Objective To investigate the effects and feasibility of mini-thoracotomy focus cleaning in the management of cavitary pulmonary tuberculosis or pulmonary tuberculoma. Methods The mini-thoracotomy approach was adopted in patients with cavitary pulmonary tuberculosis or pulmonary tuberculoma who had undergone long-term anti-tuberculosis therapy or needed a re-treatment.Eight patients with chronic fibro-cavitative pulmonary tuberculosis and 10 patients with pulmonary tuberculoma underwent focus cleaning, irrigation, and folding suture. Results All the 18 patients were cured clinically, with their sputum findings turning negative for bacteria and pulmonary shadows subsiding. No operative complications occurred. Follow-up for 1～4 years found no recurrence. Conclusions Focus cleaning is an effective surgical alternative for pulmonary tuberculosis after proper selection of cases. The procedure is minimally invasive and patient's pulmonary function can be protected to the greatest possible advantage.

Objective To evaluate the possible correlation between anxiety state and serum angiontensin Ⅱ levels in patients with vitiligo.Methods Sixty patients with progressive vitiligo and 30 normal human controls were included in this study.Self-rating anxiety scale (SAS) was used to evaluate the anxiety state,and enzyme linked immunosorbent assay was performed to determine the serum level of angiontensin Ⅱ,in these subjects.Results SAS score was significantly increased in patients compared with the controls (46.13 ±11.72 vs.36.73 ± 12.59,t =3.50,P ＜ 0.01),and 48.3％ of the patients were affected by anxiety.The SAS score and prevalence of anxiety were statistically higher in female than in male patients (t =2.47,x2 =4.58,both P ＜ 0.05),in unmarried than in married patients (t =2.59,P ＜ 0.01; x2 =6.17,P ＜ 0.05),in patients with lesions on exposed areas than in those with lesions on unexposed areas (t =3.60,P ＜ 0.01; x2 =5.84,P ＜0.05).In patients affected by anxiety,the level of serum angiontensin Ⅱ was significantly elevated compared with patients without anxiety (63.83 ± 10.92 vs.40.74 ± 8.70 ng/L,t =9.09,P ＜ 0.01 ).Conclusions Patients with vitiligo are usually affected by anxiety.The serum level of angiontensin Ⅱ is closely correlated with anxiety state in patients with vitiligo as well as with the development of vitiligo,and may have an impact on the initiation and progression of vitiligo.

Objective To evaluate the feasibility and effectiveness of four closure techniques ,large incision with plastic distal at‐tachment and clip with suction ,1 .1 cm small incision with plastic distal attachment and clip with suction in natural orifice translu‐minal endoscopic surgery(NOTES) .Methods Forty‐one ex vivo porcine stomachs were involved in this research .According to the size of incision and different methods of incision closure ,all ex vivo porcine stomachs were divided into four groups .Group A in‐volved 8 ex vivo porcine stomachs ,their size of incision were 1 .2-2 .0 cm ,and their incisions were closured by a clip closure direct‐ly ;group B involved 10 ex vivo porcine stomachs ,their size of incision were 1 .2-2 .0 cm ,and their incisions were closed by plastic end attachment with suction and clip enclosure technique;group C involved 10 ex vivo porcine stomachs ,their size of incision were smaller than 1 .1 cm ,and their incisions were by a clip closure directly ;group D involved 13 ex vivo porcine stomachs ,their size of incision were smaller than 1 .1 cm ,and closured by plastic end attachment with suction and clip enclosure technique .Stomach leaks were evaluated by leaking studies after the procedure .Results In group A ,1 incision was closed successfully ,7 incisions were clo‐sured unsuccessfully ;in group B ,2 incisions were closed successfully ,8 incisions were closed unsuccessfully ;in group C ,2 incisions were closed successfully ,8 incisions were closured unsuccessfully ;in group D ,11 incisions were closed successfully ,2 incisions were Closured unsuccessfully .Fisher′s exact test showed that group D was significantly related to the success of incision closure .The were significant differences between group A and D ,group B and group D(P<0 .05) .Conclusion Small incision(smaller than 1 cm) and plastic end attachment with suction and clip enclosure technique are optimal in NOTES procedure in this ex vivo porcine stomachs study .

