BACKGROUND: Lung cancer is currently the most prevalent malignancy and the leading cause of cancer deaths worldwide. Although the early stage non-small cell lung cancer (NSCLC) presents a relatively good prognosis, a considerable number of lung cancer cases are still detected and diagnosed at locally advanced or late stages. Surgical treatment combined with perioperative multimodality treatment is the mainstay of treatment for locally advanced NSCLC and has been shown to improve patient survival. Following the standard methods of neoadjuvant therapy, perioperative management, postoperative adjuvant therapy, and other therapeutic strategies are important for improving patients' prognosis and quality of life. However, controversies remain over the perioperative management of NSCLC and presently consensus and standardized guidelines are lacking for addressing critical clinical issues in multimodality treatment. METHODS: The working group consisted of 125 multidisciplinary experts from thoracic surgery, medical oncology, radiotherapy, epidemiology, and psychology. This guideline was developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. The clinical questions were collected and selected based on preliminary open-ended questionnaires and subsequent discussions during the Guideline Working Group meetings. PubMed, Web of Science, Cochrane Library, Scopus, and China National Knowledge Infrastructure (CNKI) were searched for available evidence. The GRADE system was used to evaluate the quality of evidence and grade the strengths of recommendations. Finally, the recommendations were developed through a structured consensus-building process. RESULTS: The Guideline Development Group initially collected a total of 62 important clinical questions. After a series of consensus-building conferences, 24 clinical questions were identified and corresponding recommendations were ultimately developed, focusing on neoadjuvant therapy, perioperative management, adjuvant therapy, postoperative psychological rehabilitation, prognosis assement, and follow-up protocols for NSCLC. CONCLUSIONS This guideline puts forward reasonable recommendations focusing on neoadjuvant therapy, perioperative management, adjuvant therapy, postoperative psychological rehabilitation, prognosis assessment, and follow-up protocol of NSCLC. It standardizes perioperative multimodality treatment and provides guidance for clinical practice among thoracic surgeons, medical oncologists, and radiotherapists, aiming to reduce postoperative recurrence, improve patient survival, accelerate recovery, and minimize postoperative complications such as atelectasis.
Humans ; Carcinoma, Non-Small-Cell Lung/therapy* ; Lung Neoplasms/therapy* ; Combined Modality Therapy ; Perioperative Care

Objective To explore the difference in the mid-term efficacy of arthroscopic treatment for small-and medium-size(≤3 cm)rotator cuff tears combined with or without shoulder joint adhesion.Methods A retrospective analysis was conducted on the clinical data of 254 cases of small-and medium-size rotator cuff tears treated by arthroscopy in our department from January 2018 to January 2023 and followed up for more than one year.Among them,86 cases were combined with shoulder joint adhesion,and 168 cases were not combined with shoulder joint adhesion.A total of 81 pairs of data were obtained through propensity score matching(PSM).The shoulder joint pain and functional scores at the last follow-up of the two groups were compared,including the Visual Analogue Scale(VAS)for pain,the American Shoulder and Elbow Surgeons(ASES)score,Constant-Murley score,and shoulder joint score of the University of California at Los Angeles(UCLA).The rotator cuff healing and retearing rate were evaluated by using the range of motion of the shoulder joint and the Sugaya classification of MR.Results The follow-up time of the shoulder joint adhesion group and the non-shoulder joint adhesion group was(42.2±13.0)months and(44.7±14.2)months,respectively(P=0.248).The preoperative VAS score,ASES score,Constant-Murley score and UCLA score in the shoulder joint adhesion group were all worse than those in the non-shoulder joint adhesion group(P<0.01).At the last follow-up,the VAS scores,ASES scores,Constant-Murley scores and UCLA scores of both groups were significantly improved compared with those before the operation(P<0.001),and there was no significant difference between the two groups(P>0.05).The angles of anterior flexion,abduction,lateral internal rotation and lateral external rotation of the shoulder joint in the shoulder joint adhesion group before the operation were all smaller than those in the non-shoulder joint adhesion group(P<0.001).At the last follow-up,the four ranges of motion of the shoulder joint in both groups were significantly larger than those before the operation(P<0.01),and the shoulder joint adhesion group was still worse than the non-shoulder joint adhesion group(P<0.05).There was no rotator cuff retear(Sugaya type Ⅳ and typeⅤ)in both groups.The proportion of Sugaya type Ⅰ in the shoulder joint adhesion group at the last follow-up was lower than that in the non-shoulder joint adhesion group[21.0%(17/81)vs.60.5%(49/81),P<0.001].Conclusions Arthroscopic rotator cuff repair and joint capsule release surgery for patients with small-and medium-size rotator cuff tears combined with shoulder joint adhesion can relieve shoulder joint pain.The shoulder joint function score at the mid-term follow-up is similar to that of those without shoulder joint adhesion.Although the range of motion of the shoulder joint is significantly improved compared with that before the operation,it still could not reach the level of those without shoulder joint adhesion.

