With the aging population and the widespread implementation of lung cancer screening programs, an increasing number of elderly patients are undergoing curative lung resection. Due to diminished physiological reserve and complex comorbidities, this demographic exhibits a significantly higher incidence of severe perioperative complications (defined as Clavien-Dindo grade≥Ⅲ), which adversely affects both perioperative safety and long-term prognosis. In recent years, the research paradigm has shifted from univariate analysis toward multidimensional risk integration and the development of predictive models. This article systematically reviews the key risk factors for severe perioperative complications in elderly lung cancer patients, encompassing biological aging processes, frailty and sarcopenia, cardiopulmonary and renal functional reserves, inflammatory-immune and coagulation status, and perioperative interventions. Furthermore, it traces the evolution of risk assessment tools from traditional regression models to machine learning models that integrate multimodal data. The review also discusses common challenges in this field, including the standardization of outcome definitions, external validation, calibration assessment, and clinical translation. Future efforts should prioritize the deep integration of predictive tools with clinical decision support systems to establish a closed-loop care pathway from risk identification to stratified intervention, thereby effectively reducing complication rates and enhancing surgical outcomes for elderly lung cancer patients.

Objective:To analyze risk factors associated with false-positive results of quantitative fecal immunochemical testing (FIT), evaluate its performance for detecting advanced colorectal neoplasia across different subgroups, and explore the optimal positivity thresholds for each subgroup.Methods:Individuals who participated in the Zhejiang Colorectal Cancer Screening Program in 2020-2021, completed questionnaire-based risk assessment and quantitative FIT for initial screening, and undertook colonoscopy for confirmed diagnosis were included in this study. The information of individuals, including demographic characteristics, lifestyles, history of diseases, and family history of colorectal cancer (CRC), was collected by using questionnaires. The diagnostic outcomes of the individuals were obtained through colonoscopy and pathological examination. Multivariate logistic regression analyses were conducted to identify factors associated with false-positive FIT results. The optimal threshold of FIT was determined based on the receiver operating characteristic (ROC) curve and 10-fold cross-validation. The effectiveness of FIT screening in different subgroups was compared using the unified threshold of 100 ng/ml or optimal positivity thresholds.Results:There were 25 874 individuals included in the analysis, with 14 694 (56.79%) having fecal hemoglobin concentrations ≥100 ng/ml. A total of 3 830 advanced adenoma cases (14.80%) and 362 CRC cases (1.40%) were identified. Age below 60 years old, females, underweight, smoking, drinking, use of nonsteroidal anti-inflammatory drugs, no family history of CRC, no history of intestinal disease, no history of hypertension, and physical inactivity were associated with an elevated risk of false-positive results in FIT ( P<0.05). Compared to the predetermined threshold of 100 ng/ml, the false positive rate (FPR) of quantitative FIT decreased from 52.3% to 37.3% in all individuals, and decreased by more than 20% in females, individuals with normal weight, smokers, and those without a history of intestinal disease when adopting the optimal threshold (all P<0.001). Conclusion:The risk of false-positive results in quantitative FIT varies across different subgroups. Adopting the optimal thresholds could improve the specificity and reduce the FPR of quantitative FIT for CRC screening.

