With the accelerating trend of population aging, the number of elderly patients with lung cancer continues to rise, and the disease burden is becoming increasingly heavy. The clinical management of these patients faces severe challenges due to their decreased physiological reserve, complex comorbidities, and significant individual heterogeneity. Consequently, under traditional diagnosis and treatment models, doctors often struggle to identify the individualized risks of elderly patients in a timely and comprehensive manner, which can easily lead to decision biases such as undertreatment or overtreatment. In view of this, this study advocates for the establishment of an umbrella decision-making model specifically tailored for elderly lung cancer patients. Grounded in a multidisciplinary team (MDT) platform, this model deeply integrates oncological indicators with the comprehensive geriatric assessment (CGA) system. By holistically considering multidimensional variables including tumor burden, organ function, frailty index, cognitive status, and social support, the model establishes an operational mechanism characterized by "single entry, precise stratification, and targeted selection". Accordingly, patients can be scientifically triaged into distinct intervention tiers, such as active surveillance, minimally invasive surgery, drug therapy, radiotherapy, and best supportive care, thereby achieving real-time alignment between treatment intensity and patient fitness. This article elaborates on the construction logic and key operational procedures of this novel decision-making framework, aiming to guide clinical practice beyond the limitations of a tumor-centric perspective toward a holistic, dynamic, whole-course management strategy. This transition seeks to ensure optimal quality of life and clinical net benefit for elderly patients alongside survival prolongation.

BACKGROUND:Liuwei Dihuang Wan takes"three tonifying and three reducing effects"as its compatibility feature to nourish yin and tonify the kidneys,while Zuogui Wan takes"seeking yin in yang"as its compatibility feature to nourish yin and tonify the kidneys by promoting yang.Both of them belong to the same method of nourishing yin and tonifying the kidneys,and have better curative effects at the symptomatic and cellular molecular levels. OBJECTIVE:To observe the effects of Liuwei Dihuang Wan and Zuogui Wan in bone metabolism,and to explore their mechanism of action in the osteoprotegerin(OPG)/receptor activator of nuclear factor-κB ligand(RANKL)osteoblastic pathway. METHODS:Thirty-two Sprague-Dawley rats were randomized into model,Liuwei Dihuang Wan,Zuogui Wan,and sham operation group,with eight rats in each group.Osteoporosis models were prepared using removal of both ovaries in the first three groups.Starting at 30 days postoperatively,rats in the Liuwei Dihuang Wan group were gavaged with Liuwei Dihuang Wan 1.125 g/kg/d;rats in the Zuoqui Wan group were gavaged with Zuogui Wan 2.25 g/kg/d;and rats in the sham operation group and the model group were gavaged with saline 10 mL/kg/d.After 12 weeks of gavage,the rat tibia was taken to measure bone mineral density.The serum levels of estrogen,bone alkaline phosphatase,and cAMP/cGMP were measured using ELISA,and the expression of OPG/RANKL in the femur was detected using western blot. RESULTS AND CONCLUSION:Compared with the sham operation group,the model group showed a decrease in bone mineral density and levels of estrogen and bone alkaline phosphatase(P＜0.05)and an increase in cAMP/cGMP level(P＜0.05).Compared with the model group,the Liuwei Dihuang Wan group and the Zuogui Wan group significantly increased bone mineral density(P＜0.05)and bone alkaline phosphatase levels(P＜0.05);the Zuogui Wan group significantly decreased cAMP/cGMP levels(P＜0.05)and upregulated OPG expression(P＜0.05);the Liuwei Dihuang Wan group upregulated OPG expression and downregulated RANKL expression(P＜0.05);and both groups were unable to significantly increase estrogen levels(P＞0.05).To conclude,Zuogui Wan,which seeks yin from yang,can effectively increase the expression of OPG but cannot downregulate the expression of RANKL.However,Liuwei Dihuang Wan,which has three tonifying and three reducing effects,can bidirectionally regulate the expression of OPG and RANKL.This result suggests that Liuwei Dihuang Wan can significantly inhibit osteoclastic function compared with Zuogui Wan,and further research is needed to verify this conclusion.

