Volume 106 · Issue 40 · 2026

As a critical breakthrough in healthcare service model innovation, day surgery has evolved over nearly two decades in China from a mere efficiency tool into a strategic vehicle for systematically reshaping the landscape of surgical care delivery. Currently, the development of day surgery in China faces three core bottlenecks-policy lag and implementation obstacles, resource allocation imbalance, and delayed cognitive transformation-resulting in a significant gap compared with developed countries. Over the next decade, the focus should shift from "pure volume expansion" to "parallel advancement of quantity and quality" by establishing a four-pillar high-quality development system characterized by "standard guidance, payment coordination, tiered collaboration, and digital empowerment". In this process, anesthesiologists, leveraging their professional advantages in perioperative medicine, should become the core drivers of enhanced recovery after surgery implementation and assume a "hub" role in the full-process management of day surgery, leading the strategic transformation of anesthesiology from "intraoperative support" to"comprehensive perioperative management".

Artificial intelligence (AI) has rapidly expanded its applications in medicine, demonstrating potential in imaging analysis, risk prediction, and decision support. Owing to the complexity of disease patterns and the experience-dependent nature of clinical decision-making, AI holds considerable promise in cervical spine surgery. However, most existing studies remain focused on retrospective modeling and technical validation, with limited evidence supporting clinical usability and generalizability. From a clinically driven perspective, this review summarizes the major application scenarios and developmental trends of AI in cervical spine surgery, and highlights key challenges related to causal inference, data quality, multi-center collaboration, and legal and ethical considerations, aiming to provide a rational basis for the standardized application of AI in this field.

Epithelial ovarian cancer (EOC) remains the gynecological malignancy with the highest mortality rate. Despite numerous challenges, breakthroughs in its treatment are being achieved at an unprecedented pace. This article focuses on EOC and provides reviews and discussions centered around four current clinical decision-making hot-spots: optimization of initial treatment strategies, breakthroughs in the dilemma of first-line maintenance therapy, re-evaluation of the secondary cytoreductive surgery, and the latest evidence on strategies for platinum-resistant recurrence. By discussing these key issues, we aim to provide a theoretical reference for optimizing clinical strategies and promising avenues for future study, thereby contributing to the continuous advancement of precision and individualized care in the management of epithelial ovarian cancer. Thereby continuously improving the overall precision and individualization of epithelial ovarian cancer management.

Day surgery involves a limited period of in-hospital observation, with most recovery occurring after discharge, placing greater demands on perioperative risk management. As indications expand and more older adults and patients with chronic comorbidities undergo day surgery, risk management must encompass patient selection, anesthesia and analgesia, hemodynamic management, postoperative symptom control, and functional recovery. This article discusses the perioperative risk profile and key considerations for anesthetic management in day surgery, focusing on preoperative assessment, intraoperative anesthetic management, postoperative recovery monitoring, and postdischarge follow-up to reduce postdischarge risk and improve patient safety and the quality of recovery.

Ambulatory surgery and the concept of enhanced recovery after surgery (ERAS) are deeply integrated, reshaping the surgical care model. This article systematically reviews and critically analyzes advances in ERAS-driven ambulatory surgery across multiple dimensions, including its current status, the expanding scope of enhanced recovery, and future perspectives. Available evidence shows that ERAS-guided ambulatory surgery not only ensures surgical safety but also significantly shortens hospital stay, reduces medical costs, and improves patient satisfaction. In the future, technologies such as artificial intelligence, wearable devices, and telemonitoring will further promote ambulatory surgery toward individualization, comfort, and intelligence.

Pediatric anesthesia in China currently faces challenges including shortages of qualified personnel and a low degree of specialization, which seriously affect perioperative safety in children. Drawing on recent evidence, this article focuses on three major issues: emergence delirium, airway management safety, and perioperative pain management. Specifically, we discuss individualizing medication and detecting burst suppression guided by electroencephalographic monitoring to reduce the risk of emergence delirium; optimizing airway safety through risk stratification, appropriate selection of airway devices, and anesthesia maintenance strategies; and implementing opioid-sparing anesthesia centered on regional anesthesia and multimodal analgesia. Furthermore, we emphasize the necessity of personnel training, quality control, and artificial intelligence-assisted decision support to drive a paradigm shift from an experience-based to a data-driven practice, which is essential to ensuring pediatric safety from the beginning of life.

