Volume 105 · Issue 19 · 2025

Functional gastrointestinal disorders (FGIDs) include a category of diseases with gastrointestinal symptoms as the main manifestations, in which multiple factories may affect the gastrointestinal motility, induce visceral hypersensitivity, intestinal mucosal and immune function changes, the gut microbiota changes, and influence central nervous system processing the signals from gut. In essence, the pathophysiology of FGIDs is disorders of gut-brain interaction (DGBI). The characteristics of pathophysiology determine the relative specificity of the key symptoms of each FGIDs, overlapping and transition among FGIDs. Psychological factors affect patients′ symptoms and symptom perception in the all levels of gut-brain interaction. The conceptual shift from FGIDs to DGBI is conducive for clinicians to understand the symptom features and the patients′ feelings on the symptoms from the pathophysiological mechanism, to make a multicomponent diagnosis and select effective and individualized treatment for patients.

Centrally mediated abdominal pain syndrome (CAPS) is a functional gastrointestinal disorder newly proposed in the Rome Ⅳ diagnostic criteria, highlighting the important role of abnormal gut-brain interaction in pathogenesis. Careful and detailed inquiry of the characteristics of abdominal pain, accompanying behaviors, and psychosocial background can help to establish the diagnosis of CAPS and reduce unnecessary examinations and interventions. The good and effective doctor-patient relationship, combined with medications such as neuromodulators and non-drug treatments such as psychotherapy can maximize the efficiency. This article addresses the challenges in the diagnosis and treatment of CAPS by elaborating on the diagnostic criteria, pathogenesis, clinical features, and therapeutic strategies, aiming to enhance the understanding of CAPS.

Reflux hypersensitive (RH) is a type of functional esophageal disorders that can cause gastroesophageal reflux symptoms. Its pathogenesis is not completely clear, but it is generally believed to be related to the abnormal interaction of brain-gut axis, including increased peripheral nerve sensitivity, damaged mucosal integrity, increased central nervous sensitivity and psychological factors. Currently, there is no standardized treatment for RH. The commonly used treatment methods include acid suppression therapy, pain modulators, anti-reflux surgery, psychotherapy, etc. However, these treatments, can only benefit some patients. This article will focus on the above pathogenesis, diagnosis and treatment, and further explore the causes of RH symptoms.

Alzheimer′s disease (AD) poses a significant challenge to China′s aging population, and treatment is now comprehensively shifting toward disease-modifying therapy (DMT). By intervening core pathophysiological mechanisms, DMT seeks to alter the natural progression of the disease. As an emerging therapeutic paradigm, there is an urgent need for expert consensus to standardize the clinical use of DMT drugs in AD. This consensus systematically reviews both clinical practice and research advancements related to DMT for AD, including the target populations, contraindications and high-risk groups, pre-treatment evaluation procedures, administration methods and durations, efficacy assessments, and adverse event monitoring. It presents 17 recommendations aiming to guide the clinical application of DMT in AD.

The application of enhanced recovery after surgery (ERAS) is particularly necessary in late old patients (>75 years) with poor tolerance to surgical stress due to the common problems such as organ dysfunction. However, some relatively radical measures have resulted in ERAS not being widely applied in late old patients with spinal fusion. Therefore, the China Medicine Education Association Enhanced Recovery After Surgery for Geriatric Spine Specialty Committee organized domestic experts in related fields to developed this guide based on current medical evidence, this guideline summarizes and discusses the key measures with high safety in ERAS protocol for elderly spinal fusion, aiming at helping orthopedic surgeons to standardize the application of ERAS measures in the perioperative management of elderly spinal fusion.

To analyze the effect of iodine staining endoscopy in the screening of esophageal early cancer.

The clinical data of people who underwent gastroscopy from January 1, 2019 to December 31, 2023 in Xuyi People′s Hospital affiliated to Kangda College of Nanjing Medical University were retrospectively analyzed. According to whether the esophagus was stained with Lugo′s iodine solution, the patients were divided into iodine staining group (Lugo′s iodine solution staining) and non-iodine staining group. According to the years of operation, endoscopists were divided into less experienced endoscopists (<10 years) and experienced endoscopists (≥10 years). The basic characteristics of the patients in the iodine staining group and the non-iodine staining group were compared, and the differences in the detection rates of low-grade intraepithelial neoplasia (LGIN), high-grade intraepithelial neoplasia (HGIN) and early esophageal cancer among endoscopists with iodine staining and different years of experience were compared.

