Objective:To study the clinical results and the hospitalization cost of video-assisted thoracoscopic surgery (VATS) with ligation and suture for the treatment of spontaneous pneumothorax.Methods:Thirteen patients were treated by VATS with ligation and suture.The consumed time of operation,duration of the chest drainage,amount of the chest drainage,percentage of patient discontinuing anodyne within the postoperative 24 hours,the average length of hospitalization and the hospitalization cost were analysed.Results:Satisfactory therapeutic effects were found in all cases without postoperative death and complications. The average hospitalization time was 3 days.VATS with ligation and suture was preferable to transaxillary minithoracotomy (TAMT) in the clinical results.The hospitalization cost is less for VATS with ligation and suture (7372.47?871.3) than that with Endo-GIA (12524.32?2962.18) (P

Objective To investigate the feasibility of laparoscopic radical gastrectomy for gastric cancer.Methods Laparoscopic radical gastrectomy was performed in 8 cases from Febrary 2005 to April 2005,including radical distal gastrectomy in 6 cases,radical total gastrectomy in 1 case,and radical proximal gastrectomy in 1 case.Results All the 8 patients underwent laparoscopic radical gastrectomy smoothly and no conversion to open surgery was required.The operation time was 340?62 minutes in radical distal gastrectomy,was 362 minutes in radical proximal gastrectomy,and 423 minutes in radical total gastrectomy.The intraoperative blood loss was 100～250 ml(mean,140 ml) in radical distal gastrectomy,300 ml in radical total gastrectomy,and 170 ml in radical proximal gastrectomy.No blood transfusion was needed.The number of havested lymph nodes was 18～37(mean,23).No surgical-related complications occurred.The time to first flatus was 38～56 hours(mean,42.4 hours),and the time to liquid diet was 2～5 days(mean,2.5 days).All the 8 cases were followed for 12～14 months postoperatively and no recurrence or metastasis was observed.Conclusions Laparoscopic radical gastrectomy is a feasible technique for patients with gastric cancer at early stage or early progressive stage.

The paper makes a brief introduction to the application of natural language processing in Traditional Chinese Medicine (TCM).Through research and analysis of relevant literatures , it describes the features and application directions of such methods as the association rule mining , clustering analysis , information extraction , machine learning , etc.It also summarizes methods related to the es-tablishment of knowledge networks on TCM and proposes new ideas for future researches of natural language processing in TCM based on the establishment of knowledge networks .

Objective To summarize the experience in surgical treatment of Ebstein anomaly,and evaluate the therapeutic effect.Methods Thirty-five patients of Ebstein anomaly were treated by operation.New York heart association(NYHA)heart function classⅠ?was in 11 cases,classⅡ?was in 14 cases,class III-Ⅳ?was in 10 cases.The cue of echocardiogram about tricuspid valve regurgitation in 24 cases were severe,5 cases were moderate and 6 cases were mild.Two patients accepted tricuspid valve replacement.Thirty-three cases were accepted tricuspid valve repair and right ventricle folded,in which 2 cases accepted Danielson method,and 31 cases accepted Carpentier method,among them,9 cases accepted one and a half ventricular repair.Associated heart anomaly was corrected at the same time.Results One patient died.There were 2 cases with third degree atrioventricular block after tricuspid valve replacement,2 cases with low cardiac output syndrome and 2 cases with atrial fibrillation combined premature ventricular contraction.The heart was lower by chest X-ray and echocardiogram examination,tricuspid valve regurgitation in 22 cases were disappeared,9 cases were mild,3 cases were moderate.All patients were followed up from 1 month to 7years,tricuspid valve regurgitation in 21 cases were disappeared,12 cases were mild,heart function were class Ⅰ-Ⅱ.Because of heart function aggravation,1 patient was operated again 3 years after operation.Condusions Ebstein anomaly is a rare congenital heart disease,Carpentier method tricuspid valve repair can decrease regurgitation obviously and protect right ventricular function.One and a half ventricular repair should be adopted according to the function of tricuspid valve and right ventricle.

Objective To evaluate the outcome of endovascular treatment with coarctation of aorta (CoA).Methods Between November 2007 and March 2012,11 patients,including 8 male and 3 female from 17 to 43 years old,with native CoA who were diagnosed by computed tomography angiography accepted the endovascular treatment.The arterial pressure difference between the femoral artery and the narrow segment was measured during the operation,and the stent was released by expanding the balloon.Results Endovascular treatment were successful in all cases without any major adverse events.Significant reduction of systohc blood pressure was observed from (64.09 ± 7.81) mmHg (1 mmHg =0.133 kPa) to (11.18 ± 3.37) mmHg.The mean CoA diameter pre-stent (4.000 ± 0.775) mm,post-stent (17.090 ± 2.427) mm.1 patient associated with patent ductus arteriosis had no persistent left-to-right shunt after covered stent implantation.The follow up range was 33 months.1 patient in simple balloon was retreatment by surgical because of restenosis.And no retraction was observed of 10 patients after stent implantation.Conclusion The early and midterm result of endovascular treatment with CoA is satisfactory,and longer follow-up is needed for its longterm outcomes.

