the control group halfa after operation （P＝0.306）.One case of mediastinal lymph node metastasis in the observation group （1.28%） and one case of mediastinal lymph node metastasis in the control group （1.45%）（P＞0.05）.
Conclusion
Flex-3D thoracoscopic lobectomy has a good application effect in NSCLC patients，which is conducive to shortening the operation time，improving the efficacy of lymph node dissection，and reducing intraoperative injury，and the safety is comparable to that of traditional 2D thoracoscopic lobectomy.
To establish an automatic lung ultrasound screening technology for high altitude pulmonary edema based on deep learning technology based on the ultrasonic lung image data collected by the General Hospital of Xizang Military Region，which can automatically screen the disease of HAPE and improve the diagnostic accuracy.
Methods
This study investigated the application effect of Convolutional Neural Network （CNN） based artificial intelligence （AI） model in the diagnosis of high altitude pulmonary edema.The study included 174 confirmed cases of high altitude pulmonary edema admitted to our hospital from January 2021 to December 2023.The cases were divided into 121 training sets，18 verification sets and 35 test sets according to random stratification.The research methods include the collection of patients＇lung ultrasound image data，the automatic recognition and analysis of the image using CNN model，and the training and verification of the model for several times to improve the diagnostic performance.In the model performance evaluation，the diagnostic accuracy，recall （sensitivity） and specificity of the AI system wTo establish an automatic lung ultrasound screening technology for high altitude pulmonary edema based on deep learning based on the data of lung ultrasound images collected by the General Hospital of Xizang Military Region，and to automatically screen HAPE and improve the diagnostic accuracy.Methods： This study investigated the application effect of Convolutional Neural Network （CNN） based artificial intelligence （AI） model in the diagnosis of high altitude pulmonary edema.The study included 174 confirmed cases of high altitude pulmonary edema admitted to our hospital from January 2020 to December 2023.The cases were divided into 121 training sets，18 verification sets and 35 test sets according to random stratification.The research methods include the collection of patients′lung ultrasound image data，the automatic recognition and analysis of the image using CNN model，and the training and verification of the model for several times to improve the diagnostic performance.
Result
In the model performance evaluation，the sensitivity of the AI model was 95.00%，the specificity was 96.00%，and the overall accuracy rate was 95.50% （including 115 training set images，17 validation set images，and 33 test set images），which was higher than the sensitivity of 84.33%，specificity of 87.67%，and overall accuracy rate of 85.50% of the physician group （including 106 training set images，16 validation set images，and 31 test set images）.Statistical analysis indicated that the differences in diagnostic sensitivity，specificity，and accuracy rate between the AI system and the manual screening method were statistically significant （P ＜0.05）.
Conclusion
This study demonstrated the superior performance of CNN-based AI screening technology in the diagnosis of high altitude pulmonary edema.Compared with traditional manual screening methods，the AI model performs well in terms of diagnostic sensitivity，specificity and accuracy，and can effectively compensate for the limitations caused by the inexperience of doctors.
To analyze the correlation between the concentration of lipoarabinomannan（LAM） in sputum and bacterial load and treatment response of pulmonary tuberculosis （PTB）.
Methods
All of 77 patients with PTB treated in our hospital from May 2020 to June 2022 were selected as subjects，45 patients with smear and culture positive PTB smear positive group and 32 patients with smear negative but sputum culture positive PTB smear negative group.Patients with PTB smear positive received standard treatment，and sputum LAM was detected by sandwich enzyme-linked immunosorbent assay before treatment and at 7，14，28，and 56 days after treatment.Sputum LAM＞15 pg/ml was positive.The outcome of the study was 14-day early bactericidal activity （EBA），which was assessed based on mycobacteria growth indicator tube（MGIT） positive detection time （TTD）.