Obesity is a chronic metabolic disease characterized by excessive fat accumulation, and scientific weight management is pivotal to its prevention and treatment. With the clinical application of novel anti-obesity medications and bariatric surgery, rapid weight loss is often accompanied by muscle loss, which increases the risks of falls and frailty. Clinical assessment should comprehensively evaluate physical function, mobility and quality of life to promptly identify and intervene in muscle loss. Developing multidisciplinary management regimens covering nutrition, exercise, pharmacotherapy and psychological support based on patients′ age, baseline muscle function, comorbidities and nutritional status serves as a vital approach to fat loss while preserving muscle mass. In recent years, remarkable progress has been made in the research and development of muscle-protective drugs, offering new strategies for muscle preservation during weight management. Implementing muscle protection strategies throughout the entire weight management process to achieve high-quality weight loss is crucial for improving long-term prognosis of patients with obesity.

Portal hypertension (PH) is one of the major complications of cirrhosis. Transjugular intrahepatic portosystemic shunt (TIPS) is a primary therapeutic modality for complications of portal hypertension, including variceal bleeding and refractory ascites, by establishing an intrahepatic channel between the hepatic vein and the portal vein. TIPS also serves as a bridging therapy for patients with decompensated cirrhosis awaiting liver transplantation. In 2019, the Chinese College of Interventionalists (CCI) issued the Chinese Clinical Practice Guidelines for TIPS in portal hypertension, which have played an important role in standardizing TIPS practice in China. With advances in TIPS techniques, evolving treatment concepts, and the emergence of new high-level evidence, the CCI has revised and updated these guidelines. This updated clinical practice guideline was developed by more than 30 Chinese experts in the field of TIPS application, including specialists in interventional radiology, hepatobiliary surgery, hepatology, and gastroenterology. The recommendations are based on latest evidence, supplemented by relevant domestic expert consensuses and high-quality clinical studies. This guideline provides up-to-date recommendations for TIPS treatment of portal hypertension, with the aim of improving the quality of TIPS clinical practice in China.

To compare the postoperative recovery between non-intubated spontaneous ventilation (NISV) anesthesia and endotracheal intubation (ETI) general anesthesia in children undergoing thoracoscopic surgery.

This retrospective study included 260 children undergoing elective thoracoscopic resection of pulmonary or mediastinal lesions at the Capital Children′s Medical Center, Capital Medical University between June 2024 and October 2025. Patients were classified into the NISV group (n=86) and ETI group (n=174). Propensity score matching was performed to balance age, sex, body weight, American Society of Anesthesiologists physical status, surgical site, and laterality between the two groups. After 1∶1 matching, 86 patients were included in each group. The primary outcome was postoperative length of stay. Secondary outcomes included chest drain duration, postoperative pulmonary complications, intraoperative respiratory parameters, time to removal of the airway device, post-anesthesia care unit stay, emergence delirium and hospitalization costs.

Baseline characteristics were well balanced after matching. Compared with the ETI group, the NISV group had a shorter postoperative length of stay [3.0 (3.0, 4.0) vs 4.0 (3.0, 5.0) days; Hodges-Lehmann (HL) difference=-2.0 days, 95%CI -2.5 to -1.0, P<0.001], a shorter duration of chest drain [2.0 (0, 3.0) vs 2.5 (2.0, 4.0) days; HL difference=-1.5 days, 95%CI -2.5 to -1.0, P<0.001], and a lower incidence of postoperative pulmonary complications [0 vs 7.0% (6/86); risk difference=-7.0, 95%CI -12.8 to -2.3, P=0.041]. The NISV group had higher lowest SpO₂ and peak EtCO₂, shorter time to airway-device removal, and lower hospitalization costs (all P<0.05).

Compared with ETI general anesthesia, NISV anesthesia in pediatric thoracoscopic surgery can shorten postoperative length of stay and the duration of chest drain placement, reduce the incidence of postoperative pulmonary complications, and help promote postoperative recovery in children.

