The 3D Res U-Net-Faster RCNN model was meticulously trained and learned using CT imaging data of histopathology-confirmed pulmonary nodules to develop a predictive model capable of distinguishing between benign and malignant pulmonary nodules.
Methods
A retrospective study incorporating 528 pulmonary nodules cases （malignant 442 and benign 86 ） treated between October 2020 and October 2023 was conducted. The cases were randomly divided into a training set and a test set in a 7∶3 ratio. A modified 3D residual U-shaped network， fused with faster region-based convolutional neural networks （Faster R-CNN）， was utilized to identify regions of interest （ROI） within pulmonary nodules and to extract CT imaging features. This approach was employed to construct a predictive model capable of distinguishing between benign and malignant pulmonary nodules， as well as to judge and screen the CT imaging feature weights of malignant nodules. The diagnostic accuracy of the model for pulmonary nodules was determined by confusion matrix， accuracy， by precision， recall， F1 value， Dice similarity coefficient （dice loss）， subject operating characteristic curve（receiver operating characteristic， ROC）， and the performance of the model was verified with external data.
Results
In the pulmonary nodule properties prediction model based on 3D Res U-Net-Faster RCNN deep learning technology， the Dice Loss of segmentation ROI was 0.85， and the accuracy of the test set to identify malignant lung nodules was 0.85， the recall rate 0.76， F1 value 0.80， and the area under the curve （area under the curve， AUC） value 0.86. For the external validation set， lung nodules identification accuracy was 0.86， malignant nodules identification accuracy 0.92， recall rate 0.87， F1 value 0.90； benign nodules identification accuracy 0.92， recall rate 0.82， and F1 value 0.87. The mean gray value， maximum diameter to volume ratio， and surface area to volume ratio gave the highest weight to the prediction of malignant lung nodules. The diameter， burr and vascular travel were significantly different between the benign and malignant nodules （P＜0.05）.
Conclusion
The AI-driven diagnostic model constructed based on the CT-imaging features of deep learning of 3D Res U-Net-Faster RCNN technology has good predictive performance for the properties of pulmonary nodules and has auxiliary diagnostic significance for improving the screening of early lung cancer.
To investigate the diagnostic value of endobronchial bronchial ultrasound-guided Transbronchial Needle Aspiration combine X-ray guided tranbronchial lung biopsy in hilar and mediastinal diseases.
Methods
Retrospectively analyzed the clinical data of 89 patients with hilar and mediastinum diseases who underwent X-ray guided tranbronchial lung biopsy （TBLB） and/or endobronchial bronchial ultrasound-guided Transbronchial Needle Aspiration （EBUS-TBNA） in Hongkong University-Shenzhen hospital from August 2020 to November 2021. The diagnostic yield of EBUS-TBNA combined with TBLB in hilar and mediastinum diseases was analyzed.
Results
89 patients with hilar and mediastinal diseases were underwent transbronchial TBLB and/or EBUS-TBNA biopsy. 80 patients were pathologically positive （89.89%）， 69 cases of lung carcinoma， 5 cases of pulmonary tuberculosis，2 cases of pulmonary sarcoidosis， one case of pulmonary mycosis， one case of pulmonary abscess， one case of organizing pneumonia and one case of pulmonary actinomycosis were diagnosed. The total biopsy positive rate of EBUS-TBNA was 61.80%（55/89）， and TBLB was 67.19%（43/64）. 64 patients who underwent EBUS-TBNA combined with TBLB， 53 （82.81%） had a positive pathological diagnosis. 25 patients who underwent EBUS-TBNA only， 16 （64.0%） had a positive pathological diagnosis. The positive rate of EBUS-TBNA combined with TBLB was statistically significantly higher than that of EBUS-TBNA alone （P＜0.05）.
Conclusion
Combination of EBUS-TBNA and X-ray guided TBLB can significantly improve the pathological diagnosis yield in hilar and mediastinal diseases.
To analyze the expression of regulatory T cells （Treg）/T helper cells 17（Th17） and dendritic cells （DC） in different progression stages of chronic obstructive pulmonary disease（COPD） and their relationships with prognosis.
Methods
The clinical data of 73 patients with COPD admitted to Suzhou Jiulong Hospital， Shanghai Jiaotong University School of Medicine from September 2019 to February 2023 were retrospectively analyzed. Among them， 35 patients in the acute exacerbation stage were included in the observation group， and 38 patients in the stable stage were included in the control group. The levels of CT image parameters ［percentage of wall area （WA%）， bronchial lumen area （Ai）］， Treg， Th17， Treg/Th17 and DC cells were detected， and the patients was divided into good prognosis （77 cases） and poor prognosis（18 cases） according to the follow-up results. The levels of Treg， Th17， Treg/Th17 and DC cells in stable group， exacerbation group and control group were compared； Spearman correlation coefficient was used to analyze the correlation between the levels of Treg， Th17， Treg/Th17， DC cells and the severity of COPD； the general data ［including sex， age， body mass index （BMI）， course of disease， underlying diseases］ and the levels of Treg， Th17， Treg/Th17 and DC cells of the good prognosis group and the poor prognosis group were compared； ROC analysis was used to analyze the value of Treg， Th17， Treg/Th17 and DC cells in evaluating the poor prognosis of patients.
