With the continuous advancements in immunotherapy and targeted therapy, the treatment management and surgical resection assessment of locally advanced lung cancer have undergone significant changes. In October 2024, the Society of Thoracic Surgeons (STS) released the "STS expert consensus on the multidisciplinary management and resectability of locally advanced non-small cell lung cancer", which provides the latest insights on the evaluation of resectability and multidisciplinary management of locally advanced lung cancer, neoadjuvant (including perioperative) therapy, and adjuvant therapy. This article aims to interpret this consensus, with the goal of introducing the latest perspectives of the STS consensus to thoracic surgeons and providing a reference for the rational implementation of surgical resection, multidisciplinary management, and standardized comprehensive treatment models for non-small cell lung cancer in China.

Objective To compare the efficacy of endoscopic bougie/balloon dilation(EBD),endoscopic radial incision(ERI),and ERI combined with esophageal stent placement(ESP)for the treatment of benign esophageal stenosis,and evaluate the feasibility and safety of ERI combined with ESP for the treatment of benign esophageal stenosis.Methods 48 Patients with benign esophageal stenosis from January 2019 to January 2023 were recruited,and divided into EBD group(n=24),ERI group(n=17)and ERI+ESP group(n=7).The differences in operating success,restenosis and complications among the three groups were compared.Results The number of previous endoscopic treatment in ERI+ESP group was more than that in EBD group and ERI group,and the differences were statistically significant(P＜0.05).Technical success was achieved in 23 cases and clinical remission in 23 cases in EBD group,technical success in 16 cases and clinical remission in 15 cases in ERI group,technical success in 7 cases and clinical remission in 7 cases in ERI+ESP group.There was no significant difference in technical success rate and clinical remission rate among the three groups(P＞0.05).After 3 months of follow-up,there were 15,9 and 1 cases of esophageal restenosis in the EBD group,ERI group and ERI+ESP group,respectively.There was no significant difference in the rate of esophageal restenosis among the 3 groups(P＞0.05).After 6 months of follow-up,there were 20 cases of esophageal restenosis in the EBD group,13 cases in the ERI group and 1 case in the ERI+ESP group.The rate of esophageal restenosis in the ERI+ESP group was significantly lower than that in the EBD group and the ERI group(P＜0.05).However,there was no statistically significant difference in the esophageal restenosis rate between the EBD group and the ERI group(P＞0.05).The time to the first postoperative restenosis was 74.00(48.75,159.00)days in the EBD group,84.00(54.50,195.00)days in the ERI group,and 250.00(206.00,289.00)days in the ERI+ESP group.The time to the first postoperative restenosis was longer in the ERI+ESP group than that in the EBD and ERI groups.The differences were statistically significant(P＜0.05),but there was no significant difference in restenosis time between EBD group and ERI group(P＞0.05).There were 5,5 and 3 cases of complications in the EBD group,ERI group and ERI+ESP group,respectively,and there was no significant difference in the incidence of complications among the three groups(P＞0.05).Conclusion ERI+ESP is comparable to EBD and ERI in terms of technical success and short-term clinical remission rate for the treatment of benign esophageal stenosis,and is superior to EBD and ERI in terms of long-term restenosis rate and restenosis time,with no influence on the occurrence of complications.

Objective:To explore the medication rules of Professor Wang Pei in the treatment of colon cancer.Methods:The medical records of Professor Wang Pei's outpatient treatment for colon cancer were collected, entered into the Traditional Chinese Medicine Inheritance Computing Platform V3.0, and the laws of the prescription's nature, flavor, meridian, drug frequency, drug combination, association rules, and cluster analysis were explored.Results:A total of 65 prescriptions were collected, including 150 Chinese materia medica. The medicinal properties of these Chinese materia medica are mainly warm, cold and flat, the tastes were mainly sweet, bitter and pungent, and the meridians were mainly liver, spleen and kidney meridians. Dampness category and blood circulation promoting and blood stasis category were mainly used, and the most frequently used drugs include Poria, Polyporus, Scutellariae Barbatae Herba, Astragali Radix, Curcumae Rhizoma, and the pairs of Polyporus- Poria, Astragali Radix- Astragali Radix Praeparata cum Melle, Scutellariae Barbatae Herba- Curcumae Rhizoma. Twenty nine high-related drug pairs were obtained from association rules, including Polyporus- Astragali Radix Praeparata cum Melle- Astragali Radix, Poria- Scutellariae Barbatae Herba- Polyporus, Scutellariae Barbatae Herba- Curcumae Rhizoma- Polyporus. The cluster analysis showed the combination of 6 types of medicines mainly focuses on strengthening the spleen and removing dampness, nourishing qi and promoting blood, clearing heat and detoxifying, and astringing the intestines to stop bleeding. Conclusion:Professor Wang Pei mostly discusses the treatment of colon cancer from "spleen dampness, rectification deficiency, heat toxin, blood stasis, bleeding", and the treatment is "invigorating the spleen and removing dampness, invigorating Qi and strengthening the body, clearing away heat and detoxifying, promoting blood circulation and removing blood stasis, and astringent intestines to stop bleeding", which is in line with the thought of Traditional Chinese Medicine treatment of tumors, strengthening the righteousness and eliminating pathogenic factors, and and can be used for clinical reference.

