The International Association for the Study of Lung Cancer (IASLC) recently introduced the ninth edition of the TNM classification for lung cancer. This milestone is supported by a comprehensive database comprising 124 581 lung cancer patients from 75 centers across 25 nations between 2011 and 2019. Following the exclusion of incomplete data, the analysis focused on 87 043 patients. These insights guided the modifications in the ninth edition of the TNM classification for lung cancer. The updated classification now includes a higher representation of Asian patients, particularly showing significant growth among Chinese patients. This revised classification will offer more pertinent benchmarks for the diagnosis and prognostic assessment of lung cancer. This article delves into the database updates, stage adjustments, and rationale behind the IASLC ninth edition of the TNM classification for lung cancer.

Objective:To evaluate the feasibility of abandoning prophylactic abdominal drainage in patients undergoing minimally invasive minor hepatectomy based on a propensity score matching (PSM) study.Methods:Retrospective review of a prospectively collected database of patients undergoing minimally invasive minor hepatectomy from July 2022 to May 2023 at the Department of Hepatopancreatobiliary Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital. A total of 108 patients were enrolled, including 48 males and 60 females, aged (60.8±13.7) years old. According to whether the abdominal drainage tube was prophylactically placed intraoperatively, patients were divided into two groups: the drainage group (with prophylactic placement of abdominal drainage tubes, n=76); the no-drainage group (without prophylactic placement of abdominal drainage tubes, n=32). PSM was used to compare the perioperative data between the groups, including extent of liver resection, intraoperative blood loss, operative time, and postoperative complications. Postoperative survival status within 90 days was followed up through telephone review. Results:Before PSM, the two groups differed significantly on age and the history of hypertension (both P<0.05). After PSM, there were 23 patients in each group. Patients in the two groups showed comparable results regarding the intraoperative parameters including the surgical method, pathological types, the number and maxium diameter of hepatic lesions, the extent and complexity of liver resection, and the duration of hepatic inflow occlusion (all P>0.05). No postoperative intra-abdominal bleeding occurred in either group. The incidences of postoperative complications were comparable between the groups, including fever, bile leakage, incision infection, and abdominal acupuncture for drainage (all P>0.05). After PSM, compared to patients wothout prophylactic abdominal drainage, prophylactic abdominal drainage group showed a decreased white blood cell counts on postoperative day 1 [9.39(6.30, 10.58)×10 12/L vs. 13.19(10.15, 14.90)×10 12 /L, P=0.006] and a shorter length of postoperative hospital stay [4(3, 5) d vs. 5(4, 5) d, P=0.033]. No postoperative death within 90 days occurred in either group. Conclusion:In minimally invasive minor hepatectomy, abandoning prophylactic abdominal drainage could be feasible, which facilitates fast recovery without increasing the incidence of postoperative fever, perihepatic fluid accumulation and postoperative abdominal acupuncture for drainage.

Objective To analyze the total alkaloids and six alkaloid components,including peimisine,of Fritillariae Anhuiensis Bulbus and five types of Fritillaria medicinal materials;To providebasis for the medicinal use of Fritillariae Anhuiensis Bulbus.Methods The total alkaloid content and 6 alkaloid components(peimisine,sipeimine-3β-D-glucoside,sipeimine,peimine,peiminine and isoverticine)of Fritillariae Anhuiensis Bulbus and 5 medicinal Fritillaria were determined by UV-Spectrophotometry and UPLC-ELSD method,and 18 batches of Fritillaria medicinal materials were classified by clustering analysis and principal component analysis.Results The total alkaloid content of Fritillariae Anhuiensis Bulbus was significantly higher than that of other Fritillarias.The results of clustering and principal component analysis showed that Fritillariae Anhuiensis Bulbus was classified into one class with Fritillariae Thunbergii Bulbus and Fritillariae Hupehensis Bulbus.Conclusion Fritillariae Anhuiensis Bulbus is similar to Fritillariae Thunbergii Bulbus and Fritillariae Hupehensis Bulbus in the composition of alkaloids,which can be used as a medicinal cultivation variety.

