1.Progress of Ground-Glass Nodules and Lung Cancer Evolution: Molecular and Imaging Studies
Jiaxing MU ; Hao LI ; Kezhong CHEN
Medical Journal of Peking Union Medical College Hospital 2026;17(3):607-616
Ground-glass nodules (GGNs) are common imaging manifestation in the early screening of lung adenocarcinoma. With the widespread use of low-dose computed tomography (LDCT) in lung cancer screening, the detection rate of GGNs has significantly increased. According to the presence or absence of a solid component, GGNs are mainly classified into pure ground-glass nodules (pGGNs) and mixed ground-glassnodules (mGGNs), which differ in their natural course and biological behavior. In general, pGGNs tend to progress more slowly, whereas mGGNs are more likely to develop invasive features. The vast majority of pGGNs remain stable for years, but some pGGNs and mGGNs may show an increase in size or in the solid component. The "indolence" observed on the surface of GGNs hides complex genomic, metabolic, and immune changes, which are difficult to capture with traditional image-based data. In recent years, multi-omics analysis, radiomics, and artificial intelligence models have provided new tools for identifying high-risk GGNs. However, there is still controversy over the clinical generalizability, interpretability, and standardization of these models. Furthermore, there is no consensus on whether surgical resection is required. This article reviews the molecular mechanisms, metabolic, and immune microenvironment changes involved in the progression of GGNs, discusses the advantages and limitations of imaging prediction models, and combines domestic and international guidelines and survival studies to explore the controversial points in follow-up and surgical strategies, aiming to provide references for the personalized management of GGNs.
2.Interpretation of the Multidisciplinary Expert Consensus on Diagnosi and Treatment of Multiple Lung Cancers by the Chinese Anti-Cancer Association
Jianqi MAO ; Xiaoqiu YUAN ; Jing WANG ; Zhuowei LI ; Yukun CHEN ; Kezhong CHEN
Medical Journal of Peking Union Medical College Hospital 2026;17(3):626-636
With the widespread application of low-dose computed tomography (CT), the detection rate of multiple lung cancers (MLCs) is gradually increasing. The diagnosis and treatment of MLCs have become a major challenge in clinical practice in thoracic surgery and oncology. In April 2025, the Lung Cancer Professional Committee of the China Anti-Cancer Association (CACA) organized multidisciplinary experts from both domestic and international fields to release the first edition of the CACA Expert Consensus on the Diagnosis and Treatment of Multiple Lung Cancers, providing systematic recommendations for the diagnostic system, molecularassessment strategies, and surgical and non-surgical management of MLCs. This article provides a detailed interpretation of the core content of this consensus and, by incorporating the latest research progress in the field, delves into the pathogenesis, precise diagnostic strategies, and individualized treatment pathways for multiple lung cancers, aiming to offer a more comprehensive reference for clinical practice.
3.Dual-Center Clinical Study on Detection of Intraoperative Air Leak During Pulmonary Resection Using Nebulized Indocyanine Green
Zhenfan WANG ; Songjing ZHAO ; Ruiheng JIANG ; Zhuoer CUI ; Yingtai CHEN ; Jian ZHOU ; Kezhong CHEN ; Yun LI
Medical Journal of Peking Union Medical College Hospital 2026;17(3):646-651
To evaluate the clinical value of nebulized indocyanine green(ICG) combined with near-infrared fluorescence imaging for intraoperative detection of air leaks during pulmonary resection. This was a two-center randomized controlled trial enrolling patients undergoing thoracoscopic pulmonary resection. After enrollment, patients were randomly divided into an experimental group and a control group. The experimental group received nebulized ICG and fluorescence imaging in addition to the conventional water immersion test, while the control group underwent the water immersion test alone. Intraoperative air leak detection and postoperative air leak incidence were compared between the two groups. Multivariable logistic regression analysis was performed to assess the association between ICG nebulization intervention and postoperative air leaks after adjusting for confounding factors including age, sex, smoking history, history of respiratory disease, surgical procedure, and study center. A total of 181 patients were enrolled(90 in the experimental group, 91 in the control group). The experimental group showed significantly higher intraoperative air leak detection rate(37.8% Nebulized ICG combined with near-infrared fluorescence imaging significantly improves intraoperative detection of air leaks, reduces the incidence of postoperative air leaks, and shortens chest tube duration. This technique is convenient, safe, and holds important clinical value for application.