A total of 9 918 patients were enrolled, including 4 564 males and 5 354 females, with age of (57.3±7.3) years. There were 4 965 cases [2 312 males and 2 653 females, aged (57.4±7.4) years] in the non-iodine staining group. There were 4 953 patients [2 252 males and 2 701 females, aged (57.2±7.2) years] in the iodine staining group. There was no significant difference in sex and age between the two groups (both P>0.05). The detection rate of esophageal LGIN [0.3% (5/4 965) vs 3.2% (159/4 953)], the detection rate of HGIN [0.2% (10/4 965) vs 0.7% (32/4 953)] and the detection rate of early case [0.2% (12/4 965) vs 0.7% (35/4 956)] in the non-iodine staining group were lower than those in the iodine staining group (all P<0.001). There was no significant difference in the detection rate of early esophageal cancer between the two groups [0.0% (2/4 965) vs 0.1% (3/4 953), P>0.05]. In the non-iodine staining group, the detection rate of esophageal LGIN [0.6% (12/1 991) vs 0.1% (3/2 974)], the detection rate of HGIN [0.4% (8/1 991) vs 0.1% (2/2 974)], the detection rate of early case [0.5% (9/1 991) vs 0.1% (3/2 974)], and the positive rate of biopsy [35.3% (9/1 991) vs 13.6% (30/2 974)] in the experienced endoscopists were all higher than those of the less experienced endoscopists (all P<0.05). There was no significant difference in the detection rate of early-stage esophageal cancer between the two groups [0.0% (1/2 974) vs 0.1% (1/1 991), P=0.279]. In the iodine staining group, there were no statistical difference in the detection rates of LGIN, HGIN, early-stage esophageal cancer and early cases between the experienced endoscopists and the less experienced endoscopists (all P>0.05).

Iodine staining endoscopy can improve the detection rate of early esophageal cancer and precancerous lesions, especially for less experienced endoscopists.

To investigate the impact of the apex position of lumbar lordosis on the occurrence of adjacent segment disease (ASD) following short-segment lumbar fusion surgery.

A retrospective analysis was conducted on 234 patients [102 males and 132 females with a mean age of (60.1±10.0) years] who underwent posterior lumbar interbody fusion for lumbar degenerative diseases from January 2009 to January 2019 at the Third Affiliated Hospital of Nanjing Medical University, Changzhou Second People′s Hospital and Affiliated Drum Tower Hospital, Medical School of Nanjing University. The patients were divided into an ASD group and a non-ASD group based on whether ASD occurred postoperatively. The actual postoperative apex position of lumbar lordosis was compared with the theoretical position, and the patients were categorized into "matched" (actual apex position congruent with theoretical position) or "mismatched" groups according to the comparing results. General patient data were compared between the two groups, and multivariate logistic regression analysis was performed to identify factors associated with risk of ASD. Furthermore, patients were stratified into three subgroups based on apex position: ideal position group, superior-to-ideal group, and inferior-to-ideal group. Stratified analyses were subsequently conducted to compare ASD incidence and perioperative parameter variations among the subgroups.

All patients successfully underwent surgery and completed follow-up with a mean duration of (70.6±11.9) months. Among the 234 patients, 68 (29.1%) developed ASD postoperatively. The ASD group exhibited a significantly higher proportion of postoperative lumbar lordosis apex position mismatch (64.7%, 44/68) compared to the non-ASD group (41.0%, 68/166) (P=0.001). Pelvic incidence (PI) demonstrated significant correlations with the proximal lordosis (PL) and lordosis distribution index (LDI) (r_P=0.447, r_s=-0.300, both P<0.01), but demonstrated no correlation with the distal lordosis (DL) (r_s=0.098, P=0.133). Multivariate logistic regression identified the following risk factors for ASD: old age (OR=1.057, 95%CI: 1.014-1.103), two-level fusion (OR=3.195, 95%CI: 1.494-6.832), smaller postoperative DL (OR=0.950, 95%CI: 0.912-0.990), and apex position mismatch (OR=3.165, 95%CI: 1.625-6.163). Stratified analysis demonstrated that the three groups exhibited statistically significant differences in postoperative DL, PL, and LDI (all P<0.001). Patients in the superior-to-ideal group and inferior-to-ideal group position groups adjusted sagittal balance through pelvic retroversion compensation and persistent upper lumbar opening compensation, respectively; however, both compensatory mechanisms may increase the risk of ASD due to stress concentration at adjacent segments.

