With the accelerating trend of population aging, the number of elderly patients with lung cancer continues to rise, and the disease burden is becoming increasingly heavy. The clinical management of these patients faces severe challenges due to their decreased physiological reserve, complex comorbidities, and significant individual heterogeneity. Consequently, under traditional diagnosis and treatment models, doctors often struggle to identify the individualized risks of elderly patients in a timely and comprehensive manner, which can easily lead to decision biases such as undertreatment or overtreatment. In view of this, this study advocates for the establishment of an umbrella decision-making model specifically tailored for elderly lung cancer patients. Grounded in a multidisciplinary team (MDT) platform, this model deeply integrates oncological indicators with the comprehensive geriatric assessment (CGA) system. By holistically considering multidimensional variables including tumor burden, organ function, frailty index, cognitive status, and social support, the model establishes an operational mechanism characterized by "single entry, precise stratification, and targeted selection". Accordingly, patients can be scientifically triaged into distinct intervention tiers, such as active surveillance, minimally invasive surgery, drug therapy, radiotherapy, and best supportive care, thereby achieving real-time alignment between treatment intensity and patient fitness. This article elaborates on the construction logic and key operational procedures of this novel decision-making framework, aiming to guide clinical practice beyond the limitations of a tumor-centric perspective toward a holistic, dynamic, whole-course management strategy. This transition seeks to ensure optimal quality of life and clinical net benefit for elderly patients alongside survival prolongation.

Objective:To evaluate the value of a combined model based on primary lesion 18F-fluorodeoxyglucose ( 18F-FDG) PET/CT radiomics for predicting lymph node metastasis in non-small cell lung cancer (NSCLC) . Methods:A retrospective analysis was conducted on the clinical data of 203 NSCLC patients who underwent pre-treatment PET/CT imaging at Nanjing Drum Tower Hospital from June 2013 to July 2023. Patients were randomly assigned to the training set ( n=142) and the validation set ( n=61) at a ratio of 7∶3. A predictive model was developed in the training set, and its predictive performance and clinical application value were assessed in both the training and validation sets. Traditional PET/CT parameters and PET/CT radiomics features of the primary lesion were obtained by 3D-slicer software. Least absolute shrinkage and selection operator (LASSO), random forest, and extreme gradient boosting were performed to extract features. Support vector machine was used to construct a radiomics score (Radscore). Univariate and multivariate logistic regression analysis was used to predict the influencing factors of lymph node metastasis in NSCLC patients and to establish models. Predictive performance of the models was evaluated by receiver operator characteristic (ROC) curves and clinical application value was assessed by calibration curves and decision curve analysis (DCA) . Results:Among 203 NSCLC patients, 116 had lymph node metastasis, with 64 cases in the training set and 52 cases in the validation set. Three complementary classical machine learning methods were used for feature screening, and finally 10 radiomics features were obtained. The optimal threshold for Radscore-PET was 0.43 and the optimal threshold for Radscore-CT was 0.39. Univariate analysis showed that, sex ( OR=0.48, 95% CI: 0.24-0.95, P=0.036), tumor marker levels ( OR=3.81, 95% CI: 1.84-7.91, P<0.001), long diameter of tumor ( OR=2.56, 95% CI: 1.27-5.16, P=0.009), short diameter of tumor ( OR=3.73, 95% CI: 1.75-7.92, P=0.001), vacuolar sign ( OR=0.32, 95% CI: 0.12-0.86, P=0.024), ring-like metabolism ( OR=3.67, 95% CI: 1.33-10.13, P=0.012), maximum standardized uptake value (SUV max) ( OR=6.57, 95% CI: 3.03-14.25, P<0.001), metabolic tumor volume (MTV) ( OR=2.91, 95% CI: 1.43-5.92, P=0.003), total lesion glycolysis (TLG) ( OR=4.23, 95% CI: 2.08-8.59, P<0.001), Radscore-PET ( OR=21.93, 95% CI: 9.04-53.20, P<0.001) and Radscore-CT ( OR=13.72, 95% CI: 6.12-30.76, P<0.001) were all influencing factors for predicting lymph node metastasis in NSCLC patients. Multivariate analysis showed that, tumor marker levels ( OR=2.55, 95% CI: 1.11-5.90, P=0.028), vacuolar sign ( OR=0.26, 95% CI: 0.08-0.83, P=0.023), SUV max ( OR=5.94, 95% CI: 1.99-17.75, P=0.001), Radscore-PET ( OR=25.51, 95% CI: 5.92-110.22, P<0.001), and Radscore-CT ( OR=8.68, 95% CI: 2.73-27.61, P<0.001) were independent influencing factors for predicting lymph node metastasis in patients with NSCLC. Based on the above independent influencing factors, models were constructed: the traditional model (tumor marker levels, vacuolar sign, SUV max), the PET model (SUV max, Radscore-PET), the CT model (vacuolar sign, Radscore-CT), and the combined model (tumor marker levels, vacuolar sign, SUV max, Radscore-PET, Radscore-CT). ROC curve analysis showed that, the area under curve (AUC) of the traditional, PET, CT, and combined models in the training set were 0.75 (95% CI: 0.67-0.82), 0.90 (95% CI: 0.84-0.95), 0.85 (95% CI: 0.78-0.90), and 0.94 (95% CI: 0.88-0.97), respectively. The predictive value of the combined model was higher than that of the traditional model ( Z=5.01, P<0.001), the PET model ( Z=1.99, P=0.047), and the CT model ( Z=3.25, P=0.001). In the validation set, the AUCs for the traditional model, PET model, CT model, and combined model were 0.65 (95% CI: 0.52-0.77), 0.86 (95% CI: 0.74-0.93), 0.85 (95% CI: 0.73-0.93), and 0.90 (95% CI: 0.80-0.96), respectively. The predictive value of the combined model was superior to that of the traditional model ( Z=3.23, P=0.001). The sensitivity and specificity of the combined model in the training set were 84.37% and 91.03%, while in the validation set, the sensitivity and specificity were 82.61% and 94.74%, respectively. Calibration curves showed a good agreement between the predicted and actual probabilities in both the training and validation sets. DCA showed that the combined models had good discriminative ability in both the training and validation sets. Conclusions:Tumor marker levels, vacuolar sign, SUV max, Radscore-PET, and Radscore-CT are all independent influencing factors for predicting lymph node metastasis in patients with NSCLC. The combined model based on these factors demonstrates excellent predictive performance and clinical application value for predicting lymph node metastasis in NSCLC.

