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 explore the association between insulin resistance (IR) and genome-wide DNA methylation based on Shanghai twin study.Methods:Monozygotic twins (MZ) from Shanghai were recruited during 2012-2013, 2017-2018, and 2022-2023. Data were collected by questionnaire survey, physical examination and laboratory tests. Genome-wide DNA methylation was quantified. Generalized linear mixed effect model was applied to analyze the association between methylation level at each site and homeostatic model assessment 2-insulin resistance (HOMA2-IR). Non-paired and paired designs were used to assess the association between DNA methylation and phenotype of IR. Cluster analysis was conducted to identify the clusters of top significant sites. Generalized linear regression was performed to examine the differential methylation patterns from clusters.Results:A total of 100 MZ pairs were included in this study. Hypermethylated cg10535199-2q23.1 ( β=0.74%, P=1.51×10 -7, OR=1.06, 95% CI: 1.03-1.09) and ch.17.49619327- SPOP ( β=0.23%, P=7.54×10 -7, OR=1.17, 95% CI: 1.08-1.28) were identified with suggestive significance. After correcting for multiple testing, no sites reached genome-wide significance. There was no statistical significance in the paired analysis. Two clusters with hypomethylated ( β=-0.39%, P<0.001) and hypermethylated ( β=0.47%, P<0.001) patterns were observed for HOMA2-IR. Conclusions:IR was significantly associated with DNA methylation, and genetic factors might contribute to the association.

Diabetes is a complex disease caused by the combined effects of genetic and environmental factors， which seriously affects people’s health level and living quality. As a special research tool， the twin method can be used to estimate the relative effects of genes and environment on diabetes-related traits. Moreover， compared with regular study subjects， twins have natural controls. The extended methods combined with genetic statistics and molecular biology techniques also help to analyze risk factors of diabetes and clarify the true relationship between exposure and outcome. This paper reviewed the progress of the application of the twin method to diabetes factorial studies in the past ten years at home and abroad， and summarized the advantages and limitations of the classical twin model， co-twin control studies， and genome-wide and epigenetic epidemiological studies.

Objective:To retrieve, evaluate and summarize the relevant evidence on the management of hyperphosphatemia in adult maintenance hemodialysis patients.Methods:Domestic and foreign databases and relevant professional websites were searched for best practices, evidence summaries, guidelines, expert consensus and systematic reviews on hyperphosphatemia in adult maintenance hemodialysis patients. The retrieval time was from the establishment of the databases to January 2023. The methodological quality of the included articles was evaluated, and the best evidence was extracted and summarized.Results:A total of 13 articles were included, including 2 clinical decisions, 4 guidelines and 7 systematic reviews. A total of 23 evidences were summarized from 5 aspects, including blood phosphorus monitoring, adequate dialysis, diet control, drug management and health education.Conclusions:This study summarizes the best evidence on the management of hyperphosphatemia in maintenance hemodialysis patients and provides a reference for clinicians to manage hyperphosphatemia in adult maintenance hemodialysis patients.

A novel paper-based analytical device(PAD)was prepared and applied to determine the xanthine oxi-dase(XOD)inhibitory activity of Salvia miltiorrhiza extracts(SME).First,polycaprolactone was 3D printed on filter paper and heated to form hydrophobic barriers.Then the modified paper was cut according to the specific design.Necessary reagents including XOD for the colorimetric assay were immobilized on two separate pieces of paper.By simply adding phosphate buffer,the reaction was performed on the double-layer PAD.Quantitative results were obtained by analyzing the color intensity with the specialized device system(consisting of a smartphone,a detection box and sandwich plates).The 3D-printed detection box was small,with a size of 9.0 cm x 7.0 cm x 11.5 cm.Color component G performed well in terms of linearity and detection limits and thus was identified as the index.The reaction con-ditions were optimized using a definitive screening design.Moreover,a 10％glycerol solution was found to be a suitable stabilizer.When the stabilizer was added,the activity of XOD could be maintained for at least 15 days under 4℃or-20℃storage conditions.The inhibitory activity of SME was investigated and compared to that of allopurinol.The results obtained with the PAD showed agreement with those ob-tained with the microplate method.In conclusion,the proposed PAD method is simple,accurate and has a potential for point-of-care testing.It also holds promise for use in rapid quality testing of medicinal herbs,intermediate products,and preparations of traditional Chinese medicines.

In fighting against the outbreak of coronavirus disease 2019 (COVID-19), focusing on the six key points of man, machine, material, method, environment and monitoring in quality management, our hospital took a series of effective measures in advance to intervene in the key factors that affected the quality of emergency management of public health emergencies. With the development of the epidemic situation, they were further improved with continuous evaluation and adjustment. The emergency response ability and emergency management quality of our hospital have been greatly improved and patients’ safety has been ensured.

