Lung cancer constitutes the most prevalent and lethal malignant tumor in China. Approximately 85% of lung cancer diagnoses correspond to the non-small cell histological subtype [non-small cell lung cancer (NSCLC)]. Despite surgery being the mainstay for early-stage disease, postoperative recurrence remains high and adjuvant chemotherapy offers limited benefit. In recent years, targeted therapy has demonstrated substantial advantages in driver mutation-positive NSCLC. To this end, the Lung Cancer Medical Education Committee of the Chinese Medical Education Association developed guidelines based on a systematic review of evidence through November 2025, using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach and a modified Delphi method. Focusing on epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK), and addressing ROS proto-oncogene 1 (ROS1), B-Raf proto-oncogene serine/threonine kinase (BRAF) V600E mutation, and mesenchymal-epithelial transition factor (MET) exon 14 (METex14) skipping, the guideline covers molecular testing, neoadjuvant/adjuvant therapy, perioperative strategies, minimal residual disease monitoring, and postoperative surveillance. It defines testing requirements, specifies stage-directed and subtype-specific treatments, and standardizes minimal residual disease monitoring. These recommendations emphasize precision and feasibility to improve survival and quality of life.

Objective To explore the risk factors for postoperative respiratory failure (RF) in patients with esophageal cancer, construct a predictive model based on the least absolute shrinkage and selection operator (LASSO)-logistic regression, and visualize the constructed model. Methods A retrospective analysis was conducted on patients with esophageal cancer who underwent surgical treatment in the Department of Thoracic Surgery, Sun Yat-sen University Cancer Center Gansu Hospital from 2020 to 2023. Patients were divided into a RF group and a non-RF (NRF) group according to whether RF occurred after surgery. Clinical data of the two groups were collected, and LASSO-logistic regression was used to optimize feature selection and construct the predictive model. The model was internally validated by repeated sampling 1000 times based on the Bootstrap method. Results A total of 217 patients were included, among which 24 were in the RF group, including 22 males and 2 females, with an average age of (63.33±9.10) years; 193 were in the NRF group, including 161 males and 32 females, with an average age of (62.14±8.44) years. LASSO-logistic regression analysis showed that the percentage of forced expiratory volume in one second/forced vital capacity (FEV1/FVC) to predicted value (FEV1/FVC%pred) [OR=0.944, 95%CI (0.897, 0.993), P=0.026], postoperative anastomotic fistula [OR=4.106, 95%CI (1.457, 11.575), P=0.008], and postoperative lung infection [OR=3.776, 95%CI (1.373, 10.388), P=0.010] were risk factors for postoperative RF in patients with esophageal cancer. Based on the above risk factors, a predictive model was constructed, with an area under the receiver operating characteristic curve of 0.819 [95%CI (0.737, 0.901)]. The Hosmer-Lemeshow test for the calibration curve showed that the model had good goodness of fit (P=0.527). The decision curve showed that the model had good clinical net benefit when the threshold probability was between 5% and 50%. Conclusion FEV1/FVC%pred, postoperative anastomotic fistula, and postoperative lung infection are risk factors for postoperative RF in patients with esophageal cancer. The predictive model constructed based on LASSO-logistic regression analysis is expected to help medical staff screen high-risk patients for early individualized intervention.

