The use of immune checkpoint inhibitors(ICIs)has dramatically changed the treatment landscape of advanced non-small cell lung cancer (NSCLC), and have improved the survival outcomes of advanced patients while offering better overall safety compared to chemotherapy.However, due to immune senescence, the efficacy and safety of immunotherapy in elderly patients are different from those in non-elderly patients.Moreover, most clinical trials have limited data on elderly patients, and immunotherapy in the elderly population lacks high-level evidence-based medical support.This article introduces the theoretical basis of immunotherapy in the elderly population, summarizes clinical data on the efficacy and safety of immunotherapy for advanced NSCLC in the elderly, and analyses the immunotherapy for special subgroups of elderly patients, aiming to provide a reference basis for treating this population.The results showed that single-agent immunotherapy had good efficacy and safety in elderly patients with advanced NSCLC in the age group of 65-74 years, obtaining long-term survival benefits, However, the benefits of immunotherapy in the elderly population ≥75 years old remian unclear, and the outcomes of immunotherapy in the elderly ≥80 years old were poor.In addition, the performance status (PS) score of ≥2 was a significant factor in reducing the efficacy of single-agent immunotherapy in elderly patients.In addition, a pre-treatment PS score of ≥2 was an independent risk factor for reducing the efficacy of immunotherapy alone.Immunotherapy in combination with chemotherapy in the elderly has shown efficacy comparable to the overall population.However, there is an increased incidence of treatment-related adverse events(TRAEs)in patients ≥75 years of age.Dual-immunity combination therapies are not currently recommended for the treatment of advanced NSCLC in the elderly.Elderly patients with brain metastases have poor prognosis, and treatment may consider ICIs in combination with local radiotherapy.Basic research on how to improve the benefit of immunotherapy in elderly patients is also ongoing.In conclusion, the therapeutic prospect of immunotherapy in advanced NSCLC in the elderly is promising, and more exploration is needed in the future.

Objective:To explore the relationship between thyroid hormone sensitivity and metabolic dysfunction-associated steatotic liver disease(MASLD) in a population with normal thyroid function, with a particular focus on sex-specific differences.Methods:This retrospective study included 41 355 euthyroid cases who underwent routine health examinations at the Health Management Centre of the Second Affiliated Hospital of Dalian Medical University from January 2014 to December 2023 were included. The free triiodothyronine(FT 3) to free thyroxine(FT 4) ratio(FT 3/FT 4) was calculated in order to reflect the peripheral sensitivity of the thyroid gland. Similarly, thyroid feedback quantile-based index(TFQI), thyrotrophic thyroxine resistance index(TT 4RI), and the FT 3-based TFQI-derived index(TFQI-FT 3) were calculated in order to reflect the central sensitivity of the thyroid gland. A Logistic regression was employed to analyse the effect of sex-specific thyroid hormone sensitivity indices on the prevalence of MASLD. The restricted cubic spline was used to analyse the non-linear relationship between the thyroid sensitivity hormone indices and MASLD. Furthermore, the correlation between the thyroid hormone sensitivity indices and MASLD in different subgroups was also analysed. Results:The prevalence of MASLD in the study population was 28.8%. After adjusting the model for confounders, the risk of MASLD increased by 7%, 3%, 10%, and 5% for each standard deviation increase in FT 3/FT 4, TFQI, TFQI-FT 3, and TT 4RI in the total population, respectively. The risk of MASLD increased by 6% and 5% for each standard deviation increase in FT 3/FT 4 and TFQI-FT 3 in men, respectively. For each standard deviation increase in FT 3/FT 4, TFQI, TFQI-FT 3, and TT 4RI in women, the risk of MASLD increased by 6%, 5%, 11%, and 5%, respectively. Higher FT 3/FT 4 and TFQI-FT 3 were positively associated with the risk of developing MASLD in men, and higher FT 3/FT 4, TFQI, TFQI-FT 3, and TT 4RI were positively associated with the risk of developing MASLD in women. There was a non-linear, inverted U-shaped relationship between TFQI and risk of MASLD in women. Subgroup analyses showed positive associations between FT 3/FT 4, TFQI, TFQI-FT 3, and MASLD. Conclusions:The thyroid hormone sensitivity indices may provide a basis for clinical prevention and management of MASLD in individuals with normal thyroid function. Additionally, FT 3/FT 4 and TFQI-FT 3 may indicate the risk of MASLD in the general population, while TFQI and TT 4RI are more suitable for assessing the risk of MASLD in women.