The apex position of lumbar lordosis significantly impacts the occurrence of ASD, to restore the physiological apex position intraoperatively, strategic adjustment of the DL is imperative.

This study proposes to establish a new lymph node staging system for limited-stage small cell lung cancer (LS-SCLC) and evaluate its prognostic efficacy for patients after surgery.

A retrospective study included 869 small-cell lung cancer (SCLC) patients who underwent surgery from 2004 to 2020 in the Surveillance, Epidemiology, and End Results (SEER) database, comprising 368 males and 501 females, with a median age [M(Q₁, Q₃)] of 66.7 (57.6, 75.8) years. These patients were randomly divided into a training set (n=603) and an internal validation set (n=266) at a ratio of 7∶3 using a random number table method. A total of 230 postoperative SCLC patients treated at Shanxi Cancer Hospital from January 2000 to December 2021 were retrospectively included as an external validation set, with a median age of 58.2 (48.4, 68.0) years, comprising 175 males and 55 females. A new lymph node staging system, termed pNLODDS staging, was constructed by integrating pathological N stage (pN) and high/low-risk groups based on the log odds of positive lymph nodes (LODDS). The Kaplan-Meier survival curve method was used to analyze survival rates in each group, and differences in survival rates between groups were compared using the log-rank test. The integrated discrimination improvement index, continuous net reclassification improvement index and median risk score improvement index were adopted to evaluate the predictive efficacy of the pNLODDS staging system for the prognosis of postoperative patients with LS-SCLC.

In the training set, based on the survival analysis results of the six risk groups formed by pN and LODDS, N0-LODDS (low) was classified as the new pN0 stage(n=323), N0-LODDS (high), N1-LODDS (low), and N2-LODDS (low) risk groups were classified as the new pN1 stage(n=118), and N1-LODDS (high) and N2-LODDS (high) risk groups were classified as the new pN2 stage(n=162). The 1, 5, and 10-year overall survival rates for patients in the new pN0, pN1, and pN2 stages in the training set were 91.4%, 59.8%, 42.1% vs 86.1%, 42.8%, 14.8% vs 71.8%, 24.2%, 16.6% (P<0.001). In the internal validation set, the 1, 5, and 10-year overall survival rates for patients in the new pN0, pN1, and pN2 stages were 89.7%, 60.9%, 46.4% vs 82.3%, 44.6%, 20.9% vs 70.3%, 27.5%, 14.4% (P<0.001). In the external validation set, the 1, 5, and 10-year overall survival rates for patients in the new pN0, pN1, and pN2 stages were 92.9%, 67.2%, 60.7% vs 86.5%, 50.5%, 34.6% vs 6.3%, 28.2%, 25.4% (P<0.001). Patients in the external validation set were followed up until April 18, 2023, with a median follow-up time of 60.8 (49.8, 73.6) months. During the follow-up period of 12 to 120 months, the pNLODDS staging system demonstrated an improvement of 1.4%-3.3% in the integrated discrimination improvement index, an improvement of 14.8%-27.8% in the continuous net reclassification improvement index, and an improvement of 1.4%-4.9% in the median risk score improvement index compared to the pN staging (all P<0.05).

A pNLODDS staging system for LS-SCLC was established by combining pN and LODDS. This system has improved the accuracy of predicting the prognosis of postoperative LS-SCLC patients to some extent.

To construct a intestine-specific Toll-like receptor 5 (TLR5) overexpression mouse model and investigate its protective role against Salmonella infection.

In-Fusion cloning technology was used to construct a conditional TLR5 overexpression homologous recombination vector. This vector was integrated into the genome of C57BL/6 mice via gene editing. The F0-generation mice were bred to obtain stable F1-generation progeny, which were further crossed with intestine-specific Cre mice to generate TLR5-overexpressing mice (TLR5 group). The littermates lacking the transgene served as wild-type controls (WT group). Both groups consisted of 4-6 weeks old mice weighing 22-25 g. Eight mice in TLR5 group and WT group were selected 3 times each for the experiment: phosphate buffered saline (PBS) buffer was intraperitoneally injected in the first time (blood was taken at 0 hour after injection), flagellin was injected intraperitoneally in the second time (blood was taken at 1 hour after injection) and the third time (blood was taken at 4 hour after injection) to activate TLR5. The expression levels of inflammatory factors, such as serum levels of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) were measured in both groups. Another 8 mice in TLR5 group and WT group were selected to establish Salmonella enteric infection model by oral feeding, and fecal bacterial loads were monitored on the 1st, 3rd, and 5th day. Kaplan Meier method was used to draw survival curves to compare the survival time of mice infected with Salmonella. Eight mice in TLR5 group were divided into TLR5 infected group and TLR5 uninfected group, and 8 mice in WT group were divided into WT infected group and WT uninfected group, with 4 mice in each group. TLR5 infected group and WT infected group were fed salmonella orally, and TLR5 uninfected group and WT uninfected group were fed with PBS buffer orally. All mice were euthanized on day 5 to compare splenic and colonic tissue damage.

