Immune checkpoint inhibitors(ICIs)treatment significantly prolonged the survival period of patients with lung cancer, liver cancer, and malignant melanoma and other solid malignant tumors and improved the quality of life.But at the same time a variety of immune-related adverse reactions(irAEs)appeared.The incidence of immune-mediated liver injury(IMH)caused by ICIs is increasing but the severity is different.To diagnose IMH earlier and perform individualized diagnosis and treatment, it is necessary to have a reasonable application of drug treatment.

The quality of life of elderly patients with lung cancer can be affected by various symptoms such as frailty, coexistence of multiple diseases, malnutrition, and decreased function.Identifying these potential problems through reasonable and effective assessment, and providing early intervention and symptom management, can help improve the quality of life of patients.Although several methods have been developed, applied, and clinically verified to evaluate the quality of life in elderly patients with lung cancer, they all have their limitations.Therefore, choosing the appropriate evaluation method has become a practical challenge in clinical settings.This article aims to review the different methods used to assess the quality of life of elderly patients with lung cancer, providing theoretical guidance for clinicians and researchers.

Objective To analyse the clinical effect and safety of Alimta (Pemetrexed) combined with cisplatin treatment (PP) on elderly patients with non small cell lung cancer (NSCLC).Methods We retrospectively analyzed the clinical data of 40 cases of NSCLC patients treated with Pemetrexed combined with cisplatin for first-line chemotherapy,and 24 cases of them continually received single Pemetrexed for maintenance treatment (PP + C).Then we compared the results with 35 patients in the non-Pemetrexed regimen (control group) and 26 patients with best supportive care (BSC) in the same period.The adverse reactions and short-term efficacy [response rate (RR),disease control rate (DCR)] were evaluated.Time to progression (TTP),median survival time (MST),one-year and three-year survival rates and follow-up overall survival (OS) were calculated.Results Among 40 patients with Pemetrexed regimen,2 patients had complete remission (CR),and the RR was 47.8％,which was better than 42.8％ (P =0.026) in the control group.The main adverse reactions of pemetrexed regimen were myelosuppression,fatigue,nausea and vomiting,but all were tolerated and no treatment-related death occurred.24 patients received single Pemetrexed maintenance therapy.The MST of the PP + C group was superior to the other groups (P =0.03,P ≤0.05);the median OS of the PP + C group,the control group,and the BSC group reached 13.2,10.4 months and 8.6 months,respectively (P ≤ 0.001).Conclusions For elderly patients with advanced NSCLC,especially adenocarcinoma,the combination of Pemetrexed and cisplatin is a better treatment option.It is convenient to administer and has less toxicity and adverse reactions related to chemotherapy.Patients with better PS score after first-line treatment can obtain longer survival period after maintenance treatment.

Corticotroph tumors (CTs) are classified into functional CTs and silent CTs (SCTs)according to presence or absence of Cushing's disease manifestations. The pathological manifestations of functional CTs and SCTs are consistent, and both adrenocorticotrophic hormone (ACTH) and T-box transcription factor TBX19 expressions are seen by immunohistochemistry. SCTs have normal peripheral blood ACTH levels, without Cushing's disease manifestations; and SCTs exhibit invasive growth with high recurrence rate. Some studies have suggested that the biochemical silencing mechanism of SCTs involves pro-opiomelanocortin ( POMC, ACTH precursor) gene expression and ACTH secretion. In this paper, the biochemical silencing mechanism of SCTs will be reviewed from aspects of physiological synthesis and regulation of ACTH in normal adenohypophysial cells, and transcription, post-transcriptional regulation, and post-translational regulation of POMC gene, and ACTH abnormal secretion in SCTs.

Sepsis is a life-threatening multiple organ dysfunction disease with high mortality and has become leading causes of death affecting intensive care unit (ICU) patients. Both long non-coding RNA (lncRNA) and microRNA (miRNA) are involved in the pathophysiological process of sepsis and can regulate the inflammatory response, both of which could be used as important diagnostic indicators and therapeutic targets of sepsis. The interaction among lncRNA, miRNA and messenger RNA (mRNA) plays an important role in sepsis and multiple organ dysfunction. This paper reviewed the regulatory relationship of lncRNA, miRNA and mRNA, as well as the regulatory role of lncRNA-miRNA-mRNA axis in inflammatory immune response and multiple organ dysfunction syndrome in sepsis, to provide new targets and strategies for the treatment of sepsis and organ dysfunction.

Lung cancer is one of the malignant tumors with serious health consequences for people all over the world.Non small-cell lung cancer(NSCLC)is the most common type of lung cancer,making up 80％ to 85％ of all cases.As a result of low rates of early detection,more than 70％ of patients,many of them elderly patients,are in late stages(Ⅲ-Ⅳ)at the time of diagnosis,and cannot be effectively treated with surgery.First line chemotherapy is the most common and critical treatment for patients with advanced or recurrent lung cancer.Elderly patients show decreased tolerance for side effects and toxicities of chemotherapy agents because of low basic metabolic rates and functional decline of major organs.Therefore,first-line chemotherapy strategies for elderly patients with NSCLC need further investigation.

Venous thromboembolism(VTE)is one of the common and serious complications of malignant tumors.In elderly lung cancer patients, problems such as decreased autonomic activity, bed rest, poor performance status(PS), combined underlying diseases and the use of chemoradiotherapy are often considered as risk factors for high incidence of VTE.This article is aimed to review the clinical features and pathogenesis of lung cancer in the elderly combined with VTE, to investigate the risk factors and explore feasible evaluation and prevention strategies.