Volume 104 · Issue 18 · 2024

Lung cancer remains the most prevalent and lethal malignancy in our country. Early diagnosis and treatment are crucial for improving patient prognosis in lung cancer/pulmonary nodules. Recent advancements in non-invasive/minimally invasive liquid biopsy, multi-omics, and artificial intelligence technologies have significantly enhanced the accuracy of early lung cancer/pulmonary nodule diagnosis. However, an early diagnostic method with both high sensitivity and specificity is yet to be established. Furthermore, addressing the methods and extent of early precision surgery, local precision therapy, perioperative combined treatment, and postoperative recurrence and metastasis monitoring are urgent challenges in the early management of lung cancer/pulmonary nodules. Integrating the advantages of various treatment strategies and formulating personalized and precise treatment plans is key to further improving patient survival. In the future, while exploring new therapeutic strategies, it is necessary to continuously search for biomarkers to identify the population that will benefit from the treatment effectively. Additionally, large-sample randomized controlled clinical studies should be conducted to investigate the benefits of long-term patient survival under a diverse range of treatment strategies.

Thyroid diseases are relatively common in clinical practice. Surgery and use of related drugs may exacerbate the underlying thyroid diseases, increasing the difficulty of perioperative management. However, there is a lack of guidelines and consensus for non-thyroid surgery in patients with thyroid dysfunction. This review mainly summaries the perioperative management of non-thyroid surgery in patients with hypothyroidism and hyperthyroidism to provide clinical treatment suggestions and reduce the risk of perioperative complications.

Recently, the topic of "overdiagnosis" of thyroid cancer has once again sparked controversy in the medical academic community, as well as extensive discussions from patients and the general population. To some extent, the overdiagnosis of thyroid cancer has been over interpreted. This article provides a detailed discussion on how to correctly understand the overdiagnosis of thyroid cancer from the perspective of a thyroid surgeon. The author believes that there are two elements to the occurrence of overdiagnosis of thyroid cancer: the presence of a large "silent pool" of inert tumors in the human body and medical methods to improve detection rates. In recent years, thyroid cancer has become the fastest growing malignant tumor in the world in terms of incidence rate. The exponential growth mode makes thyroid cancer over diagnosed and inevitably becomes a hot topic in academia. However, the overdiagnosis of thyroid cancer is not contradictory to the early screening and diagnosis of thyroid cancer. The overdiagnosis of thyroid cancer should be viewed scientifically and rationally, especially avoiding overinterpretation.

In recent years, the incidence of thyroid cancer has rapidly increased, whereas the mortality rate has not risen correspondingly. Therefore, scholars at home and abroad have proposed the view of overdiagnosis in thyroid cancer, sparking intense debates about the phenomenon of overdiagnosis and overtreatment. A historical review and discussion of the primary reasons for the increase in thyroid cancer incidence and the improvement in treatment outcomes are beneficial. It helps clarify that the real increase in thyroid cancer is primarily due to the higher incidence rate, rather than overdiagnosis. Additionally, it allows us to reevaluate which factors guarantee favorable efficacy in thyroid cancer.

The incidence of differentiated thyroid cancer is increasing rapidly worldwide, with subcentimeter papillary thyroid carcinoma (SPTC) with a diameter of less than 1 cm accounting for more than 50%. Active surveillance (AS) as an alternative to immediate surgery for low-risk SPTC was launched in Japan in the 1990s and has been implemented in several countries, including Japan and the United States. However, the indications and safety of performing AS for low-risk SPTC remain controversial. In this article, the author summarizes the existing literature and explores its limitations of AS implementation, the effectiveness of surgical treatment, and the different attitudes of countries on AS, aiming to provide some references for the treatment options of low-risk SPTC.

The 5^th edition WHO classification of thyroid tumors proposed high-grade non-anaplastic thyroid carcinoma, which includes traditional poorly differentiated thyroid carcinoma (PDTC) and differentiated high-grade thyroid carcinoma (DHGTC), with a prognosis between highly differentiated thyroid carcinoma and anaplastic thyroid carcinoma (ATC), in which about 50% of patients do not take radioactive iodine. Therefore, this classification is of great clinical significance. This article interprets the diagnostic criteria and genetic features of high-grade non-anaplastic thyroid carcinoma in 5^th edition WHO classification, comparing with ATC.