4.Lipidomics Combined with Machine Learning for Screening Biomarkers of Early-Stage Lung Cancer in the Elderly
Qing WANG ; Yue HE ; Xu LIU ; Zifan LI ; Kezhong CHEN
Medical Journal of Peking Union Medical College Hospital 2026;17(3):652-662
Based on plasma lipidomics combined with machine learning approaches, this study aimed to screen molecular biomarkers for the diagnosis of early-stage lung cancer in elderly patients and to evaluate their diagnostic performance. This was a retrospective diagnostic study consisting of two parts. The first part involved molecular biomarker screening. Elderly patients with early-stage lung cancer (early lung cancer group), patients with benign pulmonary nodules (benign nodule group), and contemporaneous healthy individuals undergoing physical examinations (healthy control group) were enrolled from Peking University People's Hospital between November 2023 and November 2024. In addition, early-stage lung cancer patients and healthy controls meeting the inclusion criteria from a previous study of our research group were included as an independent validation cohort. Plasma samples were collected from all subjects, and untargeted lipidomics analysis was performed using high-performance liquid chromatography-mass spectrometry. Principal component analysis and orthogonal partial least squares discriminant analysis were used to evaluate metabolic differences between groups. L1-regularized support vector machine combined with incremental feature selection was employed to screen diagnostic biomarkers for early-stage lung cancer. Model performance was assessed using receiver operating characteristic curves, calibration curves, Brier scores, and decision curve analysis. The second part involved functional validation of the molecular biomarkers using the human lung adenocarcinoma cell line A549, with palmitoylcarnitine (CAR 16∶0) selected as a representative biomarker for functional validation via CCK-8 and cell scratch assays. A total of 36 patients in the early lung cancer group, 35 patients in the benign nodule group, and 41 healthy controls were enrolled, along with an independent validation cohort of 110 individuals (59 patients with early-stage lung cancer and 51 healthy controls). The principal component analysis results demonstrated that quality control samples were tightly aggregated at the centroid of all samples, reflecting robust instrument performance and dependable data quality.Orthogonal partial least squares discriminant analysis revealed significant metabolic differences between the early lung cancer group and the control group (benign nodule group + healthy control group) (R2X=0.406, R2Y=0.529, Q2Y=0.44). L1-regularized support vector machine identified five carnitine-related lipids-palmitoleoylcarnitine(CAR 16∶1), palmitoylcarnitine, The five plasma carnitine-related lipids screened based on untargeted lipidomics and machine learning may serve as potential molecular biomarkers for the diagnosis of early-stage lung cancer in elderly patients. The high-sensitivity characteristic of the model makes it particularly suitable for screening scenarios in early-stage lung cancer.
5.Exploration on the pathogenesis and treatment of gastric polyps from the theory of kenang
Zhuozhi GONG ; Zhuotai ZHONG ; Yue LIAN ; Zikuan SUN ; Teng LI ; Kezhong NI ; Yun TIAN ; Wei WEI ; Tao LIU
International Journal of Traditional Chinese Medicine 2025;47(6):750-754
Gastric polyps, as a common digestive system disease, have shown an increasing detection rate and are regarded as one of the precancerous states of gastric cancer. In TCM, gastric polyps can be classified as diseases such as "stomachache" and "fullness and distension in the stomach". TCM holds that the disease is often related to the accumulation of pathogenic factors such as phlegm and blood stasis in the body to form "kenang", which has the characteristics of insidiousness, stubbornness, and recurrence. Deficiency of healthy qi and disorder of qi movement can lead to the adhesion of phlegm and blood stasis, which highly aligns with the etiology and pathogenesis of gastric polyps. The treatment principles are promoting blood circulation to remove blood stasis, regulating qi movement, and strengthening the body resistance to consolidate the essence. Understanding the etiology, pathogenesis, and treatment principles of gastric polyps from the theory of "kenang" has important guiding significance for clinical diagnosis and treatment, providing new ideas and methods for the treatment of gastric polyps.
