Non-small cell lung cancer(NSCLC)is the leading cause of cancer-related mortality worldwide,with approximately 30％of patients initially presenting at stage Ⅱ-Ⅲ and thus potentially eligible for surgical resection.However,surgery alone is insufficient to control postoperative recurrence and distant metastasis effectively.Therefore,neoadjuvant treatment has gradually become a critical approach to improving patient prognosis.Conventional neoadjuvant chemotherapy has historically shown limited pathological complete response(pCR)rates,while neoadjuvant targeted therapy,despite enhancing objective response rates(ORR),still results in relatively low pCR.Recently,neoadjuvant immunotherapy combined with chemotherapy has demonstrated groundbreaking progress.Several large-scale international and domestic clinical trials have reported that this combination strategy significantly increases pCR rates to between 17％and 41％and notably prolongs event-free survival.However,neoadjuvant immunotherapy also introduces new surgical challenges,including increased intraoperative difficulty due to tissue fibrosis,expanded surgical resections resulting from inadequate preoperative prediction,and emerging concerns surrounding the perioperative management of immune-related adverse events(irAEs).Recent advancements in artificial intelligence(AI)-assisted imaging models,multi-omics integration,and dynamic ctDNA monitoring offer novel perspectives and tools for accurately predicting pathological responses preoperatively.Furthermore,intensive studies on mechanisms underlying immunotherapy resistance,such as exosomal PD-L1 regulatory pathways and oxidative stress pathways,alongside emerging strategies involving bispecific antibodies and metabolic interventions,provide theoretical foundations for further optimizing therapeutic approaches.Looking forward,the development of precise preoperative efficacy prediction systems,deep integration of AI technology,and the expansion of multi-modal combination strategies will represent primary directions in the evolution of neoadjuvant immunotherapy for NSCLC.

Non-small cell lung cancer(NSCLC)is the leading cause of cancer-related mortality worldwide,with approximately 30％of patients initially presenting at stage Ⅱ-Ⅲ and thus potentially eligible for surgical resection.However,surgery alone is insufficient to control postoperative recurrence and distant metastasis effectively.Therefore,neoadjuvant treatment has gradually become a critical approach to improving patient prognosis.Conventional neoadjuvant chemotherapy has historically shown limited pathological complete response(pCR)rates,while neoadjuvant targeted therapy,despite enhancing objective response rates(ORR),still results in relatively low pCR.Recently,neoadjuvant immunotherapy combined with chemotherapy has demonstrated groundbreaking progress.Several large-scale international and domestic clinical trials have reported that this combination strategy significantly increases pCR rates to between 17％and 41％and notably prolongs event-free survival.However,neoadjuvant immunotherapy also introduces new surgical challenges,including increased intraoperative difficulty due to tissue fibrosis,expanded surgical resections resulting from inadequate preoperative prediction,and emerging concerns surrounding the perioperative management of immune-related adverse events(irAEs).Recent advancements in artificial intelligence(AI)-assisted imaging models,multi-omics integration,and dynamic ctDNA monitoring offer novel perspectives and tools for accurately predicting pathological responses preoperatively.Furthermore,intensive studies on mechanisms underlying immunotherapy resistance,such as exosomal PD-L1 regulatory pathways and oxidative stress pathways,alongside emerging strategies involving bispecific antibodies and metabolic interventions,provide theoretical foundations for further optimizing therapeutic approaches.Looking forward,the development of precise preoperative efficacy prediction systems,deep integration of AI technology,and the expansion of multi-modal combination strategies will represent primary directions in the evolution of neoadjuvant immunotherapy for NSCLC.

Objective    To investigate the feasibility and safety of hybrid coronary revascularization (HCR) in patients with multivessel coronary artery disease (MVCAD). Methods    A total of 50 patients with MVCAD who underwent HCR technique in our heart center from May 2016 to April 2019 were included in this study (a HCR group), including 38 patients who underwent two-stage HCR and 12 patients one-stop HCR. There were 39 males and 11 females, with an average age of 62.4 (46-82) years. Another 482 patients who underwent conventional median incision under off-pump coronary artery bypass grafting (OPCAB) at the same period were selected as control (an OPCAB group), including 392 males and 90 females, with an average age of 64.2 (48-84) years. The safety and feasibility of HCR were evaluated and compared with conventional OPCAB technique. Results    There was no perioperative death in both groups. Compared with the OPCAB, HCR was associated with shorter operation time, less chest tube drainage, lower requirement of blood transfusion, shorter mechanical ventilation time and shorter postoperative intensive care unit (ICU) stay (P<0.05). There was no statistical difference in the incidence of major adverse cardiac or cerebrovascular events during the follow-up of 6 to 36 months between the two groups. Conclusion    HCR provides favorable short and mid-term outcomes for selected patients with MVCAD compared with conventional OPCAB.