BACKGROUND:Studies have reported that alendronate intake significantly increases bone mineral density in patients with osteoporosis. OBJECTIVE:To analyze and compare the changes in metabolites before and after alendronate intervention in ovariectomized rats by chromatography-mass spectrometry,and to further explore the specific mechanism and target of alendronate in the treatment of osteoporosis. METHODS:A total of 36 female Sprague-Dawley rats were randomly divided into model group,alendronate sodium group and sham operation group.The osteoporosis model was established by ovariectomy in the first two groups.Four weeks after modeling,the rats in the alendronate group were intragastrically given alendronate sodium,while those in the sham operation group and model group were given equal volume of normal saline.After 12 weeks of continuous gavage,the metabolites of the lumbar spine were analyzed by chromatography-mass spectrometry,and the common differential metabolites were obtained,which were analyzed by bioinformatics such as Kyoto Gene and Genome Encyclopedia pathway. RESULTS AND CONCLUSION:Totally 17 different metabolites were obtained in the three groups.The enrichment analysis of the Kyoto Encyclopedia of Genes and Genomes showed that alendronate sodium could regulate unsaturated fatty acid biosynthesis,linoleic acid metabolism and other pathways to protect ovariectomized rats.These results indicate that alendronate sodium may exert its anti-osteoporosis effect by interfering with unsaturated fatty acid bioanabolism and linoleic acid metabolism,so as to achieve the purpose of preventing osteoporosis

BACKGROUND:The mechanisms and targets of alendronate in the treatment of osteoporosis still need to be investigated in depth. OBJECTIVE:To investigate the mechanism by which alendronate regulates bone metabolism in rats with osteoporosis and to perform a bioinformatics analysis of differentially expressed proteins. METHODS:Female Sprague-Dawley rats were randomly divided into three groups(n=12 per group):model group,alendronate group and sham-operated group.Animal models of osteoporosis were prepared using ovariectomy in the model and alendronate groups.At 4 weeks after modeling,rats in the alendronate group were gavaged with alendronate;the other two groups were given the equal volume of normal saline.After 12 weeks of continuous gavage,the bone mineral density of the tibia was measured and the lumbar spine of the rats was taken for proteomic analysis using Tandem mass tag-liquid chromatography-tandem mass spectrometry technique to identify differentially expressed proteins for gene ontology,Kyoto Encyclopedia of Genes and Genomes pathway and protein-protein interaction analysis. RESULTS AND CONCLUSION:There were 32 up-regulated proteins and 51 down-regulated proteins identified between the alendronate group and model group.Gene ontology enrichment analysis showed that the differentially expressed proteins were mainly involved in molecular functions,such as binding and catalytic activity,and in biological processes,such as cellular process and metabolic process.Kyoto Encylopedia of Genes and Genomes enrichment analysis showed that the differentially expressed proteins in the alendronate group and model group were mainly involved in the biosynthesis of pantothenate and coenzyme A.Protein-protein interaction analysis indicated that among the differentially expressed proteins in the alendronate group and model group,Hspa1l,Enpp3,Unc45a,Myh9 and Cant1 were located at the nodes of the protein-protein interaction network and were closely related to bone metabolism.Overall,these findings indicate that alendronate may regulate bone metabolism in the rat model of osteoporosis by regulating the expression of differentially expressed proteins and biosynthesis of pantothenate and coenzyme A.

Gut microbiota plays an important role in development of diabetes with frailty. Therefore, it is of great significance to study the structural and functional characteristics of gut microbiota in Chinese with frailty. Totally 30 middle-aged and the aged participants in communities with diabetes were enrolled in this study, and their feces were collected. At the same time, we developed a metagenome analysis to explore the different of the structural and functional characteristics between diabetes with frailty and diabetes without frailty. The results showed the alpha diversity of intestinal microbiota in diabetes with frailty was lower.
Aged ; Diabetes Mellitus ; Epstein-Barr Virus Infections ; Frailty ; Gastrointestinal Microbiome ; Herpesvirus 4, Human ; Humans ; Middle Aged

