The surgical management of empyema (excluding those caused by mycobacterium tuberculosis and non-tuberculous mycobacteria) is rapidly evolving towards minimally invasive, precise, and stepwise approaches. The traditional three-stage classification (exudative, fibrinopurulent, and organizing) has limitations in guiding dynamic clinical decision-making. For the first time, this consensus explicitly identifies two critical junctures in the pathological progression of empyema: "early transformation" (stage Ⅰ to Ⅱ) and "late transformation" (stage Ⅱ to Ⅲ), and thereby constructs a corresponding "identification-early warning-intervention" stepwise therapeutic framework. The consensus emphasizes that proactive debridement via video-assisted thoracoscopic surgery should be performed during the early transformation phase to halt disease progression. Conversely, during the late transformation phase, therapeutic goals should be rationally adjusted to prioritize adequate drainage, avoiding futile pleural decortication. Moreover, the consensus underscores the pivotal role of precise perioperative etiological diagnosis (e.g. metagenomic nest-generation sequencing) and standardized anti-infective therapy. Integrating practical experiences from multiple thoracic surgery centers in China and relevant evidence-based literature, this consensus formulates recommendations on the precise definitions of staging, surgical indications for each phase, key technical points, perioperative management, and training systems. It aims to promote the standardized and individualized surgical management of empyema, ultimately optimizing patient prognosis.

Objective:To evaluate the application effect of management mode based on constraint theory for medical equipment in equipment management of vascular surgery. Methods:Based on five-step method of constraint theory,an operation evaluation system was formulated. An information management mode of medical equipment was constructed to manage quality of medical equipment in department of vascular surgery. A total of 60 sets used medical equipment in the Department of Vascular Surgery at The Second Affiliated Hospital of Xi'an Jiaotong University from 2021 to 2022 were selected. The conventional management mode was adopted to manage these equipment between January to December 2021,while equipment was managed by using medical equipment management mode based on constraint theory (constraint theory management) of the department of vascular surgery from January to December 2022. The quality scores of operation and maintenance of equipment,average incidence rates of risk,configuration effectiveness,and timeliness of equipment management were compared between the two management modes. Results:After constraint theory management was implemented,the average scores of operation and maintenance of equipment,which included success starting-up,operation,routine maintenance and fault repair,were respectively (90.69±8.65),(89.65±4.65),(88.65±5.63),and (90.58±6.01),all of which were higher than those of conventional management mode. The differences of them between two modes were statistically significant (t=13.482,17.867,14.552,14.449,P<0.05). The average incidence rates of the risks of testing equipment,treatment,monitoring equipment and auxiliary equipment of adopting constraint theory mode management were (0.89±0.22)％,(0.84±0.23)％,(0.74±0.32)％ and (0.75±0.32％),all which were lower than those of the conventional management mode,with statistically significant differences (t=9.162,17.745,19.469,15.019,P<0.05). The average utilization rate of equipment and the average amplification of cost benefit of equipment were respectively (88.69±5.54)％ and (50.36±2.69)％ after constraint theory mode was adopted,which were significantly higher than those of conventional management mode,and the average floating rate of using equipment of constraint theory mode was (1.23±0.97)％,which was lower than that of conventional management model,the differences of them between two modes were statistically significant (t=14.174,21.564,11.811,P<0.05). The average times of emergency management for risk events included the safety of power consumption of equipment,safety of diagnosis and treatment,biological safety and radiation safety were respectively (2.36±0.64)h,(3.26±0.78)h,(4.23±1.24)h and (2.26±1.23)h after the constraint theory mode was adopted,all of which were significantly less than those of conventional management mode,and the differences of them between two modes were statistically significant (t=16.704,13.421,9.029,13.971,P<0.05). Conclusion:The application of the management mode based on the constraint theory of medical equipment in department of vascular surgery can improve the quality of operation and maintenance of equipment for safety,and shorten the emergency response time of equipment,and reduce the incidence of equipment risk,and strengthen the effect of configuration for equipment.

