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 investigate the effect of intravenous anesthesia on the detection rate of lesions in diagnostic gastroscopy.Methods:A total of 9 071 subjects who underwent diagnostic gastroscopy at the Digestive Endoscopy Center of Yangzhou University Affiliated Hospital from March 2021 to February 2022 were selected. Data were collected from the gastroscopy quality control system, including age, gender, examination physician, Helicobacter pylori infection, examination method, withdrawal time, number of images left, number of biopsies, biopsy site, gastroscopy diagnosis, pathological diagnosis, etc. They were divided into anesthesia group and general group based on the examination method, and propensity score matching (PSM) was performed on the two groups of subjects. Excluding confounding factors, the detection of lesion location and lesion type in two groups of subjects was analyzed; Simultaneously, univariate and multivariate logistic regression analysis was used to analyze the influencing factors of the detection rate of precancerous lesions and malignant tumors in the upper gastrointestinal tract.Results:After PSM, 1 655 subjects were included in both groups. In terms of lesion location, the detection rate of gastric body lesions in the anesthesia group was higher than that in the general group ( P<0.05), and the detection rate of esophageal lesions in the anesthesia group was lower than that in the general group ( P<0.05); In terms of lesion types, the detection rate of precancerous lesions such as gastric polyps, mucosal protrusions, mucosal atrophy, and intestinal metaplasia in the anesthesia group was higher than that in the general group (all P<0.05). The results of logistic regression analysis showed that intravenous anesthesia was an independent influencing factor for the detection rate of precancerous lesions and malignant tumors in diagnostic gastroscopy ( OR=1.338, 95% CI: 1.070-1.674, P<0.05). Conclusions:Intravenous anesthesia is an independent influencing factor for the detection rate of precancerous lesions and malignant tumors in diagnostic gastroscopy, and can improve the detection rate of upper gastrointestinal lesions.

The incidence and mortality of lung cancer ranked the first in China. China had 787, 000 new cases of lung cancer in 2015, and a majority of these patients with advanced lung cancer. With the development and popularization of high-resolution computed tomography, more and more early-stage lung adenocarcinomas are found in screening. The imaging finding of early-stage lung adenocarcinomas often manifests as part solid nodule (PSN) containing ground glass opacity (GGO). Although the imaging manifestation of the nodules can′t accurately predict the pathologic type of nodules, the parts of solid nodule and GGO still have some pathologic indications, and the prognostic evaluation effect of the maximum diameter of PSN is superior to that of the whole nodule. With the development of the molecular radiography and molecular pathology, the relationship of imaging manifestation of the PSN and metastasis were focused on. Some PSNs with special nature are more active and rapidly progressed than the pure GGOs. While compared to the pure solid nodules, the aggressiveness of PSNs are insufficient, with lower metastatic rates of lymph node and better prognoses. Currently, international acknowledge recommends to take active intervention measure for PSNs which are highly suspected to be malignant. We focus on the diagnosis and treatment of PSNs, systemically depict their staging, follow-up, surgical treatment, gene detection and immunotherapy.

The incidence and mortality of lung cancer ranked the first in China. China had 787, 000 new cases of lung cancer in 2015, and a majority of these patients with advanced lung cancer. With the development and popularization of high-resolution computed tomography, more and more early-stage lung adenocarcinomas are found in screening. The imaging finding of early-stage lung adenocarcinomas often manifests as part solid nodule (PSN) containing ground glass opacity (GGO). Although the imaging manifestation of the nodules can′t accurately predict the pathologic type of nodules, the parts of solid nodule and GGO still have some pathologic indications, and the prognostic evaluation effect of the maximum diameter of PSN is superior to that of the whole nodule. With the development of the molecular radiography and molecular pathology, the relationship of imaging manifestation of the PSN and metastasis were focused on. Some PSNs with special nature are more active and rapidly progressed than the pure GGOs. While compared to the pure solid nodules, the aggressiveness of PSNs are insufficient, with lower metastatic rates of lymph node and better prognoses. Currently, international acknowledge recommends to take active intervention measure for PSNs which are highly suspected to be malignant. We focus on the diagnosis and treatment of PSNs, systemically depict their staging, follow-up, surgical treatment, gene detection and immunotherapy.