To explore the value of detection of epidermal growth factor receptor (EGFR) gene amplification in peripheral blood rare cells in the assessment of benign and malignant pulmonary nodules.

A total of 262 patients with pulmonary nodules were selected as the retrospectively study subjects from the Second Affiliated Hospital of Army Military Medical University and Peking Union Medical College Hospital from July 2022 to August 2023. There were 98 males and 164 females, with the age range from 16 to 79 (52.1±12.1) years. The EGFR gene amplification testing was performed on the rare cells enriched from patients′ peripheral blood, and the clinical manifestations, CT imaging features, histopathological and/or pathological cytological confirmed results of patients were collected. The receiver operating characteristic (ROC) curve was used to determine the optimal cut-off value of the method of detection of EGFR gene amplification in peripheral blood rare cells, and its diagnostic efficacy was evaluated.

Among the 262 patients, 143 were malignant pulmonary nodules and 119 were benign pulmonary nodules. The differences between malignant pulmonary nodules and benign pulmonary nodules in nodule diameter and nodule density were statistically significant (both P<0.001), while the differences in age, gender and nodule number were not statistically significant (all P>0.05). The number [M (Q₁, Q₃)] of EGFR gene amplification positive rare cells in patients with malignant pulmonary nodule was 8 (6, 11), which was higher than that in patients with benign pulmonary nodule [2 (1, 4), P<0.001]. The ROC curve results showed that when the optimal cut-off value was 5 (that was, the number of EGFR gene amplification positive rare cells was>5), the area under the curve (AUC) of the detection of EGFR gene amplification in peripheral blood rare cells for discrimination of benign and malignant pulmonary lesions was 0.816 (95%CI: 0.761-0.870), with a sensitivity of 83.2%, a specificity of 80.7%, and an accuracy of 82.1%. Based on the analysis of the diameter of the nodules, the AUC for distinguishing between benign and malignant pulmonary nodules with diameter 5-9 mm and 10-30 mm was 0.797 (95%CI: 0.707-0.887) and 0.809 (95%CI: 0.669-0.949), respectively, with sensitivity, specificity and accuracy reached 75% or above. Based on the analysis of nodule density, the AUC for distinguishing between benign and malignant solid nodule and subsolid nodule was 0.845 (95%CI: 0.751-0.939) and 0.790 (95%CI: 0.701-0.880), respectively, with sensitivity, specificity and accuracy reached 75% or above. Based on the analysis of nodule number, the AUC for distinguishing between benign and malignant solitary pulmonary nodule and multiple pulmonary nodule was 0.830 (95%CI: 0.696-0.965) and 0.817 (95%CI: 0.758-0.877), respectively, with sensitivity, specificity and accuracy reached 80% or above.

The detection of EGFR gene amplification in peripheral blood rare cells contributes to the evaluation of benign and malignant pulmonary nodules, and can be used in the auxiliary diagnosis of benign and malignant pulmonary nodules.

To investigate the prognostic value of skeletal muscle measured by CT at the level of the fourth thoracic vertebra (T4) in advanced epidermal growth factor receptor (EGFR)-positive non-small cell lung cancer (NSCLC) patients treated with ecotinib.

The study retrospectively reviewed clinical and pathological characteristics of 176 patients with advanced EGFR-positive NSCLC who received ecotinib and underwent chest CT scans at Wuhan Union Hospital between January 2017 and October 2020. Among them, 70 were male and 106 were female, with ages ranging from 27 to 80 (58.6±10.6) years. As of August 21, 2021, the median follow-up duration was 19.2 months (95%CI: 15.3 to 23.7 months). The optimal cut-off value of skeletal muscle density (T4-SMD) on CT images at the T4 level were determined using X-tile software. Kaplan-Meier analysis and log-rank test were used to plot progression-free survival curves. Cox proportional hazards regression models were employed to analyze factors influencing 1-year progression-free survival (PFS), and a nomogram prognostic model was constructed accordingly. Receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) were utilized to evaluate the predictive value of the nomogram.