Gel electrophoresis confirmed the successful construction of the homologous recombination vector, as evidenced by a distinct band at 16 943 bp, consistent with the theoretical size. After the reproduction of F0 generation mice, some offspring mice produced by the hybridization of F1-generation mice and gut-specific Cre mice were identified by PCR with 3.7 kb fragment amplified by 5′ arm and 4.0 kb fragment amplified by 3′ arm. Subsequent gene sequencing further confirmed that TLR5 was gut-specific overexpressed mice. Following flagellin injection, serum IL-6 level in the TLR5 group was higher than that in the WT group at 1 hour [M (Q₁, Q₃), 1 079 (516, 1 498) vs 71 (54, 236) ng/L, P<0.05]. Serum IL-6 level [1 512 (1 247, 1 522) vs 75 (17, 964) ng/L] and serum TNF-α level [248 (188, 464) vs 21 (6, 119) ng/L] in the TLR5 group were higher than those in the WT group at 4 hours (all P<0.05). The survival time of TLR5 group was longer than that of WT group [9.0 (8.0, 10.5) vs 8.0 (7.5, 8.5) d, P<0.05]. Fecal salmonella test of mice showed that on the 5th day after salmonella infection, the bacteria amount of Salmonella in TLR5 group was lower than that in WT group [650 (148, 2 175) vs 44 (1, 128)×10⁴ colony forming units (CFU)/g, P<0.05]. The experiment of dissecting mice on the 5th day after infection showed that the colonic length of TLR5 infected mice was longer than that of WT infected mice [(9.1±1.1) vs (7.0±0.7) cm, P<0.05].

In this study, an intestine-specific TLR5 overexpression mouse model is successfully constructed. The intestine-specific TLR5 overexpression plays a protective role against Salmonella infection in mice.

To investigate the long-term efficacy of subthalamic nucleus deep brain stimulation (STN-DBS) on non-motor symptoms in Parkinson′s disease (PD). A retrospective analysis was performed on 13 PD patients who underwent bilateral STN-DBS surgery at the First Affiliated Hospital of Sun Yat-sen University from 2010 to 2011. Nonmotor symptoms were comprehensively assessed at baseline and 1, 3, and 10 years after surgery. The assessment include Mini-mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), the Hamilton Anxiety Scale (HAMA), the Hamilton Depression Scale (HAMD), the Parkinson′s Disease Sleepiness Scale-Chinese Version (PDSS-CV), the Epworth Sleepiness Scale (ESS) and the Parkinson′s Disease Quality of Life Questionnaire (PDQ-39). Levodopa quivalent daily dosage (LEDD) was recorded. MoCA scores improved within 3 years postoperatively (all P<0.05), while MMSE scores showed no significant change compared to baseline (all P>0.05). Both MMSE [(23.7±5.7) vs (28.4±2.4)] and MoCA [(18.4±6.4) vs (22.2±5.0)] scores were lower than preoperative levels more than 10 years after operation(all P<0.05). PDSS-CV scores showed no significant differences at any postoperative time point compared with those before operation(all P>0.05). Compared with baseline, ESS scores remained stable within 3 years (all P>0.05) but increased significantly beyond 10 years [(10.9±8.2) vs (6.9±4.2), P=0.042].HAMD and HAMA scores were lower than those before operation within the first 3 years (P<0.05), but returned to baseline levels beyond 10 years (both P>0.05). Compared with baseline, The PDQ-39 Summary Index decreased within 3 years (P<0.05), but returned to baseline beyond 10 years (P=0.089).Compared with the preoperative LEDD [(689±204) mg], significant reductions were observed at 1 year [(439±300) mg], 3 years [(411±213) mg], and beyond 10 years [(489±170) mg] postoperatively (all P<0.05), corresponding to reductions of 36.29%, 40.40%, and 29.10%, respectively. STN-DBS improves quality of life, emotion, and cognition of PD patients within 3 years postoperatively. Beyond 10 years, quality of life and emotion return to baseline, while cognition deteriorates compared with that before surgery.