Objective The optimal access for natural orifice transluminal endoscopic surgery is still uncertain .This study was designed to compare the practicability and maneuverability of transgastric ,transunmbilical ,and transrectal approach in abdominal surgery in a canine model .Methods Three dogs were used in this research .Three approach :trangastric ,transunmbilical and tran-srectal approach were carried out for abdominal exploration ,liver biopsy ,bladder biopsy and an attempted cholecystectomy .The ma-neuverability ,endoscopic image ,performer′s perception ,and spatial orientation were evaluated .Results The maneuverability of trangastric ,and transrectal approach NOTES were better than transunmbilical NOTES .Abdominal exploration ,live biopsy ,and bladder biopsy were completed successfully .The cholecystectomy was failed because of poor exposure and difficulty of separating the around tissure .Conclusion The optimal approach for upper abdomen NOTES is transrectal route .For lower abdomen NOTES , the trangastric approach is superior to other accesses .Further study is needed to develop more flexible and precise equipment for NOTES and to evaluate more feasible access approach .

Objectives To evaluate the effectiveness of cognitive behavior therapy for insomnia (CBT-i) in chronic insomnia patients in terms of the improvements of psychological and sleep diary parameters. Methods Patients who met the diagnostic criteria of chronic insomnia, were divided into primary group or comorbid group. Both groups received standard CBT-i interventions. Psychological scales and sleep diaries were used to evaluate participants' severity of insomnia and psychological conditions related to insomnia at four time points:before intervention (baseline), immediate after intervention, 4 weeks and 16 weeks after intervention. Results Both groups achieved significant improvements after intervention on psychological measurements and sleep diary parameters. Such improvements were maintained at 4-week and 16-week follow-ups. The sleep diary data indicated that by the end of the intervention, there were significant differences on sleep onset latency(51.72 min to 10.53 min in primary group, P<0.01;59.26 min to 15.67min in comorbid group, P<0.01)and sleep efficiency (71％to 95％in primary group, P<0.01;68％to 90％in comorbid group, P<0.01). There were differences on sleep onset latency (10.00 min vs. 13.93 min,P<0.05), total sleep time (355.71 min vs. 327.85 min, P<0.05) and sleep efficiency (95％vs. 91％, P<0.01) in primary group and comorbid group respectively. No differences were found on wake after sleep onset in the two groups. Conclusions Chronic insomnia patients with or without comorbidities both have improvements after CBT-i. Sleep diary parameters rather than psychological measurements are different in two groups. Thus, CBT-i is an effective non-pharmaceutical therapy inpatients with chronic insomnia.

Objective:Using quantitative analysis to explore the health care industry policy documents of the Yangtze River Del-ta,reveal the exising policies problems,and provide scientific references for the healthy development of the health care industry.Methods:It uses the open coding method of qualitative research to code health care industry policy texts of Zhejiang,Jiangsu,Anhui and Shanghai,and carries out quantitative analysis based on the policy tool and health care format.Results:The policies and measures related to the health care industry in the Yangtze River Delta are scattered in the policy documents such as health pen-sion,health care,health care travel,etc.There is no special policy to guide the overall development of the health care industry.In the use of policy tools,there is a shortage of environmental tools,supply tools and demand tools,and there is an imbalance in the internal structure of various policy sub-tools;In terms of industrial format,the Yangtze River Delta can develop the advanta-geous format of health care industry based on local resource endowment,but there was insufficient attention to health and culture.Conclusion:The Yangtze River Delta should speed up the formulation of special policies for health care industry,strengthen the construction of health care service standards and product quality evaluation system,increase the proportion of demand-oriented tools,increase the supply of health care and culture policies,and promote the development of health care industry.

