To evaluate the features of carotid web (CW) by ultrasonography.

A total of 66 patients with CW were retrospectively enrolled from January 2018 to June 2019 at Xuanwu Hospital, Capital Medical University. All patients were examined by both ultrasonography and CTA, and were divided into either a<50% stenosis group (54 cases) or a ≥50% stenosis group (12 cases). The ultrasonographic characteristics of CW, including the length, thickness, direction (forward or backward to the flow), acute angle between the web and carotid wall, and thrombus between the web and carotid wall were compared between the two groups. The stenosis degrees of carotid artery were compared between patients with and without ischemic stroke.

Forty-two (42/66, 63.6%) patients were diagnosed with CW by initial CDFI examination, of whom 21 (21/66, 31.8%) were diagnosed with ulcerative plaque and 3 (3/66, 4.5%) were diagnosed with carotid dissection at first but confirmed by second examination. There were no differences in the web length, thickness, direction, or thrombus detected between the two groups (P>0.05). The angle between the web and carotid wall in the<50% stenosis group was significantly smaller than that of the ≥50% stenosis group (median angel 39o vs 73o, P=0.002), and the percentage of patients with an angle≤ 60o in the<50% stenosis group was significantly higher than that of the ≥50% stenosis group (74.1% vs 41.7%, P=0.042). The diameter of the residual carotid artery at CW location in the<50% stenosis group was significantly larger and peak systolic velocity was significantly higher in the<50% stenosis group than in the≥50% stenosis group (P<0.001). The stenosis degrees of carotid artery were not statistically different between patients with and without ischemic stroke (P=0.321).

Ultrasonography can be used to evaluate the characteristics of carotid web in 2D and color mode. When the angle between the CW and carotid wall is large, the carotid artery stenosis ≥ 50% is more likely to happen, but carotid artery stenosis is not the main cause of ischemic stroke.

The aim of the present study was to evaluate the efficiency of sling exercise, therapeuticultrasound, therapeuticultrasound and sling exercise in patients to alleviate pain and improve lumbar function with lumbar disc herniation.

Individuals were selected from a list of patients being followed at the department of Rehabilitation in the third hospital of Hebei Medical University. 30 patients who were diagnosed with lumbar disc herniation were collected, the diagnoses were established upon medical history, physical examination, and results of imaging studies. The patients were randomly divided into three groups: therapeuticultrasound group received 14 sessions of ultrasonic therapy to the lumbar region, Sling exercise group received 14 sessions of sling exercise, and therapeuticultrasound and sling exercise group received therapeuticultrasound and sling exercise therapy 14 sessions of therapeuticultrasound to the lumbar region,7 sessions per week, 2 weeks. The VAS and ODI were compared with the assessment of the patients before and at the end of the therapy.

At the end of treatment, three groups VAS scores (F=3.069, P=0.043) and ODI scores (t=12.676, P<0.001) was lower than that at the beginning of treatment (P<0.05), at the end of treatment the VAS scores (F=59.400, P<0.001) and of the ODI scores (t=12.737, P<0.001) of ultrasonic and sling exercise therapy group was lower than the other group, the difference is significantly.

All three groups could reduce pain and improve lumbar function, and the ultrasonic and sling exercise therapy was most effective for lumbar disc herniation treatment in the three groups.

To analyze the treatment of different types of traumatic cerebral infarction in children, and explore its pathogenesis in combination with literature so as to improve the cure rate and reduce disability rate.

The clinical data of 42 cases of traumatic cerebral infarction in children were retrospectively analyzed in The Hospital of 81^st Group Army PLA from January 2015 to December 2019. The diagnosis of traumatic cerebral infarction in children was made by CT scan and MRI scan. According to different conditions, children with traumatic cerebral infarction were classified, and different treatment strategies were selected. Children with lacunar infarction were treated with calcium antagonists and neurotrophic drugs, supplemented by hyperbaric oxygen and exercise rehabilitation. The children of focal cerebral infarction and complex cerebral infarction treated by junior dehydrant and hormone also included the calcium antagonist and nutritional nerve drugs. The therapeutic regimen perhaps adjusted by the evolution of the disease. The children of extensive cerebral infarction underwent emergency cranial decompression, and was treated by reducing intracranial pressure and preventing complications after operation. The treatment results and recovery were observed.

