Objective     To share the clinical experience of video-assisted thoracoscopic surgery (VATS) anatomic basal segmentectomy by single-direction method. Methods     The clinical data of 352 patients who underwent VATS anatomic basal segmentectomy in West China Hospital between April 2015 and April 2021 were retrospectively reviewed, including 96 males and 256 females with a median age of 50 (range, 26-81) years. All basal segmentectomies were performed under thoracoscopy, through the interlobar fissure or inferior pulmonary ligament approach, and following the strategy of single-direction and the method of "stem-branch". Results    All patients underwent basal segmentectomy successfully (49 patients of uniportal procedure, 3 patients of biportal procedure and 300 patients of triportal procedure) without addition of incisions or conversion to thoracotomy and lobectomy. The median operation time was 118 (range, 45-340) min, median intraoperative blood loss was 20 (range, 5-500) mL, median drainage time was 2 (range, 1-22) d and median postoperative hospital stay was 4 (range, 2-24) d. The postoperative complications included pneumonia in 6 patients, prolonged drainage (air leakage duration>5 d or drainage duration>7 d) in 18 patients, cerebral infarction in 1 patient and other complications in 2 patients. All patients were treated well and discharged without main complaints. No perioperative death happened. Conclusion    VATS anatomic basal segmentectomy is feasible and safe. It can be performed in a simple manner following the strategy of single-direction.

Objective:To assess the association between the different prehospital transfer pathways to the hospital and reperfusion delay in patients with ST segment elevation myocardial infarction (STEMI).Methods:We retrospective collected 320 STEMI patients aged 18 years or older who underwent primary percutaneous coronary intervention (PPCI) from June 1, 2016 to July 31, 2018. They were divided into three groups according to different prehospital transfer pathways: patients directly transferred from the field by ambulance to PCI-capable center hospital (field transfer group, n=29); patients transferred by ambulance from PCI-incapable hospitals to PCI-capable center hospital (inerhospital transfer group, n=111); patients transferred by friends or relatives to PCI-capable center hospital (self-transfer group, n=180). The basic characteristic attributes, reperfusion time and fatal complications such as acute left heart failure cases (ALHF) cases, ventricular fibrillation (VF) cases, and in hospital death were collected and compared. In addition, logistic regression analysis was used to analyze uni- and multivariate of door-to-balloon (D2B) time less than 90 min. Results:The S2FMC interval were 118 min (50, 377) min , FMC-to-balloon interval were 87 min (66, 120.5) min and the onset-to-balloon time were 221 min (135, 482.5) min. The above three interval in the interhospital transfer group were longer than those in the field transfer and self-transfer groups ( P<0.05). S2FMC accounted for 51.14% of onset-to-balloon time in the field transfer group, 63.29% in the interhospital transfer group and 55.26% in the self transfer group. The door-to-catheter room interval were 33 min (9, 53.5) min. The interval in the interhospital transfer group were shorter than those in the field transfer and self-transfer groups ( P<0.05). The interval in the self-transfer group were longer than those in the interhospital transfer and field transfer groups ( P<0.05). Multiple regression analysis showed that the interhospital transfer group ( OR=15.251, 95% CI: 5.328-43.657, P<0.01), field transfer group ( OR=8.219, 95% CI: 1.861-36.307, P=0.005), FMC2ECG time ( OR=0.975, 95% CI: 0.962-0.989, P<0.01), and smoking ( OR=2.099, 95% CI: 1.015-4.341, P=0.045) were independent predictor of goal time less than 90 min ( P<0.05 for all variables). Adverse events in STEMI patients mainly occurred within 6 h of the initial symptoms. The incidence of VF was 3.75% (95% CI: 3.73%-3.77%), ALHF was 10.94% (95% CI: 7.52%-14.36%) and in-hospital mortality was 2.5% (95% CI: 0.79%-4.21%). There was no significant difference in the incidence of adverse events among the three groups ( P>0.05). Conclusions:The symptoms of STEMI patients are at risk in the early stage. Ambulances can shorten the reperfusion time, but the ambulance system is less used by patients. It is necessary to further optimize the treatment process of non-PCI hospitals and strengthen the popularity of emergency knowledge related to chest pain among residents, so as to shorten the reperfusion time.