This study explores the safety and efficacy of neoadjuvant immunotherapy combined with chemotherapy in non-small cell lung cancer (NSCLC) patients undergoing dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI). A retrospective analysis was conducted on clinical data from NSCLC patients who underwent staged PCI, neoadjuvant immunotherapy combined with chemotherapy, and thoracoscopic lobectomy at Beijing Anzhen Hospital from January 2022 to June 2023. A total of 21 patients were included, consisting of 18 males and 3 females, with a median age [M(Q₁, Q₃)] of 68.0 (61.5, 71.5) years. After PCI, patients received aspirin and clopidogrel for 12 weeks as antiplatelet therapy. Clopidogrel was discontinued 5 d before lung cancer surgery, while aspirin was continued perioperatively. Based on post-operative drainage conditions, clopidogrel was resumed within 24-72 h post-surgery. During DAPT, 3 cycles of antitumor therapy were administered using tislelizumab, albumin^-bound paclitaxel, and cisplatin. Thoracoscopic lobectomy was performed 4 weeks after treatment completion. One month postoperatively, patients received maintenance therapy with tislelizumab every 3 weeks for 1 year. The adverse reactions during the treatment, the disease control status and the impact on the surgery were observed. During neoadjuvant immunotherapy combined with chemotherapy, 80.9% (17/21) patients experienced grade≤2 adverse events, primarily including liver and kidney function abnormalities and gastrointestinal reactions. The objective response rate after neoadjuvant therapy was 61.9% (13/21), while the disease control rate was 100% (21/21). All patients underwent thoracoscopic lobectomy with R0 resection. However, 2 cases transferred to thoracotomy due to intraoperative anatomical difficulties. The perioperative complication rate was 14.3% (3/21). Postoperative pathology revealed a major pathological response rate of 42.9% (9/21) and a pathological complete response rate of 19.0% (4/21). By May 2024, with a median follow-up of 12.0 (8.5, 15.0) months, no recurrence or distant metastase was observed in any patients. These findings suggest that neoadjuvant immunotherapy combined with chemotherapy is a safe and effective approach for NSCLC patients in stage Ⅰb undergoing treatment during DAPT.

This paper reports a case of severe airway stenosis caused by malignant tracheal tumor treated with rescue carbon ion. An 83-year-old male patient developed cough, expectoration, chest tightness and shortness of breath one month ago. Chest CT examination in the local hospital showed tracheal neoplastic lesions. Bronchoscopy showed cauliflower-like neobiotic obstruction in the lower tracheal carina, resulting in severe tracheal stenosis, which could not be further observed, stent implantation and medical examination could not be performed. Three days before admission, the patient had aggravated dyspnea, sitting breathing, and obvious near-death feeling. The emergency department was admitted to the Department of Critical Care Medicine of our hospital with "severe airway stenosis and tracheal tumor". After admission, he was treated with rescue carbon ion therapy for tracheal tumor supported by high-flow nasal tube oxygen therapy. After the symptoms were relieved, he was definitively diagnosed as tracheal squamous cell carcinoma. Combined with chemotherapy and immunotherapy, after treatment, the airway tumor was significantly reduced, and the airway stenosis was significantly relieved. The efficacy was evaluated as partial relief, and he was discharged from hospital. The effect of carbon ion therapy in this patient is remarkable, which provides a new idea for the treatment of severe airway stenosis caused by malignant tracheal tumor.

Celiac disease is an autoimmune enteropathy induced by gliadin in food on the basis of genetic susceptibility and clinically manifested as chronic diarrhea with malnutrition. Most patients can improve after the de-maize diet, but a small number of patients have not remitted clinically and histopathologically after 1 year of de-maize diet, which is called refractory celiac disease (RCD). RCD is divided into type I (RCD Ⅰ) and type II (RCD Ⅱ). In this paper, the mechanism, characteristics, diagnostic criteria, treatment and prognosis of RCD are systematically expounded in combination with the latest literature progress. By improving the understanding of this difficult and rare disease, we can further promote the efficiency and accuracy of clinical diagnosis and treatment, thereby preventing serious complications and improving patient prognosis.