To evaluate the clinical safety and efficacy of the adjustable monitoring and filtering type B transnasal specialized airway catheter (hereafter referred to as the adjustable monitoring nasopharyngeal airway) during anesthesia for elective ambulatory gastrointestinal polypectomy under digestive endoscopy in obese patients.

This randomized controlled trial enrolled 92 obese patients (body mass index≥28 kg/m²) scheduled for elective ambulatory gastrointestinal polypectomy under digestive endoscopy at the General Hospital of Northern Theater Command between June and December 2025. Using a random number table, we split the participants evenly into an adjustable airway group (Group R, n=46) and a standard nasal cannula group (Group C, n=46). Anesthesia was inducted and maintained with remimazolam and alfentanil. Patients in Group R were fitted with the adjustable monitoring nasopharyngeal airway for oxygen delivery and end-tidal carbon dioxide (etCO₂) monitoring, and Group C received supplemental oxygen through conventional nasal cannula. The primary outcome was defined as the incidence of intraoperative hypoxemia [pulse oximetry saturation(SpO₂)<90%]. Secondary outcomes were the variations in respiratory rate, heart rate and mean arterial pressure (MAP) at time points before induction (T₀), upon endoscope insertion (T₁), 5 minutes post-insertion (T₂), at the end of surgery (T₃), and 5 minutes after waking up (T₄). Additional secondary outcomes included arterial partial pressure of oxygen (PaO₂) and arterial partial pressure of carbon dioxide (PaCO₂) at T₂ in both groups, and partial pressure of end-tidal carbon dioxide (PetCO₂) in group R. The duration of endoscopic therapy, dosages of remimazolam and alfentanil, the frequency of hands-on airway interventions, nasal bleeding episodes, and overall physician satisfaction scores were all systematically documented.

The baseline demographic and clinical characteristics matched up well between the two groups (all P>0.05). The incidence of intraoperative hypoxemia was significantly lower in group R compared with group C [2.2%(1/46) vs 32.6%(15/46),χ²=14.829,P<0.001]. Patients in Group R exhibited significantly elevated SpO₂ levels at T₁, T₂, and T₃ (all P<0.05). At T₂, Group R demonstrated significantly higher PaO₂ and lower PaCO₂ compared to Group C, their heart rates also stayed distinctly lower (P<0.05). MAP remained comparable across both cohorts at every measured interval (P>0.05). Intraoperative PetCO₂ values in Group R were consistently maintained within normative physiological parameters, accompanied by continuous and stable monitoring waveforms. Compared with Group C, Group R registered a significantly lower rate of necessity for airway interventions, shorter endoscopic procedure duration and emergence time, lower remimazolam consumption, and highter physician satisfaction (all P<0.05).

During anesthesia for elective ambulatory gastrointestinal polypectomy under gastrointestinal endoscopy in obese patients, the adjustable monitoring nasopharyngeal airway directly protects against hypoxemia by improving oxygen delivery and curtails carbon dioxide retention. Concurrently, accurate ventilation tracking helps maintain a highly stable hemodynamic profile, the clinical safety and efficacy of this airway device substantially surpass those of the conventional nasal cannula.

To identify factors associated with postoperative length of stay (LOS) in patients undergoing surgery for gynecologic tumors within an enhanced recovery after surgery (ERAS) pathway.

Patients who underwent minimally invasive surgery for gynecologic tumors within an ERAS pathway at Guizhou Provincial People′s Hospital between November 2021 and January 2024 were retrospectively screened. ERAS compliance was defined as the number of completed elements among 24 predefined ERAS elements. Postoperative LOS was analyzed using accelerated failure time (AFT) models, with associations expressed as time ratios (TR). Model A adjusted for preoperative and intraoperative covariates, whereas Model B additionally adjusted for the Clavien-Dindo classification of postoperative complications. Restricted cubic spline (RCS) analysis and surgeon-related sensitivity analyses were also performed.