Objective To evaluate the outcomes of sleeve resection following neoadjuvant chemoimmunotherapy for lung cancer. Methods The clinical data of patients diagnosed with lung cancer and underwent sleeve lobectomy surgery at Tianjin Chest Hospital were retrospectively analyzed. Patients were divided into two groups: a neoadjuvant treatment group and a surgery alone group. The clinical data of two groups were compared. Results Finally 22 patients were collected, including 19 males and 3 females with a median age of 63 years. There were 7 patients in the neoadjuvant treatment group, and 15 patients in the surgery alone group. There was no statistical difference in surgical time, intraoperative bleeding, lymph node dissection, postoperative catheterization time, or postoperative drainage volume between the two groups (P>0.05). In the neoadjuvant treatment group, 1 patient had a second thoracotomy exploration for hemostasis due to bronchial artery bleeding, 2 patients had wound infection, 1 patient had immune-associated pneumonia before surgery, and 1 patient had immune-associated pneumonia before postoperative adjuvant therapy. Postoperative pathological results of patients in the neoadjuvant treatment group showed that 1 (1/7, 14.3%) patient had pathological complete response, and 3 (3/7, 42.9%) patients achieved major pathological response. Conclusion Neoadjuvant chemoimmunotherapy can lead to complications, including operation-related complications and immunotherapy-related complications. However, the degree of postoperative pathological remission is also significantly improved. Overall, sleeve resection following neoadjuvant chemoimmunotherapy can be considered as a treatment option for patients with lung cancer.

Objective To investigate the safety, efficacy, and clinical value of a fracture reduction and fixation system. Methods The design and application of components [Kirschner wire (K-wire) limiter and K-wire guiding locking device] of the fracture reduction and fixation system were described. Six surgeons implanted K-wires into synthetic bones using the K-wire limiter or by perception respectively, and the length of K-wire protrusion was assessed. K-wire guiding locking device combined with locking plates and two 1.5 mm K-wires, two 1.5 mm K-wires, as well as two 2.0 mm K-wires were used to fix a fracture model constructed by synthetic bones, and the torque at failure was measured. Results The K-wire limiter reduced the length of K-wire protrusion(P < 0.001). The failure torque of fractures fixed by K-wire guiding locking device with locking plates and two 1.5 mm K-wires was larger than those fixed with two 1.5 mm K-wires and two 2.0 mm K-wires(P < 0.05). Conclusion The fracture reduction and fixation system offers a new technique for reducing and reconstructing fractures, assessing and optimizing the position of locking plate screws, as well as protecting the blood supply of fractures.

Objective:To evaluate the effectiveness of the artificial intelligence-assisted diagnosis and treatment system in distinguishing benign and malignant lung nodules.Methods:Clinical data of 1 650 patients with pulmonary nodules admitted to the Tianjin Chest Hospital Affiliated to Tianjin University from January 2015 to October 2022 were retrospectively analyzed, which included a total of 1 650 nodules. The malignant probability was compared to and analyzedpredict the benign and malignant nodules.Results:A total of 1 650 nodules were included, which were divided into a malignant tumor group(n=1 391, 84.3%) and a benign lesion group(n=259, 15.7%). Between the malignant tumor group and the benign lesion group, the malignant probability was significantly different, and the malignant probability could better distinguish malignant nodules and benign lesions[(78.85±22.91)% vs.(54.91±28.68)%, P<0.001]. The area under the curve( AUC) was 0.768. The critical value of malignant probability for diagnosis of lung cancer was 81.3% with a sensitivity of 0.620 and specificity of 0.815. Stratified analysis results showed that the accuracy of the AI intelligent system for diagnosing pulmonary nodules with the sizes of 0-1 cm, 1-2 cm and 2-3 cm was also increased, and the areas under ROC curve were 0.717, 0.769 and 0.804, respectively. Conclusion:The malignant probability of lung nodules calculated by the artificial intelligence-assisted diagnosis and treatment system can be used in the assessment of the preoperative benign and malignant lung nodules.