Objective To study the effects and mechanism of Xuling-Jiangu formula on bone mineral density in the osteoporosis model rats.Methods According to the random number table method,50 SD female rats were randomly divided into the sham group,the model group,the low dose group of Xuling-Jiangu formula group,the medium dose group and the high dose of group.In addition to the sham group,the other groups were osteoporosis model.After 30 days,low dose group received intragastric Xuling-Jiangu formula solution 7.5 g/kg;medium dose group and high dose group received 15 and 30 g/kg,respectively.And the sham group and the model group received normal saline 10 ml/kg.After 12 weeks treatment,the bone mineral density of the left tibia was measured by double energy X ray.Estrone,osteocalcin in serum had been detected by Enzyme linked immunosorbent assay (ELISA).The mRNA expression of osteoprotegerin (OPG),receptor activator of nuclear factor κB ligand (RANKL) in lumbar were measured by quantitative real-time PCR.Results The bone mineral density (0.215 ± 0.010 g/cm2,0.222 ± 0.013 g/cm2 vs.0.196 ± 0.016 g/cm2) of the Xuling-Jiangu formula group were significantly higher than that of the model group (P＜0.01 or P＜0.05).The estrone in low,middle and high dose groups showed an upward trend,but there was no significant difference compared with the model group.The OC (87.0 ± 8.9 ng/L vs.100.5 ± 16.8 ng/L) of high dose group was significantly lower than that of the model group (P＜0.05).Compare with the model group,OPG mRNA level (0.97 ± 0.23 vs.0.78 ± 0.17) in high dose group increased (P＜0.05),the RANKL mRNA level decreased significantly (1.12 ± 0.17,0.97 ± 0.38,1.04 ± 0.29 vs.1.31 ± 0.18) in three Xuling-Jiangu formula groups (P＜0.05).Conclusions The bone mineral density of rats with osteoporosis can be improved by treating Xuling-Jiangu formula.It may be related to the increase of mRNA expression of OPG,and the reduction of RANKL.

Objective To study the effects ofXuling-Jiangu formula on bone mineral density and the bone biomechanic in the osteoporosis model rats.Methods According to the random number table method, 40 SD female rats were randomly divided into the caltrate D group, theXuling-Jianguformula group, the model group and the sham group,10 rats each group. In addition to the sham group, the other groups were osteoporosis model. After 30 days, the Caltrate D group received intragastric caltrate D mixed suspension 0.126 g/kg; the Xuling-Jiangu formula group receivedXuling-Jianguformula solution 15 g/kg, and the sham group and the model group received normal saline 10 ml/kg. After 12 weeks treatment, detection of left tibia bone mineral density andthree-point bending method was used for biomechanical testing.Results The mineral density of the Xuling-Jiangu formula group (0.244 ± 0.022 g/cm2,0.195 ± 0.017 g/cm2vs. 0.223 ± 0.013 g/cm2) were significantly higher than the model group and caltrate D group (P<0.01); compared with the model group, the bone biomechanictests in theXuling-Jiangu formula group (0.072 ± 0.036 kN vs.0.041 ± 0.015 kN; 843.754 ± 428.722 N/mm2vs. 482.084 ± 176.646 N/mm2) were significantly higher (P<0.05).ConclusionXuling-Jiangu formula canimprove the bone mineral density and the bone lbiomechanic of osteoporosis rats.

BACKGROUND:Studies have shown the bone mineral density of postmenopausal women is closely related to parathyroid hormone. But there are differences in different areas.
OBJECTIVE:To investigate the association between BstBⅠ polymorphism of parathyroid hormone gene with bone mineral density in postmenopausal women from Fuzhou area.
METHODS:The bone mineral densities of the lumbar spine, femoral neck, trochanter and Ward’s triangle were measured in 150 postmenopausal women by dual energy X-ray absorptiometry. The genotype of parathyroid hormone gene was determined by polymerase chain reaction-restriction fragment length polymorphism.
RESULTS AND CONCLUSION:(1) The distribution of parathyroid hormone genotypes were BB genotype 68.8%, Bb 24.1%, and bb 7.1%. The B al elic gene frequencies reached 81%, while b was 19%. The distribution fol owed the Hardy-Weinberg equilibrium. (2) Analysis of the relationship between the genotypes and bone mineral density:There was no significant difference in the bone mineral densities of the lumbar spine, femur, neck, trochanter and Ward’s triangle among the three genotypes (P>0.05). BstBⅠ gene polymorphism of parathyroid hormone gene is not correlated to bone mineral density, and there is no enough evidence to support genotype of parathyroid hormone gene as a genetic marker in predicting the risk of developing osteoperosis in Fuzhou postmenopausal women.