Objective:To explore the potential risk factors for cancer in patients with adenomatous polyps based on tumor markers and polyp lesion characteristics.Methods:A retrospective analysis was conducted to collect clinical data of 115 patients with adenomatous intestinal polyps who visited Nanjing Jiangbei Hospital from November 2022 to November 2024. They were divided into a cancerous group (17 cases) and a non cancerous group (98 cases) based on whether they were cancerous or not. Clinical data such as tissue type and polyp site and tumor marker levels such as carcinoembryonic antigen (CEA) and cancer antigen 72-4 (CA72-4) were collected at the first visit of all patients. The potential risk factors of adenomatous intestinal polyp canceration were investigated by Logistic regression analysis.Results:Univariate analysis revealed that the proportion of villous tubular adenomas, central depression of polyps, and lobulated polyps in the cancerous group were higher than those in the non cancerous group. Serum levels of CEA and CA72-4 were also higher in the cancerous group than in the non cancerous group : 13/17 vs.47.96% (47/98), 7/17 vs. 15.31% (15/98), 6/17 vs. 8.16% (8/98), (6.41 ± 1.81) μg/L vs. (4.23 ± 1.48) μg/L, (6.98 ± 1.83) kU/L vs. (5.66 ± 1.78) kU/L, respectively. The difference was statistically significant ( P<0.05). The results of Logistic regression analysis showed that the histological subtype of villous tubular adenoma, central depression of polyps, lobulated polyps, and high levels of CEA and CA72-4 were independent risk factors for cancer in patients with adenomatous intestinal polyps ( P<0.05). A nomogram risk model was constructed based on the influencing factors of canceration in patients with adenomatous intestinal polyps. The calibration curve was drawn, and the calibration curve was similar to the Y-X straight line, suggesting that the evaluation results of the nomogram risk model were highly consistent with the actual observation results. The receiver operating characteristic (ROC) curve was drawn. The results showed that the area under the curve (AUC) of the nomogram risk model for evaluating the canceration of patients with adenomatous intestinal polyps was 0.956, and the evaluation value was high. The decision curve was drawn, with the threshold of high risk as the horizontal coordinate and the net rate of return as the vertical coordinate. The results showed that when the threshold was in the range of 0 - 0.85, 0.96 - 0.99, the net benefit rate of predicting the cancer risk of patients with adenomatous intestinal polyps was greater than 0 and the maximum net benefit rate was 0.148. Conclusions:The histological classification of villous tubular adenoma, central depression of polyps, lobulated polyps, and high levels of CEA and CA72-4 are independent risk factors for cancer in patients with adenomatous intestinal polyps; The evaluation efficiency of the column chart risk model constructed based on the above factors is good.