Objective To explore the appropriately operative chance , method, and perioperative management of coronary arterybypass grafting (CABG) in the patients with severe left main artery (LMA) stenosis with three-vessel-disease.Methods A total of296 patients with severe LMA stenosis with three-vessel-disease who underwent CABG surgery was analyzed retrospectively from 2003through 2013.Of them, 276 patients underwent conventional coronary artery bypass surgery on pump ( CCABG)and 20 patients underwentoff-pump CABG( OPCAB); 172 Patients was over 60 years old (58.1%)and 246 patients (83.10%) had concomitant diseasesincluding valve lesion, hypertension, diabetes, myocardial infarction, left ventricular aneurysm with septal defect , stroke, renal failure,and cancer.Left internal mammary artery use was in 281 patients (95.1%); and 32 patients were implanted intra-aortic ballonpump(IABP) perioperatively.Results There were 7 cases(2.36 %) death of postoperative low cardiac output , ventricular fibrillation,cerebral infarction, renal failure, and multiple organ failure, respectively.Postoperative complications were low cardiac output ,respiratory failure , ventricular fibrillation, cereboembolism, cardiac tampomade, renal failure, stroke, and multiple organ failure.Afterfollow-up 2 to 84 months, there was 3 death in which 2 death of cardiac factors.Conclusions CCABG was a safe and effectivemethod in patients with severe LMA stenosis with severe three -vessel-disease.Preoperative insertion of IABP can certainly avoid the po -tential operative risk factor and significantly decrease the mortality and morbidity .

Objective To investigate the effect of adjusting tube current time product (mAs) according to head circumference index on head CT image quality and organ-specific-dose level based on Monte Carlo analysis platform.Methods A total of 92 patients including children and adolescents with different clinical symptoms undergoing head CT scan were prospectively selected between September 2017 and June 2018 in the First Hospital of Jilin University.Without limiting the size of the head circumference,there were 22 patients were selected as conventional group by random number table,whose head circumference was 48.1-59.2 cm.Low dose group was divided into following three subgroups according to different head circumferences:A group 54.1-57.0 cm (n=22);B group 51.1-54.0 cm (n=26) and C group 48.1-51.0 cm (n=22).Tube current time product was 250 mAs for conventional group,200 mAs for A group,150 mAs for B group and 100 mAs for C group,respectively.The organ-specific-radiation doses (brain,eye lens and salivary gland) were recorded by Monte Carlo analysis platform and the subjective and objective image quality score was evaluated.Analyses of the differences between four groups were compared with image quality score as well as organ-specific-radiation dose by single factor variance.Results Radiation dose to brain was conventional group (34.37±3.62),A group (25.91±0.99),B group (23.18±6.11) and C group (17.38 ± 3.23) mSv,respectively.The difference was of statistical significance in the four groups (F=54.51,P＜0.05).Dose to eye lens was conventional group (41.54± 1.04),A group (33.03±0.35),B group (26.18±2.72) and C group (20.88±4.45) mSv,with statistical significance in difference between the four groups (F=189.75,P＜0.05).Dose to salivary gland was conventional group (35.04 ± 4.94),A group (25.92 ± 0.99),B group (22.93 ± 6.54) and C (14.96±2.67) mSv,respectively,with statistical significance in difference between the four groups (F=65.74,P＜0.05).Image quality scores were respectively conventional group (4.97±0.13),A group (4.77 ± 0.49),B group (4.60 ± 0.49) and C group (3.98 ± 0.61),respectively,with statistical significance between them (F=3.89,P＜0.05),but without statistical significance in difference between the four groups (P ＞ 0.05).The signal-to-noise ratios of gray matter in A,B and C groups were conventional group (18.69 ± 3.55),A group (16.76 ± 2.87),B group (15.05 ± 2.80) and C group (13.65±2.53),respectively,without statistical significance in difference between the four groups (P＞ 0.05);The signal-to-noise ratios of white matter in conventional group (17.46±3.72),A group (15.54± 2.81),B group (13.71±2.43) and C group (11.77±2.18),respectively,without statistical significance in difference between the four groups (P＞0.05).Conclusions Adjusting the tube current time product (mAs) according to head circumference index of children and adolescents can make scanning program more personalized and reduce organ-specific-radiation doses to sensitive organs without compromise of image quality.