Results
The Ai［（8.76±2.45） mm2］ of the observation group was significantly lower than that of the control group ［（14.97±3.61）mm2］， and the WA% （77.62±7.74） % was significantly higher than that of the control group ［（66.81±7.04） %］ （P＜0.05）. The levels of Treg， Treg/Th17 and DC cells in observation group ［（2.59±0.54） %， （0.41±0.11）， （1.38±0.41） %］ were significantly lower than those in control group ［（4.38±0.77） %， （0.82±0.26）， （2.52±0.82） %］， and the levels of Th17 in observation group ［（6.28±0.99）%］ were significantly higher than those in control group ［（5.32±0.63）%］（P＜0.05）. Treg， Treg/Th17 and DC cells were negatively correlated with the severity of the disease （r=-0.563，-0.571，-0.536， P＜0.05）， and Th17 was positively correlated with the severity of the disease （r=0.542， P＜0.05）. The levels of Treg， Treg/Th17 and DC cells in the good prognosis group ［（3.87±1.22） %，（0.69±0.21）， （2.33±0.52） %］ were significantly higher than those in the poor prognosis group ［（2.38±0.75）%， （0.34±0.11）， （1.92±0.32） %］， and the level of Th17 in the good prognosis group ［（5.64±1.15）%］ was significantly lower than that in the poor prognosis group ［（6.91±1.42） %］ （P＜0.05）. ROC results showed that the area under the curve of Treg， Th17， Treg/Th17 and DC cells to evaluate the poor prognosis of patients was 0.856， 0.702， 0.825 and 0.790， respectively（P＜0.05）.
Conclusion
The levels of Treg/Th17 and DC cells were highly expressed in both stable and acute exacerbations of COPD， and the levels of Treg/Th17 and DC cells in the good prognosis group were significantly higher than those in the poor prognosis group.
To investigate the relationship between serum Clara cell secretory protein（CC16） expression and lung function and emphysema phenotype in patients with chronic obstructive pulmonary disease （COPD） in the stable stage.
Methods
A cross-sectional study was conducted in 100 patients with stable COPD in which serum CC16 concentrations were measured by enzyme-linked immunosorbent assay（ELISA）. Spearman′s correlation and linear regression were used to test the relationship between CC16 levels and lung function in COPD.
Results
Patients were categorized into 47 cases of non-emphysematous COPD（NE-COPD） and 53 cases of emphysematous COPD （E-COPD） using the Z-score of single breath diffusion of carbon monoxide （TLCO）. Compared with NE-COPD，the emphysema index （EI） ［1.40%（0.95%，1.86%） vs.5.00%（3.13%，8.64%）］was significantly increased in patients with E-COPD （P＜0.05）， whereas， z-score of forceful expiratory volume in the first second （FEV1）/forceful lung capacity （FEV1/FVCz-score）［-2.51（-3.06，-1.97） vs. -2.96（-3.85，-2.25）］， TLCOz-score［-0.89（-1.32，-0.05） vs. -2.79（-4.02， -2.18）］， alveolar volume （VA）z-score［0.01（-0.92，0.84）vs. -1.03（-1.69，-0.36）］， diffusion constant for carbon monoxide（KCO）z-score［-0.78（-1.30，0.06） vs. -2.33（-3.14，-1.41）］，and serum CC16［14.63（8.87，26.74）ng/ml vs.8.90（2.90，14.89）ng/ml］ were significantly reduced （P＜0.05）. After Sperman correlation analysis， serum CC16 level was negatively correlated with EI （Rho=-0.344）； while it was negatively correlated with TLCOz-score（Rho=0.384）， KCOz-score（Rho=0.266）， VAz-score（Rho=0.214）， FEV1/FVCz-score（Rho=0.383） were positively correlated； all P＜0.05. In the subgroups of E-COPD （Rho=0.408）， NE-COPD （Rho=0.379）， the levels of serum CC16 were positively correlated with FEV1/FVCz-score were all positively correlated （P＜0.001）. After correcting for demographics， cardiopulmonary exercise test parameters， medication， and other clinical factors，serum CC16 levels remained significantly correlated with FEV1/FVCz-score in all COPD patients， E-COPD， and NE-COPD subgroups （P＜0.05）.
Conclusion
Serum CC16 level is an important factor associated with lung function and emphysema phenotype in patients with COPD， and low serum CC16 signifies that patients with COPD may have more severe disease and may combine more complex pathological phenotypes with poorer lung function.
To analyze the role and mechanism of miR-200b-3p in seawater inhalation acute lung injury （ALI）.