Radiation‐induced lung injury (RILI) is one of the common and serious complications in chest cancer patients after undergoing radiotherapy. In recent years, gut microbiota has garnered attention as a research hotspot. Multiple studies found that it has preventive and therapeutic effects on RILI. It can exert its effects through various mechanisms including the regulation of the immune system, the gut‐lung axis and its own metabolites, etc. In this article, the mechanism of RILI was elucidated and the protective mechanism of gut microbiota against RILI was comprehensively analyzed, providing new insights for the prevention and treatment of RILI in clinical practice and offering new methods to improve patient prognosis and enhance the quality of life.

Objective To explore the difference in the mid-term efficacy of arthroscopic treatment for small-and medium-size(≤3 cm)rotator cuff tears combined with or without shoulder joint adhesion.Methods A retrospective analysis was conducted on the clinical data of 254 cases of small-and medium-size rotator cuff tears treated by arthroscopy in our department from January 2018 to January 2023 and followed up for more than one year.Among them,86 cases were combined with shoulder joint adhesion,and 168 cases were not combined with shoulder joint adhesion.A total of 81 pairs of data were obtained through propensity score matching(PSM).The shoulder joint pain and functional scores at the last follow-up of the two groups were compared,including the Visual Analogue Scale(VAS)for pain,the American Shoulder and Elbow Surgeons(ASES)score,Constant-Murley score,and shoulder joint score of the University of California at Los Angeles(UCLA).The rotator cuff healing and retearing rate were evaluated by using the range of motion of the shoulder joint and the Sugaya classification of MR.Results The follow-up time of the shoulder joint adhesion group and the non-shoulder joint adhesion group was(42.2±13.0)months and(44.7±14.2)months,respectively(P=0.248).The preoperative VAS score,ASES score,Constant-Murley score and UCLA score in the shoulder joint adhesion group were all worse than those in the non-shoulder joint adhesion group(P<0.01).At the last follow-up,the VAS scores,ASES scores,Constant-Murley scores and UCLA scores of both groups were significantly improved compared with those before the operation(P<0.001),and there was no significant difference between the two groups(P>0.05).The angles of anterior flexion,abduction,lateral internal rotation and lateral external rotation of the shoulder joint in the shoulder joint adhesion group before the operation were all smaller than those in the non-shoulder joint adhesion group(P<0.001).At the last follow-up,the four ranges of motion of the shoulder joint in both groups were significantly larger than those before the operation(P<0.01),and the shoulder joint adhesion group was still worse than the non-shoulder joint adhesion group(P<0.05).There was no rotator cuff retear(Sugaya type Ⅳ and typeⅤ)in both groups.The proportion of Sugaya type Ⅰ in the shoulder joint adhesion group at the last follow-up was lower than that in the non-shoulder joint adhesion group[21.0%(17/81)vs.60.5%(49/81),P<0.001].Conclusions Arthroscopic rotator cuff repair and joint capsule release surgery for patients with small-and medium-size rotator cuff tears combined with shoulder joint adhesion can relieve shoulder joint pain.The shoulder joint function score at the mid-term follow-up is similar to that of those without shoulder joint adhesion.Although the range of motion of the shoulder joint is significantly improved compared with that before the operation,it still could not reach the level of those without shoulder joint adhesion.

Radiation‐induced lung injury (RILI) is one of the common and serious complications in chest cancer patients after undergoing radiotherapy. In recent years, gut microbiota has garnered attention as a research hotspot. Multiple studies found that it has preventive and therapeutic effects on RILI. It can exert its effects through various mechanisms including the regulation of the immune system, the gut‐lung axis and its own metabolites, etc. In this article, the mechanism of RILI was elucidated and the protective mechanism of gut microbiota against RILI was comprehensively analyzed, providing new insights for the prevention and treatment of RILI in clinical practice and offering new methods to improve patient prognosis and enhance the quality of life.