Objective:To investigate the occurrence of complications in domestic children's arterial blood specimen collection, analyze its influencing factors, so as to provide an improved basis for improving the quality of arterial blood specimen collection.Methods:This study adopted the cross-sectional research method. From July to September 2019, convenience sampling was used to select 2 235 children admitted to the Department of Pediatrics of 17 children's specialized hospitals and ClassⅢ Grade A hospitals across the country as the research object. The self-designed Childhood Arterial Blood Specimen Collection Complications Questionnaire was used to investigate the status of children's arterial blood specimen collection and the occurrence of complications, and its influencing factors were analyzed. Single factor analysis and binomial Logistic regression were used to analyze the influencing factors of complications in children's arterial blood specimen collection. A total of 2 235 questionnaires were issued, and 2 205 valid questionnaires were returned with the valid response rate of 98.7%.Results:The incidence of complications in the collection of arterial blood specimens in children was 73.2% (1 614/2 205) , mainly subcutaneous hemorrhage, accounting for 71.7% (1 581/2 205) . The incidence of single complications was 57.6% (1 269/2 205) . Binomial Logistic regression analysis showed that the angle of needle insertion, pressing time and the operator's working years were the influencing factors for the complications of arterial blood specimen collection in children, and the differences were statistically significant ( P<0.05) . Conclusions:The incidence of complications in the collection of arterial blood specimens in children is relatively high, which is related to the angle of needle insertion, pressing time, and the working years of the operator. It is necessary to establish standardized operating procedures and homogenized management to further improve the operating level and reduce the incidence of complications in the collection of arterial blood specimens in children.

Objective:To improve accuracy of prediction amount of length of gastric tube placed through nose and reduce occurrence of adverse events thorough clinical observation of measurement of length of nasogastric tube placement in critically ill children.Methods:Using the convenient sampling method, critically ill children who were hospitalized and needed a nasogastric tube in Pediatric Intensive Care Unit (PICU) of Beijing Children's Hospital Affiliated to Capital Medical University were selected from April to September 2019. The prediction method of "nos-ear-xiphoid (NEX) increased by 5 cm" (NEX+5 cm) was adopted. The values of placed length in this study were collected and compared with those predicted by traditional measurement method (namely NEX) , improved "nose-ear-mid-umbilicus" (NEMU) and formula method.Results:A total of 52 critically ill children were enrolled in this study. The length of placed nasogastric tube was 31.5 (28.3, 35.8) cm, and 43 cases (82.7%) were determined to be qualified by X-ray. The length of gastric tube required to be placed in children was 27.0 (24.1, 31.0) cm according to the NEX method, and the length of gastric tube required to be placed in children was 26.1 (22.5, 29.0) cm measured by the formula method. Both were shorter than that measured by NEX+5 cm, and the differences were statistically significant ( P<0.01) . The NEMU method measured the length of gastric tube to be inserted into the child to be 31.0 (28.3, 36.0) cm. Compared with the length measured by NEX+5 cm, and the difference was not statistically significant ( P>0.05) . Conclusions:This study uses NEX+5 cm to predict the actual length of the gastric tube inserted through the nose. The accuracy is relatively high and the operation method is simple. It is necessary to consider individual differences in clinical applications, especially the large variability in infants and young children. After catheterization, abdominal ultrasound, X-ray and other auxiliary examination methods should be used to determine the location of catheterization, and individualized catheterization programs should be given to children according to different therapeutic objective.

Objective:To investigate the clinical practice status of neonatal arterial blood gas collection in Class Ⅲ Grade A children's hospitals in China, so as to provide a reference for further standardizing neonatal arterial blood gas collection operating standards.Methods:From July to September 2020, convenience sampling and self-designed Neonatal Arterial Blood Gas Collection Technology Practice Questionnaire were adopted to conduct a cross-sectional survey on the technical operation of 824 nurses of Neonatology Department in 15 ClassⅢ children's hospitals, general hospitals, and maternal and child health hospitals across the country. A total of 824 questionnaires were distributed, 791 were retrieved, and 747 valid questionnaires were collected.Results:The most common site for neonatal arterial blood gas collection was the radial artery, accounting for 98.80% (738/747) , followed by the brachial artery 47.79% (357/747) . The radial artery was often selected below the place where the pulsation was strongest (46.86%, 350/747) , and the most needles were inserted at an angle of 15° to 30°. The brachial artery was often selected below the place where the pulsation was strongest (58.77%, 439/747) , and the most needles were inserted at an angle of 30° to 45°. The more common complications after arterial blood gas collection were bruising, bleeding, and hematoma. A total of 390 (52.21%) nurses received uniform training in arterial blood gas collection in the past year. There was a statistically significant difference in the incidence of needle stick injuries in the collection of nurses of Neonatology Department who received uniform training or not ( P<0.05) . Conclusions:The operating standards for neonatal arterial blood gas collection are not uniform, and it is necessary to standardize the collection process and management. Although the training for nurses has been carried out in clinical practice, the incidence of needle stick injuries among nurses still needs to be further reduced, especially the targeted training of arterial blood gas collection and operation skills. The collection tools should be improved to increase the success rate of arterial blood collection, reduce the occurrence of complications, and ensure the safety of nurses.