Methods
Thirty-two healthy SD rats were selected and divided into blank control group， seawater stimulation group， miR-200b-3p antagomir pretreatment group and antag NC pretreatment group， with 8 rats in each group. The rat pulmonary microvascular endothelial cells （RPMVECs） model of seawater inhalation lung injury and rat pulmonary microvascular endothelial cells were constructed. Wet-dry ratio（W/D） of lung tissue was observed， and microvascular permeability of lung was detected by Evans blue method. Western blot analysis of the expression of -hypoxia inducible factor-1（HIF-1α） and vascular endothelial growth factor （VEGF） were detected. Dual luciferase reporter gene assay was used to verify the relationship between HIF-1α and miR-200b-3p.
Results
After seawater treatment for 4 h， the wet-dry ratio（W/D） and permeability of lung tissue were significantly increased， and the expression of miR-200b-3p， HIF-1α and VEGF were significantly increased in lung tissue and cell models. However， inhibition of the expression of miR-200b-3p significantly alleviated pulmonary edema， the expression of HIF-1α and VEGF were decreased in lung tissues and cell models. Dual luciferase reporter gene verified that miR-200b-3p directly targeted HIF-1α. Compared with blank control group， the expressions of HIF-1α and VEGF in lung tissue and HIF-1α and VEGF in RPMVECs cells were increased in seawater stimulated group.
Conclusion
Increased expression of miR-200b-3p plays a key role in the development of pulmonary edema induced by seawater aspiration injury，which is mediated by the HIF-1α/VEGF pathway.
To analyze the risk factors in postoperative delirium （POD） in primary lung cancer and predict prognosis.
Methods
All of 337 patients admitted to intensive care unit after primary lung cancer resection in our hospital from February 2018 to March 2023 were selected. 27 patients with postoperative delirium were included in the observation group and 310 patients without postoperative delirium were included in the control group. Clinical data were collected. LASSO regression analysis and multiple Logistic regression were used to analyze the risk factors of postoperative delirium after primary lung cancer resection. Postoperative delirium occurrence， overall survival （OS） and disease-free survival （DFS） were recorded， and the relationship between postoperative delirium occurrence and prognosis was analyzed.
Results
The risk factors of postoperative delirium were cerebrovascular disease， squamous cell carcinoma and age ＞71 years old. The simplified formula of risk score is： 1× （age＞71 years） +1×（squamous cell carcinoma） +1× （cerebrovascular disease）. The receiver operating characteristic curve （ROC） for predicting postoperative delirium risk was 0.840 （95%CI： 0.796 ～0.877）， when risk score ＞1， sensitivity and specificity were 74.07% and 85.48%，respectively. The postoperative delirium incidence was 1.50%， 3.60%， 22.41% and 100.0% （P＜0.05） in patients with risk scores 0 to 3， respectively. By the end of follow-up， 147 cases （43.62%） had relapsed and 95 cases （28.19%） had died in 337 cases of lung cancer， there were 6 deaths （22.22%）among 27 patients in the observation group and 35 deaths（11.29%） among 310 patients in the control group. The DFS of the observation group was 10.00 （4.00-43.00） months， and that of the control group was 10.00 （3.00-91.00）months （P＞0.05）. The OS 33.00 （8.00-68.00） months in the observation group was shorter than that in the control group 39.50 （3.00-69.00） months （P＜0.05）.
Conclusion
The prediction of postoperative delirium risk score after primary lung cancer resection has clinical significance， and the patients with postoperative delirium have shorter overall survival.
To investigate the changes of serum amyloid P （SAP） and matrix metalloproteinases （MMPs） expression before and after stereotactic body radiation therapy （SBRT） in lung cancer patients and their correlation with radiation-induced lung injury （RILI） and prognosis.
Methods
A total of 75 patients with lung cancer who received SBRT in our hospital between January 2020 and August 2023 were selected as the study subjects . Serum SAP and MMPs （MMP1， MMP2， MMP9） levels were detected by ELISA. Progression-free survival （PFS）， overall survival （OS）， local progression-free survival （LPFS）， and distant metastasis-free survival （DMFS） were recorded after SBRT. In addition， the incidence of RILI （CTCAE≥grade 2） within 6 months after radiotherapy was assessed according to the Common Terminology Criteria for Adverse Events （CTCAE 5.0）.
