With the widespread application of low-dose computed tomography (CT), the detection rate of multiple lung cancers (MLCs) is gradually increasing. The diagnosis and treatment of MLCs have become a major challenge in clinical practice in thoracic surgery and oncology. In April 2025, the Lung Cancer Professional Committee of the China Anti-Cancer Association (CACA) organized multidisciplinary experts from both domestic and international fields to release the first edition of the CACA Expert Consensus on the Diagnosis and Treatment of Multiple Lung Cancers, providing systematic recommendations for the diagnostic system, molecularassessment strategies, and surgical and non-surgical management of MLCs. This article provides a detailed interpretation of the core content of this consensus and, by incorporating the latest research progress in the field, delves into the pathogenesis, precise diagnostic strategies, and individualized treatment pathways for multiple lung cancers, aiming to offer a more comprehensive reference for clinical practice.

As a fundamental aspect of bone fracture treatment, fracture reduction plays a decisive role in restoring the structural integrity and function of bones. At present, fracture reduction techniques mostly rely on semi-automatic interaction methods or healthy-side bone templates for registration, which have many limitations in clinical practice. In order to enhance treatment efficiency and accuracy, an automatic fracture reduction algorithm is proposed. This algorithm utilizes the similarity of fracture cross-sections for registration, thereby reducing the workload of physicians and eliminating the need for a healthy-side bone template. Initially, the closed edge is identified and extracted by analyzing the differences in the fracture surface and the calorific value diagram of the roughness distribution. Next, the fracture section is determined by using the identified closed edge as a guideline for regional expansion and similarity matching. During the registration phase, the iterative closest point (ICP) algorithm is highly sensitive to distance. Therefore, the geometric features of point clouds are incorporated into the objective function of the registration algorithm to mitigate the influence of noise, and fracture section registration is implemented one by one. Finally, the algorithm is tested and compared on 180 simulated datasets and 16 publicly available datasets. The results show that the proposed algorithm significantly improves the registration accuracy, and the registration error of clinical bone fracture cases is controlled within 1.7 mm.
Algorithms ; Fractures, Bone/therapy* ; Humans

Objective To establish an ultra-high-performance liquid chromatography-triple quadrupole tandem mass spectrometry method for the determination of N-(1,3-dimethylbutyl)-N′-phenyl-p-phenylenediamine quinone (6PPDQ) in human plasma and urine. Methods Plasma and urine samples (0.3 mL each) were mixed with 0.9 mL acetonitrile and dichloromethane, vortexed, and subjected to ultrasonic treatment to facilitate extraction. After centrifugation, the extract was collected, evaporated to dry powder under nitrogen, and reconstituted. Separation was performed on a C18 column, and detection was carried out using ultra-high-performance liquid chromatography-triple quadrupole tandem mass spectrometry with external standard quantification. Results 6PPDQ showed good linearity in the range of 0.01-25.00 μg/L in both human plasma and urine, with correlation coefficients of 0.999 5 and 0.999 7, respectively. The detection limits for plasma and urine were 8 and 6 ng/L, and the lower limits of quantification were 27 and 19 ng/L, respectively. The average recovery rates were 97.00%-100.00% for plasma and 90.00%-96.50% for urine. The within-run relative standard deviations (RSDs) were 4.35%-10.00% for plasma and 2.34%-11.11% for urine, while the between-run RSDs were 6.80%-8.46% and 2.60%-10.00%, respectively. Samples can be stored for seven days at 4 ℃ or -20 ℃. respectively. Samples can be stored for seven days at 4 ℃ or -20 ℃. Matrix effects ranged from 87.12%-99.27% for plasma and 91.00%-97.56% for urine. Conclusion The proposed method is simple, highly sensitive, and reproducible, and is suitable for the determination of 6PPDQ in human plasma and urine samples.