The T4-SMD [M (Q₁,Q₃)] of 176 patients was 42.56 (37.05, 45.93) HU. Patients were divided into low T4-SMD group (n=122) and high T4-SMD group (n=54) based on the cut-off value (The values for males and females were 49.44 and 41.41 HU, respectively) of T4-SMD. The median PFS time and 1-year PFS rate in the low T4-SMD group were significantly lower than those in the high T4-SMD group [10.4 (95%CI: 9.3-11.8) vs 13.7 (95%CI: 11.1-18.5) months, 36.1% vs 59.3%, respectively, P=0.034]. Eastern Cooperative Oncology Group performance status (HR=3.308, 95%CI: 1.183-9.247, P=0.023), lactate dehydrogenase level (HR=1.852, 95%CI: 1.037-3.307, P=0.037), systemic immune-inflammation index (HR=1.772, 95%CI: 1.019-3.080, P=0.043), and T4-SMD (HR=0.563, 95%CI: 0.325-0.974, P=0.040) were prognostic factors for 1-year PFS in advanced EGFR-positive NSCLC patients treated with ecotinib. A nomogram for predicting 1-year PFS of advanced EGFR-positive NSCLC patients treated with ecotinib was constructed based on the four indicators selected by multivariate Cox regression analysis. The area under the ROC curve of the nomogram was 0.775 (95%CI: 0.676-0.874). The calibration curve showed good consistency between the predicted and actual 1-year PFS. DCA demonstrated good clinical prediction effectiveness of the nomogram.

Low T4-SMD is a prognostic risk factor for patients with advanced EGFR-positive NSCLC receiving icotinib therapy.

To investigate the impact of peripheral blood inflammatory indicators on the efficacy of immunotherapy in patients with advanced non-small cell lung cancer (NSCLC) complicated with chronic obstructive pulmonary disease (COPD).

A retrospective cohort study was performed to include 178 patients with Ⅲ-Ⅳ NSCLC complicated with COPD who received at least 2 times of immunotherapy in Xinqiao Hospital of the Army Medical University from January 2019 to August 2021. Baseline peripheral blood inflammatory indicators such as interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-α (TNF-α) were collected within 2 weeks before the first treatment, with the last one being on or before February 7, 2022. X-tile software was used to determine the optimal cut-off value of peripheral blood inflammatory indicators. The Cox multivariate regression models were used to analyze the factors affecting progression free survival (PFS) and overall survival (OS).

Among the 178 patients, there were 174 males (97.8%) and 4 females (2.2%); the age ranged from 42 to 86 (64.3±8.3) years old.There were 30 cases (16.9%) of immunotherapy monotherapy, 114 cases (64.0%) of immunotherapy combined with chemotherapy, 21 cases (11.8%) of immunotherapy combined with antivascular therapy, and 13 cases (7.3%) of immunotherapy combined with radiotherapy. The median follow-up period was 14.5 months (95%CI: 13.6-15.3 months). The objective response rate (ORR) and disease control rate (DCR) were 44.9% (80/178) and 90.4% (161/178) for the whole group, the median PFS was 14.6 months (95%CI: 11.6-17.6 months), and the median OS was 25.7 months (95%CI: 18.0-33.4 months). The results of Cox multivariate analysis showed that IL-6>9.9 ng/L (HR=5.885, 95%CI: 2.558-13.543, P<0.01), TNF-α>8.8 ng/L (HR=3.213, 95%CI: 1.468-7.032, P=0.003), IL-8>202 ng/L (HR=2.614, 95%CI: 1.054-6.482, P=0.038), systemic immune inflammatory index (SII)>2 003.95 (HR=2.976, 95%CI: 1.647-5.379, P<0.001) were risk factors for PFS, and advanced lung cancer inflammation index (ALI)>171.15 was protective factor for PFS (HR=0.545, 95%CI: 0.344-0.863, P=0.010). IL-6>9.9 ng/L(HR=6.124, 95%CI: 1.950-19.228, P<0.002), lactate dehydrogenase (LDH)>190.7 U/L (HR=2.776, 95%CI: 1.020-7.556, P=0.046), SII>2 003.95 (HR=4.521, 95%CI: 2.241-9.120, P<0.001) were risk factors for OS, and ALI>171.15 was a protective factor for OS (HR=0.434, 95%CI: 0.243-0.778, P=0.005).

Baseline high levels of IL-6, TNF-α, IL-8, SII, LDH, and low levels of ALI are risk factors for poor prognosis in patients with advanced NSCLC-COPD receiving immunotherapy.

To evaluate the effects of obesity on the incidence of postoperative pulmonary complications (PPCs) following laparoscopic colorectal surgery.