Objective    To investigate the clinical value of artificial intelligence (AI)-assisted chest computed tomography (CT) in the diagnosis of peripheral lung shadow. Methods    The CT image data of 810 patients with peripheral pulmonary shadow treated by thoracic surgery in Tianjin Chest Hospital Affiliated to Tianjin University from January 2018 to July 2019 were retrospectively analyzed using AI-assisted chest CT imaging diagnosis system. There were 339 males and 471 females with a median age of 63 years. The malignant probability of preoperative AI-assisted diagnosis of peripheral pulmonary shadow was compared with the results of postoperative pathology. Results    The pathological diagnosis of 810 patients with peripheral pulmonary shadow was lung cancer in 627 (77.4%) patients, precancerous lesion in 30 (3.7%) patients and benign lesion in 153 (18.9%) patients. The median probability of malignant AI diagnosis before operation was 86.0% (lung cancer), 90.0% (precancerous lesion) and 37.0% (benign lesion), respectively. According to the analysis of receiver operating characteristic (ROC) curve of AI malignant probability distribution in this group of patients, the area under the ROC curve was 0.882. The critical value of malignant probability for diagnosis of lung cancer was 75.0%with a sensitivity of 0.856 and specificity of 0.814. A total of 571 patients were diagnosed with AI malignancy probability≥ 75.0%, among whom 537 patients were pathologically diagnosed as lung cancer with a positive predictive value of 94.0%(537/571). Conclusion    The AI-assisted chest CT diagnosis system has a high accuracy in the diagnosis of peripheral lung cancer with malignant probability≥75.0% as the diagnostic threshold.

Objective:To study the effectiveness and safety of programmed cell death receptor 1(PD-1) monoclonal antibody combined with chemotherapy in the preoperative neoadjuvant treatment of stage ⅢA non-small cell lung cancer(NSCLC).Methods:A total of 65 patients with stage ⅢA NSCLC who underwent preoperative neoadjuvant treatment in our hospital from January 2019 to October 2020 were selected. According to the preoperative neoadjuvant treatment plan, they were divided into control group(31 cases) and observation group(34 cases). Patients in the control group were treated with albumin-bound paclitaxel and cisplatin for injection, and the patients in the observation group were treated with immunotherapy(carrelizumab/sintilizumab) on the basis of the control group, all underwent 2 cycles of preoperative neoadjuvant treatment. Compared the clinical efficacy of imaging, T lymphocyte subsets, drug side effects, surgical resection rate, major pathological remission(MPR), complete pathological remission(pCR) and postoperative complications of the two groups of patients, and analyzed the factors those affected MPR.Results:The clinical efficacy of PR and ORR of imaging in the observation group was better than that of the control group( P<0.05). The positive rate of CD3 + cells, the positive rate of CD4 + cells, the positive rate of CD8 + cells and the ratio of CD4 + /CD8 + cells in the observation group after treatment were higher than those in the control group( P<0.05). The drug toxicity of the observation group was higher than that of the control group in RCCEP/rash, abnormal thyroid function, and abnormal myocardial enzymes( P<0.05). Compared among the observation group(carrelizumab group/sintilizumab group), the toxicity of carrelizumab group was higher than that of sintilizumab group in RCCEP/skin rash, bone marrow suppression and abnormal myocardial enzymes( P<0.05). The MPR and pCR of the observation group were higher than those of the control group( P<0.05). There was no significant difference in surgical resection rate, surgical methods and postoperative complications between the two groups( P>0.05). The results of univariate analysis showed that ECOG score, pathological type, neoadjuvant treatment plan were related to MPR( P<0.05). The results of binary logistic regression analysis showed that ECOG score and neoadjuvant treatment plan were independent risk factors affecting MPR( P<0.05). Conclusion:PD-1 monoclonal antibody combined with chemotherapy can enable patients to obtain better MPR and pCR, and can improve the immune function of patients. But the side effects caused by immunotherapy drugs are worthy of attention, and the side effects are different between different immune drugs.