6.Analyses of human papilloma virus vaccination willingness and its influencing factors among adult women in Qinghai Province
Jin XU ; Xiaoqing LIU ; Guiyan MA ; Xiaolin LI ; Lei WANG ; Yan LIU ; Kezhong A
Shanghai Journal of Preventive Medicine 2025;37(10):865-870
ObjectiveTo analyze the willingness to receive human papilloma virus (HPV) vaccine and its influencing factors among adult women in Qinghai Province, so as to provide scientific basis for the formulation of targeted health intervention strategies. MethodsA multi-stage whole cluster random sampling method was used to conduct a questionnaire survey on the willingness to receive HPV vaccine in eight cities or states of Qinghai Province from December 2024 to January 2025. Hierarchical multiple regression analyses were used to identify the influencing factors associated with HPV vaccination willingness. ResultsThe results of the 923 participants participated the questionnaire survey revealed that adult women’s HPV vaccination willingness scores differed statistically significant by educational level (F=9.596, P<0.001) and occupation (F=8.494, P<0.001). The hierarchical multiple regression modeling showed that perception of susceptibility (β=0.078, P<0.05), cues to action(β=0.134, P<0.05), and subjective norms (β = 0.407, P<0.001) were positively associated with HPV vaccination willingness among adult women, while perceptual disorder (β =-0.113, P<0.001) was negatively associated with it. ConclusionThe willingness to receive HPV vaccine among adult women in Qinghai Province is influenced by perception of susceptibility, perceptual disorder, cues to action, and subjective norms. Policy makers and public health agencies should therefore adopt targeted strategies, such as optimizing health education, improving vaccine accessibility, lowering barriers to vaccination, and reinforcing supportive social networks, to increase HPV vaccine uptake and ultimately achieve the goal of effective prevention, control, and elimination of cervical cancer.
7.The significance and advancements of circulating tumor DNA in the diagnosis and treatment of operable non-small cell lung cancer
Zifan LI ; Yue HE ; Kezhong CHEN
Chinese Journal of Surgery 2025;63(2):171-176
Non-small cell lung cancer, characterized by high incidence and mortality rates, significantly threatens human health. Precisely assessing patient prognosis and implementing adaptive treatment strategies have emerged as pivotal issues in contemporary thoracic oncology. Postoperative minimal residual disease (MRD) detection through liquid biopsy has demonstrated substantial potential. Circulating tumor DNA (ctDNA) enables real-time dynamic monitoring of tumor alterations. With advancements in ctDNA detection technologies, ctDNA has become a core method for MRD assessment. In the context of postoperative surveillance, ctDNA detection facilitates more accurate prognostic stratification and early prediction of tumor recurrence. Regarding therapeutic interventions, ctDNA detection can predict the efficacy of neoadjuvant and adjuvant therapies. In the future, further elucidating the value of assessing ctDNA status in predicting patient prognosis and guiding drug therapies will contribute to the advancement of precision medicine and adaptive treatments.
8.Analysis of consistency and influencing factors in diagnosis reports of inpatients with hepatitis B in Qinghai Province
Jin XU ; Kezhong A ; Zengping HAO ; Wensheng BA ; Bingju GUAN ; Xiaoping LI ; Xingxing DU ; Xiaoqing LIU ; Guiyan MA
China Modern Doctor 2025;63(12):14-18
Objective To review the diagnostic information of 3368 viral hepatitis B inpatient cases reported by some healthcare institutions in Qinghai Province in the National Notifiable Disease Report System(NNDRS)in 2021,and to analyse the consistency of their reports and influence factor.Methods The study used the typical survey method to study 3368 hospitalized cases of hepatitis B reported by 32 medical institutions in Qinghai Province in 2021 from July 2022 to April 2023.The consistency between the reported classification and the reviewed classification was evaluated by reviewing diagnostic information of the cases,combined with the Kappa consistency test,and the consistency-influencing factors were analysed in a univariate and multivariate analysis.Results The consistency between acute,chronic,and unclassified reporting classifications and review classifications was poor(Kappa<0.40);the consistency between acute and chronic review was poor(Kappa<0.40).The main influence factor of the consistency of review included the level of medical institution,the patient's gender,occupation,past history,and the unit of diagnosis of initial onset of illness.Provincial medical institutions reported higher consistency,and male cases and herder cases had better consistency than female cases and other occupations.Review consistency of cases with past history was better than that of cases with unclear past history.Conclusion The consistency of diagnosis and reporting of hepatitis B cases in healthcare institutions in Qinghai Province in 2021 was low,with problems of inaccurate classification and duplicate reporting.It is recommended to strengthen the training and supervision of healthcare institutions,standardise the filling of'attached card'information,and promote the hepatitis B core antibody IgM test to improve the classification and diagnosis of acute and chronic hepatitis B,so as to comprehensively improve the accuracy of the diagnosis and reporting of hepatitis B cases.
