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 explore the mechanism of Wenyang Yiqi Huoxue Prescription(WYYQHXP)in the treatment of chronic heart failure(CHF)by regulating miR-126-3p and PI3K/Akt signaling pathway based on network pharmacology and experimental studies.Methods Active components and targets of WYYQHXP were obtained through TCMSP,SwissTargetPrediction,SwissADME and PubChem.Four miRNA databases were used to obtain miR-126-3p targets,and four disease databases were used to obtain CHF related targets.The intersection of the three was taken as the potential target of action;the protein-protein interaction network relationships of potential targets were explored using STRING and Cytoscape 3.9.1 software,and the main active components and core targets were screened;GO and KEGG pathway enrichment analysis was performed using R 4.2.1 software;Molecular docking was performed on the main active components with the core targets.Isoproterenol was used to induce a rat model of CHF with qi deficiency and blood stasis syndrome,and intervened with WYYQHXP.MiR-126-3p and core target expression in coronary endothelial cells were detected by immunohistochemistry,RT-qPCR,and Western blot.Results Network pharmacology screened main active components of WYYQHXP,including β-sitosterol,doustanol,kaempferol,quercetin,baicalein and luteolin,and the core targets of EGFR,VEGFA and AKT1;KEGG was enriched to the signaling pathways such as PI3K/Akt,and the 3 core targets were distributed to the PI3K/Akt signaling pathway;molecular docking showed good binding ability of β-sitosterol and stigmasterol to three core targets.Animal experiments showed that WYYQHXP could increase left ventricular ejection fraction and left ventricular fractional shortening in model rats(P<0.01),reduce serum brain natriuretic peptide content(P<0.01),increase expression of miR-126-3p(P<0.05,P<0.01,P<0.001),the medium-dosage of WYYQHXP could increase mRNA and protein expressions of EGFR,PI3K,AKT1 and VEGFA in coronary endothelial cells(P<0.01).Conclusion WYYQHXP may activate PI3K/Akt signaling pathway by acting on miR-126-3p,thereby restoring endothelial dependent vasodilation of coronary arteries,repairing endothelial dysfunction of coronary arteries,and treating CHF.

Objective To explore the mechanism of Wenyang Yiqi Huoxue Prescription(WYYQHXP)in the treatment of chronic heart failure(CHF)by regulating miR-126-3p and PI3K/Akt signaling pathway based on network pharmacology and experimental studies.Methods Active components and targets of WYYQHXP were obtained through TCMSP,SwissTargetPrediction,SwissADME and PubChem.Four miRNA databases were used to obtain miR-126-3p targets,and four disease databases were used to obtain CHF related targets.The intersection of the three was taken as the potential target of action;the protein-protein interaction network relationships of potential targets were explored using STRING and Cytoscape 3.9.1 software,and the main active components and core targets were screened;GO and KEGG pathway enrichment analysis was performed using R 4.2.1 software;Molecular docking was performed on the main active components with the core targets.Isoproterenol was used to induce a rat model of CHF with qi deficiency and blood stasis syndrome,and intervened with WYYQHXP.MiR-126-3p and core target expression in coronary endothelial cells were detected by immunohistochemistry,RT-qPCR,and Western blot.Results Network pharmacology screened main active components of WYYQHXP,including β-sitosterol,doustanol,kaempferol,quercetin,baicalein and luteolin,and the core targets of EGFR,VEGFA and AKT1;KEGG was enriched to the signaling pathways such as PI3K/Akt,and the 3 core targets were distributed to the PI3K/Akt signaling pathway;molecular docking showed good binding ability of β-sitosterol and stigmasterol to three core targets.Animal experiments showed that WYYQHXP could increase left ventricular ejection fraction and left ventricular fractional shortening in model rats(P<0.01),reduce serum brain natriuretic peptide content(P<0.01),increase expression of miR-126-3p(P<0.05,P<0.01,P<0.001),the medium-dosage of WYYQHXP could increase mRNA and protein expressions of EGFR,PI3K,AKT1 and VEGFA in coronary endothelial cells(P<0.01).Conclusion WYYQHXP may activate PI3K/Akt signaling pathway by acting on miR-126-3p,thereby restoring endothelial dependent vasodilation of coronary arteries,repairing endothelial dysfunction of coronary arteries,and treating CHF.

Environmental monitoring technologies competition can effectively improve the comprehensive quality and technical skills of technical personnel by means of professional theory exams and on-site practical assessment. In view of the undertaking work of the Second National Competition of Professional and Technical Personnel in Ecology and Environment Monitoring (special competition for radiation monitoring), this paper summarized the experience and gains in the aspects of preliminary preparation, field implementation, achievement generation, etc., analyzed the problems in national radiation environmental monitoring through the achievements of the special competition for radiation monitoring, and put forward recommendations for the next step, in order to provide reference for undertaking similar major events in the future and provide ideas and directions for national radiation environmental monitoring.

