This article elucidates therapeutic approaches for KRAS G12C-mutant advanced non-small cell lung cancer, with focus on global advancements in inhibitor research. It also summarizes clinical evidence on the efficacy of targeted agents in monotherapy and combination therapies, analyzes their clinical advantages and challenges, and explores future directions for novel treatment modalities.

Objective To optimized the extraction process of the"Honghuangbai"gel and to establish the content determination method of the gel.Methods The contents of salidroside,berberine hydrochloride and 1,4-bis[4-(glucose-oxy)benzyl]-2-isobutyl malate in"honghuangbai"extract were determined by HPLC with gradient elution;the content of total polysaccharide was determined by anthrone-sulfuric acid method.AHP-CRITIC composite weighting method was used to calculate the weight coefficient of 4 indicators,and the comprehensive score was taken as the evaluation index.Combined with L9(34)orthogonal experiment design,the effects of solid-liquid ratio,extraction time and times on the extraction process of"honghuangbai"gel were investigated,and the optimal extraction process was selected and verified.The method for the determination of 4 index components in the gel was established and the methodology was investigated.Results The optimal solid-liquid ratio was 1∶45,the optimal extraction time was 2 h and the optimal extraction times was twice.The linear relationships of the four indexes were good in their respective linear ranges,with R2＞0.999 0.The average recoveries were 98.67％～102.09％,and RSD was 0.77％～3.17％.Good precision,repeatability and stability,RSD≤2.28％.Conclusion The optimal extraction process of"honghuangbai"gel optimized by AHP-CRITIC combined with orthogonal test is stable and economical.The method of the gel content determination is feasible and the result is reliable,which provides experimental basis for the establishment of the quality standard of the gel.

The cost economics of early-stage lung cancer treatments is a key focus in the field of lung cancer. The primary treatment modalities for early-stage lung cancer include radiotherapy and thoracic surgery, each offering distinct advantages in therapeutic outcomes and costs. To better understand the cost-effectiveness of radiotherapy versus thoracic surgery for early-stage lung cancer, this paper reviews the progress of recent research on economic evaluations of these two treatment approaches.

Objective To optimized the extraction process of the"Honghuangbai"gel and to establish the content determination method of the gel.Methods The contents of salidroside,berberine hydrochloride and 1,4-bis[4-(glucose-oxy)benzyl]-2-isobutyl malate in"honghuangbai"extract were determined by HPLC with gradient elution;the content of total polysaccharide was determined by anthrone-sulfuric acid method.AHP-CRITIC composite weighting method was used to calculate the weight coefficient of 4 indicators,and the comprehensive score was taken as the evaluation index.Combined with L9(34)orthogonal experiment design,the effects of solid-liquid ratio,extraction time and times on the extraction process of"honghuangbai"gel were investigated,and the optimal extraction process was selected and verified.The method for the determination of 4 index components in the gel was established and the methodology was investigated.Results The optimal solid-liquid ratio was 1∶45,the optimal extraction time was 2 h and the optimal extraction times was twice.The linear relationships of the four indexes were good in their respective linear ranges,with R2＞0.999 0.The average recoveries were 98.67％～102.09％,and RSD was 0.77％～3.17％.Good precision,repeatability and stability,RSD≤2.28％.Conclusion The optimal extraction process of"honghuangbai"gel optimized by AHP-CRITIC combined with orthogonal test is stable and economical.The method of the gel content determination is feasible and the result is reliable,which provides experimental basis for the establishment of the quality standard of the gel.

Bone is the main metastatic site of prostate cancer, and bone metastasis of prostate cancer seriously affects the prognosis and quality of life of patients. Exosomes are lipid bilayer vesicles secreted by cells, which play a significant role in intercellular communication. Exosomes can regulate the specific colonization of prostate cancer cells in bone tissue, reshape the pre-metastatic niche conducive to the survival of tumor cells, and modulate the immune microenvironment of bone. At the same time, exosomes can also regulate the differentiation and maturation of osteoblasts and osteoclasts, resulting in bone remodeling. Further understanding of the role of exosomes in bone metastasis of prostate cancer will help to develop new targets for delaying the progression of bone metastasis.

