The management of non-small cell lung cancer is rapidly advancing toward precision and individualized care. The National Comprehensive Cancer Network (NCCN) has recently released the 2026 version 1, 2, and 3 updates of the NCCN Clinical Practice Guidelines in Oncology: Non-Small Cell Lung Cancer. These updated guidelines introduce significant revisions in several core areas, including the adoption of the AJCC 9th Edition TNM Staging System, optimization of recommendations for lung cancer screening and mediastinal staging, updates on perioperative immunotherapy and targeted therapy strategies, and the inclusion of emerging biomarkers such as neuregulin 1 (NRG1) fusions and mesenchymal-epithelial transition factor (MET) protein overexpression. This article provides a systematic interpretation of these key updates and focuses on integrating international guidelines with clinical practice in China. Specifically, considering the high prevalence of epidermal growth factor receptor (EGFR) mutations in the Chinese population, it analyzes the first-line positioning of osimertinib- and lazertinib-based combination regimens and evaluates the clinical value of domestic third-generation tyrosine kinase inhibitors. In response to the NCCN's cautious stance on “conversion therapy” for initially unresectable disease, the article elaborates on China’s exploratory efforts and the evolving evidence base for conversion strategies utilizing programmed death receptor 1 (PD-1) inhibitors (e.g., tislelizumab, toripalimab). Furthermore, it clarifies the “dual-track” diagnostic approach distinguishing MET pathway mutations from protein overexpression. Aimed at aligning with China’s clinical context, this review seeks to offer clinicians a practical reference that synthesizes cutting-edge international perspectives with local applicability.

To address the growing challenge of an increasing number of elderly lung cancer patients amidst China's aging population and to fill the gap in quality control standards for surgical treatment in this special population, this study aimed to develop a standardized surgical evaluation system for elderly lung cancer patients tailored to China's national conditions. The system was established through a literature review, integrated the pathophysiological characteristics of elderly patients, and was constructed following review, feedback, and revision by experts from multiple thoracic surgery centers. Employing a 100-point scoring system, it comprises three primary domains: physical infrastructure and geriatric adaptability foundational conditions (10 points); management level and perioperative care models (20 points); and technical proficiency and clinical outcomes (70 points). The system places a strong emphasis on geriatric adaptability, proposing specific, quantifiable indicators for age-friendly facility modifications, control of elderly-specific complications, multidisciplinary collaboration, and standardized perioperative management. It provides a convenient and measurable assessment tool for quality control in the surgical treatment of elderly lung cancer in China, which is expected to promote the standardization and homogenization of diagnosis and treatment.

Vascular cognitive impairment(VCI)is a syndrome of cognitive decline attributed to vascular risk factors and cerebrovascular diseases.A range of pathophysiological processes induced by vascular injury,including inflammation,oxidative stress,cell death,disruption of the blood-brain barrier,and synaptic damage are intricately linked to the development of VCI.Nuclear factor E2-related factor 2(Nrf2),encoded by the NFE2L2 gene,is a potent transcription factor that plays a critical role in antioxidant defense.Extensive research has demonstrated that Nrf2 mitigates oxidative stress and inflammation by upregulating the expression of antioxidant response elements,thereby reducing the production of reactive oxygen species.Nrf2 also modulates programmed cell death,enhances blood-brain barrier integrity,and promotes synaptic plasticity,ultimately delaying the progression of VCI.This review examines the role of Nrf2 in VCI and highlights recent research on traditional Chinese medicines targeting Nrf2 for the prevention and treatment of VCI,thus providing novel insights and approaches for managing this condition.

Vascular cognitive impairment(VCI)is a syndrome of cognitive decline attributed to vascular risk factors and cerebrovascular diseases.A range of pathophysiological processes induced by vascular injury,including inflammation,oxidative stress,cell death,disruption of the blood-brain barrier,and synaptic damage are intricately linked to the development of VCI.Nuclear factor E2-related factor 2(Nrf2),encoded by the NFE2L2 gene,is a potent transcription factor that plays a critical role in antioxidant defense.Extensive research has demonstrated that Nrf2 mitigates oxidative stress and inflammation by upregulating the expression of antioxidant response elements,thereby reducing the production of reactive oxygen species.Nrf2 also modulates programmed cell death,enhances blood-brain barrier integrity,and promotes synaptic plasticity,ultimately delaying the progression of VCI.This review examines the role of Nrf2 in VCI and highlights recent research on traditional Chinese medicines targeting Nrf2 for the prevention and treatment of VCI,thus providing novel insights and approaches for managing this condition.

