Over 2 million thoracoscopic pulmonary resections are performed globally each year,however,postoperative persistent air leak(PAL)remains a common and challenging complication.It not only prolongs hospital stays and increases treatment costs but may also lead to severe complica-tions,particularly inducing a higher risk in patients undergoing mechanical ventilation.In recent years,with the improvement of preoperative preventive measures,the advancement of surgical tech-niques,and the application of repair materials,the incidence of PAL has decreased.This review sys-tematically summarized the definition,clinical impact,risk factors and preventive strategies of PAL,and explored commonly used treatment modalities,such as thoracic drain management,pleurodesis and the application of novel repair materials.It also analyzed the effectiveness,safety and challenges of existing techniques.Furthermore,this review proposed the establishment of an enhanced recovery after surgery(ERAS)integrated pathway combining bovine pericardium(BP)patch with electro-me-chanical stapler and conducted corresponding treatment benefit-cost assessment.

Objective:To explore the impact of Lupeol on Th17/Treg immune balance in rats with ulcerative colitis(UC)and the regulatory mechanism on PI3K/AKT/NF-κB signal pathway.Methods:All rats were randomly grouped into control group,model group,positive drug group(sulfasalazine),PI3K inhibitor group(LY294002 group),Lupeol group and Lupeol+PI3K activator group(Lupeol+740Y-P group),with 15 rats in each group.The rats were scored with UC disease activity index(DAI);HE staining was used to observe the pathological changes of the colon in rats and inflammation scoring was performed;the levels of serum IL-17 and IL-10 were detected by ELISA;the levels of Th17 and Treg cells in the mucosa of lamina propria of colon were detected by flow cytome-try;Western blot was applied to detect the expressions of RORγt,FOXP3 and PI3K/AKT/NF-κB pathway related proteins in colon tis-sue.Results:Compared with the control group,DAI score,inflammation score,serum IL-17 content,colon tissue Th17 cell level,RORγt expression and p-PI3K/PI3K,p-AKT/AKT,p-NF-κB p65/NF-κB p65 of rats in model group were increased,IL-10 content,Treg cell level and FOXP3 expression were decreased(P<0.05);compared with the model group,DAI score,inflammation score,serum IL-17 content,colon tissue Th17 cell level,RORγt expression and p-PI3K/PI3K,p-AKT/AKT,p-NF-κB p65/NF-κB p65 of rats in positive drug group,LY294002 group and Lupeol group were decreased,IL-10 content,Treg cell level and FOXP3 expression were increased(P<0.05);after further addition of PI3K activator 740Y-P,it was found that 740Y-P reversed the inhibition of Lupeol on Th17 cells and the promotion on Treg cells(P<0.05).Conclusion:Lupeol regulates Th17/Treg immune balance in UC rats by inhibiting PI3K/AKT/NF-κB signal pathway.

Objective:To explore the impact of Lupeol on Th17/Treg immune balance in rats with ulcerative colitis(UC)and the regulatory mechanism on PI3K/AKT/NF-κB signal pathway.Methods:All rats were randomly grouped into control group,model group,positive drug group(sulfasalazine),PI3K inhibitor group(LY294002 group),Lupeol group and Lupeol+PI3K activator group(Lupeol+740Y-P group),with 15 rats in each group.The rats were scored with UC disease activity index(DAI);HE staining was used to observe the pathological changes of the colon in rats and inflammation scoring was performed;the levels of serum IL-17 and IL-10 were detected by ELISA;the levels of Th17 and Treg cells in the mucosa of lamina propria of colon were detected by flow cytome-try;Western blot was applied to detect the expressions of RORγt,FOXP3 and PI3K/AKT/NF-κB pathway related proteins in colon tis-sue.Results:Compared with the control group,DAI score,inflammation score,serum IL-17 content,colon tissue Th17 cell level,RORγt expression and p-PI3K/PI3K,p-AKT/AKT,p-NF-κB p65/NF-κB p65 of rats in model group were increased,IL-10 content,Treg cell level and FOXP3 expression were decreased(P<0.05);compared with the model group,DAI score,inflammation score,serum IL-17 content,colon tissue Th17 cell level,RORγt expression and p-PI3K/PI3K,p-AKT/AKT,p-NF-κB p65/NF-κB p65 of rats in positive drug group,LY294002 group and Lupeol group were decreased,IL-10 content,Treg cell level and FOXP3 expression were increased(P<0.05);after further addition of PI3K activator 740Y-P,it was found that 740Y-P reversed the inhibition of Lupeol on Th17 cells and the promotion on Treg cells(P<0.05).Conclusion:Lupeol regulates Th17/Treg immune balance in UC rats by inhibiting PI3K/AKT/NF-κB signal pathway.

