Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Objective To explore the value of magnetic resonance relaxation time quantitative imaging in predicting molecular subtypes of invasive ductal carcinoma(IDC)of breast.Methods A total of 79 IDC patients underwent routine magnetic resonance imaging(MRI)scanning and relaxation time quantitative imaging.According to immunohistochemical results of lesions,patients were divided into different immunohistochemical index groups and molecular subtype groups.The differences in MRI signs,T1 values and T2 values of lesions were statistically compared between each group.Patient operating characteristic(ROC)curve was used to evaluate values of T1 and T2 alone and the combination of them in differential diagnosis of IDC molecular subtypes.Results There were 82 samples of lesion in 79 patients,in which,Luminal A type 16(19.51%),Luminal B1 type 11(13.41%),Luminal B2 type 27(32.93%),tyrosine kinase receptor-2 overexpression type(Erb-B2)14(17.07%)and TNBC 14(17.07%).There were no significant differences in patient age,lesion distribution,maximum diameter,morphology,margin and enhancement performance between patients with various molecular subtypes(P>0.05).Among the immunohistochemical indexes,only the Ki-67 positive group had higher T1 value than the negative group(P<0.05).In ROC analysis,the critical T1 value of Ki-67 positive lesions was 2 145 ms,Yoden index was 0.368,the sensitivity was 53.47%,the specificity was 83.33%and the area under the curve(AUC)was 0.640(95%CI:0.527-0.744).There were no significant differences in T1 and T2 values between Luminal A,Luminal B1,Luminal B2,Erb-B2 enriched and TNBC subtypes(P<0.05).T1 and T2 values were lower in Luminal type lesion than those of TNBC type lesion(P＜0.05).ROC curve analysis showed that the combined T1 and T2 values were more effective in differentiating Luminal/TNBC type than those of T1 and T2 values alone.Conclusion T1 mapping can be used as one of the methods to predict the high or low expression levels of Ki-67 in IDC tumors.The combination of T1 and T2 values can improve the ability to predict Luminal/TNBC subtypes.

Objective:To investigate the clinical effect of the relaying perforator flap for repairing the donor site of the anterolateral thigh flap.Methods:From March 2019 to June 2020, 28 consecutive patients who underwent anterolateral thigh free flap reconstruction for limb soft tissue defects were retrospectively reviewed. A relaying perforator flap was selected from one of the four areas adjacent to the donor site of the anterolateral thigh flap for covering the donor site of the anterolateral thigh flap. The secondary donor site was closed directly. The followed-up contents included the appearance and texture of the flaps. The postoperative followed-up was performed through outpatient visits, telephone, and WeChat interviews.Results:A total of 28 patients were included, with an average age of 37.3 (ranging from 15 to 65). The relaying perforator flap was selected from the anteromedial thigh region ( n=13), the proximal anterolateral thigh region( n=6), the distal anterolateral thigh region ( n=5), and the ilioinguinal region ( n=4). The size of the anterolateral thigh flap ranged from 12.0 cm×10.0 cm to 20.0 cm×13.0 cm, and the size of the relaying perforator flap ranged from 6.0 cm×5.0 cm to 11.0 cm×7.5 cm. The followed-up time ranged from 1 to 6 months (mean 4.8 months). The color, texture, and contour of the flaps were good. Only one linear scar is left in the donor site. Two cases with small necrosis (1.0 cm×2.0 cm and 1.5 cm×1.5 cm, respectively) were found in the distal edge of relaying perforator flaps. Conclusions:The relaying perforator flap is considered as an optimized and reliable method for repairing the donor site of an anterolateral thigh flap and should be recommended.

Objective:To investigate the clinical effect of the relaying perforator flap for repairing the donor site of the anterolateral thigh flap.Methods:From March 2019 to June 2020, 28 consecutive patients who underwent anterolateral thigh free flap reconstruction for limb soft tissue defects were retrospectively reviewed. A relaying perforator flap was selected from one of the four areas adjacent to the donor site of the anterolateral thigh flap for covering the donor site of the anterolateral thigh flap. The secondary donor site was closed directly. The followed-up contents included the appearance and texture of the flaps. The postoperative followed-up was performed through outpatient visits, telephone, and WeChat interviews.Results:A total of 28 patients were included, with an average age of 37.3 (ranging from 15 to 65). The relaying perforator flap was selected from the anteromedial thigh region ( n=13), the proximal anterolateral thigh region( n=6), the distal anterolateral thigh region ( n=5), and the ilioinguinal region ( n=4). The size of the anterolateral thigh flap ranged from 12.0 cm×10.0 cm to 20.0 cm×13.0 cm, and the size of the relaying perforator flap ranged from 6.0 cm×5.0 cm to 11.0 cm×7.5 cm. The followed-up time ranged from 1 to 6 months (mean 4.8 months). The color, texture, and contour of the flaps were good. Only one linear scar is left in the donor site. Two cases with small necrosis (1.0 cm×2.0 cm and 1.5 cm×1.5 cm, respectively) were found in the distal edge of relaying perforator flaps. Conclusions:The relaying perforator flap is considered as an optimized and reliable method for repairing the donor site of an anterolateral thigh flap and should be recommended.