A total of 458 patients with complete data were included in the final analysis. The mean age was (49.7±10.5) years, and the body mass index was (24.4±3.5) kg/m², the median postoperative LOS was 4 (2, 6) days, and postoperative complications occurred in 76 patients (16.6%). In Model A, each additional completed ERAS element was associated with an 8.9% reduction in LOS (TR=0.911, 95%CI: 0.869-0.955, P<0.001). Age, operative duration, tumor type, surgical procedure, and preoperative hemoglobin level were also associated with LOS (all P<0.05). After further adjustment for surgeon fixed effects, the association between ERAS compliance and LOS remained stable (TR=0.923, 95%CI: 0.887-0.961); leave-one-surgeon-out analyses yielded TR ranging from 0.894 to 0.933, with consistent effect direction. In Model B, each additional ERAS element completed was associated with a 7.7% reduction in LOS (TR=0.923, 95%CI:0.894-0.952, P<0.001), and complications of Clavien-Dindo grade Ⅰ-Ⅲ were associated with longer LOS (all P<0.05). RCS analysis showed a significant overall association between ERAS compliance and LOS (P=0.025), with no evidence of nonlinearity (P=0.661).

Greater adherence to ERAS elements was associated with shorter postoperative LOS among patients undergoing minimally invasive surgery for gynecologic tumors, even after adjustment for postoperative complication severity.

To investigate the association of aural symptom burden (ASB) with anxiety and depression in patients with sudden sensorineural hearing loss (SSNHL).

Patients with SSNHL who were admitted to participating centers of the Chinese Refractory Inner Ear Disease Cohort (CRIEDC) between August 2024 and December 2025 were prospectively enrolled. Aural symptom burden (ASB) was defined as the number of symptoms accompanying hearing loss, including tinnitus, ear fullness, dizziness/vertigo, and hyperacusis. Patients were categorized into four groups according to symptom burden: ASB1 (0 or 1 symptom), ASB2 (2 symptoms), ASB3 (3 symptoms), and ASB4 (4 symptoms). Anxiety and depression were assessed using the Generalized Anxiety Disorder-7 (GAD-7) scale and the Patient Health Questionnaire-9 (PHQ-9), respectively. Multivariable logistic models were used to evaluate the associations between ASB and anxiety/depression; trend tests and sensitivity analyses were also performed. Subgroup analyses and interaction tests were conducted according to sex, age, and disease duration.

A total of 982 SSNHL patients aged [M (Q₁, Q₃)] 45.4 (35.6, 54.6) years were included, with 497 females (50.6%) and 485 males (49.4%). The proportions of patients in the ASB1-ASB4 groups were 16.3% (160/982), 38.5% (378/982), 36.9% (362/982), and 8.3% (82/982), respectively. The prevalence of anxiety and depression increased progressively with increasing ASB (both P for trend<0.001). The prevalence of depressive symptoms increased from 3.1% (5/160) in the ASB1 group to 14.6% (12/82) in the ASB4 group (P<0.001), while the prevalence of anxiety symptoms increased from 3.8% (6/160) to 14.6% (12/82) (P=0.003). Multivariable logistic regression analyses demonstrated significant dose-response relationships between ASB and depression/anxiety (both P for trend<0.001). Compared with the ASB1 group, the risk of depression was elevated in the ASB2 (OR=2.93, 95%CI: 1.26-8.27), ASB3 (OR=5.34, 95%CI: 2.37-14.77), and ASB4 groups (OR=4.98, 95%CI: 1.82-15.43). Similarly, the risk of anxiety was higher in the ASB2 (OR=3.00, 95%CI: 1.37-7.74), ASB3 (OR=4.08, 95%CI: 1.89-10.39), and ASB4 groups (OR=4.29, 95%CI: 1.63-12.32). Sensitivity analyses showed that the associations between ASB and anxiety/depression remained significant after adjustment for each accompanying symptom individually (all P<0.05). Subgroup analyses demonstrated consistent associations across different sex, age, and disease-duration subgroups, with no significant interactions (all P for interaction>0.05).

Increased aural symptom burden is associated with a higher risk of anxiety/depression among patients with SSNHL. Patients with a higher symptom burden are more likely to experience anxiety and depressive symptoms than those with a lower symptom burden.

To construct and validate an overall survival (OS) prediction model for patients with colorectal cancer liver metastases (CRLM) undergoing R0 resection after conversion therapy.