Objective:To investigate the knowledge, attitude and practice of ICU medical staff in in ICU children with delirium in children's hospitals and analyze its influencing factors.Methods:Using the convenient sampling method, ICU medical staff from 26 children's hospitals in China were selected as the research objects from April 20, 2020 to May 10, 2020. A self-designed ICU pediatric delirium knowledge-attitude-practice questionnaire was used to investigate knowledge, attitude and practice scores of ICU medical staff in children's hospitals. Multiple linear regression analysis was used to analyze the influencing factors. A total of 740 questionnaires were collected, of which 734 were effective, with the effective recovery of 99.2%.Results:Among 734 ICU staff in children's Hospital, 78 (10.6%, 78/734) had a good knowledge of delirium and only 236 (32.2%, 236/734) had received training on ICU delirium. 395 (53.8%, 395/734) medical staff carried out clinical delirium management in ICU. And the assessment implementers were mainly doctors, accounting for 63.5% (251/395) , and nurse evaluators accounted for 36.5% (144/395) . The item with the highest score of attitude of 734 pediatric ICU medical staff towards delirium was "the need to understand the relevant knowledge of ICU delirium in clinical nursing work", with a score of (4.22±0.83) . Multiple linear regression analysis showed that the identity of medical staff, department and whether to receive training were the influential factors for the level of knowledge, attitude and practice of delirium among ICU medical staff in children's hospital ( P<0.05) . Conclusions:Pediatric ICU medical staff have insufficient knowledge of delirium and positive attitude towards ICU delirium. They have insufficient initiative in nursing behavior and the clinical development of ICU pediatric delirium management is insufficient and lacks standardization. It is recommended to carry out a diversified training program on ICU delirium related knowledge for pediatric ICU medical staff, formulate an ICU pediatric delirium assessment process and normalize the delirium assessment into clinical practice, so as to identify early delirium in ICU children and take preventive measures to reduce occurrence of delirium.

Objective:To explore the effect of three-level delirium nursing management process on the treatment outcome and quality of care in the pediatric intensive care unit (PICU).Methods:Since January 2019, three-level delirium management process for PICU were developed. 75 children were randomly selected as the experimental group for 6 months, and 75 patients who received routine care between July and December 2018 were selected as the experimental group. The control group received routine nursing care, and compared the differences in the incidence, duration, and length of PICU stay in the intensive care unit (DICU) between the two groups of children. The family members' satisfaction with the quality of care and the evidence-based knowledge of PICU nurses were compared before and after implementation.Results:The incidence of DICU in the experimental group was 21.33% (16/75), the incidence of unsafe events related to DICU was 2.67% (2/75), and the control group was 40.00% (30/75), 12.00% (9/75). The difference was statistically significant ( χ2 values were 6.145, 4.807, P<0.05); the duration of the DICU in the test group (14.16±4.25) hours, and the length of ICU hospitalization (48.62 ± 8.85) hours were less than (17.37±5.36) hours and (52.03±8.10) hours in the control group, the difference was statistically significant ( t values were 2.070, 2.462, P<0.05); The score of Nursing Delirium Screening Scale (Nu-DESC) for nursing care of DICU patients in the two groups was not statistically significant ( P>0.05). The score of the test group after nursing was (1.72 ± 0.75) points, which was lower than (2.17±0.63) points of the control group. The difference was statistically significant ( t value was 2.159, P<0.05); The results of the nursing quality evaluation questionnaire showed that the satisfaction of family members in the test group with respect to nursing services was 93.33% (60/75), which was higher than 82.67% (52/75) in the control group, with a significant difference ( χ2 value was 4.040, P<0.05). After the implementation, the correct answer rate of the "risk factors for delirium" questionnaire in the deliberate evidence-based knowledge questionnaire was significantly higher than before the implementation ( P < 0.05). After 6 months of implementation, the score of evidence-based knowledge of delirium was (6.82 ± 1.74) points higher than (4.26 ± 0.85) points before implementation, the difference was statistically significant ( t value was 3.739, P<0.01). Conclusions:The three-level nursing management process in the PICU ward can better prevent the occurrence of paralysis, strengthen the quality of nursing services, and exercise the comprehensive quality of nursing staff.