To identify the predictors of prolonged mechanical ventilation in patients undergoing surgery for stanford type A acute aortic dissection. Methods 202 patients who underwent surgery for acute aortic dissection type A from May 2009 to May 2016 were divided into two groups based on their mechanical ventilation time after surgery, including 70 patients with mechanical ventilation 48 hours or more(group A), 132 patients with mechanical ventilation less than 48 hours (group B). Univariate and multivariate analysis(logistic regression) were used to identify the predictive risk factors. Results The mechanical ventilation time was(146. 8 ±78. 5)h and(21. 7 ±9. 5)h in group A and group B respectively. Overall inhospital mortality was 8. 6％ and 2. 3％. Multivariate logistic analysis showed that BMI(OR = 5. 956, 95％ CI: 2. 585 - 13. 723, P =0. 000), CPB time(OR =1. 108, 95％CI: 1. 052 -1. 166, P =0. 000), DHCA(OR =4. 562, 95％ CI: 1. 250 - 16. 640, P =0. 022), red blood cell transfusion intraoperative and in 24 hours postoperatively(OR =2. 625, 95％ CI: 1. 515 -4. 549, P =0. 001) were the independent predictors for prolonged mechanical ventilation. Conclusion The incidence of prolonged mechanical ventilation is high after surgery for stanford type A acute aortic dissection. It can be predicted based on above factors, for patients with these risk factors, more perioperative care strategies are needed in order to shorten the mechanical ventilation time.

To investigate the effect of preoperative uses of levosimendan in patients with low LVEF(≤0. 40) undergoing off-pump coronary artery bypass grafting(OPCABG). Methods 63 patients with low LVEF coronary artery diseases were prospectively enrolled during June 2015 to May 2018, randomized to levosimendan-treated group(n =32) and control group(n =31)preoperatively. Patients in levosimendan-treated group underwent levosimendan intravenous infusion 24 h before OPCABG. All patients underwent OPCABG at normal temperature. Internal mammary artery and great saphenous vein were used as bypass materials. Hemodynamics and cardiac function were compared between the two groups after OPCABG. Results Compared to control group, the systemic vascular resistance(SVR) and central venous pressure(CVP) of levosimendan- treated group were decreased significantly and the CO and LVEF increased significantly at 12h and 24h after surgery(P < 0. 05). The heart rate and mean artery pressure had no statistical difference between the two groups(P >0. 05). The dosage and administration time of vasoactive agents in levosimendan-treated group were significantly smaller than those in control group (P <0. 05). The time of mechanical ventilation, the ICU stay length, the BNP level in the first two days after operation, and the incidence of new atrial fibrillation were less than those of the control group(P <0. 05). The perioperative intra-aortic balloon pump implantation rate in levosimendan-treated group was significantly lower than that of the control group(P < 0. 05). Conclusion Preoperative use of levosimendan can significantly improve the hemodynamic and cardiac function status of patients with low LVEF after OPCABG, shorten the time of ventilator assisted and ICU hospitalization, and reduce the incidence of adverse events.

Objective    To investigate the effect of postoperative use of levosimendan on patients with valve replacement. Method    Patients with valvular diseases who underwent valve replacement were prospectively enrolled during Jan 2014 to May 2018 in Qingdao Municipal Hospital, randomized to a levosimendan-treated group (n=93) and a control group (n=92) preoperatively. Patients in both groups underwent the same routine treatment preoperatively and postoperatively. In addition, patients in the levosimendan-treated group underwent levosimendan intravenous infusion 24 hours after entering ICU postoperatively. The clinical effect of the two groups was compared. Results    Compared to the control group, the cardiac output(CO, 5.2±1.0 L/min vs. 4.4±1.1 L/min on the seventh day after surgery) and left ventricular ejection fraction (LVEF, 55.7%±2.5% vs. 50.5%±2.2% on the seventh day after surgery) of levosimendan-treated group were increased significantly at different time points(1 day, 3 days and 7 days after surgery)(P<0.05), and the brain natriuetic peptid (BNP) level (312.5±34.6 pg/ml vs. 455.4±45.2 pg/ml on the seventh day after surgery) was less than that of the control group (P<0.05). The dosage (11.5±1.8 mg/kg vs. 20.4±2.1 mg/kg) and administration time of vasoactive agents in the levosimendan-treated group were significantly lower or shorter than those in the control group (70.4±11.2 h vs. 110.5±12.1 h, P<0.05). The ICU stay length, and the total incidence of adverse events were less than those of the control group (P<0.05). Conclusion    Postoperative use of levosimendan immediately after surgery can significantly improve the   cardiac function status of patients who underwent valve replacement, reduce the dosage of vasoactive agents, shorten the time of ICU hospitalization, reduce the incidence of adverse events and enhance the patient’s recovery after valve replacement.