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.

It is believed that there is a pathogenesis of yang deficiency in polycystic ovary syndrome （PCOS） infertility， and it is concluded that warm-yang method has a better effect in improving endometrial abnormality， enhancing the quality of follicles， correcting endocrine disorders， and resolving or alleviating clinical symptoms in PCOS infertility. Based on Yanghe Decoction （阳和汤）， a representative traditional Chinese medicine decoction for warming yang， Yanghe Xiaonang Decoction （阳和消囊汤） was formulated， combining with warm medicinals according to symptoms， and aerobic exercise was also advocated to help generate and develop yang qi， in order to provide ideas for clinical treatments.

Polycystic ovary syndrome（PCOS） and its resulting infertility is one of the common diseases of gynecology and reproductive endocrinology. The phosphatidylinositol 3-kinase/protein kinase B（PI3K/Akt） signaling pathway is relatively well-studied in the development of intervention in PCOS， and the experiments on PCOS in rats conducted by traditional Chinese medicine through this signaling pathway is also the main direction of mechanistic research. In this paper， 20 articles published in academic journals in the past 5 years were selected through the corresponding criteria， and the objective situation and existing problems of the selected research projects were analyzed from five aspects， namely， baseline data， modeling and treatment， grouping， evaluative indexes， and pharmacodynamic indexes. It is found that there were different degrees of problems in each research project， such as the observation indicators of modeling， criteria for judging the success of the model， the treatment period， the calculation of dosage of prescription/active ingredients and specific dosage were not clearly defined， which could easily lead the bias of the results or reduce the validity of experimental data. Based on this， the list of PCOS rat experimental research operations was formed， involving five categories of experimental rats， model construction， study implementation， outcome measures and analysis and report with a total of 21 operation lists， with a view to provide a reference for the subsequent PCOS experiments related to scientific research and helping to form high-quality results.

Purpose To construct a nomogram model based on conventional ultrasound(US)and contrast-enhanced ultrasound(CEUS)features for predicting extrathyroidal extension(ETE)of papillary thyroid carcinoma,and to evaluate its diagnostic performance.Materials and Methods A retrospective analysis of clinical and ultrasound data from 715 papillary thyroid carcinoma patients in the First Medical Center of Chinese PLA General Hospital from January 2017 to December 2022 was conducted.The patients were divided into two groups based on the presence or absence of ETE.Univariate and Multivariate analyses was performed to identify independent risk factors associated with ETE.Three models were established:clinical,clinical+US and clinical+US+CEUS.The nomogram of the best model was constructed and validated.Results The model based on clinical+US+CEUS features performed the best,the area under the curve was 0.885.Multivariate analysis indicated that older age(OR=1.029,95%CI 1.011-1.047),higher body mass index(OR=1.108,95%CI 1.049-1.171),capsular contact<25%(OR=4.716,95%CI 2.079-10.701),capsular contact 25%-50%(OR=21.320,95%CI 8.240-55.160),capsular contact>50%(OR=24.045,95%CI 6.792-85.126),nodules adjacent to the lateral side(OR=4.265,95%CI 1.366-13.318),nodules adjacent to the medial side(OR=6.416,95%CI 2.067-19.920)and interrupted capsular enhancement(OR=6.044,95%CI 3.588-10.180)were independent risk factors for ETE(all P<0.05).Decision curve analysis and clinical impact curve indicated high net benefit and strong clinical utility of the model.Ten-fold cross-validation showed good model stability.Conclusion The nomogram model constructed based on US and CEUS features demonstrates good predictive performance and holds significant clinical utility.

[Purpose]To investigate the acceptance and willingness-to-pay(WTP)of combined can-cer screening among rural residents in Shandong Province,and to analyze its influencing factors.[Methods]A face-to-face questionnaire survey was conducted among rural residents aged 40～70 in villages setected by cluster sampling from three counties(county level city or district)in Shan-dong Province.The questionnaire was developed using the method of double-bound dichotomous choice combined with open-ended questions in contingent valuation.The factors influencing inten-sity of WTP was analyzed with using single-factor and ordinary least squares regression models.[Results]A total of 962 subjects were surveyed.89.19％of the respondents were willing to accept cancer combined screening,and 62.00％were willing to pay part of the costs.The average of WTP was 963.67 CNY,which accounted for 32.12％of the total cost.The proportion of respon-dents who were willing to pay between 0～1 500 CNY was the highest(76.49％).In the multivariate analysis,age,sex and income had significant effects on the maximum payment of multi-cancer screening.[Conclusion]The acceptance of multi-cancer screening among rural residents in the study sites is high,but the willingness-to-pay is limited.The out-of-pocket payment for multi-can-cer screening should be controlled,and a co-payment mechanism among government,enterprises,social organizations and individuals should be explored.