A total of 150 patients with pathological diagnosis of colorectal cancer who accepted laparoscopic colorectal excision from January to May 2023 were retrospectively recruited. All the patients scored 26 points or more in the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) model, making them all in intermediate to high risks of PPCs. Patients were divided into obesity group and non-obesity group depending on whether they were obese or not. Propensity score matching (1∶1) was performed to achieve the balance of clinicopathological characteristics with the matching factors of age, sex, respiratory complications and ARISCAT score. A total of 96 patients were eventually enrolled, with 48 patients in obesity group and 48 patients in non-obesity group. Besides, the patients were divided into 25°-30° Trendelenburg subgroup and ±10°-15° Trendelenburg subgroup according to surgical sites for further analysis. The incidence of PPCs, the intraoperative airway pressure and blood biomarker expression of lung injury, including soluble receptor for advanced glycation end products (sRAGE) and angiopoietin-2 (ANG2) at postoperative day (POD) 1 and POD3 between the two groups were compared. The relationship between obesity and incidence of PPCs within 30 postoperative days were analyzed with unifactorial Cox proportional hazard model.

The obesity group was comprised of 35 males and 13 females with a median age of 60 (49, 69) years, and the non-obesity group was comprised of 35 males and 13 females with a median age of 60 (52, 67) years. The incidence of PPCs was 50.0% (24/48) in the obesity group, which was higher than 20.8% (10/48) in the non-obesity group and the incidence of grade Ⅰ PPCs and microatelectasis were 31.3% (15/48) and 33.3% (16/48), higher than the 12.5% (6/48) and 12.5% (6/48) of the non-obesity group (all P<0.05). The peak airway pressure (Ppeak) and plateau airway pressure (Pplat) of patients in obesity group were 34.0(31.5, 36.5) and 30.0(27.0, 32.0) cmH₂O(1 cmH₂O=0.098 kPa), which were significantly higher than the 26.0 (24.0, 29.5) and 22.0 (21.0, 26.5) cmH₂O of the non-obesity group (all P<0.001). The ANG2 level of the obesity group at POD3 was 11.9 (8.4, 16.5) μg/L, which was higher than 9.2 (6.0, 12.3) μg/L of the non-obesity group (P=0.045). In 25°-30°Trendelenburg subgroup, the incidence of PPCs in obese patients were significantly higher than that of non-obese patients [41.4% (12/29) vs 11.4% (4/35), P=0.005]. In ±10°-15°Trendelenburg subgroup, no significant difference was found in PPCs incidence between obese and non-obese patients [63.2% (12/19) vs 46.2% (6/13), P=0.215]. The unifactorial Cox proportional hazard model analysis showed that obesity was a risk factor of PPCs in 30 postoperative days (HR=3.015, 95%CI: 1.438-6.321, P=0.001).

In patients undergoing laparoscopic colorectal surgery with intermediate to high risk of PPCs, obesity raises intraoperative airway pressure and aggravates intraoperative lung endothelial injury. Obesity is a risk factor of PPCs in 30 postoperative days.

To investigate the inplementation of cardiovascular surgery for congenital heart disease (CHD) in China.

A cross-sectional study was carried out. The CHD cardiovascular surgery data collected by the Chinese Society of Extracorporeal Circulation from 2017 to 2021 in 31 provinces (autonomous regions/municipalities) of China were retrospectively reviewed, the implementation of CHD cardiovascular surgery in different provinces, regions, general/specialized hospitals, and different age groups (whether≤18 years old) were summarized, and the correlation analysis between the number of surgeries carried out in each province/region and the gross regional product and the number of the regional population was performed.