Results
The sensitivity and specificity of sputum LAM were 98.67%and 47.27%，respectively，the positive predictive value and negative predictive value were 71.84% and 96.30%，respectively，the Yodon index was 0.46.Compared with before treatment，sputum LAM decreased on the 14th day of treatment ［（3.74±0.96）log10 pg/ml vs. （2.88±1.00）log10 pg/ml， P＜0.001］.MGIT TTD was significantly prolonged on the 14th day of treatment compared with before treatment ［（133.56±34.63）h vs.（308.69±108.67）h， P＜0.001］.At 14 days of EBA，the EBA represented by MGIT TTD increased （202.42±84.94）h，and the sputum LAM concentration decreased （1.54±0.93）log10 pg/ml.There was high consistency between LAM-ELISA and MGIT in 45 cases before and during treatment.By Pearson correlation analysis，the LAM concentration of log10 transformation in all patients was correlated with MGIT TTD before treatment （r ＝-0.680， P＜0.001），on day 7 （r＝-0.541， P＜0.001），and on day 14 （r＝-0.420， P ＝0.008） and the 28th day （r＝-0.415， P＝0.015） showed a significant negative correlation.6 cases（13.33%） phlegm did not turn negative after intensive treatment.Sputum LAM before treatment was higher in patients without sputum conversion than in patients with sputum conversion ［（4.46±1.05）log10 pg/ml vs. （3.58±0.93）log10 pg/ml，P＝0.040］.The area under the receiver operating characteristic （ROC） curve of LAM before treatment for predicting sputum not turning negative after intensive treatment was 0.872 （95%CI： 0.753-0.991），the sensitivity and specificity were 83.33% and 84.62%，respectively，and the cut-off value was 4.61 log10 pg/ml.
Conclusion
Sputum LAM may be a biomarker of Mycobacterium tuberculosis（MTB）load before treatment and a pharmacodynamic biomarker of bacterial load change during treatment.Sputum LAM may be a useful tool for real-time monitoring of bacterial load and therapeutic response.
To analyze the predictive value of brain-derived cell-free DNA （bd-cfDNA） for radiation brain injury （RBI） in patients with lung cancer brain metastases.
Methods
A total of 83 patients with advanced lung cancer complicated with brain metastasis admitted to our hospital from March 2020 to March 2022 were selected as the subjects，33 patients with RBI after brain radiotherapy were selected as the observation group，and 50 patients without RBI were selected as the control group.The total cfDNA levels in plasma were measured before and after radiotherapy，and the origin of cfDNA was traced using tissue-specific methylation patterns.Multivariate binary Logistic and receiver operating characteristic （ROC） curve were used to analyze the prediction of RBI by bd-cfDNA.
Results
After radiotherapy，PLR 256.00 （226.50，289.00）and GTV Dmax 5 032.10 （4 936.25，5 125.35） in observation group were higher than those in control group 252.25 （221.50，184.25） and GTV Dmax 4 938.50 （4 833.40，5 032.93） （P ＜0.05）.There was no significant difference in cfDNA between the two groups before radiotherapy （P＞0.05）.After radiotherapy，cfDNA from oligodendrocytes，cfDNA from neurons，cfDNA from astrocytes and total bd-cfDNA were increased between the two groups （P＜0.05）.In the observation group，after radiotherapy，the source of oligodendrocytes was 12.07 （0.28，2 706.43） copies/ml，the source of neurons was 11.88 （1.44，4 394.05） copies/ml，and the source of astrocytes was cfDNA295.84 （5.63，5.28，4 394.05） copies/ml and total bd-cfDNA 8 433.13（348.75，29 514.12） copies/ml were higher than those in the control group 2.95（0.01，16.90）copies/ml，3.48（0.52，22.54）copies/ml，13.69（2.07，89.33）copies/ml，72.38（25.44，1343.92）copies/ml （P＜0.001）.In the observation group before and after radiotherapy，oligodendrocyte sources were cfDNA19.80 （0.25，3 159.96） copies/ml，neuronal sources ΔcfDNA19.61 （0.48，4 646.08） copies/ml，astrocyte sources ΔcfDNA 262.05 （1.62，8 298.91） copies/ml and Δ total bd-cfDNA 4 936.47 （229.22，24 740.52） copies/ml were higher than that of the control group 0.65 （-0.11，14.54） copies/ml，1.63 （0.07，0.07） copies/ml.15.45）copies/ml，3.93 （-2.25，77.83） copies/ml，34.71 （0.57，433.65） copies/ml （P＜0.05）.Multivariate binary Logistic analysis showed that total bd-cfDNA≥568.68 copies/ml after radiotherapy increased the risk of RBI［HR： 5.194 （95%CI： 1.760-15.326）， P＝0.003］.ROC curve analysis showed that the area under the curve of total bd-cfDNA predicting RBI after radiotherapy was 0.782 （95%CI： 0.674-0.891）（P＜0.05）.
Conclusion
bd-cfDNA can predict RBI of lung cancer brain metastases after radiotherapy，which has clinical significance.
To explore the clinical characteristics of nadroparin-induced eosinophilia in perinatal women with pulmonary embolism and provide a reference for clinical drug safety.