Objective:To explore the potential risk factors for cancer in patients with adenomatous polyps based on tumor markers and polyp lesion characteristics.Methods:A retrospective analysis was conducted to collect clinical data of 115 patients with adenomatous intestinal polyps who visited Nanjing Jiangbei Hospital from November 2022 to November 2024. They were divided into a cancerous group (17 cases) and a non cancerous group (98 cases) based on whether they were cancerous or not. Clinical data such as tissue type and polyp site and tumor marker levels such as carcinoembryonic antigen (CEA) and cancer antigen 72-4 (CA72-4) were collected at the first visit of all patients. The potential risk factors of adenomatous intestinal polyp canceration were investigated by Logistic regression analysis.Results:Univariate analysis revealed that the proportion of villous tubular adenomas, central depression of polyps, and lobulated polyps in the cancerous group were higher than those in the non cancerous group. Serum levels of CEA and CA72-4 were also higher in the cancerous group than in the non cancerous group : 13/17 vs.47.96% (47/98), 7/17 vs. 15.31% (15/98), 6/17 vs. 8.16% (8/98), (6.41 ± 1.81) μg/L vs. (4.23 ± 1.48) μg/L, (6.98 ± 1.83) kU/L vs. (5.66 ± 1.78) kU/L, respectively. The difference was statistically significant ( P<0.05). The results of Logistic regression analysis showed that the histological subtype of villous tubular adenoma, central depression of polyps, lobulated polyps, and high levels of CEA and CA72-4 were independent risk factors for cancer in patients with adenomatous intestinal polyps ( P<0.05). A nomogram risk model was constructed based on the influencing factors of canceration in patients with adenomatous intestinal polyps. The calibration curve was drawn, and the calibration curve was similar to the Y-X straight line, suggesting that the evaluation results of the nomogram risk model were highly consistent with the actual observation results. The receiver operating characteristic (ROC) curve was drawn. The results showed that the area under the curve (AUC) of the nomogram risk model for evaluating the canceration of patients with adenomatous intestinal polyps was 0.956, and the evaluation value was high. The decision curve was drawn, with the threshold of high risk as the horizontal coordinate and the net rate of return as the vertical coordinate. The results showed that when the threshold was in the range of 0 - 0.85, 0.96 - 0.99, the net benefit rate of predicting the cancer risk of patients with adenomatous intestinal polyps was greater than 0 and the maximum net benefit rate was 0.148. Conclusions:The histological classification of villous tubular adenoma, central depression of polyps, lobulated polyps, and high levels of CEA and CA72-4 are independent risk factors for cancer in patients with adenomatous intestinal polyps; The evaluation efficiency of the column chart risk model constructed based on the above factors is good.

Objective To analyze the status of influenza A and B virus infection in patients admitted to Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine from 2022 to 2023,and to provide scientific basis for the adjustment of influenza prevention and control measures in this area.Methods The positive status of influenza A and B virus antigen and nucleic acid were analyzed to deter-mine the prevalence and dominant types of influenza in 2022-2023.The peak of influenza A virus infection in 2023 was analyzed by antigen detection and nucleic acid detection,and the positive rates of influenza A virus detection in patients with different genders and ages were compared.Results In 2022 and 2023,the majority of patients were infected with influenza A virus.There was no significant difference in the positive rate of in-fluenza A virus antigen and nucleic acid detection between male and female patients(P＞0.05).The positive rates of influenza A virus antigen and nucleic acid detection in patients of different ages were statistically sig-nificant(P＜0.05).Compared with other age range,the positive rate of influenza A virus antigen and nucleic acid detection was the highest in patients＞5-10 years old.From February to December 2023,the positive rate of influenza A virus nucleic acid detection(50.91％)was significantly higher than that of influenza A vi-rus antigen detection(28.73％),and the difference was statistically significant(P＜0.05).Conclusion There is no influenza virus infection peak in 2022,and there are two influenza A virus infection peaks in 2023.The positive rates of influenza A virus antigen and nucleic acid detection are different due to different detection methods.