[Objective] To explore the temperature parameters affecting the polybrene test and determine the optimal temperature conditions for detecting unexpected antibodies of the Rh system. [Methods] The reaction of IgG human anti-D antibody with different dilutions (undiluted, 1∶2, 1∶4, 1∶8, 1∶16, 1∶32，1∶64) with D antigen-positive red blood cells was detected by manual polybrene test (MPT). Different temperatures (25℃ and 37℃) were set, and the reaction time with low ionic medium was 4 minutes. The agglutination integral value of anti-D and red cell depolymerization time were compared to observe the effect of enhanced agglutination reaction, thereby establishing the test temperature reaction conditions for enhancing the MPT. The same reaction condition was applied to 36 blood samples containing unexpected antibodies of the Rh system, and the effect of enhanced MPT was observed in comparison with the polybrene method and the antiglobulin test (column agglutination). [Results] With all other conditions held constant, when low ionic medium was added, the incubation temperature of 25℃ and 37℃ resulted in different total agglutination integral values for anti-D (20.9±2.025 vs 25.5±2.635), and the comparison showed a significant difference (P<0.05). When the antibody dilution was 1∶16, the incubation temperature of 25℃ and 37℃ resulted in different agglutination integral values (3.9±0.738 vs 5.8±0.632), and the comparison showed a significant difference (P<0.05). Erythrocyte depolymerization time (62.8±8.149 vs 90.1±10.713) was significantly different (P<0.05). At a dilution of 1∶32, the incubation temperatures of 25℃ and 37℃ resulted in different agglutination integral values (2.5±0.527 vs 4.3±0.675), as well as different red blood cell dissociation times (35.4±7.792 vs 57.4±10.885)(P<0.05), and the comparison showed a significant difference (P<0.05), with no differences observed in the other groups. In the detection of 36 Rh system unexpected antibody samples, when the antibody titer was ≤2, the enhanced polybrene method had a higher positive rate, and when the antibody titer was ≥4, the detection rates of the three methods were consistent. [Conclusion] The reference temperature condition for the modified MPT is incubation at 37℃ for 4 min after the addition of low ionic medium. The application of this temperature condition to unexpected antibody samples of Rh system could achieve a significant enhancement effect, thereby increasing transfusion safety for the treatment of emergency patients, and is worth popularizing.

Yttrium-90 selective internal radiation therapy (⁹⁰Y-SIRT) is a treatment technique that delivers radioactive microspheres precisely to the arterial vascular bed of neoplasms, utilizing beta radiation to administer a high local dose of radiation to the neoplasm tissues. This technology has demonstrated significant efficacy in patients with unresectable pirmary liver cancers and liver metastases. This article systematically reviews the development history and clinical application status of ⁹⁰Y-SIRT in the treatment of liver cancer, and looks forward to future development directions.

Frequent occurrence of disaster rescue and public health emergencies has increased demand for rapidly and efficiently emergent medical rescue.This study modified a closed van which equipped a rapid testing module for physiological indicators,clinical blood transfusion module,detection and sampling module of etiology,and module for health and epidemic prevention.This research designed one kind of emergent vehicle for rapidly comprehensive detection,which integrated test vehicle,blood transfusion vehicle,biosafety testing vehicle,and vehicle for health and epidemic prevention in one vehicle.This vehicle can meet various demands of emergently medical rescue and other tasks in clinical test,which can improve the response capability and emergency handling capability for disasters and public health emergencies,at the same time,it also can save manpower.

Objective:To investigate the mechanism by which hydrogen alleviates myocardial ischemia/reperfusion injury (IRI) through ultrasound-targeted destruction of hydrogen-loaded phospholipid microbubbles in the ischemic myocardium of rats.Methods:A total of 45 rats were randomly divided into three groups: sham operation group, IRI group (model group), and hydrogen treatment group (experimental group), with 15 rats in each group. A rat model of myocardial IRI was established. Rats in the sham group received 0.2 ml of normal saline via the tail vein, those in the model group received 0.2 ml of phospholipid microbubbles without hydrogen, and those in the treatment group received 0.2 ml of hydrogen-loaded phospholipid microbubbles. After 24 hours, cardiac function was assessed by left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS). Serum levels of cardiac troponin I (cTnI), creatine kinase-myocardial band (CK-MB), lactate dehydrogenase (LDH), and interleukin-6 (IL-6) were measured by enzyme-linked immunosorbent assay (ELISA). Expression levels of Janus knase 2(JAK2), signal transducer and activator of transcription 3(STAT3), phosphorylated JAK2(p-JAK2), and phosphorylated STAT3(p-STAT3) proteins in myocardial tissue were detected by Western blot. Myocardial infarct size was evaluated by 2,3,5-triphenyltetrazolium chloride (TTC) staining, and myocardial histopathological changes were observed by hematoxylin-eosin (HE) staining.Results:After 24 hours of reperfusion, LVEF [(54.26±2.92) % vs (45.77±27%)] and LVFS [(24.11±1.68) % vs (19.50±1.19%)] were significantly higher in the treatment group than in the model group (both P<0.001). ELISA results showed that levels of CK-MB [(13.58±2.07) μg/L vs (20.07±1.57) μg/L], LDH [(47.76±8.32) μg/L vs (74.39±10.19) μg/L], cTnI [(7.50±0.26) μg/L vs (9.05±0.34) μg/L], and IL-6 [(121.34±8.97) ng/L vs (156.99±6.46) ng/L] were significantly lower in the treatment group compared with the model group (all P<0.001). TTC staining revealed a smaller infarct size in the treatment group [(48.77±2.68)%] than in the model group [(63.53±3.10)%, P<0.001]. Western blot analysis showed that the expression levels of JAK2 and p-STAT3 proteins were significantly lower in the treatment group than in the model group ( P<0.05). HE staining showed no pathological abnormalities in major organs (heart, liver, spleen, lung, and kidney) following hydrogen microbubble treatment. Conclusions:Ultrasound-targeted destruction of hydrogen microbubbles enables local hydrogen release in the myocardium, which downregulates IL-6 and inhibits activation of the JAK/STAT signaling pathway, thereby attenuating inflammation and reducing ischemia/reperfusion injury.