[Purpose]To investigate the acceptance and willingness-to-pay(WTP)of combined can-cer screening among rural residents in Shandong Province,and to analyze its influencing factors.[Methods]A face-to-face questionnaire survey was conducted among rural residents aged 40～70 in villages setected by cluster sampling from three counties(county level city or district)in Shan-dong Province.The questionnaire was developed using the method of double-bound dichotomous choice combined with open-ended questions in contingent valuation.The factors influencing inten-sity of WTP was analyzed with using single-factor and ordinary least squares regression models.[Results]A total of 962 subjects were surveyed.89.19％of the respondents were willing to accept cancer combined screening,and 62.00％were willing to pay part of the costs.The average of WTP was 963.67 CNY,which accounted for 32.12％of the total cost.The proportion of respon-dents who were willing to pay between 0～1 500 CNY was the highest(76.49％).In the multivariate analysis,age,sex and income had significant effects on the maximum payment of multi-cancer screening.[Conclusion]The acceptance of multi-cancer screening among rural residents in the study sites is high,but the willingness-to-pay is limited.The out-of-pocket payment for multi-can-cer screening should be controlled,and a co-payment mechanism among government,enterprises,social organizations and individuals should be explored.

Objective To observe the value of artificial intelligence iterative reconstruction(AIIR)for low-dose chest CT images of infants with congenital heart disease.Methods Totally 262 infants with congenital heart disease who would undergo chest CT scanning were prospectively enrolled and randomly divided into low-dose group(n=142)and conventional dose group(n=120).Chest CT scanning with tube voltage of 80 kVp and tube current of 10 mAs was performed in low-dose group,and hybrid iterative reconstruction(HIR,group A)and AIIR(group B)were used to reconstruct images,respectively.In conventional dose group,chest CT scanning with tube voltage of 80 kVp and tube current of 100 mAs was performed,and HIR was used to reconstruct images(group C).Then subjective and objective evaluation on image quality were performed,the results were compared among 3 groups,and the value of AIIR was analyzed.Results Significant differences of image quality and clarity of displaying structures were found among 3 groups(all P＜0.001).Among them,except for the clarity of interlobar fissure,no significant difference of subjective scores was found between low-dose AIIR images and conventional dose HIR images(all corrected P＞0.05),while subjective scores of low-dose HIR images were all lower than those of low-dose AIIR images and conventional dose HIR images(all corrected P＜0.05).Significant differences of standard deviation(SD),signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)were found among 3 groups(all P＜0.001)and between each 2 groups(all corrected P＜0.05).The effective dose of low-dose group and conventional dose group was 0.09(0.08,0.10)and 0.85(0.75,1.03)mSv,respectively,and the former was lower than the latter(Z=-13.942,P＜0.001).Conclusion Using AIIR could obtain low-dose chest CT images of infants with quality comparable to conventional chest CT images.

Objective:To investigate the optimal reconstruction grade of IDream reconstruction technique in reducing image noise,optimizing image quality,and displaying liver cysts through the subjective assessment on the display of computed tomography (CT) image with differently reconstructive grades in IDream reconstruction technique of iterative reconstruction algorithm,and the objective evaluation of image quality of upper abdomen. Methods:The imaging data of CT plain scan of 53 patients with hepatic cysts who underwent plain scans on upper abdomen at Peking Union Medical College Hospital from August to September 2021 were retrospectively collected. All images were reconstructed to standard window images by using 6 kinds of methods that included filtered back projection (FBP) and IDream grades 1 to 5,which resulted in 6 groups of images that included FBP group and IDream grades 1-5. The CT values and standard deviation (SD) values of the liver,abdominal aorta,erector spine muscle,fat and spleen in images of each group were measured and recorded,respectively. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the images were calculated. Two CT diagnostic physicians with more than 8 years of experience conducted subjective scoring for the display in the images of hepatic cysts of each group. The objective parameters and the subjective scores of hepatic cysts of reconstructive images with different grades were compared. A one-way analysis of variance was adopted to analyze the objective parameters,and Kruskal-Wallis H test was conducted on the subjective score of the display of hepatic cysts. Results:There were no statistically significant differences in the CT values among different reconstruction grades on the liver,abdominal aorta,fat,erector spine muscle and spleen (P>0.05). In the FBP group and IDream grades 1 to 5 groups,the SD values of images gradually decreased with the increasing of the reconstruction grades,which were respectively (18.11±5.03),(15.37±4.97),(13.26±4.83),(11.68±4.56),(10.99±4.36) and (10.60±4.21) Hu. The SNR and CNR of the liver gradually increased. The differences in SD values,SNR,and CNR among the six groups of images were all statistically significant (F=20.75,17.72,3.15,P<0.05),respectively. The subjective scores for the display of hepatic cysts from the FBP group to IDream grades 1 to 4 were respectively (3.12±0.35),(3.63±0.46),(4.02±0.42),(4.61±0.48) and (4.63±0.48),which were gradually increasing,while the score for the IDream grade 5 group slightly decreased to (4.53±0.47). The subjective scores for hepatic cysts in the images of IDream grades 3 and 4 groups were the highest. The comparison of the average subjective scores of the images of hepatic cysts among the six reconstruction grades showed statistically significant differences (H=192.17,P<0.05). Conclusion:In CT plain scan on the upper abdomen,with the increasing of IDream reconstruction grades,the image noises gradually decrease,and objective parameters of images gradually enhance,and the reconstructions of IDream grades 3 and 4 can obtain the optimal image quality of upper abdomen at the objective score of hepatic cysts.