Between 2017 and 2021, the annual volume of CHD cardiovascular surgery was 77 120, 77 634, 81 161, 62 663 and 71 492, respectively, showing a decreasing trend. Meanwhile, the proportion of CHD patients aged≤18 years who underwent cardiovascular surgery also showed a downward trend, from 79.8% (61 557/77 120) in 2017 to 58.6% (41 871/71 492) in 2021 (P=0.027). The number of surgical cases varied greatly among different provinces, including 4 provinces with≥5 000 cases and 9 provinces with 2 000-5 000 cases. In the five years, the number of CHD cardiovascular surgeries in Central and East China was the largest, accounting for 41.1%-45.5% of the total surgical cases. The proportion of CHD surgery cases≤18 years old was the highest in Southwest China (69.7%-87.4%) and the lowest in Northeast China (28.2%-68.9%). Except for 2021, the number of cases carried out by each region between 2017 and 2020 was correlated with the gross regional product (r=0.929, 0.929, 0.893 and 0.964, respectively, all P<0.05) and the population (r=0.821, 0.893, 0.821 and 0.857, respectively, all P<0.05). Hospitals that performed more than 100 operations (20.5%±1.2% of the total number of hospitals) completed 86.2%±1.2% of the total number of operations in China during the 5-year period. In 2017 and 2021, the number of CHD cardiovascular surgeries preformed in children′s/women′s and children′s specialized hospitals accounted for 24.3% (18 772/77 120) and 23.8% (17 012/71 492) of the total number of cases in China, respectively.

From 2017 to 2021, the number of cardiovascular surgery for CHD decreases slightly, but the proportion of surgery for adult CHD patients increases significantly.There is a strong correlation between the number of CHD operations in each region and their economic development status. The scale of CHD cardiovascular surgery performed in children′s hospitals/women′s and children′s hospitals accounts for about a quarter of the total volume in China.

A total of 37 cases of thyroid tumors with pathological features suggestive of DICER1 gene mutation were selected to detect the DICER1 gene and BRAF gene using Sanger sequencing. A total of 10 patients (27.0%) exhibited DICER1 gene mutation all of whom were female with an age of [M(Q₁, Q₃)] 38.0 (30.5, 47.5) years. All patients had wild-type BRAF^V600E gene. The ultrasound examination showed high-low echogenic well-demarcated intra-thyroidal nodules with abundant peripheral and internal blood flow signals in the DICER1 mutated thyroid tumor. The tumor was confined within the thyroid gland, with a diameter of (3.68±1.31) cm. The pathological features are as follows: the majority of tumors are encapsulated, which mainly composed of large follicles rich in colloid and some are small and micro follicles. The nucleus is round and deeply stained or slightly light stained, small to medium-sized, with occasional nuclear grooves and a lack of nuclear pseudoinclusion bodies within the nucleus. Immunohistochemical staining shows that Ki67 proliferation index of approximately 2%-10%. All cases were followed up for 11 to 18 months, and there was no recurrences or distant metastase. This study confirmed that the DICER1 gene mutation is mutually exclusive with the BRAF^V600E gene mutation. The thyroid tumor with DICER1 mutation are in big size and are more common in young females with a good prognosis. Cases with the wild-type DICER1 gene may exhibit similar morphological features, and molecular testing is recommended. If somatic DICER1 mutation is confirmed, patients should undergo germline mutation testing to rule out DICER1 syndrome in order to define whether genetic counseling is necessary

A total of 25 patients with right cardiac system tumors in the Department of Cardiac Surgery, Beijing Anzhen Hospital from January 2012 to October 2022 were retrospectively included in the study. The preoperative data, and information of surgical treatment and perioperative management on these patients were analyzed and summarized. One patient developed pulmonary embolism and died before surgery, and the other 24 patients (16 males and 8 females) received surgical treatment, with an average age of (44.7±10.2) years (24-74 years). Nine patients were diagnosed with malignant tumors. Among the 24 patients who received surgical treatment, two patients died during the perioperative period, in-situ tumor recurrence was seen in three patients within about 1 year after surgery (two patients died without surgery, and one patient died 3 months after surgery), two patients had distant metastasis, and 17 patients had a good prognosis. Right cardiac system tumors are rare, with a high malignant rate, and the clinical manifestations vary greatly. Active surgical intervention is found to be effective, and the prognosis is closely related to the pathological type and extent of tumor invasion.

A case of primary myoepithelial carcinoma of the liver in a child is reported. A child, male, 1 year old, was found to occupy liver space by ultrasound during prenatal examination. After birth, ultrasound hemangioma was closely followed up. The mass was significantly enlarged in the later stage. CT scan showed low-density intrahepatic space occupation with calcification, enhanced scan showed signs of incomplete filling, and abdominal MRI plain scan showed a mass of uneven long T in the anterior lobe of right liver₁Long T₂Signal shadow, in which several circular longer T are visible₁Long T₂Signal shadows showed slightly high signal at the edge of the mass and low signal shadows at the internal components on magnetic resonance diffusion imaging (DWI) sequences. Followed by resection of liver tumor, the pathological diagnosis: liver-myoepithelial carcinoma. No adjuvant treatment was used after surgery, and no abnormalities were found after 4 years of follow-up.

