With the accelerating aging of the population, the proportion of elderly patients with lung cancer continues to rise, presenting multiple challenges to perioperative management. This paper systematically reviews the clinical characteristics of elderly lung cancer patients. Based on the comprehensive geriatric assessment, it proposes incorporating seven major geriatric syndromes—frailty, delirium, sarcopenia, cognitive impairment, malnutrition, dysphagia, and mood disorders—into the core evaluation system. By integrating multimorbidity management with complication prevention and control, an integrated "geriatric syndrome-multimorbidity-complication" perioperative management model is constructed. Furthermore, this paper outlines stratified intervention strategies for geriatric syndromes, a "five-step" workflow for comorbidity management, and a comprehensive intervention pathway for complications across the preoperative, intraoperative, and postoperative phases. Multidisciplinary team (MDT) collaboration serves as the core mechanism to achieve individualized comprehensive treatment. This paper aims to provide a novel perioperative comprehensive treatment model for elderly lung cancer patients, which is centered on geriatrics, supported by multidisciplinary collaboration, and guided by precision medicine.

ObjectiveTo evaluate the clinical efficacy and safety of Xiaozhen Formula （消疹方） in preventing skin toxicity induced by epidermal growth factor receptor inhibitors （EGFRIs） in patients with EGFR-mutant non-small cell lung cancer （NSCLC）. MethodsA randomized， double-blind， placebo-controlled， multicenter clinical study was conducted. A total of 120 patients with EGFR-mutant NSCLC from seven centers were enrolled and randomly assigned to a treatment group （60 cases） or a control group （60 cases）. On the basis of EGFRI-targeted therapy， patients in the treatment group received Xiaozhen Formula granules， whereas those in the control group received Xiaozhen Formula placebo granules， both at 10 g twice daily for 4 consecutive weeks. The primary outcomes were the grading of skin toxicity evaluated using the National Cancer Institute Common Terminology Criteria for Adverse Events （NCI-CTCAE） version 5.0 and the incidence of rash. Secondary outcomes included the time to onset and time to resolution of the highest-grade rash， the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 （EORTC QLQ-C30） scores， the Hospital Anxiety and Depression Scale （HADS） scores， and disease control rate， together with safety assessments. ResultsBased on the full analysis set （FAS）， the incidence of skin toxicity in the treatment group was 18.33% （11/60）， significantly lower than 45.00% （27/60） in the control group （P＜0.01）， with the highest severity of skin toxicity in both groups was grade 2. Among patients who developed rash， the resolution rate in the treatment group was 90.91% （10/11）， higher than that 33.33% （9/27） in the control group. The median time to resolution was 15 days （95%CI： 8-17 days） in the treatment group and it was not reached in the control group； the distribution of time to resolution differed significantly between groups （P＜0.001）. After treatment， the treatment group had higher EORTC QLQ-C30 functional scale and global health status/quality-of-life scores， and lower symptom scale， single-item scores， as well as HADS-A， and HADS-D scores than the control group （P＜0.05）. In the FAS analysis， the disease control rate （DCR） was 85.0% （51/60） in the treatment group， lower than 100.0% （60/60） in the control group （P=0.003）， whereas no significant between-group difference was observed in the per-protocol set （PPS） analysis （P=0.464）. The incidence of adverse events did not differ significantly between the two groups （P＞0.05）， and no definite safety signals related to the investigational drug were observed. ConclusionXiaozhen Formula can reduce the incidence of EGFRI-induced skin toxicity， and improve the outcome of rash regression， the patients' quality of life and psychological status in EGFR-mutant NSCLC patients.

Objective: To analyze the association between alcohol consumption and lumbar disc herniation (LDH), so as to provide a reference for the development of prevention and treatment strategies for LDH. Methods: From May to July 2022, permanent residents aged ≥18 years from eight counties (cities/districts) in Gansu Province were selected using a multistage stratified random sampling method. Data on basic characteristics, alcohol consumption in the past 30 days, hypertension, and diabetes mellitus were collected through questionnaire surveys. LDH was determined based on imaging findings, combined with disease history or clinical symptoms. Multivariable logistic regression model was used to analyze the association between alcohol consumption and LDH, with subgroup analyses conducted by gender, age, ethnicity, and altitude of residence. Propensity score matching (PSM) was utilized for sensitivity analysis. Results: A total of 4 545 individuals were surveyed. There were 2 026 (44.58%) males and 2 519 (55.42%) females. The mean age was (44.82±15.33) years. The study participants were predominantly of Han ethnicity, with 2 598 persons accounting for 57.17%. The altitude of residence was mainly above 3 500 m, with 1 941 persons accounting for 42.71%. There were 574 alcohol drinkers, accounting for 12.63%. LDH was detected in 1 035 cases, with a detection rate of 22.77%. Multivariable logistic regression analysis showed that after adjusting for gender, age, physical activity, and hypertension, compared to non-drinking residents, alcohol-consuming residents exhibited a 27.6% reduction in the risk of LDH (OR=0.724, 95%CI: 0.544-0.963). No significant interaction effects on LDH risk were observed between alcohol consumption and gender, age, ethnicity, or altitude of residence (all Pfor interaction >0.05). The results of the sensitivity analysis indicated that compared to non-drinking residents, alcohol-consuming residents exhibited a 38.8% reduction in the risk of LDH (OR=0.612, 95%CI: 0.382-0.976). Conclusion Alcohol consumption was statistically associated with a lower risk of LDH.