Objective:To assess the impact of preoperative Naples prognostic score on the prognosis of patients with hepatocellular carcinoma (HCC) after hepatic resection.Methods:Retrospective analysis was conducted on the data of 323 patients with HCC who underwent radical hepatectomy in Zhejiang Provincial People's Hospital from January 2012 to December 2017, including 281 males and 42 females, aged (56.6±11.3) years. All patients were divided into three groups according to their preoperative Naples prognostic scores: group A (0) ( n=37), group B (1-2) ( n=193), group C (3-4) ( n=93). Survival was analysed by the Kaplan-Meier method, and differences in survival were compared by the log-rank test. Univariate and multivariate Cox regression were used to analyse the effect of Naples prognostic score on prognosis. Results:The 1-, 3- and 5-year cumulative survival rates of HCC patients after hepatectomy were 91.9%, 78.4% and 68.3% in the A group, 89.1%, 76.1% and 64.4% in the B group, and 84.9%, 63.3% and 43.5% in the C group, respectively, and the cumulative survival rates showed a decreasing trend among the three groups, and the differences were statistically significant (all P<0.05). The recurrence-free survival rates at 1, 3 and 5 years after hepatectomy were 93.4%, 63.3% and 44.3% in the A group, 77.7%, 46.5% and 35.6% in the B group, and 64.1%, 41.1% and 28.2% in the C group, respectively, and the recurrence-free survival rates showed a decreasing trend among the three groups, and the differences were statistically significant (all P<0.05). On Cox multivariate analysis, patients with HCC of 3-4 had a higher risk of death after hepatic resection than those patients of 0 ( HR=2.011, 95% CI: 1.048-3.859, P=0.036), and the risk of postoperative recurrence was also higher than those patients of 0 ( HR=1.820, 95% CI: 1.081-3.066, P=0.024). Conclusion:Preoperative Naples prognostic score performs as a prognostic influence factor on survival and recurrence-free survival after hepatectomy in patients with HCC.

Objective:To explore the challenges in the implementation of drug centralized volume-based procurement policies in hospitals and propose corresponding optimization suggestions.Methods:From August to December 2023, a purposive sampling was conducted to select 11 pharmaceutical experts from tertiary hospitals in China for Delphi method. The survey content included " policy recommendations for promoting the acceleration and expansion of national drug centralized procurement and retaining surplus medical insurance funds for centralized procurement" .Results:Survey participants gave feedback on a set of existing problems found in the implementation of drug centralized procurement policies and proposed corresponding optimization methods. Kendall′s W coefficient of the specialist consultation was 0.332( P<0.05), demonstrating good consistency and concentration of the expert opinions. Among the problems, the score of drug supply guarantee was the highest(mean value of importance was 4.45). At the same time, the recommendation of strengthening monitoring and early warning, coordination and dispatch, and effectively ensuring the supply of centralized drug procurement had the highest score and concentration(mean value of importance was 4.91, coefficient of variation was 0.06). Conclusions:Through Delphi method, this study revealed issues and optimization methods in the implementation of drug centralized procurement policies in hospitals. The findings could provide valuable insights for improvements in the pharmaceutical sector and future policy adjustments.

