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 summarize the experience of surgical methods without repairing the fistula for 92 cases with gastrointestinal intrathoracic fistula.Methods:The surgical methods without repairing the fistula were performed through VATS, small incision assisted with VATS or thoracotomy. The focus of the surgery was to promote lung expansion, eliminate the residual cavity of chest cavity and keep effective drainage. After entering the chest cavity from the affected side, wash chest cavity with a large amount of warm normal saline and sterilize intermittently with iodophor to ensure the sterile environment in the pus cavity. Then completely remove the pleural cellulose or fiberboard on visceral pleura to promote lung expansion, eliminate the residual cavity of the chest cavity. The fistula was covered tightly and supported firmly by the visceral pleura on the lung. Multiple T-tubes were placed in thoracic cavity and fistula to keep effective postoperative drainage.Results:Among 92 cases, 85 cases were cured and the cure rate was 92.4% (85/92).7 cases died and the mortality rate was 7.61% (7/92). The 7 dead cases include 5 cases with esophagogastric anastomotic fistula (the death of 3 cases was cause by aortic esophagogastric fistula, the death of 1 case was cause by thoracic gastric tracheal fistula and 1 case was dead because of pulmonary infection and respiratory failure), 1 case with esophageal rupture (the cause of death was septic shock ), and 1 case with esophageal perforation(the cause of death was pulmonary infection and respiratory failure).Conclusion:Most of the surgeries without repairing gastrointestinal intrathoracic fistula are conducted simply through VATS or small incision assisted with VATS., which is safe and effective.

Objective To investigate the expressions of tumor necrosis factor-alpha (TNF-α),tumor necrosis factor receptor (TNFR)1 and TNFR2 in different cervical lesions and their relationships with clinicopathological characteristics.Methods Forty-one cases of cervical squamous cell carcinoma (CSCC) patients (CSCC group) treated in 254th Hospital of People's Liberation Army from January 2015 to December 2017 wereselected as the subjects.Forty-nine cases of high grde squmous intrepithelial lesion (HSIL) (HSIL group) and fifty cases of uterine myoma (normal group) were selected as control groups.The expression of TNF-α in cervical tissues of different lesions was detected by immunohistochemistry.The expressions of TNF-α mRNA,TNFR1 mRNA and TNFR2 mRNA were detected by quantificational real-time polymerase chain reaction (qRT-PCR).The expression level of TNFR1 and TNFR2 proteins are measured by Western blotting.The relationships between the expression level of TNF-α mRNA,TNFR1 mRNA and the clinicopathological characteristics of patients were analyzed.Results The positive rates of TNF-α in the normal group,the HSIL group and the CSCC group were 8.0％ (4/50),59.2％ (29/49) and 73.2％ (30/41).The difference between three groups was statistically significant (x2 =44.786,P ＜ 0.001).The positive rates of the HSIL group and the CSCC group were significantly higher than that in the normal group,the difference was statistically significant (x2 =29.175,P ＜ 0.001;x2 =40.883,P ＜ 0.001),but there was no statistical difference in the positive rates of TNF-α in CSCC group and HSIL group (x2 =1.934,P =0.164).The results of qRT-PCR showed that the expressions of TNF-α mRNA in normal group,HSIL group and CSCC group were 1.32 ± 0.21,3.64 ± 0.41 and 7.51 ± 1.42.The difference of TNF-α mRNA expression among three groups was statistically significant (F =655.800,P ＜ 0.001).The expressions level of TNF-α mRNA in HSIL group and CSCC group were significantly higher than that in normal group (t =31.747,P ＜ 0.001;t =51.012,P ＜ 0.001),and the expression level of CSCC group was significantly higher than that in HSIL group (t =20.039,P ＜ 0.001).The expression levels of TNFR1 mRNA in the normal group,the HSIL group and the CSCC group were 0.42 ± 0.13,0.89 ±0.21 and 2.23 ± 0.46.The relative expression of TNFR1 mRNA between the three groups was statistically significant (F =465.900,P ＜ 0.001).The expression levels of TNFR1 mRNA in group HSIL and CSCC were significantly higher than that in normal group (t =13.357,P ＜ 0.001;t =26.587,P ＜ 0.001),and the expression level of CSCC group was significantly higher than that in HSIL group (t =18.407,P ＜ 0.001).The expression of TNFR2 mRNA in the normal group,the HSIL group and the CSCC group were 0.38 ± 0.14,0.41 ± 0.11 and 0.44 ± 0.12.There was no significant difference between three groups (F =2.633,P =0.075).Western blottting showed that the expression intensity of TNFR1 in the normal group,the HSIL group and the CSCC group were 0.84 ±0.18,1.95 ±0.21 and 3.38 ±0.73,the difference was statistically significant (F =398.000,P ＜ 0.001).The expression intensity of TNFR1 in group HSIL and CSCC were significantly higher than that in normal group (t =18.273,P ＜ 0.001;t =39.894,P ＜ 0.001),and the expression in CSCC group was also significantly higher than that in group HSIL (t =22.357,P ＜ 0.001).The expression intensity of TNRF2 in normal group,HSIL group and CSCC group were 0.98 ± 0.15,1.02 ± 0.17,1.07 ± 0.21,and the difference was not statistically significant (F =2.938,P =0.056).The results of protein detection were in accordance with the results of mRNA detection.The expression of TNF-α mRNA in the CSCC tissues was related to the size of the tumor (t =-8.868,P ＜ 0.001),the degree of differentiation (t =-5.644,P ＜ 0.001),the clinical stage (t =-19.329,P ＜ 0.001),the depth of infiltration (t =-11.170,P ＜0.001),and lymph node metastasis (t =-8.339,P ＜ 0.001).The expression of TNFR1 mRNA was closely related to the tumor size (t =-13.309,P ＜ 0.001),degree of differentiation (t =-13.449,P ＜ 0.001),clinical stage (t =-12.949,P ＜0.001),depth of infiltration (t =-18.124,P ＜0.001),and lymph node metastasis (t =-20.506,P ＜ 0.001).Conclusion In cervical cancer tissues,the expression intensity of TNF-α and TNFR1 increased abnormally,while TNFR2 did not change significantly.The expressions of TNF-α and TNFR1 are positively correlated with the malignancy of cervical cancer.They are potential signals of cervical cancer and are expected to become new therapeutic targets.However,the activation of TNFR2 to downstream signaling pathway is significantly weaker than that of TNFR1.

