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.

AIM:To investigate the effects of irbesartan on the expression of hepatocyte growth factor (HGF) at mRNA and protein levels in rats with myocardial infarction (MI), and to explore the mechanisms of irbesartan attenuating myocardial fibrosis.METHODS:The male Wistar rat model of MI was successfully established.The surviving rats 24 h after the operation were randomly divided into 3 groups:model group,irbesartan group and sham group, with 9 rats in each group.The rats in irbesartan group were treated with the solution of irbesartan (50 mg·kg-1·d-1) by intragastric administration, while the rats in model group and sham group received the equal volume of saline by the same way.The body weight and left ventricle mass (LVM) of the rats were measured at the 4th week after operation, and the pathological changes of the ischemic myocardium were observed with HE staining.Meanwhile, the expression of HGF at mRNA and protein levels was detected by RT-qPCR and Western blot.RESULTS:HE staining showed that the myocardial cells in sham group were in neat arrangement, while the cardiac structure in model group and irbesartan group was in disorder.The pathological changes in irbesartan group were less than that in model group.No difference in the body weight at the 4th week after operation was observed, while the LVM was significantly different among the 3 groups (P<0.01).The LVM in model group was higher than that in sham group (P<0.01), and that in irbesartan group was higher than that in sham group (P<0.05).The LVM in irbesartan group was lower than that in model group (P<0.05).The expression of HGF at mRNA and protein levels was detected in each group.The expression of HGF at mRNA and protein levels in irbesartan group was higher than that in sham group (P<0.05), and that in model group was higher than that in sham group (P<0.01).Moreover, the mRNA and protein levels of HGF in irbesartan group were lower than those in model group (P<0.05).CONCLUSION:The LVM of MI rats with the treatment of irbesartan was reduced obviously at the 4th week after operation, and the pathological changes were also improved.At the 4th week after the operation, the treatment of irbesartan inhibited the expression of HGF at mRNA and protein levels.

Objective To explore the value of improved CT perfusion in delineation of brain arteriovenous malformation(AVM) target for stereotactic radiosurgery.Methods 22 patients diagnosed with AVM by DSA were included in this study.14 cases of AVM were detected from initial symptoms of intracereb.ral hemorrhage,of which 4 cases were given immediate intracranial hematoma evacuation,then in 3 cases postoperative embolization was performed,and other 10 cases received conservative treatment including 3 cases treated by embolization.8 cases of AVM were detected from initial symptoms of epilepsy or headache,without surgery or embolization treatment.In all patients,the improved CT perfusion and MRA examinations were performed before treatment to evaluate the diagnostic efficacy of different methods in AVM.Results The interference rates of hemorrhage and granulation tissue on MRA images were 27.3 ％ and 54.5 ％,respectively,while those on enhanced CT and improved CT perfusion images were 0 ％.The interference rate of embolization material on enhanced CT and improved CT perfusion images was 27.3％,while that on MRA images were 0％.The contrast-enhancement rates of MRA,CT and improved CT perfusion images were 4 5.5 ％,5 4.5 ％ and 7 2.7 ％,respectively.Conclusion Improved CT perfusion technique is helpful in delineation of brain AVM target for stereotactic radiosurgery in patients with AVM combined with intracerebral hemorrhage or postoperative patients.

In order to investigate the effect of sequence-specific small interfering RNA on suppressing cyclin D1 expression and proliferation and cell cycle and expression of G1 phase regulators of fibroblasts derived from keloid, the plasmid expression vector of siRNA targeted against cyclin D1 was constructed and transfected into fibroblasts with LipofectamineTM 2000. The changes of cyclin D1 expression were detected by fluorescent quantitative PCR(FQ-PCR), semi-quantitative RT-PCR. The effect of sequence- specific small interfering RNA in suppressing the proliferation of fibroblasts was detected by MTT assay. Flow cytometry were used for evaluation ofceU cycle. The expression of cyclin D1, CDK4, pRb and P16 was detected by immunohistochemical method. The results showed that: (1) The sequence- specific siRNA effectively suppressed cyclin D1 expression at both mRNA levels with inhibition rate of 63.68% and 92.83% (P<0.01). (2) Significantly inhibited the proliferation of fibroblasts, and changed cell cycle in percentage of G0/G1 phase cells was increased compared with the controls groups in fibroblasts(P < 0.05). (3) 72 h after transfection, the expression of cyclin D1, CDK4 and pRb decreased, and the expression of P16 increased. It can be concluded that the plasmid expression vector for the RNAi against cyclin D1 constructed in the study can effectively and specifically suppress cyclin D1 expression, and progression of G1/S is effected by G1 phase related regulatory protein, and suppresses proliferation of fibroblasts derived fiom keloid.

AIM:To detect the drug-resistance mycobacterium tuberculosis by using DNA microarray hybridization.METHODS: DNA microarray for detecting drug-resistance of mycobacterium tuberculosis was prepared; Clinical isolated strains were cultivated and their drug-resistance sensitivity was detected. The genome DNA of mycobacterium tuberculosis was prepared and the drug-resistance genes of the mycobacterium tuberculosis were amplified by PCR. Then the gene chip was hybridized, washed, detected and analyzed. RESULTS: Results of cultivating mycobacterium tuberculosis and detecting the drug-resistance sensitivity: one strain was drug-sensitive; four strains were multi-drug-resistant; The detecting results of the drug-resistance was consistent with the results of diagnosis therapy of the 5 clinical patients. The detecting results of gene chip confirmed the above facts. CONCLUSION: Detecting drug-resistance mycobacterium tuberculosis by the gene chip is precise, fast and highly-efficient.