The combination of thoracic radiotherapy and immunotherapy is increasingly widely used in clinical practice, which not only brings survival benefits but also increases the incidence of pneumonitis. The occurrence of pneumonitis affects the subsequent immunotherapy and can be life-threatening in severe cases. The occurrence and severity of pneumonitis after combination therapy depends on a variety of factors, including patient's age, physical strength, pulmonary function, race, combination therapy mode, radiotherapy dose parameters, type of immune checkpoint inhibitor, history of checkpoint inhibitor-related pneumonitis or radiation pneumonitis, serum indexes and so on. At present, further research is needed to find out the influencing factors of the occurrence and severity of pneumonitis attributed to combined therapy, so as to better avoid, predict, identify and treat related pneumonitis in clinical practice.

Objective:To analyze the incidence, risk factors and occurrence time of radiation pneumonia (RP) and immune checkpoint inhibitor-related pneumonia (CIP) in patients with lung cancer and lung metastatic cancer who received both thoracic radiotherapy and immunotherapy.Methods:The clinicopathological data of 137 patients with lung cancer and lung metastatic cancer receiving thoracic radiotherapy and at least one cycle of immunotherapy from January 2019 to January 2022 in Renmin Hospital of Wuhan University were retrospectively analyzed. The occurrence of RP and CIP was determined according to the clinical symptoms and thin-slice chest CT. The risk factors of symptomatic RP were evaluated by univariate and multivariate analyses of clinical data and treatment plan. The relationship between the occurrence time of symptomatic RP and the sequence of thoracic radiotherapy and immunotherapy was compared.Results:In the 137 patients with lung cancer and lung metastatic cancer who received both thoracic radiotherapy and immunotherapy, symptomatic RP was observed in 42 patients (30.7%) , including grade 2 RP in 33 patients (24.1%) , grade 3 RP in 6 patients (4.4%) , grade 4 RP in 1 patient (0.7%) , and grade 5 RP in 2 patients (1.5%) . The incidence of symptomatic RP was 40.0% (28/70) in patients who received thoracic radiation concurrent with immunotherapy and 20.9% (14/67) in non-synchronous patients, and the incidence of severe RP was 10.0% (7/70) and 3.0% (2/67) respectively. CIP was observed in 11 (8.0%) of 137 patients, including grade 2 CIP in 4 patients (2.9%) , grade 3 CIP in 6 patients (4.4%) , grade 5 CIP in 1 patient (0.7%) . There were 54.5% (6/11) of CIP patients with prior or concurrent symptomatic RP. Univariate analysis showed that smoking history ( χ2=9.85, P=0.002) , chronic obstructive pulmonary disease (COPD) history ( χ2=31.34, P<0.001) , thoracic radiotherapy concurrent with immunotherapy ( χ2=5.88, P=0.015) , total radiotherapy dose ( χ2=8.57, P=0.003) were associated with symptomatic RP. Multivariate logistic regression analysis showed that COPD history ( OR=9.96, 95% CI: 3.40-29.14, P<0.001) , thoracic radiotherapy concurrent with immunotherapy ( OR=2.84, 95% CI: 1.15-7.00, P=0.024) , and total radiotherapy dose ≥60 Gy ( OR=4.76, 95% CI: 1.68-13.50, P=0.003) were independent risk factors for symptomatic RP. RP occurred earlier in patients who received immunotherapy before thoracic radiotherapy [68.5 d (47.0 d, 101.8 d) ] than in patients who received immunotherapy after thoracic radiotherapy [117.5 d (79.0 d, 166.3 d) ], with a statistically significant difference ( Z=2.54, P=0.010) . Conclusion:The incidence of symptomatic RP is high in patients who receive both thoracic radiotherapy and immunotherapy. The history of COPD, thoracic radiotherapy concurrent with immunotherapy, and the total radiotherapy dose ≥60 Gy are independent influencing factors of symptomatic RP in patients with thoracic radiotherapy combined with immunotherapy. Symptomatic RP occurs earlier in patients who receive immunotherapy before thoracic radiotherapy than in patients who receive immunotherapy after thoracic radiotherapy.