Background:Patients with functional gastrointestinal disorders(FGIDs)often experience stigma related to symptom attribution and psychological interventions.Treatment as usual,including the use of neuromodulators,has shown limited effectiveness.Therefore,there is an urgent need for a comprehensive and individualized psychosomatic approach to effectively manage FGIDs in clinical practice.Aims:To evaluate whether the psychosomatic model of gastroenterology provide superior outcomes in FGIDs management compared with treatment as usual.Methods:A total of 165 FGIDs patients who attended the Department of Gastroenterology at the Third Affiliated Hospital of Soochow University from May 2024 to July 2024 were enrolled and randomly assigned to the treatment as usual group and the psychosomatic gastroenterology treatment group.Patients in treatment as usual group received lifestyle modifications and pharmacotherapy,including neuromodulators,while those in psychosomatic gastroenterology group received the symptom-oriented stepped reattribution model in addition to treatment as usual.After a 4-week intervention,treatment efficacy was assessed based on patient-reported outcomes.Neuromodulators adherence and overall clinical efficacy were compared between the two groups.Results:After 4 weeks of intervention,the effectiveness rates were 51.2％in the treatment as usual group and 85.0％in the psychosomatic gastroenterology group(P＜0.001).Neuromodulators adherence rates were 38.5％in the treatment as usual group and 85.4％in the psychosomatic gastroenterology group(P＜0.001).Patients in the psychosomatic gastroenterology group showed significantly lower scores on the GAD-7,PHQ-9,PHQ-15,and GCBI scales and higher scores on the GIQLI scale compared to the treatment as usual group(all P＜0.05).Conclusions:The psychosomatic model of gastroenterology significantly improves the neuromodulators adherence and the overall clinical efficacy in FGIDs patients compared with treatment as usual.

Objective:To establish the gastrointestinal cognition behavior index(GCBI) scale and conduct a preliminary clinical study, to provide a scientific tool for assessing gastrointestinal related cognition and behavior among Chinese residents.Methods:The initial GCBI scale was formed through literature review and experts′ evaluation. From January 1 to December 31, 2022, 323 healthy participants who received medical treatment or check-ups at the First People′s Hospital of Changzhou were selected by convenient sampling method for the initial GCBI scale. A total of 307 valid scales of GCBI were collected, and 98 of them were selected by convenient sampling method for the gastrointestinal quality of life index (GIQLI) scale test. A total of 50 participants of 307 were selected by random number table method for retesting the initial GCBI scale after 2 weeks. The principal component analysis was used for factor extraction to established the formal GCBI scale. From March 1 to May 31, 2023, at the First People′s Hospital of Changzhou, 40 patients with functional gastrointestinal disorder(FGID, FGID group) and 40 healthy individuals (healthy control group) were selected by convenient sampling method for formal GCBI scale test. Pearson correlation analysis and Cronbach′s α coefficient were used to evaluate the criterion validity and reliability of the scale. Rank-sum test was used to compare the total GCBI scale scores and factor scores between the FGID group and the healthy control group. Results:The results of principal component analysis showed that 2 factors and 7 items were finally extracted to establish the formal GCBI scale. The cumulative contribution rate of factor 1 and factor 2 was 84.30%, and the factor load values ranged from 0.721 to 0.913. Pearson correlation analysis showed that the total score of GCBI scale and each factor were negatively correlated with the total score and each factor of GIQLI scale (all P<0.001).The Cronbach′s α coefficient of the total GCBI scale, factor 1, and factor 2 were 0.90, 0.87, and 0.91, respectively. The test-retest reliability correlation coefficient r were 0.98, 0.97, and 0.99 (all P<0.001). The total score of GCBI scale, factor 1 and factor 2 scores of FGID group were all higher than those of the healthy control group(10.00(7.25, 13.25) vs. 2.00(0.25, 3.00), 5.00(3.25, 8.00) vs. 0.50(0, 2.00), 5.00(3.00, 6.00) vs. 0.50(0, 2.00)), and the differences were statistically significant( Z=7.42, 6.82 and 7.04, all P<0.001). Conclusion:The GCBI scale established in this study has good reliability and validity, and is suitable for evaluating the gastrointestinal-related cognition and behavior, and it is helpful for the diagnosis of FGID.