Objective:To evaluate the application effect of management mode based on constraint theory for medical equipment in equipment management of vascular surgery. Methods:Based on five-step method of constraint theory,an operation evaluation system was formulated. An information management mode of medical equipment was constructed to manage quality of medical equipment in department of vascular surgery. A total of 60 sets used medical equipment in the Department of Vascular Surgery at The Second Affiliated Hospital of Xi'an Jiaotong University from 2021 to 2022 were selected. The conventional management mode was adopted to manage these equipment between January to December 2021,while equipment was managed by using medical equipment management mode based on constraint theory (constraint theory management) of the department of vascular surgery from January to December 2022. The quality scores of operation and maintenance of equipment,average incidence rates of risk,configuration effectiveness,and timeliness of equipment management were compared between the two management modes. Results:After constraint theory management was implemented,the average scores of operation and maintenance of equipment,which included success starting-up,operation,routine maintenance and fault repair,were respectively (90.69±8.65),(89.65±4.65),(88.65±5.63),and (90.58±6.01),all of which were higher than those of conventional management mode. The differences of them between two modes were statistically significant (t=13.482,17.867,14.552,14.449,P<0.05). The average incidence rates of the risks of testing equipment,treatment,monitoring equipment and auxiliary equipment of adopting constraint theory mode management were (0.89±0.22)％,(0.84±0.23)％,(0.74±0.32)％ and (0.75±0.32％),all which were lower than those of the conventional management mode,with statistically significant differences (t=9.162,17.745,19.469,15.019,P<0.05). The average utilization rate of equipment and the average amplification of cost benefit of equipment were respectively (88.69±5.54)％ and (50.36±2.69)％ after constraint theory mode was adopted,which were significantly higher than those of conventional management mode,and the average floating rate of using equipment of constraint theory mode was (1.23±0.97)％,which was lower than that of conventional management model,the differences of them between two modes were statistically significant (t=14.174,21.564,11.811,P<0.05). The average times of emergency management for risk events included the safety of power consumption of equipment,safety of diagnosis and treatment,biological safety and radiation safety were respectively (2.36±0.64)h,(3.26±0.78)h,(4.23±1.24)h and (2.26±1.23)h after the constraint theory mode was adopted,all of which were significantly less than those of conventional management mode,and the differences of them between two modes were statistically significant (t=16.704,13.421,9.029,13.971,P<0.05). Conclusion:The application of the management mode based on the constraint theory of medical equipment in department of vascular surgery can improve the quality of operation and maintenance of equipment for safety,and shorten the emergency response time of equipment,and reduce the incidence of equipment risk,and strengthen the effect of configuration for equipment.

Frequent occurrence of disaster rescue and public health emergencies has increased demand for rapidly and efficiently emergent medical rescue.This study modified a closed van which equipped a rapid testing module for physiological indicators,clinical blood transfusion module,detection and sampling module of etiology,and module for health and epidemic prevention.This research designed one kind of emergent vehicle for rapidly comprehensive detection,which integrated test vehicle,blood transfusion vehicle,biosafety testing vehicle,and vehicle for health and epidemic prevention in one vehicle.This vehicle can meet various demands of emergently medical rescue and other tasks in clinical test,which can improve the response capability and emergency handling capability for disasters and public health emergencies,at the same time,it also can save manpower.