OBJECTIVE To study the effects of bergapten in the treatment of liver fibrosis and its mechanism based on serum metabolomics. METHODS Forty mice were divided into normal control group （0.5% carboxymethyl cellulose sodium solution）， model group （0.5% carboxymethyl cellulose sodium solution）， and BP low-dose and high-dose groups （50， 100 mg/kg）， with 10 mice in each group. Except for the normal control group， the other three groups were all treated with carbon tetrachloride to induce liver fibrosis model； they were given relevant medicine/solution intragastrically， once a day， for consecutive 8 weeks. After the last medication， the levels of alanine aminotransferase （ALT） and aspartate aminotransferase （AST） in serum were detected， and liver pathological changes were observed； the expressions of α-smooth muscle actin （α-SMA） and Collagen Ⅰ were detected in liver tissue； the serum of the mice was collected for metabolomics analysis. RESULTS Compared with the model group， serum levels of ALT and AST and protein expressions of α-SMA and Collagen Ⅰ in liver tissue were decreased significantly in BP high-dose and low-dose groups （P＜0.05）， while liver fibrosis was improved significantly. Meanwhile， metabolomics analyses showed that there were a total of 175 serum differential metabolites in the BP high-dose group and model group， of which 18 substances were upregulated and 157 substances were downregulated； the main metabolic pathways involved in bergapten intervention were pyrimidine metabolism， butanoate metabolism， fatty acid synthesis， tyrosine metabolism， β-alanine metabolism， nicotinic acid and nicotinamide metabolism， glutathione metabolism， etc. CONCLUSIONS BP is effective in the treatment of liver fibrosis by regulating pyrimidine metabolism， butanoate metabolism， glutathione metabolism and so on in rats with liver fibrosis.

Objective:To investigate the clinical and genetic features of early-onset Alzheimer's disease(EOAD)and the characteristics of pathogenic mutations in probands and their families.Methods:Clinical and genetic features of three EOAD probands and their family members China were analyzed and summarized.Peripheral blood of three probands and their relatives was collected and the genes were detected by second generation sequencing(Next Generation Sequencing, NGS). Pathogenic mutations carried by the probands were identified by whole exome sequencing and then verified by Sanger sequencing in the probands and their families.Furthermore, the clinical and genetic characteristics of EOAD were discussed.Results:The first case was familial EOAD, with the heterozygous mutation c. 851C>T(p.P284L)in exon 8 of PSEN1.The second was also a case of familial EOAD, involving the heterozygous deletion mutation c. 497_499del(p.Ile167del)in exon 6 of PSEN1.In the third proband, there was no family history and the c. 626G>A(G209E)mutation was found in exon 7 of the PSEN1 gene.All three patients had memory loss as their first symptom, accompanied by clinical manifestations of slow movement, abnormal gait, unclear speech, bladder and bowel incontinence, psychiatric and other symptoms.Conclusions:These mutations represent additional mutation types and clinical manifestations in EOAD patients.Examining the genetic characteristics of PSEN1 in EOAD may contribute to the understanding of the pathogenesis, genetic classification and clinical diagnosis of EOAD.

Forty three patients with L5-S1 spondylolisthesis undergoing surgical treatment from April 2012 to November 2014 were included for analysis,including 20 cases received transforaminal lumbar interbody fusion (TLIF group) and 23 cased received posterior lumbar interbody fusion (PLIF group).The incision length,operative time were shorter and blood loss was less in TLIF group than those in PLIF group [(9.6±0.9) vs.(16.1±1.5) cm,(125.6±13.0) vs.(156.4±11.8) minand (218.7±22.5)ml vs.(326.5 ±20.1) ml,respectively,all P =0.000].There was no statistical difference in the S1 pedicle screw (S1PS) insertion point between two approaches[(29.4 ± 1.9) vs.(28.5 ± 1.0) mm,P =0.069],but the distance from the midline to the lateral edge of the screw (12.9 ±3.6) mm,S1PS angle (23.3 ±2.1) ° and length of S1PS length with the sacral body (40.9 ± 2.6) mm in the TLIF group were better than those in PLIF group (P =0.000).Our results demonstrate that the paraspinal muscle approach for the treatment of L5-S1 spondylolisthesis may be superior with less trauma,better functional recovery and stable screw placement.