OBJECTIVETo evaluate the cost-effectiveness of two breast cancer screening modalities conducted in Minhang district of Shanghai, China.

METHODSAn organized and an opportunistic breast screening programs were implemented among women aged 35-74 years in Minhang district of Shanghai between May 2008 and Oct 2010, and were compared with the results obtained without screening. Costs related to screening were obtained by access to finance data of the screening programs, and costs of first treatment were collected through patient survey and medical reimbursement system query. Information on breast cancer stage was obtained from Shanghai Cancer Registry and confirmed by medical chart review. The effectiveness of screening was evaluated by breast cancer stage improvement.Cost-effectiveness ratios (CERs) were computed as costs of gaining a stage improvement from a specified screening strategy when compared with the results obtained without screening. Incremental cost-effectiveness (ICER) which compares the two screening strategies was calculated by dividing the difference in total net costs and the difference in stages improved between the two screening strategies.

RESULTSThirty-five, one hundred and ninety-three and four hundred and seventy-nine breast cancer cases were identified in the organized screening, opportunistic screening and control groups, with an early detection rate of 46.9%, 40.7% and 38.9%, respectively. The costs of screening were 208 yuan per person or 72 453 yuan per case detected in the organized screening group and were 21 yuan per person or 11 640 yuan per case detected in the opportunistic screening group. The total cost was 103 650 yuan per case in the organized screening group, significantly higher than 50 712 yuan in the opportunistic screening group and 35 413 yuan in the control group. However, the average direct medical cost was significantly lower in the organized screening group than that in the opportunistic screening group and control group, with median costs of 11 024 yuan, 13 465 yuan and 14 243 yuan per case, respectively (P<0.001). The additional cost per case detected was 68 237 yuan for the organized screening and 15 299 yuan for opportunistic screening. The CERs were 135 291 yuan and 152 179 yuan per stage improved in the organized screening and opportunistic screening relative to the control group, with ICER of organized versus opportunistic screening being 131 086 yuan per stage improved.

CONCLUSIONSThe organized screening modality and the opportunistic one are both effective in early detecting breast cancer in Chinese women. The organized screening costs more than opportunistic screening, but with a better cost-effectiveness. It may be used as an option in economically developed areas of China.

Adult ; Aged ; Breast Neoplasms ; diagnosis ; pathology ; China ; Cost-Benefit Analysis ; Early Detection of Cancer ; economics ; Female ; Humans ; Mass Screening ; economics ; Middle Aged ; Program Development ; economics ; Surveys and Questionnaires

Objective: This paper proposes a design of portable ECG monitor in dual processor based on 3G, analyzes the design for function module. Methods: Bases on 3G, network, multimedia technology, the monitor equips an TMS302VC5402 micro-processor as its main controller, digital signals processor BSP15 process multimedia message,and 3G communication module HC25 to realize the wireless communication. Results: The system has the functions of ECG display and automated analysis and diagnosis, which can detect and send the data to monitoring center of hospital within the coverage of 3G network.The system can help a patient far away from the hospital save herself(or himself) by the two-way video technology. Conclusions: The real-ization of this system can help doctor real-time, full-scale, no the region restrainedly to obtain the ECG message of patient. The system is suitable for the patient of coronary.The 3G leads the ECG information to deliver more rapidly and conveniently.