The use of immune checkpoint inhibitors(ICIs)has dramatically changed the treatment landscape of advanced non-small cell lung cancer (NSCLC), and have improved the survival outcomes of advanced patients while offering better overall safety compared to chemotherapy.However, due to immune senescence, the efficacy and safety of immunotherapy in elderly patients are different from those in non-elderly patients.Moreover, most clinical trials have limited data on elderly patients, and immunotherapy in the elderly population lacks high-level evidence-based medical support.This article introduces the theoretical basis of immunotherapy in the elderly population, summarizes clinical data on the efficacy and safety of immunotherapy for advanced NSCLC in the elderly, and analyses the immunotherapy for special subgroups of elderly patients, aiming to provide a reference basis for treating this population.The results showed that single-agent immunotherapy had good efficacy and safety in elderly patients with advanced NSCLC in the age group of 65-74 years, obtaining long-term survival benefits, However, the benefits of immunotherapy in the elderly population ≥75 years old remian unclear, and the outcomes of immunotherapy in the elderly ≥80 years old were poor.In addition, the performance status (PS) score of ≥2 was a significant factor in reducing the efficacy of single-agent immunotherapy in elderly patients.In addition, a pre-treatment PS score of ≥2 was an independent risk factor for reducing the efficacy of immunotherapy alone.Immunotherapy in combination with chemotherapy in the elderly has shown efficacy comparable to the overall population.However, there is an increased incidence of treatment-related adverse events(TRAEs)in patients ≥75 years of age.Dual-immunity combination therapies are not currently recommended for the treatment of advanced NSCLC in the elderly.Elderly patients with brain metastases have poor prognosis, and treatment may consider ICIs in combination with local radiotherapy.Basic research on how to improve the benefit of immunotherapy in elderly patients is also ongoing.In conclusion, the therapeutic prospect of immunotherapy in advanced NSCLC in the elderly is promising, and more exploration is needed in the future.

Objective:To explore the relationship between thyroid hormone sensitivity and metabolic dysfunction-associated steatotic liver disease(MASLD) in a population with normal thyroid function, with a particular focus on sex-specific differences.Methods:This retrospective study included 41 355 euthyroid cases who underwent routine health examinations at the Health Management Centre of the Second Affiliated Hospital of Dalian Medical University from January 2014 to December 2023 were included. The free triiodothyronine(FT 3) to free thyroxine(FT 4) ratio(FT 3/FT 4) was calculated in order to reflect the peripheral sensitivity of the thyroid gland. Similarly, thyroid feedback quantile-based index(TFQI), thyrotrophic thyroxine resistance index(TT 4RI), and the FT 3-based TFQI-derived index(TFQI-FT 3) were calculated in order to reflect the central sensitivity of the thyroid gland. A Logistic regression was employed to analyse the effect of sex-specific thyroid hormone sensitivity indices on the prevalence of MASLD. The restricted cubic spline was used to analyse the non-linear relationship between the thyroid sensitivity hormone indices and MASLD. Furthermore, the correlation between the thyroid hormone sensitivity indices and MASLD in different subgroups was also analysed. Results:The prevalence of MASLD in the study population was 28.8%. After adjusting the model for confounders, the risk of MASLD increased by 7%, 3%, 10%, and 5% for each standard deviation increase in FT 3/FT 4, TFQI, TFQI-FT 3, and TT 4RI in the total population, respectively. The risk of MASLD increased by 6% and 5% for each standard deviation increase in FT 3/FT 4 and TFQI-FT 3 in men, respectively. For each standard deviation increase in FT 3/FT 4, TFQI, TFQI-FT 3, and TT 4RI in women, the risk of MASLD increased by 6%, 5%, 11%, and 5%, respectively. Higher FT 3/FT 4 and TFQI-FT 3 were positively associated with the risk of developing MASLD in men, and higher FT 3/FT 4, TFQI, TFQI-FT 3, and TT 4RI were positively associated with the risk of developing MASLD in women. There was a non-linear, inverted U-shaped relationship between TFQI and risk of MASLD in women. Subgroup analyses showed positive associations between FT 3/FT 4, TFQI, TFQI-FT 3, and MASLD. Conclusions:The thyroid hormone sensitivity indices may provide a basis for clinical prevention and management of MASLD in individuals with normal thyroid function. Additionally, FT 3/FT 4 and TFQI-FT 3 may indicate the risk of MASLD in the general population, while TFQI and TT 4RI are more suitable for assessing the risk of MASLD in women.