Results
The incidence of RILI after SBRT was 28.0% （21/75）. The serum SAP level in the observation group before radiotherapy was significantly lower than that in the control group［14.67（11.21， 19.21）μg/ml vs. 27.62 （24.33， 32.60）μg/ml］， while MMP-1［21.70 （12.20， 30.45）ng/ml vs. 10.60 （7.65， 16.25）ng/ml］， MMP-2［701.00 （620.50， 846.00） ng/ml vs. 912.00 （779.00， 1 100.00）ng/ml］， MMP-9［6.80 （2.00， 10.30）ng/ml vs. 21.60 （10.70， 66.50）ng/ml］ was significantly higher than that in control group （P＜0.05）. The area under ROC curve of serum SAP，MMP-1，MMP-2 and MMP-9 before radiotherapy to predict RILI after SBRT were 0.881， 0.784， 0.760 and 0.885， respectively. Compared with before SBRT， the serum SAP level［23.42 （17.27， 28.57） μg/ml vs. 30.09 （23.51， 39.86） μg/ml］ was significantly increased after SBRT， while the levels of MMP-1［13.10 （8.30，21.70） ng/ml vs. 10.50 （7.00，16.80）ng/ml］， MMP-2［757.00 （660.00，880.00） ng/ml vs. 690.00 （604.00，810.00） ng/ml］ and MMP-9［6.60 （2.40， 17.20） ng/ml vs. 2.00 （2.80， 3.40） ng/ml］were significantly decreased （P＜0.05）. In the 75 cases， 63 cases（84.00%） died and 12 cases（16.00%） survived. Univariate and multivariate COX regression analysis showed that serum SAP and MMP-1， MMP-2 and MMP-9 before radiotherapy were independent influencing factors of PFS， OS and DMFS （P＜0.05）， and serum SAP and MMP-9 before radiotherapy were also independent influencing factors of LPFS （P＜0.05）. In Kaplan-Meier analysis， patients with low SAP and high MMPs had lower PFS and OS rates and shorter median PFS and OS times compared to patients with high SAP and low MMPs before radiotherapy （P＜0.05）. In the combined risk model of serum SAP and MMPs before radiotherapy， high-risk patients had lower PFS and OS rates and shorter median PFS and OS times compared with low-risk patients （P ＜0.05）.
Conclusion
Low SAP and high MMPs levels before radiotherapy are associated with a higher risk of RILI and poor prognosis after SBRT 21 cases with RIKI were divided into observation group and 54 cases without RILIum were divided into control group. Serum SAP and MMPs before radiotherapy are promising biomarkers for early prediction of RILI and poor prognosis after SBRT in lung cancer patients.
To analyze the changes in pathogen resistance and inflammatory factors in secondary lung infections in lung cancer patients after chemotherapy.
Methods
A total of 157 lung cancer patients admitted to the respiratory department from February 2019 to February 2023 were hospitalized due to chemotherapy were selected as the study subjects. There were a total of 69 patients in the observation group who developed secondary pulmonary infections， and 88 patients in the control group who did not develop secondary pulmonary infections. Respiratory samples from infected patients were sent to be tested for pathogen types.Levels of C-reactive protein（CRP）， procalcitonin（PCT）， tumor necrosis factor-α（TNF-α）and interleukin-6（IL-6） in two groups of patients were compared.
Results
A total of 84 strains of pathogenic bacteria were detected in respiratory samples. Gram-negative bacteria accounted for 61.91%（n=52）， while gram-positive bacteria accounted for 30.95% （n=26）， and fungi accounted for 7.14% （n=6）. There were differences in the resistance of different pathogens to common antibiotics. The 52 strains contained Gram-negative bacteria， 26 Pseudomonas aeruginosa， 15 Klebsiella pneumoniae， 10 Acinetobacter baumannii， and 1 other strain. Gramnegative bacteria showed high resistance to ceftriaxone， cefepime， and ampicillin， certain resistance to gentamicin， levofloxacin， and co-trimoxazole， and low resistance to imipenem.The 26 gram-positive strains，included S. aureus 15 strains ， Streptococcus pneumoniae 7 strains， S. haemolytica 4 strains. Gram-positive strains showed high resistance to penicillin， erythromycin， clindamycin， some resistance to linezolid and gentamicin， and low resistance to vancomycin and levofloxacin. Fungal 6 strains included， C. albicans 5 strains and C. glabrata 1 strain. Fungal strains showed high resistance to fluorouracil and low resistance to fluconazole，ketoconazole， and amphotericin B.In observation group CRP（24.16±5.88）mg/L， PCT（4.21±1.96）ng/ml，TNF-α（25.76±5.34）ng/L， IL-6（36.34±2.24）ng/L higher than control group（11.97±3.55）mg/L， （1.02±0.98）ng/ml， （18.55±4.21）ng/L， （22.68±1.08）ng/L（P＜0.05）. The imaging examination of secondary lung infection in lung cancer chemotherapy patients mostly showed scattered distribution sheet infiltrative changes，which could involve both lung fields， and the imaging absorption was slower.
Conclusions
Pathogens in the body of lung cancer patients with secondary lung infections after chemotherapy are various， with Gram negative bacteria having the highest infection rate. There are differences in resistance to common antibiotics and strong inflammatory reactions. Clinical selection of antibiotics should be based on drug sensitivity results and the actual situation of patients.
To analyze the expression characteristics of micro RNA （miRNA） in non-small cell lung cancer （NSCLC） and predict the resistance of platinum drugs.