Objective:To investigate the value of MULTI-parametric MR imaging with flexible design (MTP) combined with microview diffusion weighted imaging (DWI) in predicting pituitary tumor invasion of cavernous sinus.Methods:This was a cross-sectional study. The clinicopathological and imaging data of 59 patients with suspected pituitary tumor who were admitted to the First Affiliated Hospital of Dalian Medical University from December 2021 to August 2024 were prospectively analyzed. According to Knosp classification, patients with pituitary tumor were divided into non-invasive group (28 cases) and invasive group (31 cases). All patients underwent MTP and microview DWI sequence scanning, and the corresponding parameter values [T 1, R 2*, T 2* and apparent diffusion coefficient (ADC)] were measured on the MTP quantitative map and ADC map at the maximum diameter level of the pituitary tumor. Independent sample t test and Mann-Whitney U test were used to compare the clinical data, quantitative parameter values and proliferation index (Ki-67) between the non-invasive group and the invasive group. Quantitative parameter values with statistically significant differences were jointly included in logistic regression to construct the model. Receiver characteristic curve and area under the curve (AUC) were used to analyze single variables and logistic model in predicting the value invasion of pituitary tumor cavernous sinus invasion. Spearman correlation was used to analyze the correlation between the quantitative values and Ki-67 level. Results:There was no significant difference in age and gender between the non-invasive group and the invasive group ( P>0.05). T 1 and T 2* values in invasion group were higher than those in non-invasion group ( Z=4.42, P<0.001; Z=3.43, P<0.001), R 2* values and ADC values in the invasion group were lower than those in the non-invasion group, and the difference was statistically significant (t=4.07, P<0.001; Z=-3.07, P=0.002). The AUC values of T 1, R 2*, T 2*, ADC, logistic model 1(T 1+R 2*+ADC) and logistic model 2(T 1+T 2*+ADC) for predicting pituitary tumor cavernous sinus invasion were 0.835, 0.767, 0.760, 0.733, 0.926 and 0.925, respectively. Correlation analysis showed that the value of pituitary tumor T 1 was positively correlated with Ki-67 ( r=0.431, P=0.002). Conclusion:Quantitative parameters of MTP sequence and microview DWI sequence can quantitatively evaluate pituitary tumor invasion of cavernous sinus, and the combination of the two sequences can significantly improve the prediction efficiency.

Objective To analyze the clinical characteristics of cancer related anemia(CRA)in older cancer patients undergoing multi-line anti-tumor treatment.Methods A cross-sectional study was conducted,including patients with CRA who were≥65 years old and had received or were currently undergoing multi-line treatment at 9 hospitals in Beijing from June 1,2018 to September 30,2023.Data on gender,age,past history,family history,tumor type,metastasis site,clinical symptoms,blood routine,specialized examination for anemia,anti-tumor and anemia correction treatment were collected.The basic characteristics of the included patients,clinical symptoms,the status of blood cell reduction,treatment conditions,and the distribution of traditional Chinese medicine(TCM)syndrome characteristics were analyzed.Results A total of 602 patients were included.The tumor types included lung cancer,colorectal cancer,gastric cancer,esophageal cancer,breast cancer,gynecological tumors,lymphoma.The overall median hemoglobin(HGB)level was 99.00(88.00,107.00)g/L.The HGB levels of patients with different tumor types showed significant differences(P<0.001).The HGB levels of patients with gynecological tumors were significantly lower than those of patients with colorectal cancer,lung cancer and esophageal cancer(P<0.05).The most common clinical symptoms were fatigue,loss of appetite,irregular bowel movements and pain.In terms of anti-tumor treatment,405 patients were receiving multi-line anti-tumor treatment(including combined chemotherapy,combined radiotherapy,combined targeted therapy,and combined immunotherapy),197 patients were receiving symptomatic supportive treatment after multi-line anti-tumor treatment.In terms of anemia correction treatment,183 patients received erythropoietin,folic acid,iron,vitamin B12,or blood transfusion,while 293 patients received TCM for correcting anemia(including Chinese patent medicines,Chinese herbal decoctions,combinations of Chinese patent medicines and Chinese herbal decoctions).Specialized tests for anemia,such as serum iron,total iron binding capacity,transferrin saturation,transferrin,erythropoietin et al,have a detection rate of only 3.65%～27.91%.In terms of the characteristics of TCM syndromes,the main TCM syndrome types of the patients were as follows:syndrome of spleen-stomach weakness,syndrome of qi and blood deficiency,syndrome of heart-spleen deficiency,syndrome of spleen-kidney yang deficiency,syndrome of liver and kidney yin deficiency.Some patients also have the accompanying symptoms of internal binding of static blood and poison,phlegm dampness retention.Further comparison revealed that the HGB level of older patients with CRA who had syndrome of spleen-stomach weakness was significantly lower than patients with other symptom types(P<0.001).The HGB level of patients with syndrome of qi and blood deficiency was significantly lower than patients with syndrome of spleen-kidney yang deficiency(P<0.01)and syndrome of liver and kidney yin deficiency(P<0.001).Patients with symptoms of internal binding of static blood and poison,or symptoms of phlegm dampness retention had significantly lower HGB levels compared to those without accompanying symptoms(P<0.01).Conclusion The rate of specialized blood test for anemia in older patients with CRA was relatively low.The most common TCM syndrome types were syndrome of spleen-stomach weakness and syndrome of qi and blood deficiency.The overall treatment rate was also low.The screening,specialized diagnosis and monitoring of older patients with CRA need to be given more attention,and treatment methods such as TCM,Western medicine,and integrated TCM-Western medicine should be selected based on the patient's condition.

