Objective To evaluate the efficacy and safety of intraoperative pleural irrigation with Nocardia rubra cell-wall skeleton (N-CWS) for reducing pleural effusion drainage after radical surgery for lung cancer. Methods A retrospective analysis was conducted on the clinical data of lung cancer patients who underwent lobectomy and mediastinal lymph node dissection at the First Affiliated Hospital of Xiamen University between December 2024 and May 2025. Patients were divided into a control group and an irrigation group based on the intraoperative use of N-CWS. Patients in the irrigation group received pleural irrigation with 800 μg of N-CWS diluted in 10 mL of normal saline. The following outcomes were compared between the two groups: pleural effusion drainage volume at 0-24 h, 24-48 h, and 48-72 h postoperatively, degree of air leak, chest tube duration, postoperative length of stay, and the incidence of adverse events (fever, chest pain, and nausea and vomiting). Results A total of 245 patients were included (97 males, 148 females) with a mean age of (61.28±6.26) years, with 205 in the control group and 40 in the irrigation group. Compared to the control group, the irrigation group showed significantly lower pleural effusion drainage volumes at 0-24 h, 24-48 h, and 48-72 h, as well as shorter chest tube duration and postoperative length of stay (all P<0.05). There was no statistical difference in the degree of postoperative air leak (P=0.661). No significant differences were observed between the two groups regarding the highest body temperature within 72 h post-surgery (P=0.130), fever grade (P=0.196), severity of chest pain (P=0.105), or the incidence of nausea and vomiting (P=0.376). Conclusion Intraoperative pleural irrigation with N-CWS in patients undergoing lobectomy and mediastinal lymph node dissection for lung cancer can significantly reduce postoperative pleural effusion drainage volume, shorten chest tube duration and length of hospital stay. The procedure is safe and feasible.

Objective:To investigate the application effect of propofol combined with remifentanil for anesthesia in children undergoing plasma adenoidectomy.Methods:Clinical data of 103 children who underwent plasma adenoidectomy in our hospital from Apr 2023 to Apr 2024 were retrospectively analyzed.Children were divided into two groups according to different anesthesia schemes.Children who received propofol+ketamine anesthesia were enrolled in the control group(n=52)and children who received propofol+remifentanil anesthesia were enrolled in the study group(n=51).Hemodynamic parameters were compared between the two groups at four time points:before anesthesia(T0),immediately after extubation(T1),5 minutes after extubation(T2),and 10 minutes after extubation(T3).The pain scores(CHIPPS)of the two groups were compared at 10,20,and 30 min after extubation.Post-anesthesia evaluation of discomfort(PAED)and incidence of restlessness during recovery in children were compared.The indicators of stress response(cortisol and epinephrine)were measured preoperatively and 1 day postoperatively.Total perioperative adverse events were analyzed.Results:The recovery times for spontaneous breathing,eye-opening,and extubation in the study group were shorter than those in the control group(P＜0.05).The heart rate and mean arterial pressure level in the study group at T1-T3 were lower than those in the control group(P＜0.05).The CHIPPS scores at 10,20,and 30 min after extubation and PAED scores during the recovery period in the study group were lower than those in the control group(P＜0.05).The incidence of restlessness during the recovery period in the study group was lower than that in the control group(P＜0.05).The levels of cortisol and epinephrine in the study group were lower than those in the control group on day 1 after surgery(P＜0.05).There was no significant difference in the overall incidence of adverse reactions between the two groups(P＞0.05).Conclusion:The use of propofol combined with remifentanil in plasma adenoidectomy can effectively shorten the recovery time of anesthesia in children,enhance analgesic effects,reduce blood circulation fluctuations and stress reactions,and reduce the incidence of restlessness,with reliable safety.

Objective:To sort out the situation,content and practical experience of the"four sinkings"in the construction of tightly-knit county medical communities,and provide references and basis for the promotion of policies in various regions.Methods:Quantitative description methods were used to analyze the development trends of the number of health technicians and medical services in primary healthcare facilities.Literature research methods were used to analyze policy content.Case analysis methods were used to summarize and analyze the implementation content and support mechanisms of the"four sinkings"in Youxi County of Fujian Province,Dongyang City of Zhejiang Province,Dongtai City of Jiangsu Province and Suixi County of Anhui Province.Results:From 2010-2022,more health technicians and medical services still flew to hospitals,indicating that personnel is an important impact factor for service sinking.The task of personnel and service sinking to the primary healthcare level is still arduous.From 2023 to 2024,China has issued multiple national policies to clarify the content of the"four sinkings",among which personnel sinking is the core,technology sinking is the means,management sinking is the support,and service sinking is the goal.Case analysis result shows that typical regions have established a long-term mechanism to promote the"four sinkings"through talent pool constrution,economic incentives,medical insurance support and informatization construction.Conclusion and Suggestions:It is needed to enhance the understanding of the"four sinkings",and promote them as important policy measures;promote the experience of typical regions,with a focus on the establishment of a long-term mechanism;and strengthen trace study and monitoring and evaluation to ensure the implementation of the"four sinkings".