Objective:To evaluate the healthcare accessibility and quality of diagnosis and treatment services of Internet hospitals in China.Methods:One hundred and eighty Internet hospitals in 60 cities were seleted based on the sampling of development levels in the eastern, central and western regions of China. From April to May 2023, standardized patients methodology was applied to evaluate the accessibility(including the number of Internet hospitals, functional settings, online doctor status, the doctor′s attending rate and consultation fees) and diagnosis and treatment service quality(including the diagnosis and treatment services quality, response speed and patient′s evaluation) of Internet hospitals.Results:The average opening rate of Internet hospitals in China was 52.9% (560/1 058), the average online rate of doctors was 64.2% (1 099/1 713), the average doctor′s attending rate was 33.6% (112/333), the average consultation fee was 4.85 yuan, the average score of consultation was 1.92 out of 9, the average score of diagnosis and treatment was 1.12 out of 4, the average score of the response speed was 1.70 out of 3, and patient satisfaction was 2.73 out of 3.Conclusions:The Internet hospital accessibility in China is unevenly developed, and the overall quality of diagnosis and treatment is low. It is recommended to accurately position and optimize the function of Internet hospital, establish the incentive mechanism for online consultation doctors, construct and improve the regulatory system of Internet hospital diagnosis and treatment, so as to improve the accessibility and quality of diagnosis and treatment of Internet hospitals.

Objective    To explore the safety and feasibility of the modified and improved thoracoscopic surgery for esophageal cancer using the concept of "single-direction" thoracoscopic technique. Methods    The clinical data of 65 patients undergoing this modified minimally invasive esophagectomy based on "single-direction" thoracoscopic system between June 2018 and April 2019 were retrospectively analyzed, including 54 males and 11 females aged 62.5±7.8 years. Results    The thoracoscopic operation time was 133.4±28.6 min, and intraoperative blood loss was 61.9±29.2 mL. No intraoperative blood transfusion was needed. One patient was transferred to open thoracotomy (due to severe pleural adhesion atresia). Major complications included anastomotic leak, pneumonia, chylothorax, incisional infection, recurrent laryngeal nerve paralysis and gastric emptying disorders, which were recovered by conservative treatment. No postoperative death occurred. The median number of lymph nodes and lymph node station harvested was 19 and 10, respectively. The median postoperative hospital stay was 10 days. The volume of chest drainage was 1 117.3±543.4 mL. Conclusion    The minimally invasive operation mode of esophageal cancer based on "single-direction" thoracoscopic system is safe and feasible, and has good field vision and smooth and simplified procedure.