A case of Aymé-Gripp syndrome treated by cochlear implant is reported. A 1-year-old and 8-month-old child went to the doctor because "the hearing response was found to be poor for half a year". The hearing examination showed sensorineural deafness (extremely severe on the left side and severe on the right side), and there was a heterozygous mutation in MAF gene. She underwent cochlear implantation in the left ear. Before cochlear implant electrode implantation during the operation, the electrically induced auditory brainstem response was detected in the round window niche. The postoperative test showed that the impedance of 24 electrodes was normal, and the telemetry of nerve response of No. 1~22 electrodes in the cochlea was normal. The machine was turned on 1 month after the operation, and there was no adverse reaction. The postoperative rehabilitation treatment was followed up for 4 months. The child's speech rehabilitation effect was good. This case can provide a reference for the surgical treatment of cochlear implant in children with this syndrome.

Src homologous 2 domain-containing protein tyrosine phosphatase (SHP2) is a non-receptor type protein tyrosine phosphatase. Abnormally expressed SHP2 is involved in the development, development and drug resistance of a variety of malignant tumors including non-small cell lung cancer (NSCLC). In-depth research on SHP2 can help reveal the current mechanism of lung cancer resistance to multiple drugs, and provide a new perspective for tapping potential intervention targets. The study confirmed that SHP2 was closely related to cisplatin resistance, molecular targeted therapy resistance, immune checkpoint inhibitor resistance and radiotherapy resistance in NSCLC. In recent years, allosteric inhibitors developed based on SHP2, such as SHP099, RMC-4630, TNO155, PF-07284892, JAB-3312, etc., have developed rapidly, and a number of clinical study data have preliminarily confirmed the efficacy and safety of the above therapeutic drugs. However, some SHP2 inhibitors that have entered clinical trials are not as effective as expected, and more results are needed to further confirm. At the same time, the potential adverse reactions and toxicity caused by SHP2 inhibition are also worthy of attention. SHP2 has become a new target and new direction to overcome NSCLC drug resistance and improve the effect of combination therapy.

Brain metastasis of lung cancer is the main cause of death, and the role and mechanism of tumor microenvironment in promoting brain metastasis of lung cancer have attracted widespread attention. This paper summarizes the latest progress in the research of lung cancer brain metastasis related to tumor microenvironment, expounds the influence of central nervous system microenvironment on metastasis in lung cancer brain metastasis, as well as the panoramic study of brain metastasis microenvironment based on emerging technologies such as single cell sequencing and spatial transcriptomics, and describes the interaction and mechanism of each component of brain metastasis microenvironment with tumor cells, which provides a new strategy for microenvironment targeted therapy of lung cancer brain metastasis. In addition, the article also reviews the existing clinical research and treatment status of lung cancer brain metastasis targeting microenvironment, providing reference for precision medicine of lung cancer brain metastasis.

Tumors have a complex immune microenvironment. Interferon-stimulated gene (STING) signaling pathway not only mediates the innate immune response to resist infection, but also senses tumor-derived DNA to produce anti-tumor immune response, and has a regulatory effect on a variety of immune cells. This paper reviews the role of STING signaling pathway in T cells, dendritic cells (DC), natural killer cells (NK cells) and many other immune cells and immunotherapy, and summarizes the research progress and clinical application of STING signaling pathway in cancer immunotherapy in recent years.

At present, colorectal cancer (CRC) ranks second among malignant tumors of digestive system in China. A large number of CRC patients have recurrence and metastasis after surgery, which has become one of the main causes of death in China. Therefore, how to improve the therapeutic effect and prognosis of CRC has become an urgent clinical problem. Studies have found that immunotherapy has become a new benchmark for CRC treatment; The changes of immune cell function and tumor microenvironment also play a crucial role. Among them, dendritic cells (DC) have a significant anti-tumor effect, which is an important direction of CRC immunotherapy. In this paper, the role of DC in the tumor microenvironment in the immunotherapy of CRC is reviewed in combination with relevant literature.