Objective:To investigate the application effect of propofol combined with remifentanil for anesthesia in children undergoing plasma adenoidectomy.Methods:Clinical data of 103 children who underwent plasma adenoidectomy in our hospital from Apr 2023 to Apr 2024 were retrospectively analyzed.Children were divided into two groups according to different anesthesia schemes.Children who received propofol+ketamine anesthesia were enrolled in the control group(n=52)and children who received propofol+remifentanil anesthesia were enrolled in the study group(n=51).Hemodynamic parameters were compared between the two groups at four time points:before anesthesia(T0),immediately after extubation(T1),5 minutes after extubation(T2),and 10 minutes after extubation(T3).The pain scores(CHIPPS)of the two groups were compared at 10,20,and 30 min after extubation.Post-anesthesia evaluation of discomfort(PAED)and incidence of restlessness during recovery in children were compared.The indicators of stress response(cortisol and epinephrine)were measured preoperatively and 1 day postoperatively.Total perioperative adverse events were analyzed.Results:The recovery times for spontaneous breathing,eye-opening,and extubation in the study group were shorter than those in the control group(P＜0.05).The heart rate and mean arterial pressure level in the study group at T1-T3 were lower than those in the control group(P＜0.05).The CHIPPS scores at 10,20,and 30 min after extubation and PAED scores during the recovery period in the study group were lower than those in the control group(P＜0.05).The incidence of restlessness during the recovery period in the study group was lower than that in the control group(P＜0.05).The levels of cortisol and epinephrine in the study group were lower than those in the control group on day 1 after surgery(P＜0.05).There was no significant difference in the overall incidence of adverse reactions between the two groups(P＞0.05).Conclusion:The use of propofol combined with remifentanil in plasma adenoidectomy can effectively shorten the recovery time of anesthesia in children,enhance analgesic effects,reduce blood circulation fluctuations and stress reactions,and reduce the incidence of restlessness,with reliable safety.

Objective To discuss the main pathological types and imaging characteristics of pulmonary nodules that are highly suspected to be malignant in clinical practice but are pathologically confirmed to be benign. Methods A retrospective analysis was performed on the clinical data of patients with pulmonary nodules who were initially highly suspected of malignancy but were subsequently pathologically confirmed to be benign. These patients were treated at the First Affiliated Hospital of Xiamen University from December 2020 to April 2023. Based on the outcomes of preoperative discussions, the patients were categorized into a benign group and a suspicious malignancy group. The clinical data and imaging characteristics of both groups were compared. Results A total of 232 patients were included in the study, comprising 112 males and 120 females, with a mean age of (50.7±12.0) years. Among these, 127 patients were classified into the benign group, while 105 patients were categorized into the suspicious malignancy group. No statistically significant differences were observed between the two groups regarding age, gender, symptoms, smoking history, or tumor history (P>0.05). However, significant differences were noted in nodule density, CT values, margins, shapes, and malignant signs (P＜0.05). Further analysis revealed that in the suspicious malignancy group, solid nodules were predominantly characterized by collagen nodules and fibrous tissue hyperplasia (33.3%), followed by tuberculosis (20.4%) and fungal infections (18.5%). In contrast, non-solid nodules were primarily composed of collagen nodules and fibrous tissue hyperplasia (41.2%) and atypical adenomatous hyperplasia (17.7%). Conclusion Benign pulmonary nodules that are suspected to be malignant are pathologically characterized by the presence of collagen nodules, fibrous tissue hyperplasia, tuberculosis, atypical adenomatous hyperplasia, and fungal infections. Radiologically, these nodules typically present as non-solid lesions and may exhibit features suggestive of malignancy, including spiculation, lobulation, cavitation, and pleural retraction.

Objective To explore the clinical application value of simple artery occlusion (SAO) in revealing intersegmental planes during thoracoscopic pulmonary segmentectomy. Methods A retrospective analysis was conducted on the clinical data of patients who underwent thoracoscopic pulmonary segmentectomy at the First Affiliated Hospital of Xiamen University from February 2022 to December 2023. Patients were divided into a conventional group and a SAO group based on the method used to reveal the intersegmental plane during surgery. The two groups were compared in terms of intraoperative blood loss, operation time, postoperative drainage volume, time to intubation, postoperative pulmonary air leakage, and conversion to open thoracotomy rate. Results A total of 318 patients were included. There were 181 patients in the conventional group, including 86 males and 95 females, with an average age (53.35±9.20) years, and there were 137 patients in the SAO group, including 58 males and 79 females, with an average age (55.26±11.46) years. There were no statistical differences in general patient information between the two groups (P>0.05). The SAO group had less intraoperative blood loss [MD=17.568, 95%CI (9.968, 25.168), P<0.001] and postoperative drainage volume [MD=275.587, 95%CI (188.999, 362.175), P<0.001], shorter drainage tube duration [MD=1.000, 95%CI (1.000, 2.000), P<0.001] and operation time [MD=20.709, 95%CI (16.258, 25.159), P<0.001]. The incidence of postoperative pulmonary air leakage complications in the SAO group was lower than that in the conventional group [RR=0.361, 95%CI (0.181, 0.722), P=0.003]. Conclusion SAO can reduce surgical difficulty, shorten operation time, decrease the incidence of postoperative pulmonary air leakage, and enhance the safety of anatomical pulmonary segmentectomy, making it worthy of clinical promotion and application.

