Patients with cancer are at high risk of malnutrition, which is the most common complication and independent risk factor for death in cancer patients. This article elaborates on the creation and structure of the diagnostic and treatment systems for cancer malnutrition in China, as well as the process from the initial understanding to the gradual establishment and continuous innovative development of the these systems. It briefly describes the commonly used methods for cancer nutrition screening and assessment in clinical practice at present and introduces the new methods in clinical application in recent years. The aim is to provide reference basis for further optimizing this diagnostic and treatment system, thereby improving the diagnosis and treatment level of cancer malnutrition in China, thus, enhancing the prognosis of patients and reducing the medical expenses.

ObjectiveThis research focused on examining the distinctive characteristics of nutrient intake and dietary patterns among long-lived elderly individuals. Additionally， the study was aimed to explore the specific dietary components that may impact the skeletal muscle mass in this particular group. MethodsThis study was conducted in the Chongming area of Shanghai， China. A total of 206 long-lived elderly individuals aged 90 or above were recruited. The 3-day 24-hour dietary recall method was used to collect dietary information and general demographic data through face-to-face interviews with professional nutritionists. The skeletal muscle mass index（SMI） was measured by bioelectrical impedance analysis（BIA）， and low skeletal muscle mass was diagnosed based on the 2019 Asian Working Group for Sarcopenia criteria. T-test analysis， chi-square test， and logistic regression were used to analyze the relationship between dietary nutrient intake and skeletal muscle mass. ResultsIn terms of food intake categories， compared with the long-lived elderly people with normal muscle mass， the intake of cereals containing miscellaneous beans and vegetables in the long-lived elderly people with low muscle mass was significantly lower（P<0.05）. In terms of the nutrient intake， compared with the long-lived elderly people with normal muscle mass， the intake of total energy， carbohydrate， dietary fiber， vitamin D， folic acid， phosphorus， potassium， magnesium， iron， and manganese in the long-lived elderly people with low muscle mass was significantly lower（P<0.05）. After continuous adjustment for the covariates， multivariate logistic regression analysis found that the intake levels of folic acid and dietary fiber were important factors influencing skeletal muscle mass， Individuals with lower intake levels of folic acid and dietary fiber are at a higher risk of low muscle mass in long-lived elderly individuals ［OR_{folic acid T1}， _{dietary fiber T1} （95%CI）： 2.90 （1.11‒7.61）； 4.09 （1.53‒10.91）］. ConclusionThe consumption of cereals that include a variety of beans and vegetables was noticeably lower in the long-lived elderly individuals with lower muscle mass when compared to those with normal muscle mass. Furthermore， low levels of folic acid and dietary fiber intake are associated with an increased risk of low skeletal muscle mass.

Background::Few evidence is available in the early prediction models of behavioral and psychological symptoms of dementia (BPSD) in Alzheimer’s disease (AD). This study aimed to develop and validate a novel genetic-clinical-radiological nomogram for evaluating BPSD in patients with AD and explore its underlying nutritional mechanism.Methods::This retrospective study included 165 patients with AD from the Chinese Imaging, Biomarkers, and Lifestyle (CIBL) cohort between June 1, 2021, and March 31, 2022. Data on demographics, neuropsychological assessments, single-nucleotide polymorphisms of AD risk genes, and regional brain volumes were collected. A multivariate logistic regression model identified BPSD-associated factors, for subsequently constructing a diagnostic nomogram. This nomogram was internally validated through 1000-bootstrap resampling and externally validated using a time-series split based on the CIBL cohort data between June 1, 2022, and February 1, 2023. Area under receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) were used to assess the discrimination, calibration, and clinical applicability of the nomogram.Results::Factors independently associated with BPSD were: CETP rs1800775 (odds ratio [OR] = 4.137, 95% confidence interval [CI]: 1.276-13.415, P = 0.018), decreased Mini Nutritional Assessment score (OR = 0.187, 95% CI: 0.086-0.405, P <0.001), increased caregiver burden inventory score (OR = 8.993, 95% CI: 3.830-21.119, P <0.001), and decreased brain stem volume (OR = 0.006, 95% CI: 0.001-0.191, P = 0.004). These variables were incorporated into the nomogram. The area under the ROC curve was 0.925 (95% CI: 0.884-0.967, P <0.001) in the internal validation and 0.791 (95% CI: 0.686-0.895, P <0.001) in the external validation. The calibration plots showed favorable consistency between the prediction of nomogram and actual observations, and the DCA showed that the model was clinically useful in both validations. Conclusion::A novel nomogram was established and validated based on lipid metabolism-related genes, nutritional status, and brain stem volumes, which may allow patients with AD to benefit from early triage and more intensive monitoring of BPSD.Registration::Chictr.org.cn, ChiCTR2100049131.