Objective:To investigate the mechanism by which hydrogen alleviates myocardial ischemia/reperfusion injury (IRI) through ultrasound-targeted destruction of hydrogen-loaded phospholipid microbubbles in the ischemic myocardium of rats.Methods:A total of 45 rats were randomly divided into three groups: sham operation group, IRI group (model group), and hydrogen treatment group (experimental group), with 15 rats in each group. A rat model of myocardial IRI was established. Rats in the sham group received 0.2 ml of normal saline via the tail vein, those in the model group received 0.2 ml of phospholipid microbubbles without hydrogen, and those in the treatment group received 0.2 ml of hydrogen-loaded phospholipid microbubbles. After 24 hours, cardiac function was assessed by left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS). Serum levels of cardiac troponin I (cTnI), creatine kinase-myocardial band (CK-MB), lactate dehydrogenase (LDH), and interleukin-6 (IL-6) were measured by enzyme-linked immunosorbent assay (ELISA). Expression levels of Janus knase 2(JAK2), signal transducer and activator of transcription 3(STAT3), phosphorylated JAK2(p-JAK2), and phosphorylated STAT3(p-STAT3) proteins in myocardial tissue were detected by Western blot. Myocardial infarct size was evaluated by 2,3,5-triphenyltetrazolium chloride (TTC) staining, and myocardial histopathological changes were observed by hematoxylin-eosin (HE) staining.Results:After 24 hours of reperfusion, LVEF [(54.26±2.92) % vs (45.77±27%)] and LVFS [(24.11±1.68) % vs (19.50±1.19%)] were significantly higher in the treatment group than in the model group (both P<0.001). ELISA results showed that levels of CK-MB [(13.58±2.07) μg/L vs (20.07±1.57) μg/L], LDH [(47.76±8.32) μg/L vs (74.39±10.19) μg/L], cTnI [(7.50±0.26) μg/L vs (9.05±0.34) μg/L], and IL-6 [(121.34±8.97) ng/L vs (156.99±6.46) ng/L] were significantly lower in the treatment group compared with the model group (all P<0.001). TTC staining revealed a smaller infarct size in the treatment group [(48.77±2.68)%] than in the model group [(63.53±3.10)%, P<0.001]. Western blot analysis showed that the expression levels of JAK2 and p-STAT3 proteins were significantly lower in the treatment group than in the model group ( P<0.05). HE staining showed no pathological abnormalities in major organs (heart, liver, spleen, lung, and kidney) following hydrogen microbubble treatment. Conclusions:Ultrasound-targeted destruction of hydrogen microbubbles enables local hydrogen release in the myocardium, which downregulates IL-6 and inhibits activation of the JAK/STAT signaling pathway, thereby attenuating inflammation and reducing ischemia/reperfusion injury.

Objective To compare the safety and efficacy of the da Vinci robot and thoracoscopic subxiphoid approach for the treatment of anterior mediastinal tumors. Methods The clinical data of patients who underwent anterior mediastinal tumor resection through the subxiphoid approach admitted to the same medical group in the Department of Thoracic Surgery of the First Hospital of Lanzhou University between June 2020 and April 2022 were retrospectively analyzed. According to the surgery approach, the patients were divided into a robot-assisted thoracoscopic surgery (RATS) group and a video-assisted thoracoscopic surgery (VATS) group. The perioperative data and the incidence of postoperative complications were compared between the two groups. Results A total of 79 patients were enrolled. There were 41 patients in the RATS group, including 13 males and 28 females, with an average age of 45.61±14.99 years. There were 38 patients in the VATS group, including 14 males and 24 females, with an average age of 47.84±15.05 years. All patients completed the surgery successfully. Hospitalization cost and operative time were higher or longer in the RATS group than those in the VATS group, and the difference was statistically significant (P<0.05). Intraoperative bleeding, postoperative hospital stay, postoperative water and food intake time, postoperative off-bed activity time, white blood cell count, neutrophil percentage and visual analogue scale (VAS) score on the first postoperative day, white blood cell count and neutrophil percentage on the third postoperative day, duration of analgesic pump use, the number of voluntary compressions of the analgesic pump, and mediastinal drainage volume were all superior to those in the VATS group (P<0.05). The differences in VAS scores on the third postoperative day, duration of drainage tube retention and postoperative complication rates were not statistically different between the two groups (P>0.05). Conclusion RATS subxiphoid anterior mediastinum tumor resection is a safe and feasible surgical method with less injury and higher safety, which is conducive to rapid postoperative recovery and has wide clinical application prospects.