OBJECTIVE：To provide reference for the identification and proces sing end-point determination of raw Morus alba and its processed products （honey-processed M. alba ）. METHODS ：UPLC method was adopted. The determination was performed on Waters BEH Shield RP C 18 column with mobile phase consisted of acetonitrile- 0.1％ phosphoric acid solution （gradient elution ） at the flow rate of 0.30 mL/min. The column temperature was set at 30 ℃. The program wavelengths were set at 280 nm（0-4 min） and 320 nm（4-35 min）. Similarity Evaluation System for Chromatogram Fingerprint of TCM （2012 edition）was used to establish UPLC fingerprint and carry out similarity evaluation of 13 batches of M. alba and honey-processed M. alba . The chromatographic peaks were identified with reference substance fingerprint. The colorimetric value （L，a，b） of 13 batches of M. alba and honey-processed M. alba powder were determined ，and average total colorimetric value （E）was calculated. OPLS-DA and cluster analysis were adopted to analyze the differences in fingerprints and colorimetric values of M. alba before and after processing. At the same time ，the dynamic change rule of fingerprint and colorimetric value of honey-processed M. alba at different processing time points were analyzed to determine the processing end-point. RESULTS ：There were obvious differences in fingerprints before and after processing ，and the similarity of 13 batches of M. alba and honey-processed M. alba were all higher than 0.9. Totally 21 common peaks were calibrated for M. alba ，and 23 common peaks for honey-processed M. alba ；peak 1 and peak 2 were newly produced compounds of honey-processed M. alba . Peak 2，peak 7，peak 14 and peak 19 were identified as 5-hydroxymethylfurfural， mulberry glucoside A ，oxidized resveratrol ，mulberry flavonoids G. Results of OPLS-DA showed that the peak area-sample quantity ratio of peak 1，peak 2，peak 18，peak 20 and the chromaticity values （L，a，b）were the most important factors affecting the difference of raw and processed products of M. alba . When the E ranged 75.84-80.88 as the processing end-point of honey-processed M. alba ，the processing time was determined as 22-34 min. CONCLUSIONS ： The established UPLC fingerprint and colorimetric value determination method can be used to identify the raw and processed products of M. alba as well as determine the processing end-point of honey-processed M. alba .

BACKGROUND: How to locate pulmonary ground-glass nodules in thoracoscopic surgery is an important clinical topic in minimally invasive thoracic surgery. There is no unified localization method at present. This study intends to investigate the accuracy and security of body surface theodolitic puncture localization method in video-assisted thoracoscopic surgery for pulmonary ground-glass nodules. METHODS: The clinical data of 41 patients from August 2018 to December 2019 were analyzed retrospectively, including 28 males and 13 females. After anesthesia, the patient was located by body surface theodolitic puncture, and then partial lobectomy was performed under video-assisted thoracoscopy. The distance from the nodule to the marked suture and the distance from the nodule to the incisal margin were measured, and the accuracy of localization, the rate of complication and the success rate of surgical resection were calculated. RESULTS: A total of 51 nodules in 41 patients were located by body surface theodolitic puncture localization method. The accuracy rate was 96.1%, and the average location time was 8.3 min. Puncture bleeding occurred in 5 cases (12.2%), all of which were successfully stopped by video-assisted thoracoscopy, and there were no other complications. All patients underwent thoracoscopic partial lobectomy, including 33 cases of anatomical segmentectomy and 8 cases of wedge lobectomy. All the patients in operation process smoothly. The distance between nodule and incisal margin was measured, and all specimens were more than 2 cm, reaching a safe distance. The success rate of surgical resection was 100.0%. CONCLUSIONS In video-assisted thoracoscopic surgery for ground glass nodules of lung, the body surface theodolitic puncture localization method can be accurate, safe and simple.

Objective To investigate the difference of two models of respiratory failure in preterm infants with nasal continuous positive airway pressure(nCPAP)and nasal biphasic positive airway pressure (nBiPAP).Methods Comparative analysis of 81cases of premature infants with respiratory failure requi-ring respiratory support was needed.They were applied nCPAP and nBiPAP ventilation mode treatment.The use of breathing machine and total oxygen inhalation time,the number of treatment failures,the PEEP param-eters of the ventilator,the total number of recent complications and secondary infections were compared.Re-sults In the nBiPAP treatment group,the average time of noninvasive ventilation was(96.34±31.5)h,the total time of oxygen inhalation was(10.11 ±9.39)d,3cases of treatment failure,the incidence of severe complications was 5.56%(2/36),PEEP (4.08±0.73)cmH2O (1cmH2O =0.098kPa ).In the nCPAP group,the average time of noninvasive ventilation was(114.14±41.69)h,the total time of oxygen inhalation was(17.53±15.96)d,15cases were failed,the incidence of severe complications was 15.56%(7/45), PEEP(5.11±1.01)cmH2O.There were significant differences between the two groups(P﹤0.05).But there were no significant differences in infection control and patent ductus arteriosus (P ﹥0.05).Conclusion nBiPAP as one of the first choice treatment for premature infants with respiratory failure significantly better than nCPAP,as soon as the proper use can avoid invasive ventilation.