Objective:To explore the effects of Zishui Qinggan Decoction on the PTEN-induced putative kinase protein 1 (PINK1)/Parkin and cyclic GMP-AMP (cGAS)/ stimulator of interferon genes (STING) signaling pathways; To reveal the anti-inflammatory mechanism of Zishui Qinggan Decoction in treating depression.Methods:Totally 60 rats were randomly divided into control group, model group, and Zishui Qinggan Decoction low-, medium-, and high-dosage groups using a random number table method ( n=12 in each group) . All rats except for the rats in control group were prepared with CUMS induced depression models. The rats in the Zishui Qinggan Decoction low-, medium-, and high-dosage groups were orally administered with 12, 24, and 48 g/kg of Zishui Qinggan Decoction for gavage, respectively. The control group and model group were orally administered with distilled water of equal volume for gavage, once a day for 4 weeks. Forced swimming test (FST), the open field test (OFT) and the sucrose preference test (SPT) were used to detect behavioral changes in rats in each group. Hematoxylin eosin (HE) staining was used to observe the cell structure of the medial prefrontal cortex. The levels of IL-1 β, IL-6, TNF-α and Interferon-γ (IFN-γ) were detected using ELISA. Western blot was used to detect the expressions of Pink1, Parkin, cGAS and STING. Results:Behavioral testing results showed that, compared with the model group, the incubation period for rats in Zishui Qinggan Decoction low-, medium-, and high-dosage groups to enter the first immobility state in FST was significantly prolonged ( P<0.05), and the immobility time was significantly shortened ( P<0.05); the time spent in the central area was significantly increased ( P<0.05), and the incubation period for entering the central area was significantly shortened in ( P<0.05); the percentage of sugar water consumption significantly increased in ( P<0.05). HE staining revealed that the aggregation of prefrontal cortex nuclei decreased, the number of neurons increased, and the distribution of neurons was uniform in Zishui Qinggan Decoction low-, medium-, and high-dosage groups. Compared with the model group, the levels of IL-1β, IL-6, TNF-α and IFN-γ in the Zishui Qinggan Decoction groups significantly decreased ( P<0.05). The protein expressions of PINK1 and Parkin in the prefrontal cortex in Zishui Qinggan Decoction groups significantly increased ( P<0.05), while the protein expression levels of cGAS and STING significantly decreased ( P<0.05). Conclusion:Zishui Qinggan Decoction can significantly improve the depressive behavior, neuronal damage, and neuroinflammatory response in CUMS rats. Its mechanism may be related to up-regulating the PINK1/Parkin signaling pathway and inhibiting the cGAS/STING signaling pathway.

Surgery is an important method in the treatment of esophageal cancer. With the application of robotic surgery system, more and more surgeons have observed its huge advantages over the conventional minimally invasive surgical system in the esophageal surgery. To ensure the safety and fluency of the robotic surgery, it needs not only an experienced attending surgeon but also a well-trained assistant. This study summaries the skills of the surgical assistant in the robotic esophagectomy.

Objective     To summarize the perioperative and long-term outcomes of ground-glass opacity (GGO) dominant early stage lung cancer patients treated by anatomic segmentectomy. Methods     We collected clinical data of 756 patients from Western China Lung Cancer Database, who underwent intentional anatomic segmentectomy [tumor size (T) ≤ 2 cm, GGO ≥ 50%] in the Department of Thoracic Surgery, West China Hospital, Sichuan University from 2009 to 2018. There were 233 males and 523 females at a median age of 53 (25-83) years including 290 (38.4%) patients of simple segmentectomy and 466 (61.6%) patients of complex segmentectomy. All patients were diagnosed as adenocarcinoma, including 338 (44.7%) patients of minimally invasive adenocarcinoma and 418 (55.3%) patients of invasive adenocarcinoma. Results     The median operative time was 115 (38-300) min, the median blood loss was 20 (5-800) mL, 58 (7.7%) patients had postoperative complications and the postoperative stay was 4 (2-24) days. The median follow-up period was 43.0 (30.1-167.9) months. Five-year overall survival rate was 99.5% [95%CI (98.8%, 100.0%)], 5-year recurrence-free survival rate was 98.8% [95%CI (97.5%, 100.0%)], and 5-year lung cancer-specific survival rate was 100.0%. Conclusion    Anatomic segmentectomy has favorable perioperative outcomes and excellent prognosis in GGO dominant early stage lung cancer patients.