OBJECTIVE To analyze the clinical characteristics of nephrotic syndrome induced by sunitinib， and to provide reference for clinical rational drug use. METHODS Retrieved from CNKI， VIP， Wanfang data， PubMed， Web of Science and Medline， case report about sunitinib-induced nephrotic syndrome were collected from the inception to Oct. 30th， 2022. Those case reports were analyzed statistically in terms of gender， age， primary disease， drug use， clinical manifestations， treatment and outcome. RESULTS A total of 15 pieces of literature were collected and 17 patients were involved， including 10 males and 7 females. The average age of patients was （59.35±15.72） years. Among 17 patients， there were 10 patients with renal cell carcinoma and 7 patients with gastrointestinal stromal tumor， all of whom received evidence-based medication； the dosage of sunitinib in 15 cases was recorded， and all of them were within the recommended range of the instructions； 9 patients received combined therapy； the time from sunitinib application to the occurrence of nephrotic syndrome was 21 days-52 months， of which 11 cases were ≤2 years. The clinical manifestations in 13 patients were described， including edema， oliguria， foamy urine， weight gain， fatigue， dyspnea on exertion， etc. Eight patients had other adverse reactions induced by sunitinib before suffering from nephrotic syndrome， including new hypertension or worsening of original hypertension， and hand-foot syndrome. Renal biopsy mainly manifested as thrombotic microangiopathy， focal segmental glomerular sclerosis and immune complex glomerulonephritis. Sunitinib withdrawal or dosage reduction was adopted in all patients， and they were given symptomatic treatment such as glucocorticoids and antihypertensive agents. Symptoms of 16 patients were improved， and renal function of one patient deteriorated and hemodialysis was started. Sunitinib was re-challenged in 6 patients， elevated creatinine and substantial proteinuria recurred in 5 patients. CONCLUSIONS In clinical use of sunitinib， it is advisable to periodically monitor renal function. In case of deterioration of renal function， albuminuria， edema， etc.， relevant examinations should be implemented in time， and symptomatic intervention should be taken as soon as possible. Besides， we should be alert to the recurrence of nephrotic syndrome after sunitinib rechallenge.

Objective:To study the safety and feasibility of en-bloc lymph node dissection in laparoscopic radical resection for gallbladder cancer(GBC).Methods:The clinical data of 87 patients who underwent laparoscopic radical resection for GBC at Zhejiang Provincial People's Hospital from January 2014 to February 2022 were retrospectively analyzed. There were 26 males and 61 females, aged 67.0 (59.0, 72.0) years old. The patients were divided into the en-bloc dissection group ( n=29) and the non-en-bloc dissection group ( n=58) based on whether en-bloc lymph node dissection was carried out. Differences in general data, tumor characteristics, operation, recurrence and survival were compared between the two groups. Postoperative survival status of these patients was followed-up by telephone. Results:The number of lymph nodes dissected in the en-bloc dissection group was 9.0(8.0, 12.0), which was significantly higher than the 8.0(4.8, 11.0) in the non-en-bloc dissection group ( Z=-2.39, P=0.017). There were no significant differences in age, gender, preoperative blood biochemical indexes, tumor carbohydrate antigen 19-9, tumor stage, nerve and vascular invasion, operation time, intraoperative blood loss, postoperative drainage tube retention time, postoperative hospital stay, and incidences of postoperative complications (biliary fistula, abdominal hemorrhage and abdominal infection) between the two groups (all P>0.05). The median survival was longer in the en-bloc group than in the non-en-bloc group (21 vs. 15 months), and the median relapse-free survival time was 18 months in the en-bloc group compared with 10 months in the non-en-bloc group. However, there were no significant differences in postoperative cumulative survival and recurrence-free survival between the two groups (all P>0.05). Conclusion:En-bloc lymphadenectomy was safe and feasible in laparoscopic radical GBC surgery, with more lymph nodes being removed than the non-en-bloc lymphadenectomy group.