BACKGROUND: Perioperative treatment has become an increasingly important aspect of the management of patients with non-small cell lung cancer (NSCLC). Small-scale clinical studies performed in recent years have shown improvements in the major pathological remission rate after neoadjuvant therapy, suggesting that it will soon become an important part of NSCLC treatment. Nevertheless, neoadjuvant immunotherapy may be accompanied by serious adverse reactions that lead to delay or cancelation of surgery, additional illness, and even death, and have therefore attracted much attention. The purpose of the clinical recommendations is to form a diagnosis and treatment plan suitable for the current domestic medical situation for the immune-related adverse event (irAE). METHODS: This recommendation is composed of experts in thoracic surgery, oncologists, thoracic medicine and irAE related departments (gastroenterology, respirology, cardiology, infectious medicine, hematology, endocrinology, rheumatology, neurology, dermatology, emergency section) to jointly complete the formulation. Experts make full reference to the irAE guidelines, large-scale clinical research data published by thoracic surgery, and the clinical experience of domestic doctors and publicly published cases, and repeated discussions in multiple disciplines to form this recommendation for perioperative irAE. RESULTS: This clinical recommendation covers the whole process of prevention, evaluation, examination, treatment and monitoring related to irAE, so as to guide the clinical work comprehensively and effectively. CONCLUSIONS Perioperative irAE management is an important part of immune perioperative treatment of lung cancer. With the continuous development of immune perioperative treatment, more research is needed in the future to optimize the diagnosis and treatment of perioperative irAE.

Objective:To retrospectively analyze the clinical and serological characteristics in rehabilitated patients with common novel coronavirus pneumonia(COVID-19).Methods:A total of 165 patients with common COVID-19 were enrolled in this retrospective study, in which clinical data was collected from February 23 to March 15, 2020 in Leishenshan Hospital(Wuhan, China). The patients with COVID-19 were divided into elderly group and non-elderly group according to their age, and the differences in the clinical and serological metabolic characteristics between these two groups were analyzed.Results:49.7% patients were over 60 years old. The most common clinical symptoms were fever, cough, and fatigue, followed by muscle soreness. Expectoration and digestive tract symptoms were rare. Dyspnea occurred more frequently in the elderly group than in non-elderly group(47.56% vs 25.30%, P<0.01). Hypertension was the most common concomitant disease(accounting for 29.1%)followed by diabetes. Hypertension was more common in the elderly group than in non-elderly group(41.46% vs 16.86%, P<0.01), but without significant difference in diabetes between the two groups. The counts of leukocytes and lymphocytes in all patients were in the normal range, and no difference was observed between the groups. The comparison of serological indicators showed that serum creatinine in the elderly group was higher than that in the non-elderly group( P<0.01)while serum albumin, glomerular filtration rate, and serum calcium were lower in the elderly group. After serum albumin correction, the levels of albumin corrected calcium in all patients were in the normal range, without significant difference between these two groups. There was no significant difference between the two groups when the length of hospital stay was taken as the index of outcome [(34.01±10.24) vs(30.97±10.51)d, P>0.05]. Conclusion:Fever, cough, and fatigue are the most common clinical symptoms in patients with ordinary COVID-19. The elderly are more likely to develop dyspnea. The blood routine and metabolic characteristics in patients with common COVID-19 are normal, but serum albumin level is more likely to decrease in elderly patients with COVID-19.