Objective    To evaluate the efficacy and safety of programmed cell death receptor 1 (PD-1) inhibitor combined with chemotherapy in the preoperative neoadjuvant treatment of stage Ⅲ non-small cell lung cancer (NSCLC). Methods    The clinical data of 68 patients with stage Ⅲ NSCLC who underwent preoperative neoadjuvant treatment in our hospital from June 2019 to October 2020 were analyzed and divided into two groups according to a random number table. There were 34 patients in the control group including 19 males and 15 females with an average age of 59.41±4.77 years. In the observation group, there were 34 patients including 21 males and 13 females with an average age of 61.15±6.24 years. The patients in the control group were treated with albumin-bound paclitaxel and cisplatin for injection, and the patients in the observation group were treated with carrelizumab on the basis of the control group, and both groups received 2 cycles of preoperative neoadjuvant therapy. We compared the clinical efficacy of imaging, T lymphocyte subsets, drug side effects, surgical resection rate, major pathological remission (MPR), complete pathological remission (pCR) and postoperative complications of the two groups of patients, and analyzed the influencing factors for MPR. Results    The objective response rate (ORR) of imaging in the observation group (70.6%) was higher than that in the control group (38.2%, P<0.05). The positive rate of CD3+ cells, the positive rate of CD4+ cells, the positive rate of CD8+ cells and the ratio of CD4+/CD8+ cells in the observation group after treatment were higher than those in the control group (P<0.05). The drug toxicity of the observation group was higher than that of the control group in the reactive cutaneouscapillary endothelial proliferation (RCCEP)/rash, abnormal thyroid function, and abnormal myocardial enzymes (P<0.05). The MPR (66.7%) and pCR (51.9%) of the surgical observation group were higher than those of the surgical control group (MPR: 19.2%, pCR: 7.7%, P<0.05). There was no statistical difference in surgical resection rate and postoperative complications between the two groups (P>0.05). Univariate analysis showed that ECOG score, pathological type, neoadjuvant treatment plan and surgical resection were related to MPR (P<0.05). The results of binary logistic regression analysis showed that Eastern Cooperative Oncology Group (ECOG) score and neoadjuvant treatment plan were independent risk factors for MPR (P<0.05). Conclusion    The clinical efficacy of PD-1 inhibitor combined with chemotherapy in the preoperative neoadjuvant treatment of stage Ⅲ NSCLC patients is definite, and it can significantly improve the patients' MPR, pCR and cellular immune function, but the side effects caused by immunotherapy drugs need to be concerned.

Objective    To compare the 5-year survival rates between two different follow-up patterns of postoperative stage Ⅰ-ⅢA non-small cell lung cancer (NSCLC) patients. Methods    Pathological stage Ⅰ-ⅢA NSCLC 11 958 patients who underwent surgical resection and received follow-up within 6 months after initial diagnosis through telephone follow-up system were included in nine hospitals from July 2014 to July 2020. The patients were divided into two groups including a proactive follow-up group (n=3 825) and a passive follow-up group (n=8 133) according to the way of following-up. There were 6 939 males and 5 019 females aged 59.8±9.5 years. The Kaplan-Meier and Cox proportional hazards regression model were used. Results    The median follow-up frequency was 8.0 times in the proactive follow-up group and 7.0 times in the passive follow-up group. The median call duration was 3.77 minutes in the proactive follow-up group and 3.58 minutes in the passive follow-up group. The 5-year survival rate was 81.8% and 74.2% (HR=0.60, 95CI 0.53-0.67, P<0.001) in the proactive follow-up group and the passive follow-up group, respectively. Multivariate analysis showed that follow-up pattern, age, gender and operation mode were independent prognostic factors, and the results were consistent in all subgroups stratified by clinical stages. Conclusion    The proactive follow-up leads to better overall survival for resected stage Ⅰ-ⅢA NSCLC patients, especially in the stage ⅢA.

At present, there are many problems in the nail-fold microcirculation detection devices, such as huge structure, inconvenience to carry. In addition, due to the patient's body shaking, the video is difficult to keep stable in collecting with the device, which brings great difficulties to the doctor's observation. We develop a small image acquisition device for nail-fold microcirculation based on the principle of SDF imaging principle and liquid lenses technology. An annular lighting device is fixed in front of the optical system, and the overall design of the system is based on the characteristics of human fingers. The device is small, easy to carry and conform to the fingertips. It can focus quickly through a controller. It can also achieve high quality images of the nail-fold microcirculation. This study can promote the usage of nail-fold microcirculation device at the bedside. It's an efficient tool for medical workers to observe the microcirculation of patients.
Humans ; Microcirculation