A total of 364 patients with CRLM who were evaluated by a multidisciplinary team as initially unresectable and underwent R0 resection of both the primary tumor and liver metastases after conversion therapy between January 2018 and December 2023 were retrospectively included with 226 male, 138 female and a median age [M(Q₁, Q₃)] of 58.0(51.0,66.0) years and randomly divided by computer software at a 7∶3 ratio into a training set (n=255) and a validation set (n=109). Follow-up was conducted through February 2026, with OS as the primary endpoint. For model 1, all modelable baseline variables were included in the candidate pool; variable selection was performed using least absolute shrinkage and selection operator (LASSO)-Cox regression, and an OS prediction model was constructed using multivariable Cox proportional hazards regression and presented as a nomogram. Model 2 additionally included the adjuvant chemotherapy regimen variable on the basis of model 1 for sensitivity analysis. Model performance was evaluated using the concordance index (C-index), area under the time-dependent receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA).

The median follow-up was 36.2 months, and 198 deaths (54.4%) occurred. After LASSO selection from the full candidate pool, model 1 included N stage, number of liver metastases, maximum liver metastasis diameter, preoperative carbohydrate antigen 19-9 (CA19-9) level, KRAS mutation status, BRAFV600E mutation status, postoperative 1-month circulating tumor DNA (ctDNA) status, body mass index (BMI), number of conversion therapy cycles, and intraoperative blood loss. Multivariable Cox regression analysis showed that negative postoperative 1-month ctDNA (HR=0.134, 95%CI: 0.088-0.202, P<0.001), BRAFV600E wild type (HR=0.200, 95%CI: 0.106-0.379, P<0.001), having≥5 liver metastases (HR=2.564, 95%CI: 1.518-4.332, P<0.001), and preoperative CA19-9≥35 U/ml (HR=1.593, 95%CI: 1.082-2.345, P=0.018) were factors associated with OS after R0 resection following conversion therapy in CRLM. The C-index values of model 1 were 0.759 and 0.773 in the training and validation sets, respectively; the 1-, 3-, and 5-year AUC were 0.808, 0.851, and 0.862 in the training set and 0.850, 0.835, and 0.832 in the validation set, respectively. After stratification by tertiles of the linear predictor in the training set, OS differed significantly among the low-, intermediate-, and high-risk groups in both the training and validation sets (log-rank test, all P<0.001).

The combined prediction model established by LASSO selection of all baseline variables has a certain predictive value for OS after R0 resection following conversion therapy in CRLM and can provide a quantitative reference for postoperative risk stratification.

To evaluate the safety and therapeutic efficacy local flap reconstruction for skin defects following surgery for Stage ⅢB breast cancer.

A retrospective analysis was conducted on 42 patients with Stage ⅢB cancer admitted between January 2018 and December 2023. Among them, 24 patients underwent Auchincloss procedure combined with Stage local flap reconstruction, while 18 patients received neoadjuvant therapy without surgical intervention. Data recorded included operative time, intraoperative blood loss, hospital stay duration, defect reconstruction methods, and flap survival rates. 3-year overall survival rate and local recurrence-free survival rate were observed in both groups.

The neoad therapy efficacy rate for both groups was 80.95%(34/42), consisting of a complete response rate of 7.14%(3/42) and a partial response rate of 73.81%(31/42). The follow-up time [M (Q₁, Q₃)] was 39 (24, 61) months, with a of 5 deaths. Average operative time was 3.1 h (range: 2.5-5.1 h), the mean intraoperative blood loss was 310.0 ml (range: 243.3-392.0 ml), and the mean hospital stay was 11.2 d (range 9.5-17.1 d). The average soft tissue defect area was 13.5 cm×24.2 cm (range 12.0 cm×15.0 cm to 18.0 cm×26.0 cm). Reconstruction methods included direct suturing a modified ZipLine adhesive skin stretcher in 2 cases (8.3%), rectangular flap reconstruction in 6 cases (25.0%), rotation flap reconstruction in 9 cases (37.5%), and latissimus dorsi KISS flap reconstruction in 7 cases (29.2%). Flaps healed in Stage Ⅰ in 23 patients (95.8%); 1 patient (4.2%) experienced flap ischemia, which subsequently healed following intravenous vasodilator therapy. The 3-year overall survival rates for patients in the surgical group and the conservative treatment group were 91.67%(22/24) and 83.33%(15/24), respectively, with no statistically significant difference (log-rank P=0.321); the 3-year local recurrence-free survival for the surgical group and the conservative treatment group were 95.83%(23/24) and 66.67%(12/18), respectively (log-rank P=0.012).