Objective By analyzing the causes of coding errors of lower extremity arteriosclerosis occlusion with throm-bosis and the endovascular intervention,explore the principle diagnosis and intervention coding rules to improve coding quality.Methods Inpatient medical records with the principle diagnosis codes of I70-I74 and I77 accompanied by endovascular interven-tional from January 1,2023 to December 31,2023 were retrieved from a tertiary hospital.A retrospective study was conducted to analyze the causes of coding errors.Results A total of 924 eligible cases were selected.There were 41 principle diagnosis cod-ing errors,with an error rate of 4.43％,among which the lower limb atherosclerosis coding had the highest error rate,accounting for 1.30％.There were 46 intervention coding errors,with an error rate of 4.98％,among which the percutaneous thrombectomy had the highest error rate.The main reason for coding errors was insufficient reading of medical record.Conclusion The coding error rate of the principle diagnosis of lower extremity arteriosclerosis occlusion and the endovascular intervention were relatively high.Therefore,it is necessary to continuously strengthen the training of clinicians and coders,including the coding rules and clinical knowledge of specialized disciplines,actively communicate between coders and clinicians,establish a quality control and assessment system,so as to improve the coding quality.

Objective This study aimed to investigate the antimicrobial resistance profiles of bacterial strains isolated from pediatric intensive care units(PICU)in China for better antimicrobial therapy.Methods Clinical isolates were collected from 17 institutions,including tertiary care children's hospitals and pediatric department of tertiary general hospitals in China from January 1,2020 to December 31,2022.Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems.Results were interpreted according to the breakpoints released by the Clinical and Laboratory Standards Institute(CLSI)in 2020.Results A total of 10 688 isolates were collected,including gram-positive organisms(39.2％)and gram-negative organisms(60.8％).The top three organisms were S.aureus(13.6％,1 453/10 688),A.baumannii(10.0％,1 067/10 688),and coagulase-negative Staphylococcus(9.9％,1 058/10 688).Multi-drug resistant organisms(MDROs)were very common in children.The prevalence of methicillin-resistant Staphylococcus aureus(MRSA),carbapenem-resistant Enterobacterales(CRE),carbapenem-resistant E.coli,carbapenem-resistant K.pneumoniae(CRKP),carbapenem-resistant A.baumannii(CRAB),and carbapenem-resistant P.aeruginosa(CRPA)was 41.1％,19.4％,8.8％,30.9％,67.4％,and 28.8％,respectively.Overall,more than 50％of Enterobacteriales isolates were resistant to cephalosporins,while nearly 25％of Enterobacteriales isolates were resistant to carbapenems.MDROs were highly resistant to commonly used antibiotics.More than 80％of CRE and CRAB strains were resistant to all beta-lactam antibiotics.CRE and CRAB showed low resistance rates to tigecycline and polymyxin.CRPA showed lower resistance rates to piperacillin,beta-lactamase inhibitor combinations than the resistance rates to third and fourth generation cephalosporins.All of the Staphylococcus and Enterococcus isolates were susceptible to vancomycin and tigecycline.None of PRSP strains isolated from meningitis and nonmeningitis samples were resistant to rifampicin,vancomycin,or linezolid.The prevalence of β-lactamase-negative ampicillin-resistant(BLNAR)strains was 43.3％in Haemophilus influenzae.Conclusions MDROs were prevalent in PICU.It is necessary to establish an effective multidisciplinary team(MDT)to control the antimicrobial resistance.