Methods
All of 105 patients with NSCLC admitted to our hospital from September 2021 to April 2023 were selected as subjects， 66 patients with platinum therapy sensitivity were selected as control group， and 39 patients with drug resistance were selected as observation group. miRNA expression was detected by polymerase chain reaction （PCR）. Multivariate Logistic regression was used to analyze the influencing factors of platinum drug resistance in NSCLC， and the expression characteristics of miRNA were analyzed by receiver operating characteristic curve （ROC） to predict platinum drug resistance in NSCLC.
Results
The expression levels of miRNA-125b （0.92±0.21）， miRNA-106a （0.87±0.22）， miRNA-181a （0.89±0.13） and miRNA-196a （1.01±0.31） in observation group were higher than those in control group （1.75±0.35）. miRNA-106a （2.45±0.47）， miRNA-181a （1.04±0.21），miRNA-196a （2.48±0.55）， miRNA-148b （1.78±0.47） in observation group was lower than that in control group （0.97±0.16） （P＜0.05）. Multivariate Logistic regression analysis showed that the expression levels of miRNA-125b （OR=1.642）， miRNA-106a （OR=2.052）， miRNA-181a （OR=2.092）， miRNA-196a （OR=1.508） and miRNA-148b （OR= 0.385） were platinum drug resistant in NSCLC influencing factors of the situation （P＜0.05）； ROC curve showed that the expression levels of miRNA-125b， miRNA-106a， miRNA-181a， miRNA-196a and miRNA-148b predicted the AUC of platinum drug resistance in NSCLC were 0.795，0.895， 0.733， 0.878 and 0.888，respectively. The predictive value of miRNA-106a was high. When the optimal diagnostic threshold was 1.220， the sensitivity and specificity of mirNA-106A for predicting platinum drug resistance in NSCLC were 76.62% and 96.97%.
Conclusion
The expression characteristics of miRNA can predict platinum drug resistance in NSCLC. NSCLC patients with high expression levels of mirNA-125b，mirNA-106A， mirNA-181A， mirNA-196a and low expression levels of mirNA-148b are prone to platinum drug resistance.
To analyze the predictive value of carbon dioxide ventilation equivalent （VE/VCO2） slope on postoperative cardiovascular complications in patients with carcinoma of the lungs undergoing lobectomy.
Methods
A total of 169 patients with lobectomy were admitted to the hospital from March 2021 to March 2022， who were all treated with thoracoscopic lobectomy. The patients were followed up for 30 days and divided into observation group （complications） and control group （no complications） according to the prognosis. The VE/VCO2 slope of the observation group and the control group were compared， and the clinical data of the observation group and the control group were compared， and the influencing factors of postoperative cardiovascular complications in patients with pulmonary lobectomy were analyzed， and the predictive value of VE/VCO2 slope for postoperative cardiovascular complications in patients with pulmonary lobectomy was analyzed.
Results
31 patients in the observation group， 7 cases cardiovascular complications， 4 cases pulmonary embolism， 15 cases arrhythmia， 16 cases hypotension， 2 cases heart failure and 1 case required cardiopulmonary resuscitation； After surgery 30 d， 1 case each died in the observation and control groups.There were 14 patients re-admitted to ICU in the control group and 18 in the observation group （10.14% vs.58.06%， χ2=37.869， P=0.000）. The length of hospitalization ［8.0 （6.5， 13.0） vs. 6.0 （5.0， 7.0）， P=0.000］ and the duration of ICU stay ［5.0（3.0， 8.0） vs. 2.0 （2.0， 3.0）， P=0.000］ in the observation group were both significantly longer than that in the control group. In addition， VCO2， VE and PETCO2 at resting state， as well as VCO2 and PETCO2 at peak exercise were significantly decreased in observation group， and the slope of VE/VCO2 was significantly increased （P＜0.05）. Univariate and multivariate logistic regression showed that VE/VCO2 slope was associated with cardiovascular complications （OR=1.074；95%CI：1.004～1.149； P=0.039） correlation. The sensitivity， specificity and AUC of VE/VCO2 slope in predicting postoperative cardiovascular complications in lobectomy patients were 78.13%， 89.66% and 0.893， respectively. VE/VCO2 were significantly correlated with length of stay in ICU （b = 0.31， F= 19.123， t = 3.066， P = 0.003）.
Conclusion
VE/VCO2 slope can be used to predict postoperative cardiovascular complications in patients with pulmonary lobectomy， and it has high predictive value.
To investigate the prognostic value of plasma circulating tumor DNA （EGFR）in epidermal growth factor receptor （EGFR）-tyrosine kinase inhibitors （TKIs） in patients with advanced nonsmall cell lung cancer （NSCLC）.
Methods
This study reviewed 127 patients with mutant advanced NSCLC who underwent EGFR gene testing in our hospital between January 2016 and June 2022. EGFR mutation was detected by direct sequencing method and divided into four groups according to mutation sites： exon （E） 18 mutant group， E19 mutant group， E20 mutant group， and E21 mutant group. In addition， E19 deletion mutations were divided into three subtype groups based on mutation patterns： codon deletion （CD）， codon substitution and skipping （CSS）， and CD or CSS plus single nucleotide variant （SNV） （CD/CSS+SNV）. The main outcome measures were progression-free survival （PFS） and overall survival （OS）.