Objective:To investigate the distribution of HIV-1 genotypes and drug resistance in newly diagnosed HIV-1 patients in Baoding in 2020.Methods:A self-developed method was used to amplify the pol gene sequence of HIV-1, and the sequencing results were analyzed by phylogenetic analysis and compared with the Stanford drug resistance database to determine the HIV-1 subtypes and gene mutations. Results:A total of 96 patients with HIV-1 infection were recruited in this study, and 83 pol gene sequences were successfully obtained. In the study population, 88 (91.7%) were male with an average age of 39 years and 54 (56.3%) were married. Most of the patients were infected through sexual contact (95.8%, 92/96), and 75.0% (72/96) were through homosexual transmission. Phylogenetic analysis showed that various HIV-1 subtypes were detected and among them, CRF01_AE (51.8%, 43/83), CRF07_BC (24.1%, 20/83) and B subtype (10.8%, 9/83) were the most epidemic strains. Moreover, the subtypes of newly identified recombinant strains in recent years accounted for 13.3% (11/83). Drug resistance test results showed that the pre-treatment drug resistance rate in newly diagnosed HIV-1 patients was 8.4% (7/83), and the drug resistance rates to protease inhibitor (PIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs) and integrase inhibitors (INIs) were 3.6% (3/83), 1.2% (1/83) and 3.6% (3/83), respectively. Conclusions:The HIV-1 subtypes in the newly diagnosed population in Baoding in 2020 were complex and diverse. There were many unique recombinant strains and drug-resistant strains. Therefore, it was necessary to strengthen drug resistance monitoring as well as the prevention and control of HIV-1 infection in this area.

BACKGROUND: Perioperative treatment has become an increasingly important aspect of the management of patients with non-small cell lung cancer (NSCLC). Small-scale clinical studies performed in recent years have shown improvements in the major pathological remission rate after neoadjuvant therapy, suggesting that it will soon become an important part of NSCLC treatment. Nevertheless, neoadjuvant immunotherapy may be accompanied by serious adverse reactions that lead to delay or cancelation of surgery, additional illness, and even death, and have therefore attracted much attention. The purpose of the clinical recommendations is to form a diagnosis and treatment plan suitable for the current domestic medical situation for the immune-related adverse event (irAE). METHODS: This recommendation is composed of experts in thoracic surgery, oncologists, thoracic medicine and irAE related departments (gastroenterology, respirology, cardiology, infectious medicine, hematology, endocrinology, rheumatology, neurology, dermatology, emergency section) to jointly complete the formulation. Experts make full reference to the irAE guidelines, large-scale clinical research data published by thoracic surgery, and the clinical experience of domestic doctors and publicly published cases, and repeated discussions in multiple disciplines to form this recommendation for perioperative irAE. RESULTS: This clinical recommendation covers the whole process of prevention, evaluation, examination, treatment and monitoring related to irAE, so as to guide the clinical work comprehensively and effectively. CONCLUSIONS Perioperative irAE management is an important part of immune perioperative treatment of lung cancer. With the continuous development of immune perioperative treatment, more research is needed in the future to optimize the diagnosis and treatment of perioperative irAE.

Objective:To investigate the nutritional status of elderly inpatients in China, and to assess its relationship with clinical outcomes.Methods:A prospective, multicenter, parallel investigation was organized and conducted by the Chinese Medical Association's Group of Geriatric Nutrition Support.Patients aged ≥65 years from 30 major hospitals of 14 cities in China were evaluated by the Nutritional Risk Screening 2002(NRS2002)and the Mini-Nutritional Assessment-Short Form(MNA-SF), in order to understand the nutritional status and nutritional risk of elderly inpatients in China.The indicators of clinical outcomes were summarized, and the correlation between nutritional status and clinical outcomes was analyzed.Results:A total of 10 184 elderly patients who met the inclusion criteria were enrolled in this study, aged 65-112(74.81±7.01)years, with a body mass index(BMI)of 17.80-35.50(23.32±3.83)kg/m 2.Grip strength of the dominant hand was(16.95±18.42)kg, upper arm circumference was(25.68±3.70)cm, and calf circumference was(32.07±3.89)cm.BMI, grip strength, upper arm circumference and calf circumference decreased significantly with age( F=13.74, 97.47, 28.31 and 88.68, all P<0.001). NRS2002 was conducted on 10 182 patients.Of them, 10.14%(895/10 182)suffered malnutrition(BMI≤18.5 kg/m 2), and 46.42%(4 726/10 182)were at nutritional risk(NRS2002 score≥3). Nutrition deficiency and nutritional risk showed upward trends with age( F=43.41 and 177.05, both P<0.001). A total of 9 755 patients(95.79%, 9 755/10 182)completed the MNA-SF.Of them, 14.67%(1 431/9 755)had malnutrition, 35.04%(3 418/9 755)were at risk of malnutrition, and 50.29%(4 906/9 755)had normal nutritional status.The incidence of malnutrition and the risk of malnutrition significantly increased with age( F=172.79, 12.10 and 152.42, all P<0.05). Nutritional risk(NRS2002 score≥3)was related to age, BMI, mortality, infectious complications, length of hospital stay and total hospital cost(all P<0.05). Conclusions:The incidence of malnutrition and the risk of malnutrition are high in elderly inpatients in China.Nutritional risk is an influencing factor for adverse clinical outcomes.