9.To explore the application value of preoperative plasma total cholesterol level in predicting postoperative delirium in patients with esophageal cancer resection
Shengrun GAO ; Chen LI ; Liang WANG ; Kezhong LI ; Na LIU ; Chengjie GAO ; Yun LI
The Journal of Practical Medicine 2025;41(7):1004-1009
Objective To investigate the predictive value of preoperative plasma total cholesterol levels for postoperative delirium(POD)following esophagectomy and to analyze its associated risk factors.Methods The complete perioperative electronic medical records of 187 patients with POD who underwent esophagectomy at the 960 Hospital of the People's Liberation Army between January 2019 and December 2023 were retrospectively analyzed.According to the occurrence of POD within one week postoperatively,the patients were categorized into a delirium group and a non-delirium group.The preoperative plasma total cholesterol levels were used to construct a receiver operating characteristic(ROC)curve for predicting delirium after esophagectomy.The area under the curve(AUC)and its 95%confidence interval(CI)were calculated.Additionally,the plasma total cholesterol level corresponding to the maximum Youden index(sensitivity+specificity-1)was determined as the optimal critical value.Results POD occurred in 24 of 187 patients who underwent esophageal cancer resection,with an incidence rate of 12.83%.Compared to the non-delirium group,the delirium group exhibited older age,lower intraoperative blood pressure,lower plasma total cholesterol and low-density lipoprotein levels,longer anesthesia duration,and a higher preva-lence of coronary heart disease,which was identified as a risk factor for POD.Dexmedetomidine administration was associated with a reduced occurrence of POD.The AUC,95%CI,cut-off value,sensitivity,and specificity of preop-erative plasma total cholesterol level for predicting POD were 0.761,0.657~0.865,≤4.11 mmol/L,70.8%,and 77.3%,respectively.Conclusions Among non-hyperlipidemic patients,low preoperative plasma total cholesterol levels and intraoperative hypotension are identified as independent risk factors for POD following esophageal cancer resection.Preoperative plasma total cholesterol levels exhibit moderate predictive value for the occurrence of POD.
10.Analysis of consistency and influencing factors in diagnosis reports of inpatients with hepatitis B in Qinghai Province
Jin XU ; Kezhong A ; Zengping HAO ; Wensheng BA ; Bingju GUAN ; Xiaoping LI ; Xingxing DU ; Xiaoqing LIU ; Guiyan MA
China Modern Doctor 2025;63(12):14-18
Objective To review the diagnostic information of 3368 viral hepatitis B inpatient cases reported by some healthcare institutions in Qinghai Province in the National Notifiable Disease Report System(NNDRS)in 2021,and to analyse the consistency of their reports and influence factor.Methods The study used the typical survey method to study 3368 hospitalized cases of hepatitis B reported by 32 medical institutions in Qinghai Province in 2021 from July 2022 to April 2023.The consistency between the reported classification and the reviewed classification was evaluated by reviewing diagnostic information of the cases,combined with the Kappa consistency test,and the consistency-influencing factors were analysed in a univariate and multivariate analysis.Results The consistency between acute,chronic,and unclassified reporting classifications and review classifications was poor(Kappa<0.40);the consistency between acute and chronic review was poor(Kappa<0.40).The main influence factor of the consistency of review included the level of medical institution,the patient's gender,occupation,past history,and the unit of diagnosis of initial onset of illness.Provincial medical institutions reported higher consistency,and male cases and herder cases had better consistency than female cases and other occupations.Review consistency of cases with past history was better than that of cases with unclear past history.Conclusion The consistency of diagnosis and reporting of hepatitis B cases in healthcare institutions in Qinghai Province in 2021 was low,with problems of inaccurate classification and duplicate reporting.It is recommended to strengthen the training and supervision of healthcare institutions,standardise the filling of'attached card'information,and promote the hepatitis B core antibody IgM test to improve the classification and diagnosis of acute and chronic hepatitis B,so as to comprehensively improve the accuracy of the diagnosis and reporting of hepatitis B cases.

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