Objective To observe the effects of endoscopic drug therap on hemostasis, re-bleeding and the risk of occurrence of complication in patients with acute esophageal and gastric variceal bleeding (EGVB). Methods A retrospective method was conducted, and 100 patients with EGVB who were admitted to the Affiliated Hospital of Yan'an University from June 2015 to June 2017 were enrolled. According to the difference in treatment methods, they were divided into an endoscopy Sclerotherapy and Ligation group and transjugular intrahepatic portosystemic shunt (TIPS) group, 50 cases in each group. The TIPS group was treated with TIPS; the endoscopy Sclerotherapy and Ligation group underwent endoscopic variceal sclerotherapy, endoscopic esophageal variceal ligation and postoperative non-selective β blockers oral administration. After 2 years of follow-up, the patients' hemostasis, re-bleeding at acute stage, survival situation and the incidences of complications were recorded. Before treatment and 2 weeks after treatment, the levels of serum albumin (Alb), total bilirubin (TBil) and platelet count (PLT) were measured by Hitachi automatic biochemical analyzer in the two groups. Results The success rate of hemostasis in the endoscopy Sclerotherapy and Ligation group was significantly higher than that in the TIPS group [98.0% (49/50) vs. 82.0% (41/50) ], and the recurrence rate of varices, during 1- and 2-year follow-up, the recurrence rate of bleeding and the incidences of complications were significantly lower than those in TIPS group [the recurrence rate of varicose veins: 6.0% (3/50) vs. 24.0 (12/50), 1-year re-bleeding rate: 12.0% (6/50) vs. 30.0% (15/50), 2-year re-bleeding rate: 42.0% (21/50) vs. 66.0% (33/50), esophageal ulcer: 2.0% (1/50) vs. 14.0% (7/50), upper abdominal discomfort: 2.0% (1/50) vs. 14.0% (7/50), hepatic encephalopathy:4.0% (2/50) vs. 16.0% (8/50), chest pain: 6.0% (3/50) vs. 20.0% (10/50), all P < 0.05]. After treatment, the levels of Alb and PLT in the endoscopy Sclerotherapy and Ligation group were higher than those in the TIPS group [Alb (g/L):43.84±4.34 vs. 40.83±3.21, PLT (×109/L): 26.33±3.37 vs. 21.12±3.89, both P < 0.05], and the TBil was lower than that in the TIPS group (μmol/L: 13.82±4.32 vs. 19.33±4.59). Conclusion Endoscopic Sclerotherapy and Ligation can significantly improve the effect of hemostasis of patients with acute EGVB, the rate of re-bleeding does not increase compared with that of western medicine group using TIPS, and the incidences of complications are significantly lower than those of applying TIPS.

OBJECTIVETo detect FOXL2 gene mutation in a Chinese pedigree affected with blepharophimosis-ptosis-epicanthus inversus syndrome (BPES) type I, and to explore its genotype-phenotype correlation.

METHODSPeripheral blood samples were obtained from 3 patients and 19 healthy members from the pedigree for the isolation of genomic DNA. All exons and flanking sequences of the FOXL2 gene were amplified by PCR with 7 pairs of overlapping primers and sequenced.

RESULTSDNA sequencing indicated that the BPES phenotype in this pedigree was caused by a hotspot c.843_859dup17 mutation. The same mutation was not found among the healthy members of the pedigree.