Objective    To explore the treatment strategies for patients with fever and pulmonary complications after thoracic surgery during COVID-19 epidemic. Methods    The clinical data of 537 patients who ungerwent selective surgery at the Department of Thoracic Surgery, Shangjin Branch of West China Hospital between February and December 2020 were retrospectively analyzed, including 242 (45.1%) males and 295 (54.9%) females aged 53.3±13.4 years. We have established a procedure for the patients with fever and pulmonary complications after thoracic surgery to investigate the cause of the disease and track risk factors. Results    The overall postoperative complication rate was 16.4% (88/537), and 1 (0.2%) patient died. Of 537 patients, 179 (33.3%) patients were enrolled in our model according to the inclusion criteria: ratio of males [112 (62.6%) vs. 130 (36.3%), P<0.010], patients with a history of smoking [74 (41.3%) vs. 87 (24.3%), P<0.010], or with esophageal cancer surgery [36 (20.1%) vs. 15 (4.2%)], or with traditional thoracotomy [14 (7.8%)  vs. 4 (1.1%)] was higher than that of the other patients. Patients in our process due to fever or pulmonary complications had longer ICU stay and postoperative hospital stay (P=0.010). Logistic regression multivariate analysis showed that gender was an independent risk factor for postoperative fever or pulmonary complications. Conclusion    In low-risk areas of the epidemic, the treatment process is simple and feasible, and the cause traceability and corresponding treatment can basically be completed within 24 hours. At the same time, the treatment process has been running stably for a long time.

Objective     To share the clinical experience of video-assisted thoracoscopic surgery (VATS) anatomic basal segmentectomy by single-direction method. Methods     The clinical data of 352 patients who underwent VATS anatomic basal segmentectomy in West China Hospital between April 2015 and April 2021 were retrospectively reviewed, including 96 males and 256 females with a median age of 50 (range, 26-81) years. All basal segmentectomies were performed under thoracoscopy, through the interlobar fissure or inferior pulmonary ligament approach, and following the strategy of single-direction and the method of "stem-branch". Results    All patients underwent basal segmentectomy successfully (49 patients of uniportal procedure, 3 patients of biportal procedure and 300 patients of triportal procedure) without addition of incisions or conversion to thoracotomy and lobectomy. The median operation time was 118 (range, 45-340) min, median intraoperative blood loss was 20 (range, 5-500) mL, median drainage time was 2 (range, 1-22) d and median postoperative hospital stay was 4 (range, 2-24) d. The postoperative complications included pneumonia in 6 patients, prolonged drainage (air leakage duration>5 d or drainage duration>7 d) in 18 patients, cerebral infarction in 1 patient and other complications in 2 patients. All patients were treated well and discharged without main complaints. No perioperative death happened. Conclusion    VATS anatomic basal segmentectomy is feasible and safe. It can be performed in a simple manner following the strategy of single-direction.

OBJECTIVE To introduce the construction of undergraduate specialty of clinical pharmacy based on the concept of outcome-based education （OBE），and to provide new idea and enlightenment for the construction of undergraduate specialty of clinical pharmacy in Chinese universities. METHODS Through the establishment and construction of training objectives and graduation requirements ，teaching reform was designed and implemented ，and the construction of teaching support system and teaching quality assurance system were completed. RESULTS The clinical pharmacy department of our university established the training direction of clinical pharmacy talents under the guidance of post competence ，including clarifying the training needs of undergraduate talents based on the overall requirements of national undergraduate education ；defining the social and industrial needs of clinical pharmacy talents based on the normative documents or concepts of clinical pharmacy ；clarifying the post and ability needs of clinical pharmacy talents based on the investigation of graduates and clinical pharmacists ；clarifying the development needs of clinical pharmacy based on the current situation and trends at home and abroad ；forming characteristic training objectives combined with the regional characteristics and school positioning ， so as to construct training objectives and graduation requirements. The OBE concept was introduced into the undergraduate teaching reform of clinical pharmacy ；the pharmacy talent training direction were established under the guidance of post competence ；the training system was designed by reverse design method；a training mode of both innovation and practical ability was built so as to promote teaching reform ，strengthen the construction of grass-roots teaching organizations and teaching staff ， and improve the construction of teaching quality assurance system. CONCLUSIONS The undergraduate training mode of clinical pharmacy specialty based on the concept of OBE is helpful to improve students ’personal comprehensive quality and professional knowledge and skills. The established undergraduate training model of clinical pharmacy specialty is in line with the modern educational concept and social needs ，and provides theoretical basis and practical experience for the training mode of clinical pharmacy professionals.