Methods
Cases of perinatal patients diagnosed with pulmonary embolism who developed eosinophilia during treatment with nadroparin between 2020-2023 were collected.Basic patient information was extracted，including age，body weight，underlying disease，pulmonary embolism diagnosis timing，nadroparin dosage，comorbidities，baseline eosinophil count，time to onset of eosinophilia，peak eosinophil count，presence of skin symptoms，time for eosinophil count to return to normal level，and regression of adverse effects.
Results
A total of 8 perinatal women with pulmonary embolism experienced eosinophilia during the administration of nadroparin.The patients were aged 27 to 34 years and all were treated with nadroparin after diagnosis of pulmonary embolism without other concomitant medications.Eosinophilia was detected as early as 12 days post-dose，with a slightly higher basal eosinophil count （0.26×109/L） than the other patients.Eosinophilia was detected as late as 70 days postdose，and this patient had the mildest adverse effect with a peak eosinophil count of 0.55×109/L）.One patient reached the clinical diagnosis of severe eosinophilia with a peak eosinophil count of 5.31×109/L.Three patients had accompanying skin symptoms，which disappeared after discontinuation of the drug.Seven patients had their dosage reduced，discontinued the drug，or changed their anticoagulation regimen after the eosinophil count increased.The eosinophil count returned to normal levels 2-114 days after drug withdrawal without other intervention measures.Among them，the eosinophil count of patients treated with reduced dosage continued to increase and then improved after drug withdrawal.Another patient did not adjust the treatment plan，and her eosinophils continued to rise，subsequent follow-up data were lost.
Conclusion
Nadroparin-induced eosinophilia in perinatal women with pulmonary embolism occurs within 10 weeks，and some patients may experience skin symptoms such as itchiness，which generally recover after drug discontinuation.When using nadroparin to treat perinatal patients with pulmonary embolism，clinicians should closely monitor eosinophil count changes to promptly detect and appropriately manage this adverse reaction.
Pulmonary epithelioid hemangioendothelioma （PEH） is a rare，low-grade malignant vascular tumor with an incidence rate of approximately 0.01 per 100，000 individuals.To provide an evidence-based foundation for clinical decision-making by systematically analyzing the clinical manifestations，diagnostic features，and treatment strategies of PEH through a review of cases treated at our hospital and a literature review.
Methods
This study retrospectively included seven patients with PEH admitted to our hospital from April 2019 to June 2024.Data on demographic characteristics，clinical manifestations，laboratory findings，imaging features，surgical records，pathological reports，and follow-up information were collected via the electronic medical record system.Additionally，a literature search was conducted using PubMed and CNKI databases to screen relevant articles published in the last decade.A multidimensional analytical framework was constructed for in-depth review and discussion.
Results
The patients were 5 males and 2 females，ranging in age from 31 to 60 years，with an average age of （47.86±10.32） years.Clinical manifestations were nonspecific： chronic cough was present in two cases （28.57%），chest pain in one case （14.28%），and incidental findings during physical examination in four cases （57.14%）.Imaging features included small nodules（＜2 cm） in five cases （71.43%），solitary masses in one case （14.28%），and bilateral nodules in one case（14.28%）.All cases underwent surgical treatment，with thoracoscopic wedge resection in two cases（28.57%），segmentectomy in one case （14.28%），and lobectomy in four cases （57.14%）.Pathological confirmation relied on immunohistochemistry： CD31 （positive in 7/7） and CD34 （positive in 7/7）.The median follow-up duration was 27.10 months （1-63 months），with long-term follow-up indicating a generally favorable prognosis for all patients.
Conclusion
The diagnosis of pulmonary epithelioid hemangioendothelioma requires an integration of clinical，imaging，and pathological findings，with immunohistochemistry playing a crucial role.Surgical resection remains the cornerstone of curative treatment，with thoracoscopic minimally invasive techniques recommended as the preferred approach.For cases that cannot be completely resected or are multifocal，an individualized comprehensive treatment strategy，including radiotherapy，targeted therapy，and close follow-up，is suggested.
To analyze the prognostic value of serum soluble myeloid cell trigger receptor-1（sTREM-1） and vascular cell adhesion molecule-1 （VCAM-1） levels in patients with severe pneumonia complicated with Respiratory failure.