Objective:To investigate the surgical technique and initial outcomes of distal derotational femoral osteotomy (DDFO) combined with knee extension device reconstruction in adolescents with habitual patellar dislocation and severe lower limb torsional deformity.Methods:A retrospective study was conducted on 10 adolescent patients (12 knees) treated at Beijing Jishuitan Hospital and its Guizhou branch from June 2016 to June 2022. There were 6 males and 4 females with an average age of 12.0±1.5 years (range: 10.0-14.5 years) Surgical treatment included DDFO and knee extension device reconstruction (lateral retinacular release, medial retinacular plication, Roux-Goldthwait distal realignment, and MPFL reconstruction). Clinical outcomes were assessed using Lysholm scores, incidence of redislocation and complications, and imaging parameters (lateral patellofemoral angle, Insall-Salvati index, TT-TG distance, and femoral anteversion angle) preoperatively and at 1 year postoperatively.Results:All 12 knees were successfully operated on, with an average surgery time of 2.0±0.5 h (range 1.0-2.5 h), intraoperative blood loss of 47.1±17.1 ml (range 20-80 ml), and follow-up time of 46.2±18.7 months (range 24-72 months). The Lysholm knee score improved from 58.25±8.80 preoperatively to 89.17±5.32 at final follow-up ( t=-9.096, P<0.001) with significant difference. The lateral patellofemoral angle improved from -64.92±4.68 preoperatively to 6.08±2.27 at final follow-up ( t=39.178, P<0.001) with significant difference. The femoral anteversion angle decreased from 34.08±3.06 preoperatively to 14.50±2.65 at final follow-up ( t=16.916, P<0.001) with significant difference. No patellar redislocation, skin necrosis, wound infection, or limited joint mobility occurred during follow-up. Conclusion:DDFO combined with knee extension device reconstruction is an effective and safe treatment for adolescent habitual patellar dislocation with severe torsional deformity, resulting in significant clinical and radiographic improvement with low complication rates.