Objective To explore the effects and mechanisms of hepatitis B virus-X protein (HBx) on invasion and migration of hepatocellular carcinoma (HCC) cells.Methods The retrospective cohort study was conducted.The clinicopathological data of 30 patients with liver tumor (20 with HCC and 10 with benign tumor of liver) who were admitted to the Affiliated Hospital of Xuzhou Medical College between July 2014 and July 2015 were collected.HCC tissues of 20 patients with HCC (with history of HBV infection) were collected by surgical resection and peritumoral normal tissues (outside of tumor capsule) of 10 patients with benign tumor of liver (without history of HBV infection) were collected.The expressions of epidermal growth factor receptor 3 (ErbB3)in HCC tissues and peritumoral normal tissues were detected by immunohistochemistry (IHC).The relative expressions of ErbB3 and HBx in HCC tissues and peritumoral normal tissues were detected by Western blot,and relative expressions of ErbB3 in HepG2 of which green fluorescent protein (GFP) and GFP-HBx were respectively transfected were detected.The relative expressions of ErbB3 mRNA in HepG2 transfected by GFP and GFP-HBx were detected by real-time polymerase chain reaction (RT-PCR).The migration and invasion of HepG2 were respectively detected by Transwell assay with and without matrix.The measurement data with normal distribution were represented as $± s.The comparisons between groups were evaluated with the independent-sample t test.Correlation analysis was done by the Pearson test.Results (1) The expressions of ErbB3 were detected by IHC:relative value of mean optical density (MOD) of ErbB3 in HCC tissues of 20 patients with HCC and peritumoral normal tissues of 10 patients with benign tumor of liver were 2.54± 1.33 and O.99±0.29,respectively,with a statistically significant difference (t =6.542,P ＜ 0.05).(2) The relative expressions of ErbB3 and HBx were detected by Western blot:relative expressions of ErbB3 and HBx were respectively 0.79±0.13,1.10±0.28 in HCC tissues of 10 patients with HCC and 1.07±0.17,0 in peritumoral normal tissues of 10 patients with benign tumor of liver,with statistically significant differences (t =3.229,19.486,P＜0.05).The results of Pearson test showed that there was a positive correlation of expression between ErbB3 and HBx in HCC tissues (r=O.637,P＜ 0.05).(3) The relative expressions and transcriptional levels of ErbB3 were detected by Western blot and RT-PCR:relative expressions of ErbB3 in HepG2 of which GFP and GFP-HBx were respectively transfected were O.75±0.11 and 1.10±0.10,respectively,with a statistically significant difference (t=4.291,P＜0.05).The relative expressions of ErbB3 mRNA in HepG2 of which GFP and GFP-HBx were respectively transfected were O.38±0.03 and O.94±0.07,respectively,with a statistically significant difference (t=11.703,P＜O.05).(4) The effects of ErbB3 on migration and invasion of HepG2:numbers of transmenbrane cell in HepG2 of which His and His-ErbB3 were respectively transfected by Transwell assay with matrix were respectively 271± 18 and 463± 31,respectively,with a statistically significant difference (t =8.202,P＜0.05).Numbers of transmenbrane cell in HepG2 of which His and His-ErbB3 were respectively transfected by Transwell assay without matrix were respectively 315±38 and 549±34,respectively,with a statistically significant difference (t =8.310,P＜0.05).Conclusion HBx protein can promote the invasion and migration of hepatocellular carcinoma cells through up-regulating expressions of ErbB3 protein.