Objective:To evaluate the effect of ultrasound-guided adductor canal block with bupivacaine liposome on analgesia in elderly patients undergoing total knee arthroplasty.Methods:This was a prospective study. Sixty American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ patients, regardless of gender, aged 65-83 yr, weighing 50-80 kg, scheduled for elective unilateral total knee arthroplasty under subarachnoid anesthesia from April 2023 to January 2024 in Zhengzhou Orthopaedic Hospital, were divided into 2 groups ( n=30 each) using a random number table method: bupivacaine liposome group (LB group) and ropivacaine group (R group). Ultrasound-guided adductor canal block was performed at 30 min before subarachnoid anesthesia, bupivacaine liposome diluent 20 ml (133 mg) was injected in LB group, and 0.5% ropivacaine 20 ml was injected in R group. Patient-controlled intravenous analgesia was performed after operation, and tramadol was used for rescue analgesia when the visual analogue scale (VAS) score ≥3. VAS scores at rest and during activity were recorded at 8, 12, 24, 48 and 72 h after surgery. The time to the first pressing analgesia pump and rescue analgesia were recorded within 72 h after surgery. The quadriceps muscle strength was measured at 1 day before surgery and 12, 24, 48 and 72 h after surgery. The knee joint range of motion was assessed at 1 day before surgery and 24, 48 and 72 h after surgery. Patient′s satisfaction with analgesia was recorded at 72 h after surgery. The adverse reactions within 72 h after surgery were also recorded. Results:Compared with R group, VAS scores at rest and during activity were significantly decreased at 12, 24, 48 and 72 h after surgery, the time to the first pressing analgesia pump was prolonged, the rate of rescue analgesia after surgery was decreased, the score for the patient′s satisfaction with analgesia was increased, the knee joint range of motion was increased ( P<0.05), and no significant change was found in the quadriceps muscle strength and incidence of adverse reactions in LB group ( P>0.05). Conclusions:Ultrasound-guided adductor canal block with bupivacaine liposome provides better analgesia than ropivacaine in elderly patients undergoing total knee arthroplasty.

Objective To explore the efficacy of fixed-loop fixation and adjustable-loop fixation in arthroscopic anterior cruciate ligament(ACL)reconstruction with excessively short femoral tunnel.Methods A total of 493 patients undergoing ACL reconstruction at our hospital from January 2019 to July 2020 were reviewed,including 57 patients with femoral tunnel＜30 mm and 47 patients ultimately included.According to the fixation method,they were divided into EndoButton group(n=31)and TightRope group(n=16).The International Knee Documentation Committee(IKDC)score,Lysholm score,and Tegner score were used to evaluate joint function at 6 and 12 months postoperatively,respectively.The Lachman test and anterior drawer test were used to evaluate joint laxity at 12 months postoperatively.The clinical effects of the two fixation methods were compared.Results At 6 months postoperatively,the IKDC scores of the EndoButton group and TightRope group were(64.1±11.0)points and(62.6±9.2)points,respectively,with no significant difference(t=0.464,P=0.645).The Lysholm scores were(81.9±10.6)points and(85.3±9.3)points,with no significant difference(t=-1.079,P=0.286).The Tegner scores were(2.2±0.9)points and(1.9±0.9)points,with no statistically significant difference(t=0.933,P=0.356).At 12 months postoperatively,the IKDC scores of the EndoButton group and TightRope group were(81.4±9.3)points and(78.2±9.2)points,with no statistically significant difference(t=1.068,P=0.291).The Lysholm scores were(94.6±6.1)points and(93.4±7.4)points,with no statistically significant difference(t=0.626,P=0.534).The Tegner scores were(3.8±1.0)points and(3.4±1.2)points,with no statistically significant difference(t=1.402,P=0.168).There was no significant difference in the Lachman test and front drawer test between the two groups at 12 months after surgery(Z=-0.039,P=0.969;Z=-0.294,P=0.769).Conclusion In arthroscopic ACL reconstruction surgery,both EndoButton(15 mm)and TightRope can achieve good clinical results for excessively short femoral tunnel(＜30 mm).

Objective:To identify and analyze the key factors affecting online medical patient satisfaction, providing references for improving online patient satisfaction.Methods:Matched " user satisfaction, patient satisfaction" with keywords such as " internet medical, online medical", and searched for literature published from 2013 to 2023 in databases like CNKI and the Full-text Database of Chinese Medical Journals.Based on the critical appraisal skills programme for quality assessment, screened the literature. Employed the meta-ethnography method to synthesize the factors affecting online medical patient satisfaction in the included studies. Identified key influencing factors through the decision making trial and evaluation laboratory (DEMATEL) method, and then constructed a multi-level cascading structure model using the interpretative structural modelling (ISM) method to analyze the logical connections and hierarchical structure among the influencing factors, and obtained the key influencing paths.Results:20 articles were included, and through the meta-ethnography method, obtained a set of influencing factors for three thematic dimensions: personal, social, and technological, including eight influencing factors: perceived risk, perceived quality, information support, social support, environmental support, emotional support, medical technology, and platform design. By employing the DEMATEL-ISM method, information support and perceived quality were identified as key outcome factors, with centrality values of 15.713 and 15.417, respectively, and reason degrees of -0.957 and -1.095, respectively. Medical technology was identified as a key cause factor, with a centrality value of 15.476 and a reason degree of 0.956; the key influence path was platform design-medical technology-social support-information support, with a sum of centrality values totaling 59.305.Conclusions:This study identified key outcome factors, key cause factors, and key influence paths for online medical patient satisfaction. Based on these findings, it is suggested to enhance information support by improving the quality of health information on the online medical platform, improve the quality of patient perception by optimizing the doctor-patient interaction mode, improving the efficiency and response speed of doctor-patient communication, strengthening the supervision of the diagnosis and treatment process, etc., improve the level of online medical technology by establishing an Internet doctor ability evaluation index system and strengthening training, and jointly promote the improvement of online medical patient satisfaction by collaborating with multiple stakeholders.