Results
Among EGFR mutations， E19 deletion was the most common73cases （57.48%）， followed by E21 mutation 40cases（31.50%）， E18 mutation 6cases（4.72%）， and E20 mutation 8 cases （6.30%）. The median follow-up time for all NSCLC patients was 22.23 months （range 3.02 to 60 months）. Patients with E19 mutation had the longest median PFS and OS duration （13 months，30.59 months）， and were significantly longer than those with E18 mutation （9 months， 10.85 months）， E20 mutation （10 months， 19.48 months）， and E21 mutation （10 months， 16.92 months） （P＜0.05）. In the multivariate analysis model， E19 mutation was an independent influencing factor for PFS and OS in NSCLC patients （P＜0.05）. Among patients with E19 mutations， the median PFS and median OS （43 months， 51.25 months） in the CD/CSS+SNV group were significantly longer than those in the CD group （12 months， 29.87 months） and CSS group （10 months， 20.66 months） （P＜0.05）. The number of missing bases and missing amino acids in CD/CSS+SNV group （12.80±2.88， 4.40±0.91） were significantly lower than those in CD group （14.87±0.88， 4.98±0.33） and CSS group （16.73±3.35， 5.81±0.98） （P＜0.05）.
Conclusion
Compared with patients with E18/20/21 mutations， patients with E19 deletion mutations have a better prognosis for PFS and OS， suggesting that E19 deletion is a predictor of a better prognosis for PFS and OS in patients with EGFR mutant NSCLC. In addition， CD/CSS SNV was significantly associated with longer PFS and OS in patients with E19 mutations.
To analyze the clinical features， imaging patterns and pulmonary function of connective tissue disease-associated interstitial lung disease （CTD-ILD） complicated with small airway dysfunction.
Methods
All of 245 cases of CTD-ILD patients admitted to our hospital from January 2020 to June 2023 were selected. 86 cases of CTD-ILD complicated with small airway dysfunction （SAD） were treated as the observation group and 159 cases without SAD as the control group. The baseline data， radiographic characteristics and pulmonary function of the two groups were compared.
Results
In the observation group，14 cases of sjogren′s syndrome （48.28%）， 3 cases of systemic lupus erythematosus （37.50%）， 5 cases of systemic vasculitis （38.46%） and 17 cases of overlapping syndrome （36.96%） were less than those in the control group （15 cases of Sjogren′s syndrome （51.72%））. There were 5 cases of systemic lupus erythematosus（62.50%）， 8 cases of systemic vasculitis （61.54%） and 29 cases of overlap syndrome （63.04%）. There was no significant difference in age， sex and body mass index between the two groups （P＞0.05）. In the observation group， 15 cases of pulmonary hypertension （17.44%） were higher than that in the control group （8.81%）， 3 cases of coronary heart disease （3.49%） and 2 cases of cerebral infarction （2.33%） were lower than that i 17 cases of coronary heart disease （10.69%） and 26 cases of cerebral infarction （16.35%） n the control group（P＜0.05）. 84 cases of nonspecific interstitial pneumonia （NSIP） in the control group （52.83%） were higher than 32 cases of NSIP in the observation group （37.21%） （P＞0.05）. In the observation group， forced vital capacity （FVC） accounted for （72.60±19.30）% and forced expiratory volume in one second FEV1% accounted for （68.38±16.35）%， FEV1/FVC（78.94±7.80） and diffusing capacity of the lungs for carbon dioxide of expected monoxide （DLCO） （47.28±16.93）% is lower than that of control group （87.14±19.47）%， （91.56±19.13）%， （87.25±5.21），（57.03±17.11）%. The residual total ratio （RV/TLC） in the observation group was 43.00（38.00，47.25） higher than that in the control group 39.00（35.00，43.00） （P＜0.05）. The stages of interstitial lung disease-gender-age-physiology （ILD-GAP） were observed.
Conclusion
CTD-ILD patients with systemic lupus erythematosus， Sjogren′s syndrome， systemic vasculitis and overlapping syndrome are prone to SAD， pulmonary hypertension， poor pulmonary function index and high ILD-GAP stage.
To analyze the chest CT and clinical characteristics of antineutrophil cytoplasmic antibodies （ANCA）-associated vasculitis （AAV） with different target antigen types.
Methods
A retrospective analysis was conducted on the clinical and chest CT imaging data of 355 AAV patients who were treated at the Second Affiliated Hospital of Army Medical University from January 2015 to December 2023.Based on the different specific target antigens present in the serum， the patients were classified into two groups：myeloperoxidase （MPO） antineutrophil cytoplasmic antibodies （MPO-ANCA） and proteinase 3 （PR3）antineutrophil cytoplasmic antibodies （PR3-ANCA）. Among them，311 patients were positive for MPO-ANCA，and 44 patients were positive for PR3-ANCA. The two subtypes were compared in terms of age，affected organs，and different imaging manifestations.