Objective To investigate the expression and prognostic value of uncoupling protein 2(UCP2)and ubiquitin associated protein 2-like(UBAP2L)in non-small cell lung cancer(NSCLC).Methods A total of 94 patients with NSCLC who received surgical treatment in a hospital from March 2019 to March 2021 were selected as the study objects.The expressions of UCP2 protein,UBAP2L protein,UCP2 mRNA and UBAP2L mRNA in cancer tissues and adjacent tissues of NSCLC patients were detected by real-time fluorescence quan-titative polymerase chain reaction and immunohistochemistry.The correlation between UCP2 mRNA and UBAP2L mRNA in NSCLC was analyzed by Pearson correlation.Kaplan-Meier curve was used to analyze the differences in survival rates of NSCLC patients with different UCP2 mRNA and UBAP2L mRNA expres-sions,and multivariate Cox regression was used to analyze the prognostic factors of NSCLC patients.Results The positive rate of UCP2 protein and UBAP2L protein in cancer tissues of NSCLC patients was higher than that in adjacent tissues,and the difference was statistically significant(P＜0.05).The expressions of UCP2 mRNA and UBAP2L mRNA in cancer tissues of NSCLC patients were significantly higher than those in adjacent tissues,and the differences were statistically significant(P＜0.05).There was a positive cor-relation between UCP2 mRNA and UBAP2L mRNA expression in NSCLC patients(r=0.721,P＜0.001).The expression of UCP2 mRNA and UBAP2L mRNA in cancer tissues of NSCLC patients was related to TNM stage and lymph node metastasis.There was significant difference in 3-year survival rate between UCP2 mRNA high expression group and UCP2 mRNA low expression group(P＜0.05).There was significant difference in 3-year survival rate between UBAP2L mRNA high expression group and UBAP2L mRNA low expression group(P＜0.05).TNM stage Ⅲ A,lymph node metastasis,UCP2 mRNA high expression and UBAP2L mRNA high expression were risk factors for prognosis of NSCLC patients(P＜0.05).Conclusion UCP2 protein,UBAP2L protein,UCP2 mRNA and UBAP2L mRNA are up-regulated in NSCLC patients,and UCP2 mRNA and UBAP2L mRNA are helpful to evaluate the survival prognosis of NSCLC patients.

Objective To establish a scientific and feasible Chinese medicine(CM)comprehensive control and prevention program for elderly hypertension with early renal damage(EH-ERD)patients through high-level evidence-based medicine(EBM)evidence.Methods On the basis of literature research and evidence evaluation,we construct a database of specific prescriptions and implementation methods of CM comprehensive control and prevention program with EH-ERD.40 senior titled-experts were consulted in two rounds of questionnaires based on Delphi methods.We selected,evaluated,and revised specific CM comprehensive control and prevention program of EH-ERD through the analysis of multiple factors,such as expert's positive activity coefficient,authority coefficient,degree of opinion concentration and degree of coordination.Results In view of the CM appropriate intervention techniques with high-grade evidence(level Ⅰ and Ⅱ)and recommendation(level A and B),we have developed the CM comprehensive control and prevention plan items for EH-ERD.The activity coefficients in two-round consultation were 92.5%and 97.14%respectively,the overall authority coefficient(Cr)was exceeded 0.70,and the coordination coefficient was less than 0.25.With a sound activity coefficient,a relatively high Cr and a rather unified degree of opinion concentration and coordination,the CM comprehensive control and prevention program for EH-ERD was established,which included six primary indicators(CM compound preparation,acupuncture and massage,CM health education,medicinal diet therapy,health care exercise and foot bath)and seventeen secondary indicators.Conclusion The CM comprehensive control and prevention program for EH-ERD established in this study can provide a basis for the further formation of expert consensus or guidelines.Moreover,it can supply the strategy and paradigm for standardization of CM-based health management of EH-ERD.

Objective To explore the predictive efficiency of serum Dickkopf-1 protein(DKK-1)and C1q tumor necrosis factor-related protein 3(CTRP3)levels for thoracolumbar fractures in patients with osteoporosis(OP).Methods Between January 2020 and August 2024,124 OP patients treated at the hospital were recruited into the OP group.Based on the occurrence of thoracolumbar fractures,these OP patients were divided into a non-fracture group(n=70)and a fracture group(n=54).Additionally,124 healthy individuals who underwent physical examinations served as the control group.The enzyme-linked immunosorbent assay(ELISA)was employed to measure the levels of serum DKK-1 and CTRP3.Multivariate logistic regression analysis was utilized to analyze the influencing factors of thoracolumbar fractures in OP patients.Receiver operating characteristic(ROC)curves were used to evaluate the predictive value of serum DKK-1 and CTRP3 for thoracolumbar fractures in OP patients.Results In comparison with the control group,the serum level of DKK-1 was significantly higher,while the serum level of CTRP3 was significantly lower in the OP group(P<0.05).When compared with the non-fracture group,the fracture group exhibited prominently higher serum DKK-1 levels,age,duration of OP,and proportion of OP grade Ⅲ,whereas the serum CTRP3 level was significantly lower(P<0.05).High expression of DKK-1 was iden-tified as an independent risk factor for thoracolumbar fractures in patients with osteoporosis,while high expression of CTRP3 was found to be an independent protective factor for thoracolumbar fractures in such patients(P<0.05).The area under the curve(AUC)values of serum DKK-1 and CTRP3 levels for predicting thoracolumbar fractures in OP patients were 0.790 and 0.753,respectively.The AUC of the combined prediction of the two was 0.888,which was superior to the individual predictions of either one(ZDKK-1-combined=3.351,ZCTRP3-combined=3.172,both P<0.05).Conclusions In the serum of OP patients,the expression of DKK-1 is upregulated,while the expression of CTRP3 is downregulated.Both are factors influencing the occurrence of thoracolumbar fractures in OP patients.The combination of the two has a high predictive value for the occurrence of thoracolumbar fractures in OP patients.