The Auchincloss procedure combined with Ⅰ local flap transfer for the repair of massive skin defects following neoadjuvant therapy for Stage ⅢB breast cancer is feasible.

This article reports the diagnosis and treatment of a patient with IgA nephropathy with positive anti-phospholipase A2 receptor (PLA2R) antibody and thrombotic microangiopathy. A 26-year-old female patient visited the hospital due to "abnormal liver and kidney function for 1 year and lower limb edema for 3 months". A renal biopsy confirmed IgA nephropathy (focal proliferative lesion), which manifested as a rapid decline in renal function. Multiple examinations of anti-PLA2R-IgG (+), hemoglobin and platelets were decreased. Peripheral blood smear microscopy showed erythrocytes, elevated lactate dehydrogenase, and normal angiophilia factor lytic protease (ADAMTS13). The diagnosis was IgA nephropathy (positive for anti-PLA2R antibody). Acute exacerbation of chronic renal insufficiency; Thrombotic microangiopathy. Glucocorticoids, mycophenolate mofetil immunosuppression, eculizumab targeted therapy, combined with plasma exchange, hemodialysis and anti-infective therapy, blood creatinine decreased after 1 week, platelets rebounded after 1 month, heart failure and infection were controlled, edema and skin lesions improved, dialysis was removed, and the condition was stable and discharged from the hospital. Follow-up 5 months after discharge showed that the patient's biochemical indicators were stably controlled, and the subjective symptoms improved compared to before. This case provides reference value for clinical decision-making in atypical glomerular diseases.

Arrhythmia is a common clinical manifestation of various heart diseases, which can be caused by a variety of factors such as organic myocardial lesions, primary electrocardiogram abnormalities, extracardiac systemic diseases and external inducements. For heart disease patients with arrhythmias, early coronary artery assessment is a key link in guiding clinical diagnosis and treatment. As a core imaging method for non-invasive screening and exclusion of coronary artery disease, coronary CT angiography (CCTA) has outstanding clinical application value, but its diagnostic accuracy is highly dependent on image quality. Arrhythmic heart disease itself is easy to cause cardiac motion timing disorders, which in turn produces motion artifacts, phase dislocation and stepped artifacts, becoming a key technical problem restricting the imaging quality and clinical application of CCTA. In recent years, with the continuous breakthroughs in CT hardware iteration upgrades, adaptive ECG gating optimization, motion correction algorithms, and intelligent reconstruction technologies, the success rate and image diagnostic effectiveness of CCTA examinations for patients with arrhythmias have been significantly improved. This article starts with the relevant mechanisms of arrhythmia interfering with CCTA imaging, and reviews the current clinical application status and research progress in pre-examination preparation, scanning scheme, post-reconstruction processing and individualized imaging strategies, aiming to provide evidence-based reference for the standardized clinical application of CCTA in patients with arrhythmic heart disease, the improvement of examination success rate and the optimization of diagnostic accuracy.

Unicondylar arthroplasty (UKA) is one of the important surgical methods for the treatment of knee osteoarthritis, and its efficacy is closely related to the kinematics and biomechanics of the knee joint after surgery. Anterior medial osteoarthritis of the knee (AMOA) is a special pathological type of knee osteoarthritis and is the most common indication for medial UKA. Pathological changes, kinematic abnormalities and biomechanical changes in knee osteoarthritis directly affect the progression of knee lesions and the outcome after medial UKA surgery. This article will focus on the preoperative biomechanical changes of AMOA patients, the kinematic changes after medial UKA surgery, and the kinematic differences between the fixed platform and the mobile platform UKA. It will summarize the current research status and progress in the field of kinematics and biomechanics of medial UKA, in order to clarify the influence of preoperative kinematic changes of AMOA, the position of UKA prosthesis, and the lines of force on biomechanics, and then provide a reference for improving the postoperative knee function of patients.