Objective To analyze the clinical characteristics of cancer related anemia(CRA)in older cancer patients undergoing multi-line anti-tumor treatment.Methods A cross-sectional study was conducted,including patients with CRA who were≥65 years old and had received or were currently undergoing multi-line treatment at 9 hospitals in Beijing from June 1,2018 to September 30,2023.Data on gender,age,past history,family history,tumor type,metastasis site,clinical symptoms,blood routine,specialized examination for anemia,anti-tumor and anemia correction treatment were collected.The basic characteristics of the included patients,clinical symptoms,the status of blood cell reduction,treatment conditions,and the distribution of traditional Chinese medicine(TCM)syndrome characteristics were analyzed.Results A total of 602 patients were included.The tumor types included lung cancer,colorectal cancer,gastric cancer,esophageal cancer,breast cancer,gynecological tumors,lymphoma.The overall median hemoglobin(HGB)level was 99.00(88.00,107.00)g/L.The HGB levels of patients with different tumor types showed significant differences(P<0.001).The HGB levels of patients with gynecological tumors were significantly lower than those of patients with colorectal cancer,lung cancer and esophageal cancer(P<0.05).The most common clinical symptoms were fatigue,loss of appetite,irregular bowel movements and pain.In terms of anti-tumor treatment,405 patients were receiving multi-line anti-tumor treatment(including combined chemotherapy,combined radiotherapy,combined targeted therapy,and combined immunotherapy),197 patients were receiving symptomatic supportive treatment after multi-line anti-tumor treatment.In terms of anemia correction treatment,183 patients received erythropoietin,folic acid,iron,vitamin B12,or blood transfusion,while 293 patients received TCM for correcting anemia(including Chinese patent medicines,Chinese herbal decoctions,combinations of Chinese patent medicines and Chinese herbal decoctions).Specialized tests for anemia,such as serum iron,total iron binding capacity,transferrin saturation,transferrin,erythropoietin et al,have a detection rate of only 3.65%～27.91%.In terms of the characteristics of TCM syndromes,the main TCM syndrome types of the patients were as follows:syndrome of spleen-stomach weakness,syndrome of qi and blood deficiency,syndrome of heart-spleen deficiency,syndrome of spleen-kidney yang deficiency,syndrome of liver and kidney yin deficiency.Some patients also have the accompanying symptoms of internal binding of static blood and poison,phlegm dampness retention.Further comparison revealed that the HGB level of older patients with CRA who had syndrome of spleen-stomach weakness was significantly lower than patients with other symptom types(P<0.001).The HGB level of patients with syndrome of qi and blood deficiency was significantly lower than patients with syndrome of spleen-kidney yang deficiency(P<0.01)and syndrome of liver and kidney yin deficiency(P<0.001).Patients with symptoms of internal binding of static blood and poison,or symptoms of phlegm dampness retention had significantly lower HGB levels compared to those without accompanying symptoms(P<0.01).Conclusion The rate of specialized blood test for anemia in older patients with CRA was relatively low.The most common TCM syndrome types were syndrome of spleen-stomach weakness and syndrome of qi and blood deficiency.The overall treatment rate was also low.The screening,specialized diagnosis and monitoring of older patients with CRA need to be given more attention,and treatment methods such as TCM,Western medicine,and integrated TCM-Western medicine should be selected based on the patient's condition.

Objective:To investigate the surgical technique and initial outcomes of distal derotational femoral osteotomy (DDFO) combined with knee extension device reconstruction in adolescents with habitual patellar dislocation and severe lower limb torsional deformity.Methods:A retrospective study was conducted on 10 adolescent patients (12 knees) treated at Beijing Jishuitan Hospital and its Guizhou branch from June 2016 to June 2022. There were 6 males and 4 females with an average age of 12.0±1.5 years (range: 10.0-14.5 years) Surgical treatment included DDFO and knee extension device reconstruction (lateral retinacular release, medial retinacular plication, Roux-Goldthwait distal realignment, and MPFL reconstruction). Clinical outcomes were assessed using Lysholm scores, incidence of redislocation and complications, and imaging parameters (lateral patellofemoral angle, Insall-Salvati index, TT-TG distance, and femoral anteversion angle) preoperatively and at 1 year postoperatively.Results:All 12 knees were successfully operated on, with an average surgery time of 2.0±0.5 h (range 1.0-2.5 h), intraoperative blood loss of 47.1±17.1 ml (range 20-80 ml), and follow-up time of 46.2±18.7 months (range 24-72 months). The Lysholm knee score improved from 58.25±8.80 preoperatively to 89.17±5.32 at final follow-up ( t=-9.096, P<0.001) with significant difference. The lateral patellofemoral angle improved from -64.92±4.68 preoperatively to 6.08±2.27 at final follow-up ( t=39.178, P<0.001) with significant difference. The femoral anteversion angle decreased from 34.08±3.06 preoperatively to 14.50±2.65 at final follow-up ( t=16.916, P<0.001) with significant difference. No patellar redislocation, skin necrosis, wound infection, or limited joint mobility occurred during follow-up. Conclusion:DDFO combined with knee extension device reconstruction is an effective and safe treatment for adolescent habitual patellar dislocation with severe torsional deformity, resulting in significant clinical and radiographic improvement with low complication rates.