CONCLUSIONThe c.843_859dup17 frameshift mutation probably underlies the BPES type I in this Chinese pedigree, which may manifest as either BEPS type I or type II.

Intrathoracic esophagogastric anastomosis is the mainstay of esophageal reconstruction after esophagectomy for the middle and lower esophageal cancer, which is the majority of esophageal cancer. In spite of the constant development of techniques and instruments for esophageal reconstruction, incidence of anastomotic complications stays high, including anastomotic leak and stricture. The current common esophagogastric anastomosis primarily consists of hand-sewn anastomosis and stapled anastomosis. This review presented different ways of intrathoracic esophagogastric anastomosis in reference to the literatures in China and abroad, and comparisons and analyses were made according to operative techniques, anastomotic complication rates, postoperative mortality rates, etc. The results demonstrated that various anastomotic methods had individual, advantages and disadvantages. Duration of stapled anastomosis is short, and linear-stapled anastomosis has a low incidence of anastomotic stricture. Traditional hand-sewn anastomosis, as a necessary skill for thoracic surgeons, shows great manipulative flexibility and reliability. Moreover, the advances in minimally invasive esophageal surgery, such as robot-assisted esophagectomy, increases the operability and efficiency of hand-sewn anastomosis with a promising perspective. In general, among diverse anastomotic methods, mortality does not differ, and the comparison of anastomotic leak rates requires further large clinical trials. Thoracic surgeons have to decide on the anastomotic method of every single case based on patient characteristics and technical proficiency, with the final aim of minimizing anastomotic complications and maximizing patient benefits.
Anastomosis, Surgical ; Anastomotic Leak ; China ; Esophageal Neoplasms ; surgery ; Esophagectomy ; Humans ; Reproducibility of Results ; Stomach ; Suture Techniques ; Treatment Outcome

Objective·To analyze high-risk factors of infection of multidrug resistance Klebsiellapneumonia (MDR-Kpn) and difference of therapeutic effects for different treatments.Methods·One hundred and ten MDR-Kpn strains were collected from a hospital.K-B slip diffusion method was utilized to detect the drug susceptibility of all the strains.Based on electronic medical records system,MDR-Kpn infected group included 51 patients and control group was picked out,including 51 patients as well (byl:1 ratio basing on the infected group according to the rules of under the same department,similar basic disease and all the patients in the control group isolated with the strain of Kpn).Thirty-nine clinical information of MDR-Kpn infected and control groups are collected to make single-factor analysis of high risk factors of the infection with MDR-Kpn.Multi-factor analysis was utilized between MDR-Kpn infected and control groups.The lasting time of different antibiotics used in MDR-Kpn infected patients were made statistics between effective and inefficacy patients.Results·Drug susceptibility test showed that sulfonamide,phosphonomycin and amikacin,were the three most sensitive antibiotics for 110 MDR-Kpn strains.12 clinical information,such as blood transfusion、sputum suction、invasive ventilation were all high-risk factors for the infection of MDR-Kpn (P＜0.05).The lasting time during with carbapenems (P=0.025) was statistically different between effective (n=28)and non-effective group (n=23) of MDR-Kpn infection patients.Conclusion·Controlling and eliminating high-risk factors do help to protect and decrease the infection of MDR-Kpn.Using carbapenems correctly has great influence on prognosis.

RNF180 is a novel membrane-bound E3 ubiquitin ligase that participates in cell development,proliferation and apoptosis.It is a tumor suppressor gene that inhibits cell proliferation and induces apoptosis and may inhibit gastric cancer cell lymph node metastasis.The study found that RNF180 gene methylation and gastric cancer is closely related to the occurrence and development.Therefore,RNF180 gene methylation is expected as a tumor marker of gastric cancer for early diagnosis and prognosis of gastric cancer.In this paper,RNF180 on the diagnosis of gastric cancer research progress made a review.

