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.

This case report presents a 16-year-old male patient with deficiency of adenosine deaminase 2(DADA2). The patient had a history of Raynaud′s phenomenon with digital ulcers since childhood. As the disease progressed, the patient developed retinal vasculitis, intracranial hemorrhage, skin necrosis, severe malnutrition, refractory hypertension, and gastrointestinal bleeding. Genetic testing revealed compound heterozygous mutations in the ADA2 gene (paternal c.1072G > A pathogenic mutation + maternal c.1065C > A variant of unknown clinical significance). ADA2 enzyme activity was significantly reduced (0.1 U/L). A multidisciplinary treatment team developed an individualized plan to address key issues, including nutritional support, blood pressure control, rehabilitation, pain management, and balancing anticoagulation/bleeding risks. After systematic intervention, the patient′s condition showed partial improvement. This case reveals clinical challenges such as anticoagulation decisions and nutritional support of DADA2. It also emphasizes the importance of early molecular diagnosis, tumor necrosis factor-α inhibitor targeted therapy, and multidisciplinary collaboration in management, underlining the core value of precision medicine in rare disease management.

OBJECTIVE To establish the fingerprints of Tianma jiannao granules （TJG） and the method for content determination to evaluate the quality of TJG comprehensively combined with chemometric analysis. METHODS High-performance liquid chromatography （HPLC） was used to establish the fingerprints of 13 batches （S1-S3） of TJG and determine the contents of inosine， gastrodin， parishin B and parishin E. Cluster analysis， principal component analysis， and orthogonal partial least squares- discriminant analysis were performed using SPSS 20.0 and SIMCA 18 software； using variable importance projection （VIP） value greater than 1 as a criterion， marker components that affected quality were screened. RESULTS A total of 28 common peaks were identified in the 13 batches of TJG with similarities greater than 0.9， and 7 common peaks were identified， which were gastrodin， p-hydroxybenzyl alcohol， parishin B， parishin E， rhynchophylline， inosine and salidroside. The 13 batches of TJG were clustered into 3 categories， S1-S2， S8-S10 and S12 were clustered into one category； S3 and S7 were clustered into one category； S4-S6， S11 and S13 were clustered into one category. VIP of inosine was greater than 1. The contents of inosine， gastrodin， parishin B and parishin E were 62.637-176.677， 17.821-37.642， 5.748-16.077 and 5.660-13.510 μg/g. CONCLUSIONS The established HPLC fingerprints and content determination method are stable， reliable and highly reproducible， which can be used to evaluate the quality of TJG in combination with chemometric analysis. Inosine may be a marker component that affects the quality of TJG. There are differences in the quality of 13 batches of TJG.

To adapt to the general educational requirements for military academies to prepare for victory under the new situation, the present paper proposed the overall thought of strengthening the post education for military hygiene through analyzing the main problems and causes existing in the current education, combined with the experience and practice of foreign military post education. Moreover, we combined the current situation and reality of post education in military medical universities, and analyzed the corresponding countermeasures from the aspects of teaching staff, course construction, information construction, teaching method and assessment model, expecting to provide guidance and help for better carrying out the post education of military hygiene in the future.

Objective:To analyze the characteristics of the whole genome of hepatitis A virus (HAV) strains from Nanchong, Sichuan and Hetian, Xinjiang.Methods:Serum samples of 9 patients with acute hepatitis A were selected for HAV whole genome sequencing. Among them, 3 were from the same outbreak in Nanchong, Sichuan (2006) and 6 were from Hetian, Xinjiang(2016). Nine full length HAV sequences were obtained by viral RNA extraction, reverse transcription, nested PCR and sequencing. Phylogenetic analysis, neutralizing epitope sites, recombination and natural selection analysis were also performed.Results:Genotyping of HAV VP1-2A region indicated that the 9 HAV sequences all belonged to sub-genotype IA and were divided into four different branches, with 3 Nanchong sequences and 3 Hetian sequences in the same branch. While the whole genome sequence showed that the nucleotide and amino acid homology of 3 Nanchong sequences were 99.99%~100% and 100%, respectively. The difference of nucleotides and amino acids were 0.50%~0.57% and 0.08%~0.17% between 3 Nanchong and 3 Hetian sequences, respectively. The nucleotide and amino acid identities of nine HAV genomes were 98.29%~100% and 99.62%~100%, which was closely related to hd9 in China and MNA12-001 in Mongolia (nucleotide and amino acid homology: with hd9 98.60%~99.50% and 99.75%~99.92%; and with MNA12-001 98.45%~99.32% and 99.71%~99.87%, respectively). The 9 HAV sequences did not change at the neutralizing epitope sites, and no recombination events were found. Natural selection analysis indicated that the HAV coding region was subjected to a negative selection.Conclusions:There are many HAV epidemic strains in China; the 9 HAV amino acid sequences were conserved at the major neutralizing epitope sites.