In 42 cases of traumatic cerebral infarction in children, 35 cases (83.3%) were good recovery, 4 cases (9.5%) were moderate disability, 2 cases (4.8%) were severe disability, 1 case (2.4%) died, and no vegetative state. The good recovery rate of lacunar infarction was 100%, that of focal cerebral infarction was 62.5%, that of mixed cerebral infarction was 60%, and that of extensive cerebral infarction was 50%.

It is of great significance to improve the therapeutic effect and prognosis of children with traumatic cerebral infarction to adopt different treatment schemes for different types of cerebral infarction.

To characterize the patients with supratentorial hypertensive intracerebral hemorrhage (ICH) in the Tibetan Plateau over an altitude of 4000 meters.

A total of 68 cases with supratentorial hypertensive ICH were retrospectively included in Ali Regional People’s Hospital from January 2017 to September 2018. The clinical and laboratory data were collected. A simple linear correlation analysis was applied to analyze the correlation between the amount of bleeding and sex, age, nationality, time from onset , systolic blood pressure (SBP), diastolic blood pressure (DBP), hemoglobin (Hb), serum triglyceride (TG), and cholesterol. According to computed tomography (CT) findings, 68 cases were divided into the basal ganglia ICH group (33 cases) and the lobar ICH group (35 cases). The characteristics between two groups were analyzed using t-test or χ² test.

The data of sex, age, nationality, time from onset, SBP, DBP, Hb, TG, and cholesterol of 68 cases on admission did not show any definitive correlation with the hematoma volumes (P＞0.05). The SBP and DBP of patients in the basal ganglia ICH group were significantly higher than that in the lobar ICH group, respectively [(184.9±28.5) mmHg vs (164.6±24.4) mmHg; (113.0±18.1) mmHg vs (103.0±18.4) mmHg] (t=0.499, 0.486; P=0.002, 0.033).

The relevant factors of hematoma volumes in patients with ICH in plateau area were not yet clear. Diastolic and systolic blood pressure of patients in the basal ganglia ICH group was higher than that in those in lobar ICH group.

To compare the efficacy evaluation of electrospun composite biomaterials and a porcine small intestine submucosa mesh for hernia repair.

A randomized, single-blind, controlled multicenter trial was performed in 3 hospitals in Shanghai. Eligible adult patients with primary unilateral reducible groin hernias were randomly assigned (1∶1) to electrospun composite biomaterials (experimental group) or porcine small intestine submucosa (control group) mesh groups. Patients were treated with the tARB technique and assessed at 1,3 and 6 months after the surgery. The primary endpoint was hernia recurrence. The secondary endpoints were postoperative complications including groin pain and operative site infections.

172 patients were assigned to experimental (n=86) and control (n=86) groups. At 6 months follow-up, postoperative complications occurred in 5 patients (5/86, 5.95%) and 2 (2/86, 2.35%) patients in the control and experimental groups, respectively (P>0.05). There was no significant difference in VAS or SVS score between the two groups.

We demonstrate that electrospun composite biomaterial mesh can be used as a ideal choice for inguinal hernia repair. Electrospun composite biomaterial has the characteristics of low recurrence rate, absorbability and long-term comfort.It can be further applied in clinical practice in the future.

Pancreaticoduodenectomy(PD)remains one of the most complicated hepatobiliary operations. The development of minimally invasive surgery for PD has always been an hot spot. Laparoscopic pancreaticoduodenectomy(LPD) has not been widespread carried out due to its difficulty and long learning curve. LPD accounts for 9% of all PD, according to the National Cancer Data base. Compared with laparoscopic surgery, robotic surgery system has significant advantages in the field of minimally invasive PD, including stereotactic amplified vision, filtering hand tremor and simulating the wrist. The article would review the surgical techniques and notes, which could provide clinical reference for other surgeons.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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