[Updated Interpretation of the NCCN Clinical Practice Guidelines (Version 3. 2023) for Non-small Cell Lung Cancer]

Lung cancer is the malignant tumor with the highest morbidity and mortality in China. Non-small cell lung cancer (NSCLC) is the main pathological subtype of lung cancer. On April 13, 2023, the National Comprehensive Cancer Network (NCCN) released the third edition of the 2023 NCCN Oncology Clinical Practice Guidelines: Non-small Cell Lung Cancer, which reflects the latest advances in international lung cancer research. This article will interpret the main updated contents of the new edition of the guidelines, and compare it with the third edition of the NCCN guidelines in 2022, so as to provide references about the diagnosis and treatment of NSCLC for clinical medical personnel in China.
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Online breath analysis of propofol during anesthesia: clinical application of membrane inlet-ion mobility spectrometry

BACKGROUND

Breath analysis of propofol is a potential noninvasive method for approximating the plasma propofol concentration. There have been various reported techniques for measuring the exhaled propofol concentration at steady state; however, the propofol concentration undergoes marked changes during clinical anesthesia. Therefore, this study investigated the use of membrane inlet-ion mobility spectrometry (MI-IMS) to monitor exhaled propofol discontinuously and continuously during propofol anesthesia.

METHODS

The study included 19 patients of American Society of Anesthesiologists physical status I or II. In experiment I (discontinuous study), breath and blood samples were collected discontinuously, with stable target propofol concentrations of 2.8 μg/ml, 3.2 μg/ml, 3.5 μg/ml, and 3.8 μg/ml. In experiment II (continuous study), propofol concentration was maintained at 3.5 μg/ml after induction, and exhaled breath was collected continuously every 3 min during propofol infusion. Relationships of the exhaled propofol concentration with the plasma propofol concentration, measured by high-performance liquid chromatography and the continuously measured bispectral (BIS) index were investigated.

RESULTS

Comparison of the exhaled and plasma propofol concentrations revealed a bias ± precision of 2.1% ± 14.6% (95% limits of agreement: - 26.5-30.7%) in experiment I and - 10.4% ± 13.2 (- 36.3-15.4%) in experiment II. In both experiments, exhaled propofol concentrations measured by MI-IMS were consistent with, the propofol effect represented by the BIS index.

CONCLUSIONS

MI-IMS may be a suitable method to predict plasma propofol concentration online during propofol anesthesia. Monitoring exhaled propofol may improve the safety of propofol anesthesia.

[Diagnosis value of the detection of CYFRA21-1 in non-small cell lung cancer]

背景与目的

细胞角蛋白19片段（cytokeratin 19 fragment, CYFRA21-1）是血液中的一种可溶性蛋白质，它可能是一种潜在的循环肿瘤标志物。本研究旨在探讨CYFRA21-1在非小细胞肺癌（non-small cell lung cancer, NSCLC）诊断中的应用价值。

方法

采用酶联免疫吸附法分别检测107例NSCLC患者和51例肺部良性疾病患者外周血中CYFRA21-1含量，应用受试者工作曲线（receiver operaing characteristic curves, ROC）对检测结果进行临床评价。

结果

NSCLC组织与肺良性疾病组外周血CYFRA21-1水平差别有统计学意义（χ²=47.343, P < 0.001）；以3.3 μg/L为诊断临界点，CYFRA21-1诊断NSCLC的敏感性和特异性分别为74.77%和76.47%，ROC曲线下面积为0.813 9；NSCLC各病理类型之间CYFRA21-1水平差别无有统计学意义（χ²=0.450, P=0.799）；外周血CYFRA21-1在广泛期（Ⅲb、Ⅳ）病例中明显高于局限期（Ⅰ、Ⅱ、Ⅲb）病例（χ²=7.057, P=0.008）。

结论

CYFRA21-1作为肺癌肿瘤标志物具有相对较高的敏感性和特异性；血浆中CYFRA21-1水平升高提示肺癌患者可能已经发展为广泛期。