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

AIM: To investigate the application of optical coherence tomography angiography(OCTA)in observing the relationship between corneal topographic changes and retinal vessel density and thickness in myopic adolescents after wearing orthokeratology lenses.METHODS:Myopic adolescents who treated and wore orthokeratology lenses in our hospital between January and December 2023 were selected for the study, and their clinical data were retrospectively analyzed. Totally 50 cases(50 eyes)of toric orthokeratology lenses(toric group)and 50 cases(50 eyes)of spherical orthokeratology lenses(spherical group)were selected. Changes in corneal topographic indices, retinal vascular density and retinal thickness were examined in the two groups before and at 3 and 6 mo after wear. The relationship between corneal topographic indexes and retinal vessel density and thickness was analyzed.RESULTS: Compared with the pre-wear, average value of ks and kf(Avek)was significantly lower(all P<0.05), and surface regularity index(SRI)and surface asymmetry index(SAI)were significantly increased(both P<0.05)in the two groups at 3 and 6 mo post-wear. Compared with the pre-wearing period, deep retinal vessel density in whole macular area and superficial retinal vessel density in paracentral retina of macula were significantly higher in the two groups at 3 and 6 mo after wearing(both P<0.05), and the superficial retinal vessel density in macular fovea and paracentral fovea of macula of the toric group was significantly higher(all P<0.05), and the superficial retinal vessel density in paracentral macular fovea of the spherical group was significantly increased(all P<0.05). Compared with the pre-wearing period, the thickness of retina in whole macula and paracentral retina of the macula was significantly increased in the both groups at 3 and 6 mo post-wearing(all P<0.05). After wearing lenses for 3 mo, the Avek of the toric group was negatively correlated with the deep vascular density in whole macular area and paracentral macular fovea, the superficial vascular density in macular fovea and paracentral macular fovea, and the thickness of whole macular and paracentral macular fovea(all P<0.05). The SRI and SAI were positively correlated with the superficial retinal vascular density in macular fovea and paracentral macular fovea, and the retinal thickness in whole macular area and paracentral macular fovea(all P<0.05). The spherical group showed a negative correlation between Avek and the deep retinal vessel density in whole macular area and paracentral macular fovea, as well as the superficial retinal vessel density in paracentral macular fovea after wearing lenses for 3 mo(all P<0.05). SRI and SAI were positively correlated with the deep retinal vessel density in whole macular area, macular fovea and paracentral macular fovea, and the superficial retinal vessel density in paracentral macular fovea(all P<0.05). SRI was positively correlated with the retinal thickness in whole macular area(P<0.05), and SAI was positively correlated with the retinal thickness in paracentral macular fovea(P<0.05).CONCLUSION: After wearing toric and spherical corneal orthokeratology lenses, the corneal topography of myopic adolescents changes, and the retinal blood flow density and retinal thickness increase significantly, improving retinal blood circulation. Moreover, there is a significant correlation between changes in corneal topography and retinal blood flow density and retinal thickness, which has certain guiding significance for the control of myopia.