Breast cancer is one of the most common malignant tumors in women. The incidence of brain metastasis of breast cancer is higher, second only to lung cancer, ranking second and the prognosis is poor. Among them, human epidermal growth factor receptor 2 (HER2) positive breast cancer has a higher incidence of brain metastasis. At present, the treatment recommended by the guidelines is still local treatment such as whole brain radiotherapy, stereotactic radiotherapy and surgery. However, in recent years, with the research and development of HER2-targeted drugs, systemic therapy has also become one of the important treatments for brain metastasis of HER2-positive breast cancer. Trastuzumab (T-DXd) is a HER2-targeted antibody-drug conjugate (ADC), which has a bystander effect compared with emmetuzumab, the first clinically approved anti-HER2 ADC drug for the treatment of breast cancer. The higher drug-antibody ratio has become the second-line treatment regimen for HER2-positive advanced breast cancer and the standard regimen for advanced breast cancer with low HER2 expression. T-DXd has shown efficacy in preclinical and clinical studies for stable and active brain metastases as well as leptomeningeal metastases. The purpose of this article is to review the research progress of T-DXd in breast cancer brain metastasis, and to provide reference for the clinical treatment and future exploration of breast cancer brain metastasis.

The patient, a 59-year-old male, was admitted to the Department of Respiratory and Critical Care Medicine, Xichong County People's Hospital on December 1, 2024 due to "cough and blood in sputum for 6 months, aggravated for 10 days". In June 2024, the patient developed cough without obvious trigger, coughed a small amount of white foamy sputum, occasionally with blood in the sputum, which was not taken seriously. On November 21, the cough worsened, with blood in the sputum, no chest pain and dyspnea. Smoking index 80-year package. Physical examination: There was no swelling of superficial lymph nodes, slightly lower breathing sounds in the left upper lung, and scattered wet rales could be heard. Auxiliary examination: Neutrophil count 6.81×10⁹/L, lactate dehydrogenase 379 U/L, neuron-specific enolase 41.26 ng/ml. Chest enhanced CT (Dec. 1, 2024) revealed an anterior mediastinal mass with a maximum section of 5.4 cm ×5.2 cm, unclear boundaries and lobulation, with mild heterogeneous enhancement on the enhancement scan (Fig. 1A, shown by arrows), with bronchotomy in the upper lobe of the left lung (Fig. 1B, 1C, shown by arrows) and mediastinal lymph node enlargement. Bronchoscopy (Dec. 2, 2024): A new organism with fragile texture, abundant blood supply and almost complete lumen occlusion was seen at the bronchial opening in the anterior segment of the upper lobe of the left lung (Figure 1D, shown by arrows), and biopsy pathology showed a malignant tumor. Mediastinal mass puncture biopsy revealed malignancy, immunohistochemistry (06 Dec 2024): PCK (focus +), CK5/6 (-), P40 (-), Ki-67 (+, approximately 40%), CK7 (focus +), TTF-1 (-), Napsin A (-), CD56 (-), CgA (-), Syn (-), CD20 (-), CD3 (-), CD45 (-), S100 (-), HMB-45 (-), Melan-A (-). Pathology Consultation of Sichuan Cancer Hospital (Dec. 16, 2024): (Left Upper Lobe Microscopic Biopsy) Ckpan (AE1/AE3) (+), P40 (small amount +), TTF-1 (individual +), Napsin A (-), Syn (-), CD56 (partial +), Ki-67 (+, approximately 50%), CD117 (+), CD5 (+), thymic cancer of thymic origin is considered; (Mediastinal puncture) SALL4 (individual +), OCT-3/4 (-), PLAP (-), Brg-1 (SMARCA4) (+, not deleted), CgA (-), NSE (-), NKX2.2 (-), SSTR2 (partial +), INSM1 (partial +), RB (+), CK19 (partial +), consistent with thymic cancer. Thymic carcinoma is a rare epithelial tumor of the thymus with an aggressive clinical course. Distant metastasis of thymic cancer, especially lung metastasis, is relatively common, but direct intrabronchial invasion is rare in clinical practice, so attention should be paid to differentiate it from bronchopulmonary cancer.

The article "Guidelines for the Diagnosis and Application of Malnutrition in Adult Patients (2025 Edition)", Volume 105, Issue 13, April 1, 2025, Chinese Medical Journal, top left corner, page 968 "dietary reference intakes (DRIs) 2023 Edition of Chinese Residents recommends that the level of vitamin B1 in urine of adult men is 1.4 mg/d and that of adult women is 1.2 mg/d as the reference standard." It should be "dietary reference intakes (DRIs) 2023 Edition of Chinese Residents recommends that the recommended daily intake of vitamin B1 is 1.4 mg for adult men and 1.2 mg for women." It is hereby corrected.