In order to study genetic variation diversity of porcine circovirus type 2 (PCV2) strains in Shanxi,the genomic sequences of nine PCV2 strains including SXQX,SXCZ,SXTY2,SXJC,SXJX,SXLL,SXPY,SXPG and SXXY recently isolated from some areas of Shanxi from 2013 to 2016,was cloned,sequenced and received by GenBank.The amplified PCV2 genomic sequences,ORF2 sequences and Cap protein amino acid of these nine strains were analysed and compared with those of published 28 PCV2 strains by DNAStar,drawing phylogenetic tree.The results showed that the genomic sequences of SXJX,SXJC and SXXY PCV2 strains were 1 768 bp,and the others were 1 767 bp,which accounted for 33％ and 67％,respectively.The homologies of nucleotide sequences of the nine strains were 94.7％-99.8％,the homologies of nucleotide sequences of the nine strains with the 28 isolates from different regions of the world PCV strain were 93.9％-99.9％,and the homologies of nucleotide sequences of the nine strains with the domestic vaccine strains were 95.1％-99.8％.The phylogenetic analysed that SXJX,SXJC and SXXY belonged to genotype PCV-2D,SXLL,SXPY and SXCZ belonged to genotype PCV-1C,and SXTY14,SXPG and SXQX belonged to genotype PCV-1A/1B.Thus it proved that the epidemic strain of PCV2 was mainly PCV-2b in Shanxi.The homologies of ORF2 nucleotide sequences and Cap amino acid of the nine strains were 90.0％-100.0％ and 87.1 ％-100.0％ respectively,the homologies of ORF2 nucleotide sequences and Cap amino acid of the nine strains with the 28 isolates from different regions of the world PCV strain were 87.6％-100.0％ and 84.1％-100.0％ respectively,and the homologies of ORF2 nucleotide sequences and Cap amino acid of the nine strains with the domestic vaccine strains were 91.0％-100.0％ and 89.3％-100.0％ respectively.The Cap amino acids of SXQX,SXJX,SXTY14,SXPG,SXJC and SXXY PCV2 were 233,ORF2 of SXQX,SXTY14 and SXPG located at 1 033-1 734 bp,ORF2 of SXXY,SXJX and SXJC located at 1 033-1 734 bp,and the Cap amino acids of SXCZ,SXLL and SXPY PCV2 were 234,ORF2 of them located at 1 030-1 734 bp,in addition,the positions of 1 030-1 734 bp were more three bases TCA than other ORF2 genome sequence of 1 767 bp,resulting in increasing a K (Lys) of amino acid sequencein at the 234 position.Also Cap protein of 9 PCV2 strains showed more amino acid variation in addition to the only high-ly conserved glycosylation sites (NYS) (pp.143-145 amino acid).It provided theoretical basis for the PCV2 immune prevention of research in Shanxi,and the data of basic theory of molecular pathogenesis of PCV2.

Objective To investigate the antimicrobial resistance of clinical isolates from Renji Hospital,Shanghai Jiao Tong University School of Medicine during the period from 2005 to 2015.Methods Antimicrobial susceptibility testing was carried out according to Kirby-Bauer method.Results were analyzed according to CLSI 2015 breakpoints.Results A total of 55 155 nonduplicate clinical isolates were collected from 2005 to 2015.The top 5 most frequently isolated bacterial species were E.coli (15.0％),P.aeruginosa (14.0％),A.baumannii (11.9％),K.pneumoniae (11.8％) and S.aureus (10.2％).Gram positive cocci and gram negative organisms accounted for 35.8％ and 64.2％,respectively.The prevalence of methicillin-resistant strains in S.aureus (MRSA) and coagulase negative Staphylococcus (MRCNS) was 70.2％ (3 967/5 650) and 83.2％ (4 997/6 004).No staphylococcal strain was resistant to vancomycin,teicoplanin or linezolid.Fifteen strains of Enterococcus were found resistant to vancomycin.The average prevalence of ESBLs-producing strains was 70.4％ (5 843/8 300) in E.coli,53.5％ (3 500/6 539) in Klebsiella spp.and 44.1％ (557/1 263) in P mirabilis.A few carbapenemaseproducing K.pneumoniae strains were identified for the first time in 2012 with the prevalence of 0.6％ (4/656),and the prevalence hit high (30.1％,142/472) in 2015.The prevalence of carbapenemase-producing E.coli was 2.0％ (16/787) in 2015,and almost zero in the other years.The prevalence of extensively drug-resistant A.baumannii and P.aeruginosa was 39.1％ (2 566/6 556) and 4.0％ (308/7 704),respectively.Extensively drug-resistant strain was identified in 9 of the strains of 189 E.aerogenes isolates.Conclusions Bacterial resistance is still on the rise,which poses a major challenge to clinical antimicrobial therapy,especially the multi-drug resistant and extensively drug resistant bacteria.