Objective:To analyze risk factors associated with false-positive results of quantitative fecal immunochemical testing (FIT), evaluate its performance for detecting advanced colorectal neoplasia across different subgroups, and explore the optimal positivity thresholds for each subgroup.Methods:Individuals who participated in the Zhejiang Colorectal Cancer Screening Program in 2020-2021, completed questionnaire-based risk assessment and quantitative FIT for initial screening, and undertook colonoscopy for confirmed diagnosis were included in this study. The information of individuals, including demographic characteristics, lifestyles, history of diseases, and family history of colorectal cancer (CRC), was collected by using questionnaires. The diagnostic outcomes of the individuals were obtained through colonoscopy and pathological examination. Multivariate logistic regression analyses were conducted to identify factors associated with false-positive FIT results. The optimal threshold of FIT was determined based on the receiver operating characteristic (ROC) curve and 10-fold cross-validation. The effectiveness of FIT screening in different subgroups was compared using the unified threshold of 100 ng/ml or optimal positivity thresholds.Results:There were 25 874 individuals included in the analysis, with 14 694 (56.79%) having fecal hemoglobin concentrations ≥100 ng/ml. A total of 3 830 advanced adenoma cases (14.80%) and 362 CRC cases (1.40%) were identified. Age below 60 years old, females, underweight, smoking, drinking, use of nonsteroidal anti-inflammatory drugs, no family history of CRC, no history of intestinal disease, no history of hypertension, and physical inactivity were associated with an elevated risk of false-positive results in FIT ( P<0.05). Compared to the predetermined threshold of 100 ng/ml, the false positive rate (FPR) of quantitative FIT decreased from 52.3% to 37.3% in all individuals, and decreased by more than 20% in females, individuals with normal weight, smokers, and those without a history of intestinal disease when adopting the optimal threshold (all P<0.001). Conclusion:The risk of false-positive results in quantitative FIT varies across different subgroups. Adopting the optimal thresholds could improve the specificity and reduce the FPR of quantitative FIT for CRC screening.