Guidelines, consensuses and standards play a significant role in guiding clinical diagnosis and treatment practices, optimizing the allocation of medical resources and reducing medical costs. To fully leverage the pivotal role of the National Clinical Research Center as a bridge between research evidence, recommendations of guidelines, consensuses and standards, and clinical practice, it is particularly urgent to construct a set of appropriate and efficient management system for guidelines, consensuses and standards. The National Clinical Research Center for Geriatric of West China Hospital, Sichuan University (hereinafter referred to as the center) has set the overall goal of " transparency, standardization, coordination, linkage and innovation leadership" and three phased goals of " achieving scientific, transparent and applicable management" " improving the multi-level, multi-subject coordination and linkage mechanism" and " promoting the homogenization of diagnosis and treatment services, process guarantee and standardized management" to explore the establishment of a management system for guidelines, consensuses and standards. Under this framework, the center has established the management committee and office for guidelines, consensuses and standards; build a dual-channel funding support model of " out-of-hospital+ in-hospital", established differentiated implementation models and formulated standardized processes; respectively formed clinical expert groups, methodology expert groups and evidence synthesis working groups, and carried out personnel training; and constructed a support platform for formulation, evaluation and promotion. As of October 2024, relying on the established management system for guidelines, consensuses and standards, the center has achieved a series of results in three aspects: formulating international evidence-based clinical practice guidelines, establishing a system of guidelines, consensuses and standards for geriatric disability, and building a standard system for medical and nursing integration, which has strongly supported clinical practice and the improvement of people′s livelihood by the government, and preliminarily completed the construction goals of the first phase, and can provide references for medical institutions committed to building a management system for guidelines, consensuses and standards.

Objective To explore the effect of cognitive behavioral therapy(CBT)on improving anxiety,depression,sleep,and fatigue in patients with post-intensive care syndrome(PICS).Methods Sixty PICS patients transferred from the department of respiratory intensive care unit(RICU)of Puyang Oilfield General Hospital from September 2022 to February 2023 were selected as the study subjects.Patients were divided into a control group and an intervention group using a random number table method,with 30 cases in each group.The control group only received routine health education,while the intervention group received CBT on the basis of routine health education.After 3 months of intervention,the changes in hospital anxiety and depression scale(HADS),Pittsburgh sleep quality index(PSQI),and fatigue assessment scale(FAS)before and after intervention were observed in both groups of patients.Results There was no statistically significant difference in anxiety,depression,PSQI,and FAS scores between the two groups of patients before intervention.The scores gradually decreased over time and reached the lowest level at 3 months after intervention.After intervention,the above scores in the intervention group were significantly lower than those in the control group(anxiety score:5.06±1.76 vs.9.33±1.42,depression score:6.93±1.64 vs.7.63±1.61,PSQI score:5.27±1.37 vs.8.43±2.56,FAS score:5.67±0.47 vs.9.97±0.21,all P<0.05).Conclusion Implementing CBT for PICS patients can alleviate anxiety and depression,improve their sleep quality and fatigue symptoms,thereby enhancing their quality of life.

Digital screening incorporates technology into the disease assessment process and plays a significant role in large-scale screening for mild cognitive impairment(MCI)within communities.This consensus systematically reviews and evaluates the existing evidence regarding the effectiveness of digital screening for MCI in these settings.The working group has integrated the perspectives of experts from diverse fields, including clinical practice, scientific research, and industry, to clarify the definitions of digital-related terms.Furthermore, the consensus presents 12 recommendations that outline the main classifications of tools, basic elements to consider, target individuals, screening frequency, and management strategies for digital screening, while also indicating future development directions.The aim is to optimize early diagnosis and treatment strategies for MCI and to promote the advancement of digital screening in cognitive health management for middle-aged and older adults in community settings.

Objective To explore the effect of cognitive behavioral therapy(CBT)on improving anxiety,depression,sleep,and fatigue in patients with post-intensive care syndrome(PICS).Methods Sixty PICS patients transferred from the department of respiratory intensive care unit(RICU)of Puyang Oilfield General Hospital from September 2022 to February 2023 were selected as the study subjects.Patients were divided into a control group and an intervention group using a random number table method,with 30 cases in each group.The control group only received routine health education,while the intervention group received CBT on the basis of routine health education.After 3 months of intervention,the changes in hospital anxiety and depression scale(HADS),Pittsburgh sleep quality index(PSQI),and fatigue assessment scale(FAS)before and after intervention were observed in both groups of patients.Results There was no statistically significant difference in anxiety,depression,PSQI,and FAS scores between the two groups of patients before intervention.The scores gradually decreased over time and reached the lowest level at 3 months after intervention.After intervention,the above scores in the intervention group were significantly lower than those in the control group(anxiety score:5.06±1.76 vs.9.33±1.42,depression score:6.93±1.64 vs.7.63±1.61,PSQI score:5.27±1.37 vs.8.43±2.56,FAS score:5.67±0.47 vs.9.97±0.21,all P<0.05).Conclusion Implementing CBT for PICS patients can alleviate anxiety and depression,improve their sleep quality and fatigue symptoms,thereby enhancing their quality of life.