Objective To explore the efficacy of fixed-loop fixation and adjustable-loop fixation in arthroscopic anterior cruciate ligament(ACL)reconstruction with excessively short femoral tunnel.Methods A total of 493 patients undergoing ACL reconstruction at our hospital from January 2019 to July 2020 were reviewed,including 57 patients with femoral tunnel＜30 mm and 47 patients ultimately included.According to the fixation method,they were divided into EndoButton group(n=31)and TightRope group(n=16).The International Knee Documentation Committee(IKDC)score,Lysholm score,and Tegner score were used to evaluate joint function at 6 and 12 months postoperatively,respectively.The Lachman test and anterior drawer test were used to evaluate joint laxity at 12 months postoperatively.The clinical effects of the two fixation methods were compared.Results At 6 months postoperatively,the IKDC scores of the EndoButton group and TightRope group were(64.1±11.0)points and(62.6±9.2)points,respectively,with no significant difference(t=0.464,P=0.645).The Lysholm scores were(81.9±10.6)points and(85.3±9.3)points,with no significant difference(t=-1.079,P=0.286).The Tegner scores were(2.2±0.9)points and(1.9±0.9)points,with no statistically significant difference(t=0.933,P=0.356).At 12 months postoperatively,the IKDC scores of the EndoButton group and TightRope group were(81.4±9.3)points and(78.2±9.2)points,with no statistically significant difference(t=1.068,P=0.291).The Lysholm scores were(94.6±6.1)points and(93.4±7.4)points,with no statistically significant difference(t=0.626,P=0.534).The Tegner scores were(3.8±1.0)points and(3.4±1.2)points,with no statistically significant difference(t=1.402,P=0.168).There was no significant difference in the Lachman test and front drawer test between the two groups at 12 months after surgery(Z=-0.039,P=0.969;Z=-0.294,P=0.769).Conclusion In arthroscopic ACL reconstruction surgery,both EndoButton(15 mm)and TightRope can achieve good clinical results for excessively short femoral tunnel(＜30 mm).

Objective:To identify and analyze the key factors affecting online medical patient satisfaction, providing references for improving online patient satisfaction.Methods:Matched " user satisfaction, patient satisfaction" with keywords such as " internet medical, online medical", and searched for literature published from 2013 to 2023 in databases like CNKI and the Full-text Database of Chinese Medical Journals.Based on the critical appraisal skills programme for quality assessment, screened the literature. Employed the meta-ethnography method to synthesize the factors affecting online medical patient satisfaction in the included studies. Identified key influencing factors through the decision making trial and evaluation laboratory (DEMATEL) method, and then constructed a multi-level cascading structure model using the interpretative structural modelling (ISM) method to analyze the logical connections and hierarchical structure among the influencing factors, and obtained the key influencing paths.Results:20 articles were included, and through the meta-ethnography method, obtained a set of influencing factors for three thematic dimensions: personal, social, and technological, including eight influencing factors: perceived risk, perceived quality, information support, social support, environmental support, emotional support, medical technology, and platform design. By employing the DEMATEL-ISM method, information support and perceived quality were identified as key outcome factors, with centrality values of 15.713 and 15.417, respectively, and reason degrees of -0.957 and -1.095, respectively. Medical technology was identified as a key cause factor, with a centrality value of 15.476 and a reason degree of 0.956; the key influence path was platform design-medical technology-social support-information support, with a sum of centrality values totaling 59.305.Conclusions:This study identified key outcome factors, key cause factors, and key influence paths for online medical patient satisfaction. Based on these findings, it is suggested to enhance information support by improving the quality of health information on the online medical platform, improve the quality of patient perception by optimizing the doctor-patient interaction mode, improving the efficiency and response speed of doctor-patient communication, strengthening the supervision of the diagnosis and treatment process, etc., improve the level of online medical technology by establishing an Internet doctor ability evaluation index system and strengthening training, and jointly promote the improvement of online medical patient satisfaction by collaborating with multiple stakeholders.