Asia-Pacific Association for the Study of the Liver published the guidelines on management of ascites in liver disease in May 2023， which introduces the diagnosis， differential diagnosis， and treatment of ascites， hyponatremia， hepatic hydrothorax， and hepatorenal syndrome in patients with liver cirrhosis and acute-on-chronic liver failure. This article summarizes the main recommendations in the guidelines， so as to provide a reference for the treatment of ascites in patients with liver diseases in China.

OBJECTIVETo study the serotypes, antimicrobial resistance, virulence genes and molecular characteristics of Vibrio parahaemolyticus isolated from outbreaks and sporadic cases in Guangdong, 2013.

METHODS36 Vibrio parahaemolyticus strains isolated from outbreaks and 43 strains from sporadic cases were sero-typed and tested for antimicrobial resistance. PCR was used to detect for tdh(thermostable direct hemolysin gene), trh (tdh(-) related hemolysin gene), GS-PCR and orf8 genes. All the samples were analyzed by pulsed-field gel electrophoresis (PFGE).

RESULTS36 isolates from outbreaks were all identified as O3 : K6, and among the 43 sporadic isolates, O3 : K6 (23, 53.49%) was the dominant serotype. Vibrio parahaemolyticus isolates showed high resistance rate to ampicillin (96.20%) and cefalotin (40.50%), but were high sensitive to cotrimoxazole (100%) and chloramphenicol (100%). 83.33% (30/36) outbreak isolates were resistant to multi-drugs but only 37.21% (16/43) of the sporadic isolates showed so. Results from virulence gene detection suggested that all the 36 outbreak isolates belonged to tdh(+) trh(-) strains, while 86.05% (37/43) of the sporadic isolates were tdh(+)trh(-) and 11.63% (5/43)were tdh(-)trh(+) . Only one tdh(+)trh(+) strain was found. All the outbreak isolates contained GS-PCR and/or orf8 genes, whereas among the sporadic isolates only 51.16% (22/43) of them carrying the similar genes. Results from PFGE analysis suggested that 79 isolates were discriminated into 3 clusters and 32 different PFGE patterns with the similarity value between 59.8% and 100.0%. Outbreak isolates seemed to gather in the same cluster, while the sporadic isolates spreading in all the three clusters.

CONCLUSIONO3 : K6 was the dominant serotype in Vibrio parahaemolyticus strains isolated in Guangdong, 2013. These strains showed high sensitivity to most antibiotics, but with multi-drug resistance. Positive rate of tdh gene was high, and most O3 : K6 strains contained GS-PCR and/or orf8 genes. PFGE analysis revealed genetic diversity was within the Vibrio parahaemolyticus strains in Guangdong.

Bacterial Toxins ; China ; epidemiology ; Disease Outbreaks ; Drug Resistance, Bacterial ; Electrophoresis, Gel, Pulsed-Field ; Genetic Variation ; Hemolysin Proteins ; Humans ; Polymerase Chain Reaction ; Serotyping ; Vibrio Infections ; epidemiology ; Vibrio parahaemolyticus ; genetics ; pathogenicity ; Virulence

Traumatic rib fractures are the most common injury in thoracic trauma. Previously，the patients with traumatic rib fractures were mostly treated non-surgically，of which 50%，especially those combined with flail chest presented chronic pain or chest wall deformities and over 30% had long-term disabilities，being unable to retain a full-time job. In the past two decades，thanks to the development of internal fixation material technology，the surgical treatment of rib fractures has achieved good outcomes. However，there are still some problems in clinical treatment，including inconsistency in surgical treatment and quality control in medical services. The current consensuses on the management of regional traumatic rib fractures published at home and abroad mainly focus on the guidance of the overall treatment decisions and plans，and relevant clinical guidelines abroad lacks progress in surgical treatment of rib fractures in recent years. Therefore，the Chinese Society of Traumatology affiliated to Chinese Medical Association and Chinese College of Trauma Surgeons affiliated to Chinese Medical Doctor Association，in conjunction with national multidisciplinary experts，formulate the Chinese Consensus for Surgical Treatment of Traumatic Rib Fractures（2021）following the principle of evidence-based medicine，scientific nature and practicality. This expert consensus puts forward some clear，applicable，and graded recommendations from aspects of preoperative imaging evaluation，surgical indications，timing of surgery，surgical methods，rib fracture sites for surgical fixation，internal fixation methods and material selections，treatment of combined injuries in rib fractures，in order to provide references for surgical treatment of traumatic rib fractures.