Objective:To explore the morphological characteristics of the corpus callosum (CC) in patients with unilateral medial temporal lobe epilepsy (mTLE) with hippocampal sclerosis (HS), and their correlation with hippocampal volume and clinical indicators.Methods:This was a cross-sectional study. Clinical (age of onset, disease duration, seizure frequency, seizure duration, etc.) and imaging data of 44 patients mTLE with unilateral HS confirmed by postoperative pathology and 42 healthy controls (HCs) recruited at West China Hospital of Sichuan University from June 2017 to May 2023 were analyzed retrospectively. Among the 44 patients, 19 had left-sided HS and 25 had right-sided HS. All subjects underwent high-resolution 3D T 1WI. Hippocampal volumes were obtained using FreeSurfer. ART was used to measure the morphological parameters of the CC for each participant, including total CC area, volume, perimeter, length, thickness, circularity, and the area of seven CC subregions defined by Witelson: rostrum, genu, body, anterior midbody, posterior midbody, isthmus and splenium. Differences in these metrics between two or three groups were compared using independent samples t-test or one-way ANOVA. Pearson or Spearman correlation analysis was used to observe the correlation between morphological features of the CC and hippocampal volume and other clinical indicators in patients with mTLE with unilateral HS. Results:Compared with HCs, patients with mTLE with unilateral HS had significantly reduced total CC area, CC circularity, as well as the area and thickness of the genu, anterior midbody, posterior midbody, isthmus, splenium, and the area of the rostrum ( P<0.05). Significant differences were observed in the total area, circularity, and subregional areas (genu, rostrum, anterior midbody, posterior midbody, splenium), as well as thickness (genu, anterior midbody, posterior midbody, isthmus) of the CC among mTLE with left-sided HS, mTLE with right-sided HS, and HCs ( P<0.05). When compared to HCs, the total area of the CC, circularity and the areas of the genu, rostrum, anterior midbody, posterior midbody, and splenium, and the thicknesses of the genu, anterior midbody, posterior midbody, and isthmus of the CC were significantly reduced in patients with mTLE with right-sided HS ( P<0.05), and the thicknesses of the midbody and isthmus of the CC were significantly reduced in patients with mTLE with left-sided HS compared to HCs ( P<0.05), and the two-by-two comparison of the rest of the indicators did not show statistically significant differences ( P>0.05). Correlation analysis showed that some morphological abnormalities in the CC in mTLE with unilateral HS patients were significantly correlated with age of onset, disease duration, seizure frequency, seizure duration, and hippocampal volume. Conclusions:mTLE with unilateral HS patients can exhibit morphological abnormalities in the CC, particularly in those with right-sided lesions. These abnormalities are significantly associated with seizure-related factors and hippocampal atrophy.

Objective:To observe the effect of intensified heel anti-gravity posture stability training on the gait of stroke survivors.Methods:Thirty-six hemiplegic stroke survivors were randomly divided into a control group and an experimental group, each of 18. Both groups received conventional rehabilitation treatment (including limb positioning, limb movement training and conventional walking training), while the experimental group was additionally provided with 30 minutes of intense heel anti-gravity posture stability training 5 days a week for 4 weeks. Before and after the treatment, the subjects′ walking speed, stride frequency, step length, peak knee flexion angle and peak hip flexion angle were documented using three-dimensional gait analysis with a movement training system.Results:The average walking speed, stride rate, step length, peak hip flexion and peak knee flexion of both groups had improved significantly after the treatments. But the average walking speed [(0.46±0.06)m/s], step length [(85.05±6.68)cm], peak hip flexion angle [(34.80±2.80)°] and peak knee flexion angle [(40.55±3.58)°] of the treatment group were significantly better than those of the control group.Conclusions:Intensified heel anti-gravity posture stability training can significantly improve the walking speed, step length, hip flexion and knee flexion of hemiplegic stroke survivors.

Objective:To quantify thoracic and abdominal movements during breathing using inertial measurement units (IMUs) and to build a machine learning model which identifies the abdominal breathing (AB) pattern.Methods:Ten rehabilitation therapists formed the study′s professional group, while 15 patients receiving AB training comprised the validation group. Two synchronized IMUs were applied to capture breathing motions during natural breathing (NB), deep breathing (DB) and AB. Six kinematic features were extracted from each respiratory cycle, and inter-group and inter-pattern differences were analyzed. Correlation analysis was also performed with manually measured changes in thoracic and abdominal circumferences. A support vector classification model for AB pattern detection was then developed using data from the professional and validation groups.Results:A total of 1113 respiratory cycles were extracted and analyzed. The breathing pattern significantly influenced all of the kinematic features studied (0.21≤partial η 2≤0.65, all P≤0.001). The ranges of the angles in medial-lateral axis of the IMUs showed strong correlation with the changes in abdominal and thoracic circumferences (ρ1=0.928, ρ2=0.807, P≤0.001 in both cases). A greater range of abdominal angles was found during AB compared to the other patterns. The best of the models achieved an F1 score of 0.970 (sensitivity: 0.983, specificity: 0.980) in validation. Conclusions:AB generates the greatest abdominal movement. Combining IMUs and machine learning can provide real-time quantification of chest movement and accurate detection of AB during breathing training.