Objective: To understand the consistency of ALK Ventana-D5F3 immunohistochemistry (IHC) interpretation in Chinese lung adenocarcinoma among histopathologists from different hospitals, and to recommend solution for the problems found during the interpretation of ALK IHC in real world, with the aim of the precise selection of patients who can benefit from ALK targeted therapy. Methods: This was a multicenter and retrospective study. A total of 109 lung adenocarcinoma cases with ALK Ventana-D5F3 IHC staining were collected from 31 lung cancer centers in RATICAL research group from January to June in 2018. All cases were scanned into digital imaging with Ventana iSCANcoreo Digital Slide Scanning System and scored by 31 histopathologists from different centers according to ALK binary (positive or negative) interpretation based on its manufacturer′s protocol. The cases with high inconsistency rate were further analyzed using FISH/RT-PCR/NGS. Results: There were 49 ALK positive cases and 60 ALK negative cases, confirmed by re-evaluation by the specialist panel. Two cases (No. 2302 and No.2701) scored as positive by local hospitals were rescored as negative, and were confirmed to be negative by RT-PCR/FISH/NGS. The false interpretation rate of these two cases was 58.1% (18/31) and 48.4% (15/31), respectively. Six out of 31 (19.4%) pathologists got 100% accuracy. The minimum consistency between every two pathologists was 75.8%.At least one pathologist gave negative judgement (false negative) or positive judgement (false positive) in the 49 positive or 60 negative cases, accounted for 26.5% (13/49), 41.7% (25/60), respectively, with at least one uncertainty interpretation accounted for 31.2% (34/109). Conclusion There are certain heterogeneities and misclassifications in the real world interpretation of ALK-D5F3 IHC test, which need to be guided by the oncoming expert consensus based on the real world data.

Objective To analyze the clinical efficacy of multiple renal arteries on outcomes of renal donors and recipients in hand-assisted retroperitoneoscopic donor nephrectomy.Method From 2012 to 2014,121 patients underwent hand-assisted laparoscopic donor nephrectomy,including 92 cases of a single renal artery and 29 cases of multiple arteries.Donor and recipient outcomes for single artery and multiple arteries allografts were compared.Result The study included 121 pairs of donors and recipients.The demographic characteristics between multiple renal artery group and single renal artery group had no significant difference.The operative time,blood loss,postoperative complications,and hospital stay had no significant difference between two groups.Cold ischemia time and warm ischemia time in multiple renal artery group were longer than single donor renal artery group (128.5 ± 13.2 vs.50.2 ± 17.3 min,P＜0.001;196.0 ± 63.3 vs.154.1 ± 55.2 min,P=0.002,respectively).The operative time in multiple renal artery group was longer than in single renal artery group (213.5 ± 28.2 vs.182.2 ± 31.1 min,P＜0.001).There was no significant difference in blood loss,vascular complications and ureternal complications between two groups.The renal functions of two groups were likewise within one year.Conclusion There was no statistically significant difference in clinical efficacy between hand-assis-ted retroperitoneoscopic donor nephrectomy with multiple renal arteries and single artery.The use of these grafts was safe for both recipients and donors.

Objective To analyze and summarize clinical characteristics and treatment of diffuse alveolar hemorrhage syndrome (DAHS)complication after renal transplantation.Methods Clinical data of one patient,admitted to the 309 th Hospital of People's Liberation Army in December 201 2, who was complicated with DAHS after renal transplantation,were obtained.The incidence,diagnosis and treatment courses of DAHS were retrospectively analyzed.Literature review was conducted to summarize clinical experience.Results The patient was clinically manifested with respiratory failure,progressive aggravation of hemoptysis and anemia.Imaging examination revealed that diffusive infiltration of bilateral lungs was aggravated.After the diagnosis of DAHS was confirmed,adrenal cortical hormone (hormone)shock and anti-infectious medication therapies were timely delivered to actively prevent and treat relevant complications.The patient was successfully healed.Until the submission date,the patient presented with normal renal function and no pulmonary complications were noted.Conclusions DAHS is a rare and fatal complication after renal transplantation.Early diagnosis, active anti-infection therapy and timely administration of large-dose hormone shock treatment determine the success of clinical treatment.

Objective To investigate the application effect of integrated classroom teaching model oriented by cases in teaching of oral nursing care, and seek a new teaching model, to improve the clinical comprehensive ability of nursing students. Methods Totally 287 undergraduate nursing students of Wenzhou Medical University were selected as the research object, and were divided into the control group and the observation group randomly. The control group adopted the traditional teaching method, while the observation group adopted the integrated classroom teaching model oriented by cases. The autonomous learning ability, critical thinking ability and satisfaction of nursing students between two groups were compared by questionnaire. Results There were no differences between two groups in nursing students′ autonomous learning ability and critical thinking ability before teaching (P>0.05), but after teaching, the scores of autonomous learning ability and critical thinking ability of students in the observation group were significantly higher than those of students in the control group (P<0.05). The students′ satisfaction towards teaching in the observation group (91.97±11.37) was significantly higher than that of the control group (84.43±10.12) (P=0.006). The examination results of oral care clinical ability in the observation group (83.47±8.19) were significantly higher than that in the control group (71.86±6.23) (P=0.001). Conclusions The integrated classroom teaching model oriented by cases can increase nursing students′ autonomous learning ability, critical thinking ability and clinical practice ability, and improve the learning enthusiasm and comprehensive ability of nursing students.