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is prone to cardiovascular events (CVE), which is an important "interventionally vulnerable window" affecting the survival prognosis of patients. Currently, there is still a lack of unified clinical consensus on the risk factors, core mechanisms, and intervention protocols for AECOPD complicated with CVE. This paper systematically reviews the specific risk factors that trigger this comorbidity, and deeply analyzes the pathophysiological mechanisms of deep interactions such as hypoxia, systemic inflammatory response, oxidative stress, and endothelial dysfunction. Based on this, this article, combined with the latest evidence-based evidence, attempts to construct a full-process comprehensive prevention and control framework covering pre-screening of risks in the acute phase, maintenance in the stable phase, and core follow-up after discharge. This full-cycle management strategy aims to promote clinical practice towards a "cardiopulmonary treatment" model, providing theoretical guidance and practical reference for early and accurate identification and optimized joint intervention for high-risk patients.

Medial unicondylar knee arthroplasty (mUKA) is an important treatment for medial compartment knee osteoarthritis. The traditional Kozinn & Scott standard is too stringent, which severely limits the promotion and application of mUKA. In the past 30 years, the relatively lenient Oxford Standard and Berend Standard have appeared one after another. Combined with the innovation of prosthesis design and surgical technology, the application rate of mUKA has continued to rise. In recent years, evidence-based medicine research has obtained new evidence, and progress has been made in the treatment of traditional contraindications such as anterior cruciate ligament insufficiency, post-high tibial osteotomy, inflammatory arthropathy and complex deformities. However, correct patient selection is the foundation of successful surgery. In order to avoid blindly promoting this technique, it is urgent to systematically summarize the evolution of mUKA indications. By integrating historical literature and cutting-edge evidence, the author proposes the "12345" patient selection strategy, aiming to provide clinicians with a standardized decision-making framework and promote the standardized application of mUKA.

The patient, an 81-year-old male, was admitted to the Department of Thoracic Surgery of Qingdao Municipal Hospital on December 5, 2024, due to the discovery of a space-occupying lesion in the lung for 2 days. Previous history of hypertension and cerebral infarction. The specialist physical examination results showed no chest deformity, clear breathing sounds in both lungs, and no dry or wet rales. On December 5, 2024, the tests for carcinoembryonic antigen, neuron-specific enolase, squamous cell carcinoma antigen, and gastrin-releasing peptide precursor were all negative. On December 3, 2024, plain and contrast-enhanced CT scans of the lungs showed a massive, high-density shadow in the upper lobe of the left lung with lobulated edges and a larger cross-sectional area of approximately 68 mm×41 mm. The contrast-enhanced scans showed uneven, mild enhancement (Figure 1 shows a plain CT lung window image, Figure 2 shows a plain CT mediastinal window image, and Figure 3 shows a contrast-enhanced CT mediastinal window image, with white arrows indicating masses). To clarify the diagnosis and treatment, the patient underwent thoracoscopic sleeve pneumonectomy (upper left) and mediastinal lymph node dissection under general anesthesia on December 12, 2024. Pathological results showed that the mass in the upper lobe of the left lung was a poorly differentiated carcinoma, with significant necrosis, obvious cell pleomorphism, and more neutrophil infiltration (Figure 4, hematoxylin-eosin staining). Immunohistochemistry results showed p40 (−), NapsinA (individual cells+), CK5/6 (−), CK (partial+), TTF-1 (individual cells+), EMA (focal+), Vimentin (+), S100 (−), SMA (−), Desmin (−), CgA (−), Syn (−). Based on clinical manifestations and pathological results, the diagnosis was pleomorphic giant cell carcinoma of the lung. Pleomorphic giant cell carcinoma of the lung is rare, accounting for less than 0.5% of all primary lung cancers and less than 1% of all non-small cell lung cancers. The majority are middle-aged and elderly men who smoke heavily. The typical image is a huge subpleural mass with obvious lobing, relatively clear boundaries, and no typical adenocarcinoma fine burrs. The enhanced scan showed uneven annular enhancement of the surrounding tumor tissue. The histopathology is poorly differentiated cancer, with giant cells accounting for more than 10% of atypical spindle/polynuclear tumors. It has typical immunohistochemical dual expression of CK and Vimentin. The disease can be diagnosed by excluding sarcomas and metastases through immunomarkers and excluding extrapulmonary primary tumors through whole-body imaging. The disease is prone to hematogenous metastasis and has a poor overall prognosis.