Methods
Retrospective analysis of data from 58 patients with severe pneumonia complicated with respiratory failure treated at the First People′s Hospital of Huai′an City from January 2021 to December 2023，based on their prognosis after admission，they were divided into 38 cases survival is control group and 20 cases death is observation group.Compare two sets of general data ［gender，BMI，age，heart rate，comorbidities，length of hospital stay，Intensive care unit （ICU） stay，mechanical ventilation time，smoking history，drinking history，acute physiological chronic health score （APACHE Ⅱ），sequential organ failure assessment （SOFA） score］ and differences in laboratory indicators ［platelet count，lymphocyte count，white blood cell count，serum sTREM-1，VCAM-1 levels］，and analyze the APACHE Ⅱscore through ROC The value of white blood cell count，serum VCAM-1，and sTREM-1 levels in predicting the prognosis of patients with severe pneumonia combined with respiratory failure.Multivariate logistic regression analysis identifies risk factors for poor prognosis in patients with severe pneumonia combined with respiratory failure.
Results
Comparison of gender，BMI，age，heart rate，hospital stay，ICU stay，mechanical ventilation time，comorbidities，smoking history，alcohol consumption history，SOFA score，platelet count，lymphocyte count between the two groups （P＞0.05）.The control group had lower white blood cell count（13.46±4.16）×109/L-1，APACHE Ⅱscore（17.46±3.26），serum sTREM-1（75.39±13.27）ng/L，VCAM-1 levels（89.21±10.49）ng/L than the observation group（19.97±4.26）×109/L-1，（21.32±3.54），（92.65±15.65）ng/L，（104.32±12.35）ng/L（P＜0.05）.ROC analysis confirmed that white blood cell count，APACHE Ⅱscore，serum sTREM-1 and VCAM-1 levels can be used to predict the prognosis of patients with severe pneumonia complicated with Respiratory failure.The area under the curve was 0.857，0.782，0.822 and 0.832，respectively，all P ＜0.05.Confirmed by multivariate logistic regression analysis，white blood cell count≥17.215×109/L-1，APACHE Ⅱscore ≥46.195，sTREM-1 ≥87.280 ng/L，VCAM-1≥93.780 ng/L were risk factors for poor prognosis in patients with severe pneumonia complicated with Respiratory failure，all of which were P ＜0.05.
Conclusion
The prognosis of patients with severe pneumonia complicated with Respiratory failure is affected by many factors，among which white blood cell count ≥17.215×109/L-1，APACHE Ⅱscore≥46.195，sTREM-1≥87.280 ng/L，VCAM-1≥93.780 ng/L can predict the occurrence of poor prognosis，and clinical physicians should closely monitor during the treatment of this disease.
To analyze the surgical outcomes and the recurrence risk of spontaneous pneumothorax in patients.
Methods
All of 71 patients with refractory spontaneous pneumothorax were selected as subjects from January 1，2014 to July 28，2023.Indications for surgery include ipilateral spontaneous pneumothorax ＞2 times，chest gas volume ≥30%，or chronic air leakage difficult to heal.Surgical procedures（minimally invasive video-assisted thoracoscopic surgery or thoracotomy），pleuropexy，or thoracoscopic argon plasma coagulation （APC） were used.Cox regression analysis was used to predict the prognosis of spontaneous pneumothorax.Receiver operating characteristic （ROC） curve，nomogram and calibration curve were used to determine the prediction of spontaneous pneumothorax by Cox regression analysis.
Results
There was no death during or perioperative period.14 cases （19.72%） sustained air leakage ≥2 d.Postoperative complications occurred in 15 cases （21.13%），including severe complications in 9 cases （12.68%）.The median recurrence time was 110.0（17.0～351.0）days，and 12 cases （16.90%） relapsed.Single-factor analysis showed Charlson′s co-morbidity index （CCI），morbidity to surgery，severe thoracic morbidity，hemoglobin （Hb）before surgery，lymphocyte/monocyte ratio and mean length of hospital stay were associated with spontaneous pneumothorax recurrence （P＜0.05）.Cox analysis results showed that preoperative CCI ［HR（95%CI） ： 1.235 （1.057-1.443）］，time from onset to operation ［HR （95%CI） ： 1.041 （1.008-1.076）］ and Hb［HR（95%CI）： 0.976（0.960-0.992）］ was the influential factor of postoperative pneumothorax recurrence （P ＜0.05）.The Cox prediction equation was h（t） ＝0.976×（-0.025×Hb） ＋1.235× （0.211×CCI） ＋1.041× （0.041× time from onset to operation），and the column graph showed that C-index was 0.874 （95%CI： 0.821-0.928），Hb had a significant effect on spontaneous pneumothorax recurrence.Calibration curves showed that there was little deviation in predicting spontaneous pneumothorax recurrence at 3，6 and 12 months after surgery.The ROC curve predicted spontaneous pneumothorax recurrence at 3 months AUC 95%CI： 0.84 （0.74-0.94），6 months AUC 95%CI： 0.90 （0.81-0.99） and 12 months AUC 95%CI： 0.89 （0.76-1.00）.