The clinical application of immune checkpoint inhibitors (ICIs) has significantly improved the prognosis of hepatocellular carcinoma (HCC) patients. With the widespread applica-tion of ICIs in HCC, the management of immune-related adverse events (irAE) gained more and more attention. However, the complicated disease characteristics and various combination therapies in HCC throw out challenges to irAE management. Therefore, the editorial board of the 'Chinese expert consensus on the management of immune-related adverse events of hepatocellular carcinoma treated with immune checkpoint inhibitors (2021 edition)' organizes multidisciplinary experts to discuss and formulate this consensus. The consensus focuses on issues related to HCC irAE manage-ment, and puts forward suggestions, in order to improve standardized and safety clinical medication, so as to maximize the benefits of immunotherapy for patients.

The increasing use of target therapy and immunocheckpoint inhibitors in cancers has brought new hope of survival to patients with advanced tumors. However, more and more adverse side-effects and toxicities of these medications had been reported, affect almost all human organs including the eye. These adverse effects may affect the entire ocular tissues, like eyelid, eye lashes, conjunctiva, cornea, uvea, retina, optic nerve and so on, which are always been ignored by patients and doctors. In this paper we will summarize the characteristics of the related ocular diseases and give our advice on how to diagnose and manage these diseases.

The increasing use of immunocheckpoint inhibitors in tumors has brought new hope of survival to patients with advanced tumors. However, the immune system activated by immunocheckpoint inhibitors, mainly activated T-cell immunity, may attack normal tissues and organs of the human body and lead to a variety of adverse effects. In the lung, they could induce checkpoint inhibitor associated pneumonitis (CIP). CIP is different from known pulmonary interstitial pneumonitis, and had a potentially fatal risk if it was not being properly treated. We will summarize the characteristics of CIP and give our advice on how to manage immunocheckpoint inhibitor associated pneumonitis.

Objective: Pulmonary metastatic angiosarcoma is a rare, fatal disease that often presents as diffuse alveolar hemorrhage(DAH). In this report, clinical characteristics of pulmonary metastatic angiosarcoma were retrospectively reviewed. Methods: A total of 9 patients with angiosarcoma who presented as DAH were enrolled. Clinical data included age, gender, symptoms, smoking status, physical exam findings, pulmonary function tests, and radiology. Results: All patients were male with median age 41 years(range, 22 to 57 years). The most common symptom was hemoptysis(9/9). Other symptoms included dyspnea (5/9), cough(3/9), chest pain(3/9), fever(2/9,) and edema of the lower extremity and oliguria(4/9).The common misdiagnoses were tuberculosis(4/9), vasculitis(3/9) and other infection(1/9). Chest computed tomography showed bilateral,random distributed different-sized nodules(9/9),as well as ground-glass areas (9/9).The hearts, mainly right atrium, were the most common primary locations(7/9).Cardiac mass was the first manifestation in five patients by echocardiography(5/8).Two atrial masses were identified by computer tomography pulmonary angiography and magnetic resonance imaging respectively. Transbronchial lung biopsy failed to find malignancy. Computer tomography guided transthoracic needle biopsy was difficult to perform in most patients. Eight patients were diagnosed by surgical biopsy, either by lung biopsy(4/8) or cardiac biopsy(4/8).The median survival period was only 3 months after surgery. Conclusion Metastatic pulmonary angiosarcoma should be considered in patients with DAH and multiple glass ground opacity and nodules on chest CT. Careful cardiologic monitoring is necessary. Surgical biopsy is reliable for diagnosis.