Background:Patients with functional gastrointestinal disorders(FGIDs)often experience stigma related to symptom attribution and psychological interventions.Treatment as usual,including the use of neuromodulators,has shown limited effectiveness.Therefore,there is an urgent need for a comprehensive and individualized psychosomatic approach to effectively manage FGIDs in clinical practice.Aims:To evaluate whether the psychosomatic model of gastroenterology provide superior outcomes in FGIDs management compared with treatment as usual.Methods:A total of 165 FGIDs patients who attended the Department of Gastroenterology at the Third Affiliated Hospital of Soochow University from May 2024 to July 2024 were enrolled and randomly assigned to the treatment as usual group and the psychosomatic gastroenterology treatment group.Patients in treatment as usual group received lifestyle modifications and pharmacotherapy,including neuromodulators,while those in psychosomatic gastroenterology group received the symptom-oriented stepped reattribution model in addition to treatment as usual.After a 4-week intervention,treatment efficacy was assessed based on patient-reported outcomes.Neuromodulators adherence and overall clinical efficacy were compared between the two groups.Results:After 4 weeks of intervention,the effectiveness rates were 51.2％in the treatment as usual group and 85.0％in the psychosomatic gastroenterology group(P＜0.001).Neuromodulators adherence rates were 38.5％in the treatment as usual group and 85.4％in the psychosomatic gastroenterology group(P＜0.001).Patients in the psychosomatic gastroenterology group showed significantly lower scores on the GAD-7,PHQ-9,PHQ-15,and GCBI scales and higher scores on the GIQLI scale compared to the treatment as usual group(all P＜0.05).Conclusions:The psychosomatic model of gastroenterology significantly improves the neuromodulators adherence and the overall clinical efficacy in FGIDs patients compared with treatment as usual.

Objective:To investigate the correlation between the expression level of serum exosome miR-29C and postoperative cognitive dysfunction (POCD) in elderly patients undergoing surgery.Methods:A total of 119 elderly patients who underwent elective spinal surgery in the Second Hospital of Shanxi Medical University from January 2021 to January 2022 were selected and scored on the Montreal Cognitive Assessment (MoCA) Scale 1 day before surgery and 1, 7 and 21 days after surgery. The selected patients were divided into POCD group (51 cases) and non-POCD group (68 cases) according to whether the MoCA Scale score decreased ≥2 points 1 day before surgery and 1 day after surgery. S100-β, neuron-specific enolase (NSE) levels and serum exosome miR-29C expression levels were detected and analyzed in all patients 1 day before and 1 day after surgery. Pearson correlation analysis showed the correlation between MoCA Scale score and S100-β, NSE and miR-29C. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of S100-β, NSE and miR-29C for POCD occurrence in elderly patients undergoing surgery.Results:The score of MoCA Scale in POCD group were significantly decreased 1, 7 and 21 days after surgery compared with 1 day before surgery (all P<0.05), while the score of MoCA Scale in non-POCD group were significantly decreased only 1 day after surgery compared with 1 day before surgery ( P<0.05). The levels of S100-β and NSE and the expression level of serum exosome miR-29C in 2 groups were significantly increased 1 day after surgery compared with 1 day before surgery (all P<0.05). Moreover, the levels of S100-β and NSE and the expression level of serum exosome miR-29C in POCD group were significantly higher than those in non-POCD group 1 day after surgery (all P<0.05). There was a negative correlation between the MoCA Scale score and the expression level of serum exosome miR-29C 1 day after surgery in the POCD group ( P<0.05). ROC curve analysis showed that the expression levels of NSE, S100-β and exosome miR-29C 1 day after surgery predicted the risk of POCD in elderly surgical patients with area under the curve (AUC) of 0.891, 0.908 and 0.918, respectively. Conclusions:The occurrence of POCD in elderly patients with surgery is related to the increase of the expression level of serum exosome miR-29C, and the expression level of serum exosome miR-29C is negatively correlated with MoCA Scale score. Early monitoring of the miR-29C expression level can provide a basis for the occurrence and development of postoperative POCD in elderly patients, disease diagnosis and clinical intervention.

Despite exciting achievements with some malignancies, immunotherapy for hypoimmunogenic cancers, especially glioblastoma (GBM), remains a formidable clinical challenge. Poor immunogenicity and deficient immune infiltrates are two major limitations to an effective cancer-specific immune response. Herein, we propose that an injectable signal-amplifying nanocomposite/hydrogel system consisting of granulocyte-macrophage colony-stimulating factor and imiquimod-loaded antigen-capturing nanoparticles can simultaneously amplify the chemotactic signal of antigen-presenting cells and the "danger" signal of GBM. We demonstrated the feasibility of this strategy in two scenarios of GBM. In the first scenario, we showed that this simultaneous amplification system, in conjunction with local chemotherapy, enhanced both the immunogenicity and immune infiltrates in a recurrent GBM model; thus, ultimately making a cold GBM hot and suppressing postoperative relapse. Encouraged by excellent efficacy, we further exploited this signal-amplifying system to improve the efficiency of vaccine lysate in the treatment of refractory multiple GBM, a disease with limited clinical treatment options. In general, this biomaterial-based immune signal amplification system represents a unique approach to restore GBM-specific immunity and may provide a beneficial preliminary treatment for other clinically refractory malignancies.