In recent years, minimally invasive surgery has attracted much attention in the field of gynecological oncology treatment, involving diseases such as cervical cancer, endometrial cancer and ovarian cancer. Numerous reports and clinical studies have shown the feasibility, effectiveness and safety of minimally invasive surgery, highlighting its therapeutic advantages. However, the results of the 2018 randomized controlled clinical trial (LACC) of laparoscopic radical cervical cancer surgery broke previous views and showed that minimally invasive surgery may increase the risk of recurrence and death in the treatment of cervical cancer, triggering a re-examination of the impact of surgical pathways. New research has found that new technologies such as single-port laparoscopy (LESS) and trans-natural lumen laparoscopy (vNOTES) show potential advantages in the treatment of endometrial cancer. Robotic surgery has gained recognition in the treatment of endometrial cancer, but its cost-effectiveness has yet to be further investigated. For ovarian cancer, minimally invasive surgery has demonstrated safety and feasibility in early staging and interphase tumor cytoreductive surgery, but surgical choice still needs to be supported by a higher level of evidence. It is essential to continue to pay attention to research progress, carefully evaluate the impact of surgical pathways on patient survival benefits, and provide patients with the best treatment options.

The patient, a 40-year-old female, went to the National Kidney Disease Clinical Medical Research Center of the Eastern Theatre General Hospital in November 2023 due to "abnormal urine test for more than 3 years". Three years ago, due to waist discomfort, I went to the local hospital for positive urine protein examination (the urine protein quantification was 0.42 g/24 h), and my renal function was normal. There was no regular diagnosis and treatment. Recently, my urine protein increased (the quantification was 1.6 g/24 h), and my renal function and blood lipid levels were normal. The patient's mother has 5 siblings. The mother and one aunt were diagnosed with lipoprotein nephropathy (LPG) by renal puncture in an outside hospital. Another aunt had urinary abnormalities, and the first brother died unexpectedly. Now the patient's mother has entered maintenance hemodialysis. The patient has 2 siblings. Considering the possibility of LPG, the patient was admitted to the hospital for renal biopsy. The pathology showed that the glomerular volume was increased, and there were more lamellar embolus with periodate Schiff (PAS) staining in the capillary haptics (Figure 1, ×200), which was positive for apolipoprotein E (ApoE) staining (Figure 2, immunofluorescence ×400). Under the electron microscope, vacuolar lipid droplets arranged in sediment-like layers were seen in the haptic cavity (Figure 3, ×2 900), which was consistent with LPG. Whole exon sequencing confirmed that the patient had a c.580_581insCCCTCC insertion variant, resulting in the insertion of proline and leucine between amino acids 193 and 194 of the ApoE gene on chromosome 19, resulting in the mutated ApoE isomer. Family members verified the presence of the pathogenic variant in their mother, and the younger brother carried the pathogenic gene but did not have proteinuria and other kidney disease manifestations. After 2 months of fenofibrate treatment, the patient's urinary protein turned negative. LPG is a rare glomerular disease with autosomal dominant inheritance of ApoE gene mutation and incomplete manifestation. There are a large number of lamellar, apoE-positive lipoprotein embolisms in the glomerular capillary haptics, and proteinuria is the main manifestation. Most patients' blood ApoE levels are elevated, and treatment with glucocorticoids and immunosuppressants is ineffective. Fenofibrate treatment can reduce proteinuria, which progresses to renal insufficiency in the later stage. In this case, the patient only presented with moderate amount of proteinuria, no dyslipidemia, and was finally diagnosed with LPG by renal biopsy pathology, combined with genetic testing and his family history.

Chinese Medical Journal, Volume 102, Issue 34, September 13, 2022, article "Case 563rd Rash-Fever-Anuria-Vision Decrease", page 2708 Figure 1 is cited from the article "Anuria, Sudden Blindness, Disorder of Consciousness: An Unusual Case of" Adult Stills Disease "" in Rare Disease Research, Issue 1, 2022, and has obtained the secondary publication license of related images. Here, the supplementary citation of the literature "Le Si, Liu Yan, Qin Yan, et al. Anuria, Sudden Blindness, Disorder of Consciousness: An Unusual Case of" Adult Stills Disease "[J]. Rare Disease Research, 2022, 1 (1): 51-55. DOI: 10.12376/j.issn.2097-0501.2022.01.009". Corrections are hereby made.