Conclusion
Low Hb，long time from onset to operation and high CCI are risk factors for postoperative recurrence of refractory spontaneous pneumothorax.
To study the risk prediction model for respiratory failure in patients with chronic obstructive pulmonary disease （COPD）.
Methods
Relevant literature on risk prediction models for respiratory failure in COPD patients published from the establishment of the databases to September 2024 was retrieved from CNKI，Wanfang Data Knowledge Service Platform，VIP Database，China Biomedical Database，PubMed，Cochrane Library，EMbase，and Web of Science.Meta-analysis was conducted on the predictive value of common predictors in the included models using Revman 5.3 software.
Results
A total of 5 articles were included，with a sample size ranging from 177 to 25，638 cases，and the number of outcome events ranging from 44 to 3，844 cases.The number of potential predictors ranged from 14 to 42.The top six common predictors among the models were serum albumin level，force expiratory volume in 1 second（FEV1），the number of annual acute exacerbation of chronic obstructive pulmonary disease（AECOPD） episodes，white blood cell count，C-reactive protein，and the duration of COPD.A total of 29，316 COPD patients were included，among whom 4，084 （13.93%） developed respiratory failure.Five risk prediction models were included，and the area under the curve （AUC） of all models ranged from 0.645 to 0.950，with four models having an AUC≥0.8.The prediction model risk of bias assessment tool （PROBAST） results showed that all five included articles had a high risk of bias，mainly due to the lack of reporting on the handling of missing data and incomplete model performance evaluation.Meta-analysis results indicated that white blood cell count （OR ＝1.97，95%CI： 1.33-2.92） was a predictor of respiratory failure in COPD patients.
Conclusion
The existing risk prediction models for respiratory failure in COPD patients have a high risk of bias.Future studies should follow the PROBAST guidelines to improve research design，develop，update，and validate such models，and further verify their applicability and safety in clinical practice.
To investigate the clinical manifestations，diagnostic strategies，and treatment options for invasive Klebsiella pneumoniae liver abscess syndrome （IKLAS），aiming to enhance clinicians′ability to recognize and manage IKLAS at an early stage.
Methods
A case admitted to our hospital on April 16，2024 was selected on the clinical data of a diabetic patient complicated with IKLAS，including symptoms，imaging studies，laboratory tests，and treatment process，supplemented by a review of relevant literature.
Results
A 45-year-old male with no significant medical history was admitted due to a 3-week history of cough，sputum，and fever，which worsened with chest pain over the past 3 days.Chest CT revealed multiple pulmonary nodules，hilar and mediastinal lymphadenopathy，and a hypodense lesion in the right lobe of the liver.Subsequent contrast-enhanced chest CT showed enlargement of the pulmonary nodules with cavitation，vascular feeding signs，and progression of patchy infiltrates and effusions，along with mediastinal lymphadenopathy.Contrast-enhanced abdominal CT indicated a hypodense hepatic lesion，suggesting liver abscess with hepatic vein thrombosis.Blood cultures and bronchoalveolar lavage metagenomic next-generation sequencing（mNGS）both identified Klebsiella pneumoniae，with a positive string test.Random blood glucose was 21.00 mmol/L，and glycated hemoglobin was 12.9%，leading to a diagnosis of diabetes complicated by IKLAS.After upgrading antibiotic therapy to imipenem-cilastatin combined with cefoperazone-sulbactam，the patient′ s symptoms significantly improved，body temperature normalized，and follow-up CT showed marked resolution of pulmonary and hepatic lesions，resulting in discharge with improvement.
Conclusion
The clinical manifestations of diabetes complicated by IKLAS are insidious and rapidly progressive，often leading to delayed diagnosis and treatment.For diabetic patients with liver abscess，a high suspicion of Klebsiella pneumoniae infection should be maintained，with attention to common sites of invasion.Early diagnosis，prompt administration of sensitive antibiotics，and necessary abscess drainage are crucial for improving prognosis.