A two-stage-based generative adversarial network incorporating contextual transformer is proposed for synthesis and multiclass classification of pulmonary nodules.Contextual transformer adopts a channel-enhanced multi-head contextual transformer mechanism which combines channel attention and multi-head contextual transformer to better deal with the complex semantic relationship in the feature space,thereby effectively enhancing the feature extraction capability of the model.A two-stage-based generative adversarial network framework is used to achieve the injection of pulmonary nodules in the designated lung area,and divide the synthesis task into two stages.In the first stage,pulmonary nodule regions of interest images are generated and then fused with designated lung parenchyma through a Poisson blending module to generate preliminary samples;in the second stage,an improved CycleGAN model is used to fine-tune the preliminary samples.Meanwhile,the skip layer excitation module and auxiliary classifier are introduced into the discriminator for realizing the re-correction of the feature channel and the classification of pulmonary nodules.Experiments on LIDC-IDRI dataset reveal that the proposed method has a FID,IS and KID of 115.153,2.619±0.095 and 0.062 on pulmonary nodule synthesis,and achieves an accuracy,sensitivity,F1 value and AUC of 70.23%,68.66%,68.92%and 87.59%on pulmonary nodule malignancy classification,respectively,outperforming GAN-based classification models such as ADGAN,as well as benchmark networks such as VGG16.

Objective To evaluate the molluscicidal effect of spraying different formulations of niclosamide ethanolamine salt with drones against Oncomelania hupensis in ditches. Methods A semi-dry and semi-wet ditch with O. hupensis snails was selected in the second branch field of Jiangbei Farm, Jiangling County, Hubei Province in May 2023, and divided into 4 experimental areas, named groups A1, A2, B1 and B2. Environmental cleaning was performed in groups A1 and B2, and was not conducted in groups A2 or B2. Then, 50% wettable powder of niclosamide ethanolamine salt was sprayed with drones at an effective dose of 2 g/m² in groups A1 and A2, and 5% niclosamide ethanolamine salt granule was sprayed with drones at an effective dose of 2 g/m² in groups B1 and B2. O. hupensis snails were surveyed using the systematic sampling method 1, 3, 5, 7, 14 days after spraying, and the natural mortality and corrected mortality of O. hupensis snails were calculated. Results The occurrence of frames with living snails, mean density of living snails and natural mortality of snails were 97.50% (117/120), 6.30 snails/0.1 m² and 1.18% (9/765) in the test ditch before spraying, respectively. There were significant differences in the mortality of snails among four groups 1, 3, 5, 7 and 14 days after spraying niclosamide formulations with drones (χ² = 17.230, 51.707, 65.184, 204.050 and 34.435, all P values < 0.01). The overall mortality rates of snails were 94.51% (1 051/1 112), 79.44% (908/1 143), 96.54% (977/1 012) and 88.55% (1 021/1 153) in groups A1, A2, B1 and B2 (χ² = 207.773, P < 0.05), respectively. In addition, there was no significant difference in the overall snail mortality between groups A1 and B1 (P > 0.05), and the snail mortality in groups A1 and B1 were both statistically different from that in groups A2 and B2 (all P values < 0.05). Conclusion Both 50% wettlable powder of niclosamide ethanolamine salt and 5% niclosamide ethanolamine salt granule sprayed with drones are active against O. hupensis snails in ditches, and environmental cleaning may improve the molluscicidal effect.

Objective To evaluate the molluscicidal effect of spraying 5% niclosamide ethanolamine salt granules with drones against of Oncomelania hupensis snails in snail habitats in marshland areas. Methods From September to October, 2022, marshlands were sampled from Dantu District, Zhenjiang City, Jiangsu Province as study areas, and assigned into four groups, of approximately 3 000 m² per group. In Group A, environmental cleaning was performed, followed by spraying 5% niclosamide ethanolamine salt granules with knapsack sprayers at a dose of 40 g/m², and in Group B, 5% niclosamide ethanolamine salt granules were sprayed with knapsack sprayers at a dose of 40 g/m² without environmental cleaning, while in Group C, environmental cleaning was conducted, followed by spraying 5% niclosamide ethanolamine salt granules with drones at a dose of 40 g/m², and in Group D, 5% niclosamide ethanolamine salt granules were sprayed with drones at a dose of 40 g/m² without environmental cleaning. Then, the study areas in each group were equally divided into six blocks, with Block 1 for baseline surveys and blocks 2 to 6 for snail surveys 1, 3, 5, 7, 14 days following chemical treatment. The mortality of snails and the reduction of the density of living snails were calculated. Results A total of 132 frames were surveyed during the period from September to October 2022, and the occurrence of frames with living snails and means density of living snails were 61.36% (81/132) and 1.58 snails/0.1 m², respectively. The overall mortality rates of snails were 43.02% (77/179), 38.69% (77/199), 47.78% (86/180) and 31.02% (58/187) 14 days following chemical treatment in groups A, B, C and D, respectively (χ² = 11.646, P < 0.05), and there were differences detected in the snail mortality between group A and D, and between groups C and D (both P_adjusted values < 0.05). The adjusted mortality rates of snails were 37.42%, 36.07%, 38.85% and 40.40% in groups A, B, C and D 14 days post-treatment, and the density of living snails decreased by 48.10%, 63.29%, 67.09% and 69.62% 14 days post-treatment relative to pre-treatment, respectively. Conclusions Chemical treatment with drones is feasible for O. hupensis snail control in marshland areas; however, the molluscicidal effect of spraying 5% niclosamide ethanolamine salt granules with drones is comparable to spraying chemicals manually in marshland areas regardless of environmental cleaning.