Results
Among the 355 AAV patients， the mean age of 311 cases MPOANCA-positive patients was （61.26±13.29） years，while the mean age of 44 cases PR3-ANCA-positive patients was （47.75±15.07） years. The mean age of MPO-ANCA-positive patients was significantly higher than that of PR3-ANCA-positive patients （P＜0.001）. The main affected organs in AAV patients were the kidneys and lungs， with 247 cases （69.58%） involving the kidneys and 125 cases （35.21%） involving the lungs. The proportion of renal involvement in MPO-ANCA-positive patients 225 cases（72.34%） was also significantly higher than that in PR3-ANCA-positive patients 22 cases（50.00%） （P＜0.05）. The imaging manifestations of lung involvement in AAV patients were diverse， with 172 cases （48.45%） showing ground-glass opacity， 162 cases （45.63%） showing interstitial changes， 135 cases （38.03%） showing nodules or masses， and 96 cases（9.58%） showing emphysema and bullae. Among them， MPO-ANCA-positive patients had a higher proportion of interstitial lung changes （48.55% vs. 25.00%， P＜0.05） and emphysema and bullae （28.94% vs. 13.64%，P＜0.05） compared with PR3-ANCA-positive patients. In contrast， PR3-ANCA-positive patients had a higher proportion of bilateral lung nodules or masses on chest CT （68.18% vs. 33.76%， P＜0.005） compared with MPO-ANCA-positive patients.
Conclusion
Patients with AAV predominantly present with renal and lung involvement. The main imaging manifestations on chest CT are ground-glass opacity， interstitial changes，nodules， or masses. There are some differences in the chest CT imaging characteristics of AAV with different target antigens， which are of significance for auxiliary early diagnosis.
To analyze the tolerability and efficacy predictors of nintedanib （NT） in the treatment of idiopathic pulmonary fibrosis （IPF）.
Methods
Prospective inclusion of 67 patients with IPF between March 2020 and December 2023， all patients were the initial measurement of 300 mg of NT treatment，and （in group） on the day before treatment， chest CT scan and lung function test were performed before treatment （the day of enrollment） and at 6 months （M） and 12 M treatment. The occurrence of adverse events in IPF patients was recorded.
Results
A total of 45（67.16%） IPF patients experienced a reduction in NT dose during 12 M，of which 34 patients experienced a reduction within 6 M，and the reason for this reduction in all patients NT dose are adverse events happened， a total of 20（29.85%） IPF patients stopped NT within 12 M， and 10 of them stopped NT within 6 M， Adverse events were the most common reason for discontinuation in our study. IPF patients ≥75 years old had a higher incidence of dose reduction during 6 M， and most patients discontinued NT because of the occurrence of adverse events （P ＜0.05）. According to the LASSO and multiariable Logistic regression analysis， the female， forced vital capacit to the predicted value （FVC% pre）＜76.70%， surfactant protein D （SP-D）≥263.50 ng/ml for IPF patients 12 M NT independent risk factors for the development of drug discontinuation， The area under the receiver operating characteristic curve of risk score［1× （female） +1× （FVC%pre＜76.70%） +1× （SP-D≥263.50 ng/ml）］ for predicting the discontinuation of NT therapy within 12 M in IPF patients was 0.760 （95%CI： 0.688-0.822）. FVC decline in IPF patients with continued NT therapy was significantly less than that in patients with discontinued NT therapy ［0.03（-0.16，0.27）L vs. -0.14（-0.50， 0.07）L， Z=-2.405， P=0.016］. FVC change was negatively correlated with body mass index （BMI） （Rho=0.410， P＜0.001） and FVC%pre （Rho=0.427， P＜0.001）.
Conclusion
The results of this study showed that the main causes of NT dose reduction and NT discontinuation in IPF patients during 12 M were adverse events， according to gender， FVC% pre， SP-D design can predict the risk of 12 M NT drug discontinuation. In addition， patients who continued NT therapy during the 12 M period had less decline in FVC than those who discontinued NT therapy， and FVC changes were related to BMI and FVC%pre.
To analyze the significance of serum matrix metalloproteinases 9 （MMP-9），matrix metalloproteinase 2 （MMP-2） and toll-like receptor 4 （TLR4）， human epididymis protein 4（HE4） in early diagnosis of non-small cell lung carcinoma （NSCLC）.
Methods
35 patients with NSCLC admitted to our hospital from January 2021 to December 2023 were selected as the observation group， and 39 patients with benign lung lesions hospitalized during the same period were selected as the control group. The serum levels of MMP-9， MMP-2， TLR4 and HE4 were compared between the two groups， and the serum levels of MMP-9，MMP-2， TLR4 and HE4 in NSCLC patients with different clinicpathological characteristics were compared. The correlation between serum MMP-9， MMP-2， TLR4 and HE4 for the diagnosis of NSCLC was analyzed by receiver operating characteristic curve （ROC）. The correlation between serum MMP-9， MMP-2， TLR4 and HE4 and NSCLC was analyzed by multivariate Logistic regression.