Objective:To explore the correlation between body mass index(BMI)and coronary flow reserve(CFR)in patients with chest pain and no obstructive coronary artery disease(NOCA).Methods:This study was a single-center retrospective cross-sectional study. Sixty-six patients with chest pain and NOCA on coronary angiography who underwent PET/CT quantitative myocardial blood flow measurements at TEDA International Cardiovascular Hospital were retrospectively analyzed from August 2018 to October 2019. Pearson correlation analysis and linear regression analysis were used to explore the correlation between BMI and CFR. Patients were divided into 2 groups according to CFR: coronary microvascular dysfunction(CMD)group(CFR<2.5)and control group(CFR≥2.5). Logistic regression analysis was applied to analyze the association of BMI with CMD.Results:The proportions of female, obesity, and overweight plus obesity in CMD group were higher than those in control group( P<0.05). The levels of BMI and low density lipoprotein-cholesterol(LDL-C)were higher in CMD group compared with control group( P<0.05). Pearson correlation analysis showed that CFR was linearly correlated with BMI( r=-0.45, P<0.01), which still existed after adjusted by confounding factors using linear regression model( r=-0.371, P<0.01). Logistic regression analysis showed that BMI was dependently associated with CMD after adjusted by gender, age, hypertension, diabetic mellitus, and LDL-C. The OR value of CMD was 4.46(95% CI 1.47-13.55, P<0.01)with BMI increased by 5 kg/m 2. Conclusion:In patients with chest pain and NOCA, higher BMI is an independent risk factor of CMD.

Objective:To diagnose female coronary microvascular diseases (CMVD) without obstructive coronary artery disease through coronary flow reserve (CFR) measured with PET/CT imaging, and further analyze its related risk factors of quantitative parameters and clinical characteristics.Methods:From September 2017 to August 2019, a total of 75 female patients (age: 25-77 years) with clinically suspected CMVD from TEDA International Cardiovascular Hospital were retrospectively analyzed. All patients had negative results of coronary angiography (CAG) or coronary CT angiography (CCTA) and underwent 13N-NH 3·H 2O PET/CT dynamic quantitative imaging. Left ventricle (LV) coronary flow reserve (LV-CFR) value of 2.5 for critical value was divided into CMVD group and non-CMVD group. Clinical characteristics and quantitative parameters including rest LV-myocardial blood flow (MBF) and stress LV-MBF were respectively analyzed and compared between groups. Independent-sample t test, Mann-Whitney U test and Pearson correlation analysis were used to analyze the data. Results:Of 75 patients, 51 cases (68%) were diagnosed with CMVD and 24 cases (32%) with non-CMVD. Body mass index (BMI) of the CMVD group was higher than that of the non-CMVD group ((26.93±3.52) vs (23.83±3.42) kg/m 2, t=3.63, P=0.001), and LV-CFR was negatively correlated with BMI ( r=-0.341, P=0.003). The LV-CFR of the overweight group (BMI≥24 kg/m 2) was lower than that of non-overweight group (BMI<24 kg/m 2) (2.18±0.47 vs 2.54±0.55, t=-2.89, P=0.005). The rest LV-MBF in the CMVD group (0.74(0.65, 0.84) ml·min -1·g -1) was higher than that in the non-CMVD group (0.66(0.58, 0.75) ml·min -1·g -1; U=417.5, P=0.027), and the stress LV-MBF and LV-CFR was lower than that in the non-CMVD group ((1.53±0.35) vs (1.96±0.45) ml·min -1·g -1, 2.07(1.71, 2.34) vs 2.86(2.61, 2.95); t=-4.54, U=0, both P<0.001). In the hypertensive group, the CMVD sub-group had higher rest LV-MBF than the non-CMVD sub-group ((0.77±0.16) vs (0.65±0.13) ml·min -1·g -1; t=2.26, P<0.05), but lower stress LV-MBF ((1.49±0.34) vs (1.85±0.40) ml·min -1·g -1; t=-3.07, P<0.05) and LV-CFR(1.99(1.64, 2.23) vs 2.85(2.55, 2.95); U=0, P<0.05] than the non-CMVD sub-group. In the non-hypertensive group, stress LV-MBF and LV-CFR of the CMVD sub-group were lower than those of the non-CMVD sub-group (1.53(1.36, 1.97) vs 1.94(1.76, 2.16) ml·min -1·g -1, 2.35(1.94, 2.43) vs 2.87(2.65, 3.09); U values: 43.5 and 0, both P<0.05). LV-CFR of CMVD subgroup in hypertensive group was lower than that of CMVD subgroup in non-hypertensive group ( U=164.0, P=0.028). Conclusions:BMI is negatively correlated with LV-CFR in CMVD. The decrease of stress LV-MBF and the increase of rest LV-MBF in CMVD lead to the decrease of LV-CFR. Hypertension is one of the important influence factors for MBF and CFR.

This study reports the surgical treatment of a female patient at age of 64 years with novel coronavirus (SARS-CoV-2) latent infection complicated with esophageal foreign body perforation with no significant changes in the lung CT. The patient was confirmed as SARS-CoV-2 infection on the 4th day after surgery and then was transferred into the Department of Infectious Disease in our hospital for treatment. This case has guiding value for the operation of thoracic surgery during the outbreak of novel coronavirus pneumonia.