Objective:Using quantitative analysis to explore the health care industry policy documents of the Yangtze River Del-ta,reveal the exising policies problems,and provide scientific references for the healthy development of the health care industry.Methods:It uses the open coding method of qualitative research to code health care industry policy texts of Zhejiang,Jiangsu,Anhui and Shanghai,and carries out quantitative analysis based on the policy tool and health care format.Results:The policies and measures related to the health care industry in the Yangtze River Delta are scattered in the policy documents such as health pen-sion,health care,health care travel,etc.There is no special policy to guide the overall development of the health care industry.In the use of policy tools,there is a shortage of environmental tools,supply tools and demand tools,and there is an imbalance in the internal structure of various policy sub-tools;In terms of industrial format,the Yangtze River Delta can develop the advanta-geous format of health care industry based on local resource endowment,but there was insufficient attention to health and culture.Conclusion:The Yangtze River Delta should speed up the formulation of special policies for health care industry,strengthen the construction of health care service standards and product quality evaluation system,increase the proportion of demand-oriented tools,increase the supply of health care and culture policies,and promote the development of health care industry.

Objective:Using quantitative analysis to explore the health care industry policy documents of the Yangtze River Del-ta,reveal the exising policies problems,and provide scientific references for the healthy development of the health care industry.Methods:It uses the open coding method of qualitative research to code health care industry policy texts of Zhejiang,Jiangsu,Anhui and Shanghai,and carries out quantitative analysis based on the policy tool and health care format.Results:The policies and measures related to the health care industry in the Yangtze River Delta are scattered in the policy documents such as health pen-sion,health care,health care travel,etc.There is no special policy to guide the overall development of the health care industry.In the use of policy tools,there is a shortage of environmental tools,supply tools and demand tools,and there is an imbalance in the internal structure of various policy sub-tools;In terms of industrial format,the Yangtze River Delta can develop the advanta-geous format of health care industry based on local resource endowment,but there was insufficient attention to health and culture.Conclusion:The Yangtze River Delta should speed up the formulation of special policies for health care industry,strengthen the construction of health care service standards and product quality evaluation system,increase the proportion of demand-oriented tools,increase the supply of health care and culture policies,and promote the development of health care industry.

Objective:Using quantitative analysis to explore the health care industry policy documents of the Yangtze River Del-ta,reveal the exising policies problems,and provide scientific references for the healthy development of the health care industry.Methods:It uses the open coding method of qualitative research to code health care industry policy texts of Zhejiang,Jiangsu,Anhui and Shanghai,and carries out quantitative analysis based on the policy tool and health care format.Results:The policies and measures related to the health care industry in the Yangtze River Delta are scattered in the policy documents such as health pen-sion,health care,health care travel,etc.There is no special policy to guide the overall development of the health care industry.In the use of policy tools,there is a shortage of environmental tools,supply tools and demand tools,and there is an imbalance in the internal structure of various policy sub-tools;In terms of industrial format,the Yangtze River Delta can develop the advanta-geous format of health care industry based on local resource endowment,but there was insufficient attention to health and culture.Conclusion:The Yangtze River Delta should speed up the formulation of special policies for health care industry,strengthen the construction of health care service standards and product quality evaluation system,increase the proportion of demand-oriented tools,increase the supply of health care and culture policies,and promote the development of health care industry.

Objective:Using quantitative analysis to explore the health care industry policy documents of the Yangtze River Del-ta,reveal the exising policies problems,and provide scientific references for the healthy development of the health care industry.Methods:It uses the open coding method of qualitative research to code health care industry policy texts of Zhejiang,Jiangsu,Anhui and Shanghai,and carries out quantitative analysis based on the policy tool and health care format.Results:The policies and measures related to the health care industry in the Yangtze River Delta are scattered in the policy documents such as health pen-sion,health care,health care travel,etc.There is no special policy to guide the overall development of the health care industry.In the use of policy tools,there is a shortage of environmental tools,supply tools and demand tools,and there is an imbalance in the internal structure of various policy sub-tools;In terms of industrial format,the Yangtze River Delta can develop the advanta-geous format of health care industry based on local resource endowment,but there was insufficient attention to health and culture.Conclusion:The Yangtze River Delta should speed up the formulation of special policies for health care industry,strengthen the construction of health care service standards and product quality evaluation system,increase the proportion of demand-oriented tools,increase the supply of health care and culture policies,and promote the development of health care industry.