Results
The levels of MMP-9， MMP-2，TLR4 and HE4 in the observation group［（288.71±92.33） μg/L，（44.46±5.62） pg/ml，（5.30±1.24） ng/ml，（228.76±60.83） pmol/L］ were higher than those in the control group ［（214.66± 45.89）μg/L， 20.15±4.03）pg/ml， （2.58±0.84）ng/ml， （57.76±18.14）pmol/L］ （P＜0.05）. Serum levels of MMP-9， MMP-2， TLR4，and HE4 in NSCLC patients with low-differentiation and lymph node metastasis in TNM stages Ⅲto Ⅳwere higher than those in patients with medium-differentiation and no lymph node metastasis in TNM stages Ⅰto Ⅱ（P＜0.05）. According to ROC analysis， the areas under the curve of serum MMP-9， MMP-2， TLR4 and HE4 for the single diagnosis of NSCLC were 0.790 （95%CI： 0.690-0.890）， 0.804（95%CI： 0.703-0.904） and 0.813（95%CI： 0.703-0.904）. 0.813（95%CI： 0.715-0.912）， 0.817（95%CI： 0.720-0.914）， the sensitivity was 0.650（95%CI：0.596-0.712），0.800（95%CI：0.724-0.870），0.750（95%CI：0.724-0.870），0.750（95%CI： 0.689- 0.834）， 0.775（95%CI： 0.703-0.852）， the specificity was 0.825（95%CI： 0.763-0.884）， 0.750（95%CI： 0.688-0.825）， 0.825（95%CI： 0.778-0.871）， 0.800（95%CI： 0.734-0.846）； The combined diagnosis of NSCLC with serum MMP-9， MMP-2， TLR4 and HE4 was 0.953 （95%CI： 0.912-0.993），sensitivity was 0.850（95%CI： 0.782-0.913）， and specificity was 0.925（95%CI： 0.862-0.979）. Multivariate Logistic regression analysis showed that MMP-9≥237.465 μg/L （OR=2.587，95%CI：1.241-5.393）， MMP-2≥29.115 pg/ml （OR=3.129， 95%CI： 1.336-7.328）， TLR4≥3.870 ng/ml （OR=3.202， 95%CI： 1.411-7.266）， HE4≥128.030 pmol/L （OR=3.415， 95%CI： 1.508-7.734） were the risk factors for NSCLC （P＜0.05）.
Conclusion
Serum MMP-9， MMP-2， TLR4 and HE4 are useful in the diagnosis of NSCLC.
To analyze the clinical characteristics and injury mechanism of blunt traumatic aortic injury （BTAI） in the elderly， and to discuss the experience of severe treatment of BTAI in the elderly.
Methods
A total of 19 BTAI patients admitted to the intensive care unit （ICU） of our hospital from January 2013 to January 2022 were selected， with 9 patients ≥60 years old as the observation group and 10 patients ＜60 years old as the control group. The differences in disease occurrence， development and outcome between the two groups were compared， and the critical treatment strategies were summarized.
Results
Stanford classification， injury start site， heart rate before treatment （80.78±17.31） times /min， pulse pressure difference （56.44±16.49） mmHg， white blood cell （WBC） （11.50±4.55） 109/L， platelet counts（PLT）（175.56±59.49） 109/L，fibrinogen （Fib） 3.11 （2.69，4.73） g/L，serum D-dimer（D-D） 7 379.00（2 300.78，9 758.00）μg/L， cardiac troponin T （cardiac troponin， cTnT） 0.01 （0.01，0.02）μg/L in observation group compared with Stanford classification， injury initiation site， heart rate before treatment （95.00±15.43） times/min， pulse pressure difference （59.70±17.79） mmHg， WBC （13.51±7.17） 109/L， PLT （217. 60±201.79）109/L Fib 3.28 （2.66，4.18） g/L， D-D 2 501.50 （1 099.44， 6 404.50）μg/L， cTnT 0.11 （0.01， 0.27）μg/L in control group （P＞0.05）. There were 3 cases （33.33%） in the observation group and 9 cases （90.00%） in the control group （P＜0.05）. The length of stay in the observation group was 14 （7，18） d， the length of stay in the ICU was 0 （0，5） d and the number of re-admission to the ICU was 0 （0，1） times compared with the length of stay in the ICU was 21 （17，32） d， the length of stay in the ICU was 8 （4，12） d and the number of readmission to the ICU was 1 （1，2） times （P＜0.05）in the control group.
Conclusion
BTAI can occur across all age groups. The Stanford classification， injury characteristics， and clinical features of elderly BTAI patients show no differences compared to younger counterparts. For elderly BTAI patients， non-surgical treatment is primarily chosen， and intensive care unit management significantly improves the prognosis for those receiving non-surgical interventions.