ObjectiveTo observe the effectiveness and safety of modified Taohong Siwu Decoction （桃红四物汤） for patients of chronic heart failure with lower limb deep vein thrombosis in the chronic stage of blood stasis syndrome. MethodsA total of 120 patients of chronic heart failure with lower limb deep vein thrombosis in chronic stage of blood stasis syndrome were randomly divided into 60 cases each in control group and observation group. Both groups were given basic treatment of western medicine， and the observation group was additionally given modified Taohong Siwu Decoction （桃红四物汤） for oral administration， one dose per day. The treatment course for both groups lasted for 4 weeks. The total effective rate and the incidence of adverse reactions were compared between the two groups after treatment. Cardiac function indexes including left ventricular ejection fraction （LVEF）， and left ventricular end-systolic internal diameter （LVESd）， left ventricular end-diastolic internal diameter （LVEDd）， serological indexes including N-terminal natriuretic natriuretic peptide precursor （NT-proBNP）， high sensitivity C-reactive protein （hs-CRP） and vascular endothelial growth factor （VEGF）， score of traditional Chinese medicine （TCM） symptom including chest pain， swelling of the affected limb， fixed tenderness， and bruising， haemodynamics indicators including high cut whole blood viscosity， low cut whole blood viscosity， and erythrocyte pressure， and coagulation indices including activated partial thromboplastin time （APTT）， plasminogen time （PT）， and fibrinogen （FIB） levels were compared before and after treatment. ResultsDuring the study， 3 cases were excluded and 2 cases lost follow-up in the observation group， while 2 cases were excluded and 3 cases lost follow-up in the control group. A total of 110 patients completed the trial， 55 cases in each of the two groups. The total effective rate in the observation group was 92.73% （51/55）， which was significantly higher than that of the control group， 78.18% （43/55， P＜0.05）. Compared within group before treatment， LVEF， APTT and PT levels increased， LVESd， LVEDd， NT-proBNP， hs-CRP， VEGF， high cut whole blood viscosity， low cut whole blood viscosity， erythrocyte pressure volume and FIB levels decreased， chest pain， swelling of the affected limbs， stationary pressure pain and bruising score decreased in both groups after treatment， and the improvement of all above indexes was better in the observation group than that in control group （P＜0.05 or P＜0.01）. The incidence of adverse reactions was 7.27% （4/55） in the observation group and 21.82% （12/55） in the control group， and the incidence of adverse reactions in the observation group was significantly lower than that in the control group （P＜0.05）. ConclusionModified Taohong Siwu Decoction （桃红四物汤） as adjuvant treatment for patients of chronic heart failure with lower limb deep vein thrombosis in the chronic stage of blood stasis syndrome showed better clinical effectiveness when compared with western basic treatment， which can improve the clinical symptoms， cardiac function， haemodynamics， and coagulation， with good safety.

Objective To compare the clinical efficacy between liposuction combined with circumareolar small incision and three-port endoscopic surgery for the treatment of Simon Ⅱ gynecomastia (GYN). Methods Comparative case data of 120 patients with GYN were retrospectively analyzed, 61 patients in the open group underwent circumareolar small incision mastectomy after liposuction, and 59 patients in the endoscopic group underwent three-port endoscopic mastectomy after liposuction. The two groups were compared in terms of surgery-related indexes, occurrence of postoperative complications and patient satisfaction. Results The unilateral operation time of the open group was shorter than that of the endoscopic group, the unilateral gland resection weight in the open group was more than that in the endoscopic group, the hospitalization cost of the open group was less than that of the endoscopic group (all P<0.01). There was no significant difference in unilateral liposuction volume, drainage volume on the first postoperative day, and time to drain removal between the two groups (P>0.05). The incidence of complications in the open group and the endoscopic group were 8.2% and 13.6% respectively, and there was no significant difference between the two groups (P>0.05). The difference in the overall satisfaction scores between the two groups was not statistically significant (P>0.05). Conclusions Liposuction combined with circumareolar small incision or three-port endoscopic surgery both has good cosmetic effects in the treatment of Simon Ⅱ GYN. The operation with circumareolar small incision is simple, has a shorter operation time, costs less, and does not require special equipment, which is suitable for promotion and application in medical institutions.