Objective:To explore the effects of out-of-hospital cardiac rehabilitation in coronary disease patients after percutaneous coronary intervention (PCI) .Methods:From January 2017 to March 2018, this study selected 70 coronary disease patients with PCI in Department of Geriatric Medicine at Jiangsu Province Hospital as subjects by convenience sampling. Those 70 patients were randomly divided into control group and experimental group, 35 cases in each group. Two groups all carried out routine treatment and nursing in hospital. Control group implemented outpatient follow-up after discharge; experimental group adopted out-of-hospital cardiac rehabilitation. The follow-up for patients of two groups lasted one year. This study compared the scores of Seattle Angina Questionnaire (SAQ) , Self-rating Anxiety Scale (SAS) and risk factors of patients between two groups.Results:The scores of SAS of experimental group were lower than those of control group 3, 6, 12 months after discharge with statistical differences ( P<0.05) . The dimension scores of SAQ of patients between two groups 3, 6, 12 months after discharge were higher than those of admission; the scores of SAQ of experimental group were higher than those of control group in the same period with statistical differences ( P<0.05) . A total of 12 months after discharge, the body mass index (BMI) of patients in experimental group was higher than that in control group; the blood glucose and fat were lower than those in control group; the patients with smoking was less than that in control group with statistical differences ( P<0.05) . Conclusions:Out-of-hospital cardiac rehabilitation nursing can relieve the anxiety of coronary disease patients with PCI and control or reduce the risk factors so as to improve the disease condition which is a method suitable for long-term management of PCI patients.

Objective: To evaluate optical coherence tomography(OCT)for predicting invasion depth of early esophageal cancer(EEC) and to compare OCT and magnifying endoscopy-narrow band imaging (ME-NBI)in clinical performance. Methods: Twenty-eight patients who were diagnosed with EEC and accepted OCT and ME-NBI before endoscopic submucosal dissection(ESD)were enrolled in this prospective study. On the basis of OCT and ME-NBI images, real-time prediction of EEC invasion depth was conducted. Postoperative pathological results were taken as golden standard to compare the accuracy of OCT and ME-NBI in evaluation of EEC invasion depth. The procedure time and incidence of complications during evaluation process were also analyzed. Results: The overall accuracy of OCT and ME-NBI in predicting invasion depth of 28 EEC patients were 67.9% (19/28) and 75.0% (21/28) respectively, with no significant difference(P>0.05). The accuracy of OCT and ME-NBI in distinguishing lesions located in epithelium/lamina propria mucosa (EP/LPM) lesions were 78.9%(15/19) and 68.4% (13/19), with no significant difference(P>0.05). The procedure time of OCT was significantly shorter than that of ME-NBI (6.0±2.9 min VS 16.3±5.4 min, P<0.001). Conclusion The ability of OCT to predict invasion depth of EEC and distinguish lesions located in the EP/LPM is comparable with that of ME-NBI. Besides, OCT requires shorter procedure time for evaluation.

Vasovagal syncope(VVS),with its relatively high morbidity,is one of the most common types of au-tonomic-mediated reflex syncope in children,which can seriously affect pediatric patients in their life and study.A se-ries of research have shown that the mechanism for VVS is closely related to autonomic nervous imbalance,neurohor-monal factor,and cerebral blood flow abnormality,and has a certain degree of genetic tendency.Now the progress in the mechanisms for VVS at home and abroad is reviewed,in order to provide certain help for further research.

Objective: To explore the relationship between venous blood routine test parameters and syncopal recurrence of children with vasovagal syncope (VVS). Method: Sixty-three children (male 32, female 31) diagnosed as VVS in Department of Pediatrics, Peking University First Hospital from November 2010 to October 2015 were included in a case observational study.Their mean age was (11.2±2.7) years and basic treatment such as predisposing causes avoiding, standing training, autonomic nervous function exercise and oral rehydration salts were advised to them.The clinical data were obtained by out-patient visit and over telephone from December 2015 to January 2016, with a median follow-up period of 10 (4, 26) months. The effects of baseline venous blood routine test parameters, gender, age, and body mass index (BMI) on syncopal recurrence were studied via univariate and multivariate Cox regression analysis.Kaplan-Meier curve was used to evaluate the long-term prognosis. Result: Among the 63 VVS children in this study, 31 cases were diagnosed as VVS vasodepressor type, 4 cases as VVS cardioinhibitory type and 28 cases as VVS mixed type, 16 cases (25%) had experienced recurrence of syncope while 47 cases (75%) had not.The result of univariate analysis of Cox regression showed that baseline platelet count (PLT) (HR=1.012, 95%CI: 1.003-1.022) had a marked impact on the survival rate.And the result of multivariate analysis of Cox regression showed that baseline hemoglobin concentration (HGB) (HR=1.055, 95%CI: 1.007-1.105), mean corpuscular hemoglobin (MCH) (HR=0.612, 95%CI: 0.423-0.884) and PLT(HR=1.015, 95%CI: 1.006-1.024) had significant effects on survival rate of VVS children.In this study, the one-year, two-year, and three-year survival rate were 83% (52/63), 79% (50/63) and 75% (47/63), respectively. Conclusion The baseline venous blood routine test parameters HGB, MCH and PLT might be the influencing factors of the syncopal recurrence of VVS children.

Objective To compare the fast blood flow density (FBFD) of intermediate choroid between endogenous Cushing syndrome (ECS) patients and healthy control subjects.Methods Thirteen eyes of 7 eligible ECS patients (ECS group) and 13 eyes of 7 gender,age,axial length matched healthy volunteers (control group) were enrolled in this study.For each subject,macular radial scan with swept source optical coherence tomography (SS-OCT) was performed and subfoveal choroidal thickness (SCT) was measured.Then 3.0 mm× 3.0 mm macular scan with SS-OCT angiography was performed,and selected blood flow image at intermediate choroid level or 1/2 SCT beneath Bruch membrane.The grayscale images were then binarized for the analysis of FBFD.Results The SCT in ECS group was (394.7±77.7) μm,which was significantly thicker than (332.1 ± 68.1) μm in control group (t=2.923,P=0.008).The FBFD of intermediate choroid in ECS group were (76.35± 14.46)％,which were significantly greater than (63.57± 13.42)％ in control group (t=2.775,P=0.01).Conclusion ECS patients had increased FBFD at intermediate choroid level compared with healthy controls.