The protection effect of flash-radiotherapy(Flash-RT)with super-high dose on normal tissue has obtained wide attention in therapeutic radiology since it was found in 2014 year.The increasing research demand of Flash-RT with super-high dose-rate proposed new challenge for the existing radiotherapy equipment.Based on the demands of FLASH-RT research and clinical application,this review analyzed the proposed new requirement of Flash-RT for equipment,and introduce current scientific facilities with the experimental ability of X-ray FLASH-RT,as well as the situation of the specialized FLASH-RT equipment which were developing.The research of Flash-RT mechanism need the existing equipment with high-energy X-ray source develop toward high power,while the clinical application of Flash-RT demand these transient high-power devices should possess a series of radiotherapy techniques such as multi angle irradiation,conformal radiotherapy and others.Currently,China's X-ray FLASH-RT research is at the forefront of the world,which is expected to achieve the first breakthrough of high-end medical equipment in the X-ray Flash RT field.

A two-stage-based generative adversarial network incorporating contextual transformer is proposed for synthesis and multiclass classification of pulmonary nodules.Contextual transformer adopts a channel-enhanced multi-head contextual transformer mechanism which combines channel attention and multi-head contextual transformer to better deal with the complex semantic relationship in the feature space,thereby effectively enhancing the feature extraction capability of the model.A two-stage-based generative adversarial network framework is used to achieve the injection of pulmonary nodules in the designated lung area,and divide the synthesis task into two stages.In the first stage,pulmonary nodule regions of interest images are generated and then fused with designated lung parenchyma through a Poisson blending module to generate preliminary samples;in the second stage,an improved CycleGAN model is used to fine-tune the preliminary samples.Meanwhile,the skip layer excitation module and auxiliary classifier are introduced into the discriminator for realizing the re-correction of the feature channel and the classification of pulmonary nodules.Experiments on LIDC-IDRI dataset reveal that the proposed method has a FID,IS and KID of 115.153,2.619±0.095 and 0.062 on pulmonary nodule synthesis,and achieves an accuracy,sensitivity,F1 value and AUC of 70.23%,68.66%,68.92%and 87.59%on pulmonary nodule malignancy classification,respectively,outperforming GAN-based classification models such as ADGAN,as well as benchmark networks such as VGG16.

Non-small cell lung cancer (NSCLC) is the most common pathological type of lung cancer. The systemic antitumor therapy of advanced NSCLC has undergone renovations of chemotherapy, targeted therapy and immunotherapy, which results in greatly improved survival for patients with advanced NSCLC. Immune checkpoint inhibitors (ICIs), especially targeting programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1), has changed the treatment paradigm of NSCLC. ICIs have become the standard treatment for advanced NSCLC without epidermal growth factor receptor(EGFR) mutation or anaplastic lymphomakinase(ALK) translocation in the first- or second-line setting, and for locally advanced NSCLC following concurrent radiotherapy and chemotherapy. ICIs are also promising in adjuvant/neoadjuvant therapy. More and more ICIs have been approved domestically for the treatment of NSCLC. Led by the NSCLC expert committee of Chinese Society of Clinical Oncology (CSCO), this consensus was developed and updated based on thoroughly reviewing domestic and foreign literatures, clinical trial data, systematic reviews, experts' discussion and the consensus(2019 version). This consensus will aid domestic clinicians in the treatment of NSCLC with ICIs.
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