OBJECTIVE: To investigate the efficacy and safety of aromatase inhibitor letrozole in treatment of male children with disorders of sex development (DSD). METHODS: Clinical data of 12 male DSD children with a mean age of 14.6±2.5 years admitted to Peking Union Medical College Hospital from January 2014 to January 2016 were retrospectively analyzed. The patients were treated with letrozole (1.25-2.5 mg, once a day) for 3 months or longer, and followed up for 0.5-2.5 years. Clinical manifestation and laboratory test findings were documented, and the efficacy and safety were evaluated. RESULTS: After half-year treatment, the blood luteinizing hormone (LH), follicle-stimulating hormone (FSH) and testosterone levels of patients increased (all < 0.05), and estrogen levels decreased from baseline ( < 0.05). After 1 year of treatment, the blood testosterone level was significantly higher ( < 0.05); the LH and FSH levels tended to increase and the estrogen level tended to decrease, but there was no significant statistical difference ( >0.05). Semen was routinely detected in 8 patients, and sperms were detected in semen of 3 patients with hypospadias. There were no significant changes in biochemical results after treatment, and no significant adverse event was observed during the treatment. CONCLUSIONS Letrozole can effectively increase testosterone levels in patients with disorders of sex development and promote spermatogenesis, it has no significant adverse effects in short-term administration.
Adolescent ; Child ; Disorders of Sex Development ; drug therapy ; Follicle Stimulating Hormone ; Humans ; Letrozole ; therapeutic use ; Luteinizing Hormone ; Male ; Retrospective Studies ; Testosterone

Objective:To evaluate the safety and efficacy of indwelling cutting with guidewire in treatment of difficult pancreatic duct stricture.Methods:A retrospective study was performed on the data of patients with chronic pancreatitis, who failed to implant pancreatic duct stent by endoscopic retrograde cholangiopancreatography (ERCP) and whose narrow pancreatic duct only allowed the guidewire to pass through, in Nanjing Drum Tower Hospital from November 2017 to April 2019. The dilatation effect of guidewire indwelling on difficult pancreatic duct stenosis was studied. The duration of guidewire indwelling, the success rate of stent re-implantation, the level of postoperative amylase, recent complications, and follow-up results were analyzed.Results:A total of five patients received indwelling guidewire after failure of dilation of pancreatic duct stenosis during ERCP. After 2.4 days of mean indwelling time, all patients received re-ERCP. The narrow pancreatic duct was successfully expanded and the stent was placed. In terms of complications, only one patient suffered from acute pancreatitis after the first ERCP, and was improved after medical treatment.Conclusion:Guidewire indwelling is a new simple, safe, and effective method for dilatation of pancreatic duct stenosis, and has important clinical value in the management of difficult intubation of pancreatic duct in chronic pancreatitis.

Objective To discuss the clinical application of CT-guided localization of small pulmonary nodules (SPNs) by using double-hook-wire before the performance of video-assisted thoracoscopic (VATS) resection.Methods Before the performance of VATS resection,CT-guided localization by using doublehook-wire was carried out in 54 patients with SPNs (67 small pulmonary nodules in total) and CT-guided localization by using single-hook-wire was employed in 63 patients with SPNs(81 small pulmonary nodules in total).The location success rate and complication rate of the double-hook-wire technique and the singlehook-wire technique were calculated.Results The location success rate of CT-guided localization for SPNs by using double-hook-wire performed before VATS resection in 54 patients was 100％.The incidences of pneumothorax and hemorrhage were 29.6％ (16/54) and 48.1％ (26/54) respectively.In 63 patients receiving single-hook-wire technique,the location success rate for SPNs was 98.4％ (62/63).The incidences of pneumothorax and hemorrhage were 28.5％ (18/63) and 25.4％ (16/63) respectively.Conclusion CT-guided localization for SPNs by using double-hook-wire before VATS resection can reduce the risk of failure in positioning the hook-wire,and this technique is an important supplement for other localization techniques.