Objective:To assess the efficacy and safety profile of antaitasvir phosphate combined with yiqibuvir in the treatment of chronic hepatitis C (CHC) of various genotypes, without cirrhosis or with compensated cirrhosis.Methods:394 cases with CHC from 22 centers were collected from October 2021 to April 2023. They were randomly assigned to receive either the experimental drugs (antaitasvir phosphate 100 mg+yiqibuvir 600 mg) or placebo treatment in a 3∶1 ratio. The patients were administered drugs once a day for 12 consecutive weeks, and then followed up for 24 weeks after treatment cessation. All subjects were unblinded at the four-week follow-up following drug discontinuation, with the experimental drug group continuing to complete subsequent post-discontinuation follow-up. The placebo group was switched to receive the experimental drugs for a repeated 12-week treatment period and followed up for another 24 weeks after discontinuation of the drug (placebo delayed treatment phase).The sustained virologic response rate (SVR12) was observed for subjects in the double-blind phase and the placebo delayed-treatment phase at 12 weeks after treatment cessation.Virological resistance analysis was performed on subjects who failed treatment. The primary efficacy endpoint was SVR12. The number and percentage of subjects who achieved "HCV RNA

Aiming at the quality problem of preparing gut for patients in test and treatment with colonoscopy,this article involved in one kind of quality judgement system based on cloud processing,which composed of information collection module,cloud processing analysis module,and identification and judgment module for doctor.It could realize automatic interpretation and medication guidance for the quality of preparing gut.In the system,the obtained operation information of depending collection module,and the cloud processor with the ability of analyzing and processing data can judge the quality of preparing gut for patients,and effectively solve a series of problems such as inefficient judgment for preparing gut,and poor quality of preparation.It can help patients to adjust medication,and relieve the pressure of medical staffs in guideline and communication for preparing gut,and enhance the quality of preparing gut,and avoid the influence of insufficient preparation for gut on the test and treatment of colonoscopy,so as to provide more effective safety and guarantee for clinical practice.

Objective:To sort out the situation,content and practical experience of the"four sinkings"in the construction of tightly-knit county medical communities,and provide references and basis for the promotion of policies in various regions.Methods:Quantitative description methods were used to analyze the development trends of the number of health technicians and medical services in primary healthcare facilities.Literature research methods were used to analyze policy content.Case analysis methods were used to summarize and analyze the implementation content and support mechanisms of the"four sinkings"in Youxi County of Fujian Province,Dongyang City of Zhejiang Province,Dongtai City of Jiangsu Province and Suixi County of Anhui Province.Results:From 2010-2022,more health technicians and medical services still flew to hospitals,indicating that personnel is an important impact factor for service sinking.The task of personnel and service sinking to the primary healthcare level is still arduous.From 2023 to 2024,China has issued multiple national policies to clarify the content of the"four sinkings",among which personnel sinking is the core,technology sinking is the means,management sinking is the support,and service sinking is the goal.Case analysis result shows that typical regions have established a long-term mechanism to promote the"four sinkings"through talent pool constrution,economic incentives,medical insurance support and informatization construction.Conclusion and Suggestions:It is needed to enhance the understanding of the"four sinkings",and promote them as important policy measures;promote the experience of typical regions,with a focus on the establishment of a long-term mechanism;and strengthen trace study and monitoring and evaluation to ensure the implementation of the"four sinkings".

Objective:To review the health service system,personnel salary system and service model in Macao Special Administrative Region(Macao),and analyze the reference significance for the of the tightly-knit medical alliance construction.Methods:On-site visits were conducted to 2 hospitals,3 community health service centers and 1 nursing home in Macao.Interviews and focus group discussions were held with key informants.Literature review was carried out at the same time.Qualitative and quantitative analysis methods were used to analyze the collected data.Results:Macao has clearly defined the functional positioning of public hospitals and primary healthcare institutions,and has given full play to the supplementary role of private medical institutions,establishing a grid-based medical and health service system with clear division of labor and public-private cooperation.Macao has implemented a strict system of first diagnosis in primary health care and two-way referral,providing high-quality and efficient medical and health services to community residents.Macao has institutionalized the salary system for medical personnel,with only a small income gap between different types of institutions and personnel,establishing a homogenized high-level medical and health salary system.Conclusion:The mainland should strengthen the financial protection,and promote the coordinated management of staff,funds and properties.Institutionalize the income and responsibility system for medical personnel,and narrow the income gap between different types of institutions and personnel,strengthen the functional positioning of primary health care and services for key populations,and promote first diagnosis in primary health care and two-way referral.