Drug and radiofrequency ablation were used to treat atrial fibrillation ( AF) . Because the drug therapy is often empiri?cal, and the side effects of drug can leads to many adverse reactions of heart and heart outside. Patient?s compliance is poor after long term medication, so the therapeutics effect is limited. At present, catheter ablation is the main therapy for the treatment of AF, and 2014 AHA/ACC/HRS guidelines has been recommended for the treatment of AF in the first line. But there is a certain recurrence af?ter ablation. There are many factors that cause the recurrence of AF, such as left atrial size, heart rate, PR interval, inflammatory factors. Accurate prediction of recurrence of AF after catheter ablation is helpful for early identification of high?risk groups, so as to take relevant preventive measures.

BACKGROUNDTo study the metastatic pattern of thoracic lymph nodes in patients with resectable lung cancer.

METHODSFrom January 1992 to December 2000, radical lobectomy or pneumonectomy and systemic lymphadenectomy were performed in 306 patients with lung cancer. Number, size, colour and hardness of lymph nodes in each region were recorded and neoplastic metastasis was examined by pathology.

RESULTSOut of 4 614 resected lymph nodes from 2 456 regions, 954 lymph nodes from 521 regions were confirmed to have metastasis. The metastatic rates of thoracic lymph nodes and mediastinal lymph nodes were 61.8% and 43.5% , respectively. The metastatic frequencies in regions around the hilar or root of lung (11,10,7,5,4) were higher than those of regions far from the root of lung (9,6,3,2,1). There was a remarkably higher metastatic rate of lymph nodes in small cell lung cancer than that in non small cell lung cancer (P < 0.01 ). The metastatic rate was closely related to size, colour and hardness of lymph nodes (P < 0.001, P < 0.001 , P < 0.001 ).

CONCLUSIONSMost of neoplastic metastasis of lymph nodes spreads from proximal to distal areas, lower to upper regions, and from the hilar to the mediastinal. A few mediastinal lymph nodes show a skipping pattern. It is necessary to perform systemic lymphadenectomy during pulmonary resection.

BACKGROUNDTo summarize the experience of carinal resection and bronchial sleeve lobectomy in the treatment of 105 patients with central lung cancer from November, 1991, to November, 2001.

METHODSA total of 105 patients with central lung cancer underwent pulmonary resection. Carinal resection and reconstruction was performed in 19 patients, bronchial sleeve resection in 81, and bronchial sleeve combined with pulmonary artery sleeve lobectomy in 5.

RESULTSThere was no operative mortality. Postoperative complications such as anastomotic leakage, cardiac arrhythmia, asthma, pulmonary atelectasis occurred in 10.5% of total group. The 1-, 3- and 5- year survival rates were 89.9%, 60.0% and 47.2%, respectively.

CONCLUSIONSBronchial sleeve lobectomy and double-sleeve lobectomy are capable of excising pulmonary tumor as much as possible while remaining healthy lung tissues. Carinal resection and reconstruction is helpful to extend the surgical indication.

A large size tertiary comprehensive hospital designed the performance reform program not only based on RBRVS and DRGs but also combined with cost control and medical quality and safety. The hospital have implemented performance reform at 2016, with achieving the public welfare and fairness by "combination" and exploring a set of performance management methods which suit the hospital's actual condition and boost its development.

Objective:To analyze the temporal and spatial trends of maternal mortality in China, and to predict the future situation of maternal mortality.Methods:Taking the national maternal mortality rate in 1991-2018 and the maternal mortality rate in 2009-2018 in various provinces and cities of China as the research objects, using the statistical description analysis method to analyze the changes of time and space of maternal mortality, and using ARIMA time series model to predict the future situation of maternal mortality in China, rural areas and cities.Results:Regarding to the spatial and temporal distribution of maternal mortality, the maternal mortality rate in China generally showed a certain decline trend. In 1991, the maternal mortality rate was 80.0/100 000, and in 2018, China′s maternal mortality rate was 18.3/100 000, 77.1% lower than that in 1991, with an average annual growth rate of-5.3%; In 2009, Tibet′s maternal mortality rate was the highest, 232.2/100 000, and Jiangsu′s maternal mortality rate was the lowest, 5.2/100 000, with a difference of 44.7times After nine years of development, Tibet is still the province with the highest maternal mortality rate in China, which is 56.5/100 000, while Shanghai has the lowest maternal mortality rate, which is 1.4/100 000, with a difference of 40.4times. In 1991, the rural and urban maternal mortality rates were 46.3/100, 000 and 100.0/100, 000, respectively, and the urban-rural mortality rate was 1∶2.16. By 2022, the urban-rural mortality rate in China was 1∶0.95. Regarding the prediction of maternal mortality for the future, the national maternal mortality rate in 2022 is 10.1/100 000, the urban maternal mortality rate is 16.0/100 000, and the rural maternal mortality rate is 15.0/100 000.Conclusion:The maternal mortality rate in China has been greatly reduced, and the gap between urban and rural areas has decreased from 53.7/100 000 in 1991 to 0.7/100 000 in 2022, showing a downward trend. However, from the model prediction results, there is a slight rebound in the urban maternal mortality rate, while the rural maternal mortality rate remains stable, which suggests that the government and the health administration should pay more attention to the growing trend of urban maternal mortality while taking reasonable measures to reduce the rural maternal mortality rate, so as to avoid the rebound of urban maternal mortality rate.

Objective:To explore the effect of rapamycin on 1-methyl-4-phenylpyridinium iodide (MPP+ )-induced activation of Nod-like receptor protein 3 (NLRP3) inflammasome in microglia.Methods:The BV2 microglia cells were divided into control group, model group and rapamycin group.The model group and rapamycin group were treated by MPP+ to activate NLRP3 inflammasome, and rapamycin group was pretreated with rapamycin.Quantitative real-time PCR (RT-qPCR) was used to detect the mRNA levels of NLRP3, apoptosis-associated speck-like protein (ASC) and caspase-1.Immunofluorescence was used to detect the protein expression of NLRP3 and interleukin-1β (IL-1β). Western blot was carried out to assess the protein expression of NLRP3, ASC, caspase-1, beclin1 and microtubule-associated protein 1 light chain 3 (LC3).Results:The mRNA levels of NLRP3, ASC and caspase-1 in model group were higher than those in control group ( t=4.825, 3.015, 5.853, all P<0.05). The mRNA levels of NLRP3 and caspase-1 in rapamycin group were lower than those in model group ( t=2.75, 2.89, both P<0.05). In model group, the protein expressions of NLRP3 (1.54±0.22), ASC (1.02±0.13) and caspase-1 (1.42±0.30) were higher than NLRP3 (0.66±0.15), ASC (0.41±0.14) and caspase-1 (0.70±0.10) in control group ( t=5.653, 5.602, 3.964, all P<0.01), while the protein expression of beclin1 (0.28±0.09) and LC3II/LC3I ratio(0.69±0.14) were lower than beclin1 (0.60±0.11) and LC3II/LC3I (1.29±0.23) in control group ( t=4.010, 3.982, both P<0.01). The protein expressions of NLRP3 (0.80±0.18) and ASC (0.68±0.14) in rapamycin group were lower than those in model group ( t=4.413, 3.077, both P<0.05), while the protein expression of beclin1 (0.65±0.20) and LC3II/LC3I ratio(1.42±0.36) were higher than those in model group ( t=2.965, 3.278, both P<0.05). Conclusion:MPP+ activates NLRP3 inflammasome and impairs autophagic function in microglia.Rapamycin inhibits MPP+ -induced activation of NLRP3 inflammasome by restoring autophagic impairment in microglia.