Objective:To investigate the value of MULTI-parametric MR imaging with flexible design (MTP) combined with microview diffusion weighted imaging (DWI) in predicting pituitary tumor invasion of cavernous sinus.Methods:This was a cross-sectional study. The clinicopathological and imaging data of 59 patients with suspected pituitary tumor who were admitted to the First Affiliated Hospital of Dalian Medical University from December 2021 to August 2024 were prospectively analyzed. According to Knosp classification, patients with pituitary tumor were divided into non-invasive group (28 cases) and invasive group (31 cases). All patients underwent MTP and microview DWI sequence scanning, and the corresponding parameter values [T 1, R 2*, T 2* and apparent diffusion coefficient (ADC)] were measured on the MTP quantitative map and ADC map at the maximum diameter level of the pituitary tumor. Independent sample t test and Mann-Whitney U test were used to compare the clinical data, quantitative parameter values and proliferation index (Ki-67) between the non-invasive group and the invasive group. Quantitative parameter values with statistically significant differences were jointly included in logistic regression to construct the model. Receiver characteristic curve and area under the curve (AUC) were used to analyze single variables and logistic model in predicting the value invasion of pituitary tumor cavernous sinus invasion. Spearman correlation was used to analyze the correlation between the quantitative values and Ki-67 level. Results:There was no significant difference in age and gender between the non-invasive group and the invasive group ( P>0.05). T 1 and T 2* values in invasion group were higher than those in non-invasion group ( Z=4.42, P<0.001; Z=3.43, P<0.001), R 2* values and ADC values in the invasion group were lower than those in the non-invasion group, and the difference was statistically significant (t=4.07, P<0.001; Z=-3.07, P=0.002). The AUC values of T 1, R 2*, T 2*, ADC, logistic model 1(T 1+R 2*+ADC) and logistic model 2(T 1+T 2*+ADC) for predicting pituitary tumor cavernous sinus invasion were 0.835, 0.767, 0.760, 0.733, 0.926 and 0.925, respectively. Correlation analysis showed that the value of pituitary tumor T 1 was positively correlated with Ki-67 ( r=0.431, P=0.002). Conclusion:Quantitative parameters of MTP sequence and microview DWI sequence can quantitatively evaluate pituitary tumor invasion of cavernous sinus, and the combination of the two sequences can significantly improve the prediction efficiency.

Objective:To analyze the performance characteristics of the energy output of defibrillation device at different lifecycle stages of the equipment,and to improve the level of management,so as to ensure the safety and effectiveness of using the device.Methods:A total of 90 defibrillation devices of using 10 types included 861290 and CardioServ(included scrapped devices)during the period of 2015-2022 were retrospectively analyzed.The detected data of energy output of defibrillation device were analyzed as statistical method,and the error of releasing energy was calculated.A total of 36 defibrillation devices that were in the early stages of use(at the first three years of device use)were divided into the first year,the second year and the third year,and the data of energy outputs of devices among three years were compared.The data of the type A and type B defibrillation devices,which were the largest number of devices in the normal stage of use(the middle stage of use),were calibrated according to the energy release in the three years between 2018 and 2000.The difference of releasing energy at the preseted value of 100J between the two types of devices was analyzed.Finally,the errors of energy releases of 8 devices,which energy outputs exceeded the deadline,in the scrap period between 2015 and 2022 were summarized.Results:In the data of three groups of devices in the early stages of use,the differences at the first and second year of device use among 100J,150J and 200J of the energy releases of the preseted values were significant(t=-0.17,-0.17,-0.58,P>0.05).The difference of the measured values between the first and third years of device use was not significant(Z=-0.70,-0.38,-0.86,P>0.05).The results of variance analysis of repeated measurement of the energy releases of the devices in normal stage indicated that the difference of the energy release at 100J preseted point among different types of 41 devices was significant(F=4.40,P<0.05).The energy release of type X defibrillator appeared constantly high,and the relative error increased with the increasing of preseted values.The repeatability of the device was better,and the relationship between preseted energy(x)and release energy(y)conformed to linear relationship(R2=0.9985).In these defibrillation devices that were using,the qualified rate of energy output of>100J preseted point was 97.68%.Conclusion:There is slight difference in the mean value of energy release between different type of defibrillation devices within the qualified range,and the energy release still is a performance indicator that should be highly focused for defibrillation devices.We should combine with the maintenance and repair data of device to conduct in-depth analysis,so as to grasp the operating status of the device,and optimize the strategy of quality control,and ensure the safety of defibrillator in clinical use.