BACKGROUND: Lung cancer is currently the most prevalent malignancy and the leading cause of cancer deaths worldwide. Although the early stage non-small cell lung cancer (NSCLC) presents a relatively good prognosis, a considerable number of lung cancer cases are still detected and diagnosed at locally advanced or late stages. Surgical treatment combined with perioperative multimodality treatment is the mainstay of treatment for locally advanced NSCLC and has been shown to improve patient survival. Following the standard methods of neoadjuvant therapy, perioperative management, postoperative adjuvant therapy, and other therapeutic strategies are important for improving patients' prognosis and quality of life. However, controversies remain over the perioperative management of NSCLC and presently consensus and standardized guidelines are lacking for addressing critical clinical issues in multimodality treatment. METHODS: The working group consisted of 125 multidisciplinary experts from thoracic surgery, medical oncology, radiotherapy, epidemiology, and psychology. This guideline was developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. The clinical questions were collected and selected based on preliminary open-ended questionnaires and subsequent discussions during the Guideline Working Group meetings. PubMed, Web of Science, Cochrane Library, Scopus, and China National Knowledge Infrastructure (CNKI) were searched for available evidence. The GRADE system was used to evaluate the quality of evidence and grade the strengths of recommendations. Finally, the recommendations were developed through a structured consensus-building process. RESULTS: The Guideline Development Group initially collected a total of 62 important clinical questions. After a series of consensus-building conferences, 24 clinical questions were identified and corresponding recommendations were ultimately developed, focusing on neoadjuvant therapy, perioperative management, adjuvant therapy, postoperative psychological rehabilitation, prognosis assement, and follow-up protocols for NSCLC. CONCLUSIONS This guideline puts forward reasonable recommendations focusing on neoadjuvant therapy, perioperative management, adjuvant therapy, postoperative psychological rehabilitation, prognosis assessment, and follow-up protocol of NSCLC. It standardizes perioperative multimodality treatment and provides guidance for clinical practice among thoracic surgeons, medical oncologists, and radiotherapists, aiming to reduce postoperative recurrence, improve patient survival, accelerate recovery, and minimize postoperative complications such as atelectasis.
Humans ; Carcinoma, Non-Small-Cell Lung/therapy* ; Lung Neoplasms/therapy* ; Combined Modality Therapy ; Perioperative Care

Objective:To analyze the correlation between the recovery of postoperative function of hip joint in patient underwent total hip arthroplasty(THA)and anatomical parameters of femur under computed tomography(CT)three-dimensional(3D)reconstruction.Methods:From January 2022 to October 2024,a total of 120 THA patients were treated at the 904th Hospital of People's Liberation Army Joint Service Support Force were selected.At the third month post-surgery,the Harris Hip Score(HHS)system was used to assess the recovery of the function of hip joint of THA patients,and they were divided into favorable recovery group(72 cases,HHS score≥80)and poor recovery group(48 cases,HHS score<80).The femoral offset(FO),collodiaphyseal angle(CDA),and femoral neck anteversion(FNA)in anatomical parameters of femur under CT CD reconstruction for patients of two groups after surgery were measured and compared.The correlation between each parameter and the recovery of postoperative function of hip joint in THA patients was analyzed.The receiver operating characteristic(ROC)curve was plotted to analyze the assessment value of each parameter for the recovery of the function of hip joints in THA patients.Results:In the follow-up at the third month,120 patients were assessed by using the HHS scoring system.The recovery of 72 patients(60.00%)was favorable,with an average HHS score of 84.45±5.19.The recovery of 48 patients(40.00%)was poor,with an average HHS score of 73.31±4.78.Postoperative CDA and FO scores were higher than preoperative values,while FNA scores were lower than preoperative value in 120 patients.After surgery,the CDA and FO scores of favorable recovery group were lower than those of poor recovery group,and FNA was higher than that of favorable group,and the differences between the two groups were statistically significant(t=7.938,9.574,10.391,P<0.05).Pearson correlation coefficient test showed that postoperative function(HHS score)of hip joint negatively correlated with FNA in THA patients(r=-0.511,P<0.05),and it positively correlated with CDA and FO(r=0.408,0.359,P<0.05).ROC curve analysis indicated that the area under curve(AUC)values of ROC curves of single CDA,FO,FNA and the combined detection of them were respectively 0.761,0.855,and 0.827 in assessing the poor recovery of the function of hip joint,which had a certain of assessment values.The combined detection can improve the diagnostic value.Conclusion:The postoperative recovery of the function of hip joint of THA patients relates to CDA,FO and FNA parameters,and the single and combined detections of each parameter all have a certain of assessment value for the poor recovery of joints'function of patients.