Objective     To verify the feasibility and accuracy of the "lung surface intersegmental constant proportion landmarks", developed by our center, in identifying intersegmental planes during pulmonary segmentectomy. Methods    We prospectively enrolled the patients who planned to receive thoracoscopic segmentectomy in West China Hospital of Sichuan University and The Third People's Hospital of Chengdu from September 2021 to October 2021. We took a relatively objective and feasible method, intravenous injection of indocyanine green, in identifying intersegmental planes as standard control. We intraoperatively judged the consistency between "lung surface intersegmental constant proportion landmarks" and intravenous injection of indocyanine green in identifying intersegmental planes. We discerned main landmarks of intersegmental plane by the constant proportion segment module, which was built based on the "lung surface intersegmental constant proportion landmarks", as well as distinguished the planes with discrepant fluorescence by peripheral intravenous indocyanine green injection. When the distance between the landmarks determined by the "ung surface intersegmental constant proportion landmarks" and the segmental boundaries displayed by indocyanine green  fluorescence staining was ≤1 cm, the landmarks were judged to be consistent with the planes with discrepant fluorescence. As long as one of the landmarks was judged to be consistent, the method was considered to be feasible and accurate. Results 聽 聽 A total of 21 patients who underwent thoracoscopic segmentectomy were enrolled, with 5 male and 16 female patients. The median age was 55 years, ranging from 34 to 76 years. A total of 11 patients received left-side surgery, while 10 patients received right-side surgery. In the operations of 21 pulmonary segmentectomies, at least one intersegmental landmark determined by the "lung surface intersegmental constant proportion landmarks" was consistent with the intersegmental plane determined by indocyanine green fluorescence staining in each patient. Conclusion 聽 聽The intersegmental landmarks determined by the "lung surface intersegmental constant proportion landmarks" are consistent with that determined by indocyanine green fluorescence staining. The method of "lung surface intersegmental constant proportion landmarks" is feasible and accurate in identifying intersegmental planes during pulmonary segmentectomy.

The incidence of rib fracture in patients with chest trauma is about 70%. Simple rib fractures do not need special treatment. Multiple rib fractures and flail chest are critical cases of blunt trauma, which often cause serious clinical consequences and need to be treated cautiously. Nowadays, there is a controversy about the diagnosis and treatment of multiple rib fractures and flail chest. In the past, most of the patients were treated by non-operative treatment, and only less than 1% of the patients with flail chest underwent surgery. In recent years, studies have confirmed that surgical reduction and internal fixation can shorten the hospital stay, and reduce pain and cost for patients with flail chest, but there is still a lack of relevant clinical consensus and guidelines for diagnosis and treatment, which leads to great differences in clinical diagnosis and treatment plans. This article reviewed the treatment, surgical indications and surgical timing of multiple rib fractures and flail chest.

Objective    To compare the surgical efficacy of Da Vinci robot-assisted minimally invasive esophagectomy (RAMIE) and video-assisted minimally invasive esophagectomy (VAMIE) on esophageal cancer. Methods    Online databases including PubMed, the Cochrane Library, Medline, EMbase and CNKI from inception to 31, December 2019 were searched by two researchers independently to collect the literature comparing the clinical efficacy of RAMIE and VAMIE on esophageal cancer. Newcastle-Ottawa Scale was used to assess quality of the literature. The meta-analysis was performed by RevMan 5.3. Results    A total of 14 studies with 1 160 patients were enrolled in the final study, and 12 studies were of high quality. RAMIE did not significantly prolong total operative time (P=0.20). No statistical difference was observed in the thoracic surgical time through the McKeown surgical approach (MD=3.35, 95%CI –3.93 to 10.62, P=0.37) or in surgical blood loss between RAMIE and VAMIE (MD=–9.48, 95%CI –27.91 to 8.95, P=0.31). While the RAMIE could dissect more lymph nodes in total and more lymph nodes along the left recurrent laryngeal recurrent nerve (MD=2.24, 95%CI 1.09 to 3.39, P=0.000 1; MD=0.89, 95%CI 0.13 to 1.65, P=0.02) and had a lower incidence of vocal cord paralysis (RR=0.70, 95%CI 0.53 to 0.92, P=0.009). Conclusion    There is no statistical difference observed between RAMIE and VAMIE in surgical time and blood loss. RAMIE can harvest more lymph nodes than VAMIE, especially left laryngeal nerve lymph nodes. RAMIE shows a better performance in reducing the left laryngeal nerve injury and a lower rate of vocal cord paralysis compared with VAMIE.