Objective To study the effects of radical surgical treatment for early esophageal cancer, and to investigate the prevention and cure of their complications,cancer recurrence and metastasis.Methods Treatments of 240 patients with early esophageal cancer of Chinese PLA General Hospital from January 2005 to January 2009 were retrospectively analyzed.The patients were treated by left thoracotomy,thoracic or cervical mechanical anastomosis surgical methods of treatment.Their postoperative adverse reactions,complications and 1 -,3-,5-year survival rates were observed and analyzed.Results The surgical resection rate was 1 00.00%. Complications included postoperative pulmonary infection (1 2 patients,5.00%), cardiac arrhythmias (1 patient,0.42%),delayed gastric emptying (2 patients,0.83%),pleural hemorrhage (1 patient, 0.42%),recurrent laryngeal nerve injury (2 patients,0.83%)and anastomotic fistula (1 patient,0.42%). One-year,3-year and 5-year survival rates after surgery were 1 00.00% (240 /240),97.9% (235 /240)and 95.8% (230 /240)respectively.The main causes of postoperative death were tumor recurrence and metastasis. Conclusion Timely surgery for early esophageal cancer can bring in good effect and long-term outcome,with little complication,which can obtain a good forward curative effect.

OBJECTIVETo probe the clinical application and value of dual source CT quantification volume imaging to forecast lung cancer patients' postoperative pulmonary function changing.

METHODSBetween June 2012 and June 2013, there were 233 patients (121 male patients and 112 female patients, with a mean age of (53 ± 16) years) who accepted the thoracoscope lobectomy or unilateral holo-lungs pneumonectomy accepted pulmonary function test before and after 3 months of the surgery. CT scan was conducted at both inspiration phase and expiration phase before the surgery and the lung volume of the single lobe, the pixel exponential distribution histogram, and the average lung density were measured after CT scan. The discrepancy and correlation between the preoperative lung volume accepted by CT and preoperative, postoperative pulmonary function index were compared.

RESULTSThe CT volume scan showed that average lung density of the superior part at decubitus position is -(870 ± 22) HU, the inferior part was -(767 ± 16) HU (t = 3.13, P < 0.01). The volume ratio of the right upper lobe, right middle lobe, right lower lobe, left upper lobe, left lower lobe were 20.5%, 10.3%, 23.1%, 24.6%, 21.5%, whole-right lung was 53.9% and whole-left was 46.1%. There were high correlation between CT volume index and preoperative routine pulmonary function index such as total lung capacity, forced vital capacity (FVC), forced expiratory volume in the first second (FEV(1)), residual volume, and FEV(1)/FVC. The highest correlation coefficient were 0.92, 0.76, 0.70, 0.85, 0.56 (t = 3.14, 3.05, 2.86, 3.09, 2.68; all P < 0.01). The highest correlation coefficient for the postoperative pulmonary function index were 0.87, 0.68, 0.75, 0.81, -0.64 (t = 3.10, 2.85, 3.05, 3.02, 2.79; all P < 0.01).

CONCLUSIONSIt is feasible to use dual source CT quantification volume imaging to predict lung cancer patients' postoperative pulmonary function alteration, which can provide precise predictive value of these patients. CT quantification volume imaging technology has important clinical application value.

Adult ; Aged ; Female ; Forced Expiratory Volume ; physiology ; Humans ; Lung ; physiology ; Lung Neoplasms ; physiopathology ; surgery ; Male ; Middle Aged ; Pneumonectomy ; Postoperative Period ; Prospective Studies ; Respiratory Function Tests ; Tidal Volume ; physiology ; Tomography, X-Ray Computed ; methods ; Vital Capacity ; physiology

BACKGROUND:Through a ful investigation of biodegradable scaffolds, we propose a new self-expanding degradable poly-L-lactide coated endotracheal stent based on the design, production, experimental and clinical applications of nickel titanium memory alloy stent. OBJECTIVE:To design a kind of biodegradable endotracheal stent with poly-L-lactide and hydroxyapatite, and to test its mechanical properties, biocompatibility and biodegradation capacity. METHODS:With the technology of computer aided design, the stents were prepared with poly-L-lactide (Mr RESULTS AND CONCLUSION:The average radial supporting force of the tracheal stent was 7.8 kPa, the percentage of stent surface coverage was less than 20%, the stent expansion rate was≥4%, and the stent longitudinal shortening rate was≤9%, which reached the mechanical requirements for degradable endotracheal stents. After 4-16 weeks, there was no significant inflammatory response. The decline in molecular weight changes and weight loss ratio was higher for in vivo degradation than in vitro degradation at different time (P<0.05). These findings indicate that poly-L-lactide/hydroxyapatite composite stents have good mechanical properties, biocompatibility and biodegradability. 150 000) and hydroxyapatite materials, 20 mm to 26 mm in diameter. The mechanical properties were tested using a universal testing machine. These poly-L-lactide/hydroxyapatite stents were implanted into dog models of tracheal stenosis at an appropriate size. The histopathological changes of the tracheas were observed, and biodegradation property was studied via molecular weight changes and weight loss ratio after 4, 8, 12, 16 weeks.