Objective To investigate the correlation between bone mineral density(BMD)and the PXh haplotype combining estrogen receptor (ER) gene Xba Ⅰ , Pvu Ⅱ polymorphisms and osteocalcin gene Hind Ⅲ polymorphism in postmenopausal women.Methods In 307 subjects,the BMD of lumbar vertebrae and proximal femur were measured by dual energy X-ray absorptiometry and the Xba Ⅰ and Pvu Ⅱ polymorphisms of ER gene and the Hind Ⅲ potymorphism of osteocalcin gene were detected by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP).Results (1)The BMD of greater trochanter was significantly lower in XX genotype group than in xx genotype group ( P<0.05).The BMD of femoral neck, greater trochanter and Ward's triangle were lower in Xx genotype group[(0.695±0.087)g/cm2 , (0.592±0.106)g/cm2, (0.500±0.115) g/cm2] and X allele group[(0.697±0.088)g/cm2 , (0.594±0.105)g/cm2, (0.505±0.123)g/cm2] than in xx genotype group[(0.737±0.108) g/cm2,(0.653±0.119)g/cm2 ,(0.554±0.130)g/cM2] and non-X allele group[(0.737 ± 0.108) g/CM2, (0.653 ± 0.119) g/cm2 , (0.554 ± 0.130) g/cm2] ,respectively (all P<0.05 ).(2)The BMD of Ward's triangle was lower in PP genotype group and P allele group than in pp genotype group and non-P allele group (P<0.05).(3)The BMD of femoral neck, greater trochanter and Ward's triangle were lower in hh genotype group and h allele group than in I-IH genotype group, and were lower in non-h allele group than in HH genotype group(all P<0.05).(4)Women carrying PX, PXh haplotypes combining ER gene and osteocalcin gene had lower BMD at femoral neck than those not carrying PX,not carrying PXh haplotypes, respectively (all P<0.05).ConclusionsER gene(Xba Ⅰ) polymorphism and osteocalein gene(Hind Ⅲ) polymorphism are associated with BMD in postmenopausal women.The presence of X allele or h allele　shows negative influence on the BMD of postmenopausal women.The PXh haplotype is a suitable　genetic marker of postmenopausal women osteoporosis in Fuzhou area.

OBJECTIVE: To study the association of the vitamin D receptor gene BSM Ⅰ, TAQ Ⅰ and APA Ⅰ genetic polymorphisms with bone mineral density and biochemical markers of bone turnover in postmenopausal women.METHODS: ①total of 576 postmenopausal Han ethnic women of 48-84 (62.17±6.37) years old in Fuzhou city were investigated, on the basis of their informed consent, through random sampling method from January 2007 to December 2008. ②The subjects were recorded regarding to their age, menopause duration, body mineral index and postmenopausal fracture incidence. ③Dual energy X-ray absorptiometry was used for measuring the bone mineral density of vertebrae L<,2-4>, left femoral neck, trochanter and Ward's triangle. ④The genetic polymorphisms of vitamin D receptor gene BSM Ⅰ, TAQ Ⅰ and APA Ⅰ were detected using polymerase chain reaction-rastriction and fragment length polymorphism (PCR-RFLP) technique. ⑤The biochemical markers of bone turnover (serum bone gla protein, serum bone alkaline phosphatase, urinary pyddinoline and urinary deoxypyridinoline) were detected with enzyme linked immunosorbent assay.RESULTS: A total of 561 subjects up to standard were involved in the result analysis. ①There was no significant difference in bone mineral density among genotypes of vitamin D receptor gene BSM Ⅰ, TAQ Ⅰ and APA Ⅰ polymorphisms (P > 0.05). ②There was no significant difference in the biochemical markers of bone tumover among genotypes of BSM Ⅰ, TAQ Ⅰ and APA Ⅰ polymorphisms (P > 0.05). ③There was no significant difference in the incidence of osteoporosis among genotypes of BSM Ⅰ, TAQ Ⅰ and APA Ⅰ polymorphisms (P > 0.05). ④There was no significant difference in the incidence of postmenopausal fracture among genotypes of BSM Ⅰ, TAQ Ⅰ and APA Ⅰ polymorphisms (P > 0,05).CONCLUSION: BSM Ⅰ, TAQ Ⅰ and APA Ⅰ polymorphisms of the vitamin D receptor gene are not obviously associated with osteoporesis in postmenopausal women, and accordingly can not be taken as genetic markers of osteoporosis in postmenopausal women in Fuzhou.