Objective To observe the effect of sevoflurane(SEV)on the expression of myocardial biological clock gene aromatic hydrocarbon receptor nuclear transport-like protein 1(BMAL1)in diabetic rats and to explore its changes.Methods Sixty healthy male SD rats with a body mass of 200-250 g were divided into oxygen inhalation group(NC)and sevoflurane inhalation group(SEV).The diabetic model was routinely replicated,and the model was divided into oxygen group(DM)and sevoflurane group(DM+SEV)with an inhalation time of 5 h(n=15).Four groups of experimental animals were executed at 0,12 and 24 h after the anesthesia was stopped and then myocardial tissue was isolated.Western blot was used to determine the expression level of biological clock gene BMAL1 protein and its activation enzyme USP9X;HE staining microspy to observe the pathological changes of my-ocardial tissue and immuno-fluorescence co-localization to observe the relationship between USP9X and BMAL1.Results At 0 and 12 h after stopping anesthesia,the expression of BMAL1 and USP9X in the DM+SEV group was significantly down-regulated as compared with the DM group,and the expression of BMAL1 and USP9X in the DM+SEV group was significantly down-regulated(P<0.05)at 24 h after stopping anesthesia(P>0.05).HE staining microscopy found changes of myocardial tissue structure in the DM+SEV group at 0 and 12 hrs after stopping anes-thesia.This change was most significant at 0 h after stopping anesthesia,but the myocardial tissue structure was neatly arranged at 24 h.The results of immuno-fluorescence colocalization showed that USP9X and BMAL1 proteins were mainly distributed in the cytoplasm of cardio-myocardium with and overlapping parts between them.Under the influence of sevoflurane,there was less overlap between the two at 0 and 12 hrs after stopping anesthesia and more overlap between the two at 24 h,which was close to that of the DM group.Conclusions Sevoflurane reversibly changes the expression of myocardial circadian clock gene BMAL1 in diabetic rats and this change still existe for 12 h after stopping anesthesia,then significantly fade away 24 hrs after stopping anesthesia.

Azvudine and nirmatrelvir/ritonavir (Paxlovid) are recommended for COVID-19 treatment in China, but their safety and efficacy in the elderly population are not fully known. In this multicenter, retrospective, cohort study, we identified 5131 elderly hospitalized COVID-19 patients from 32,864 COVID-19 patients admitted to nine hospitals in Henan Province, China, from December 5, 2022, to January 31, 2023. The primary outcome was all-cause death, and the secondary outcome was composite disease progression. Propensity score matching (PSM) was performed to control for confounding factors, including demographics, vaccination status, comorbidities, and laboratory tests. After 2:1 PSM, 1786 elderly patients receiving azvudine and 893 elderly patients receiving Paxlovid were included. Kaplan-Meier and Cox regression analyses revealed that compared with Paxlovid group, azvudine could significantly reduce the risk of all-cause death (log-rank P = 0.002; HR: 0.71, 95% CI: 0.573-0.883, P = 0.002), but there was no difference in composite disease progression (log-rank P = 0.52; HR: 1.05, 95% CI: 0.877-1.260, P = 0.588). Four sensitivity analyses verified the robustness of above results. Subgroup analysis suggested that a greater benefit of azvudine over Paxlovid was observed in elderly patients with primary malignant tumors (P for interaction = 0.005, HR: 0.32, 95% CI: 0.18-0.57) compared to patients without primary malignant tumors. Safety analysis revealed that azvudine treatment had a lower incidence of adverse events and higher lymphocyte levels than Paxlovid treatment. In conclusion, azvudine treatment is not inferior to Paxlovid treatment in terms of all-cause death, composite disease progression and adverse events in elderly hospitalized COVID-19 patients.