Traumatic rib fractures are the most common injury in thoracic trauma. Previously，the patients with traumatic rib fractures were mostly treated non-surgically，of which 50%，especially those combined with flail chest presented chronic pain or chest wall deformities and over 30% had long-term disabilities，being unable to retain a full-time job. In the past two decades，thanks to the development of internal fixation material technology，the surgical treatment of rib fractures has achieved good outcomes. However，there are still some problems in clinical treatment，including inconsistency in surgical treatment and quality control in medical services. The current consensuses on the management of regional traumatic rib fractures published at home and abroad mainly focus on the guidance of the overall treatment decisions and plans，and relevant clinical guidelines abroad lacks progress in surgical treatment of rib fractures in recent years. Therefore，the Chinese Society of Traumatology affiliated to Chinese Medical Association and Chinese College of Trauma Surgeons affiliated to Chinese Medical Doctor Association，in conjunction with national multidisciplinary experts，formulate the Chinese Consensus for Surgical Treatment of Traumatic Rib Fractures（2021）following the principle of evidence-based medicine，scientific nature and practicality. This expert consensus puts forward some clear，applicable，and graded recommendations from aspects of preoperative imaging evaluation，surgical indications，timing of surgery，surgical methods，rib fracture sites for surgical fixation，internal fixation methods and material selections，treatment of combined injuries in rib fractures，in order to provide references for surgical treatment of traumatic rib fractures.

Myocardial ischamic-reperfusion(MIRI) is one of the leading causes of cardiac dysfunction and even death with patient after cardiopulmonary bypass, its mechanism is complex and involved widely. Recent research has found that myocardial insulin resistance is an important mechanism of MIRI. But its mechanism has not been fully elucidated. Therefore, this paper reviews the study of myocardial insulin resistance and myocardial ischemia-reperfusion injury mechanism in recent years, to preliminarily clarify the regulatory role of insulin signal in MIRI and provide new ideas for the future research on the prevention and treatment of MIRI.

BACKGROUND: Myocardial ischemia/reperfusion injury is one of the most common complications in ischemic cardiomyopathy and open heart surgery. The development of bone marrow mesenchymal stem cells provides a new method for clinical prevention and treatment of myocardial ischemia/reperfusion injury. OBJECTIVE: To review the therapeutic effect and potential mechanisms of bone marrow mesenchymal stem cells in the treatment of myocardial ischemia/reperfusion injury, in order to provide a theoretical basis for the clinical application of bone marrow mesenchymal stem cells. METHODS: Chinese Journal Full-text Database (CNKI) , WanFang, and PubMed were retrieved for articles related to the use of bone marrow mesenchymal stem cells for myocardial ischemia-reperfusion injury published from January 2000 to October 2018. The search terms were "bone marrow mesenchymal stem cells; myocardial ischaemia/reperfusion; research process" in Chinese and "bone marrow mesenchymal stem cells; myocardial ischaemia/reperfusion; cell therapy; clinical trial studies" in English. Old and repetitive viewpoints were excluded, the searched literatures were sorted out, and finally 56 articles were included for further analysis and discussion. RESULTS AND CONCLUSION: (1) In this paper, we summarize paracrine factors, exosomes miRNA and their effects in the treatment of myocardial ischemia/reperfusion injury with bone marrow mesenchymal stem cells, such as anti-inflammation, anti-apoptosis, anti-fibrosis, repair of myocardium and neovascularization. (2) We also summarize the possible molecular mechanisms of bone marrow mesenchymal stem cells involved in the treatment of myocardial ischemia/reperfusion injury, such as the role of mitochondrial fusion protein 2, regulation of myocardial autophagy, and regulation of AMPK/mTOR signaling pathway. Overall, we attempt to provide a theoretical basis for the clinical application of bone marrow mesenchymal stem cells in the treatment of myocardial ischemia/reperfusion injury.

Brain ; pathology ; Genome-Wide Association Study ; Humans ; Parkinson Disease ; genetics ; Phosphatidylinositol-3,4,5-Trisphosphate 5-Phosphatases ; genetics ; Proto-Oncogene Proteins c-crk ; genetics

OBJECTIVE： To investigate the effects of adiponectin （APN） on the expression of myocardial AMPK in myocardial insulin resistance （IR） model dogs during cardiopulmonary bypass （CPB）. METHODS： Totally 24 dogs were randomly divided into control group， model group， APN group （36 μg/kg）， AMPK inhibition group （APN 36 μg/kg+AMPK inhibitor compound C 0.5 mg/kg）， with 6 dogs in each group. All dogs underwent CPB； except for control group without medicine， CPB myocardial IR model were established in other groups， and perfused with St.Thomas cardiac cardioplegia lipid no medicine or containing relevant drugs after main artery block. Coronary sinus blood and carotid artery blood samples were collected before bypass and after 15， 90 min reperfusion following 60 min myocardial ischemia. Left ventricular apical tissue was taken， and the uptake rate of myocardial glucose and insulin resistance index （IRI） were determined and calculated； the changes of myocardial injury indexes （cTnT concentration） and cardiac function indexes （LVSP， +dp/dtmax） were monitored. The level of p-AMPK was detected. RESULTS： There was no statistical significance in above indexes of dogs before bypass （P＞0.05）. Compared with control group， the rate of myocardial glucose uptake， the levels of LVSP， +dp/dtmax and p-AMPK in model group were decreased significantly after 15， 90 min reperfusion （P＜0.05）， and the concentrations of IRI and cTnT were increased significantly （P＜0.05）. Compared with model group， the rate of myocardial glucose uptake， LVSP， +dp/dtmax and p-AMPK were increased significantly in APN group and AMPK inhibitor group （P＜0.05）， while the concentrations of IRI and cTnT were decreased significantly （P＜0.05）； moreover， the effect of APN group was better than that of AMPK inhibitor group （P＜0.05）. CONCLUSIONS： APN can promote myocardial glucose uptake and metabolism， and contribute the recovery of cardiac function， the mechanism of which may be associated with increasing the activity of AMPK.

Objective To investigate the safety and longterm outcomes of prophylactic autologous pericardium tricuspid valve annuloplasty(TVA)in patients with rheumatic heart disease(RHD). Methods A total of 832 patients with RHD were enrolled in this study ,including 146 patients with mild FTR but without TVA(observation group);434 patients with mild FTR underwent TVA(control group A)and 434 patients with moderate or severe FTR underwent TVA(control group B). Propensity score and survival analysis were used to evaluate perioperative safety ,FTR progression ,CHF and MACCE incidence after prophylactic TVA. Results A total of 192 patients were successfully matched. There was no significant difference in the perioperative complications between the observation group and the control groups(P>0.05). The progression rate of FTR in the observation group was significantly lower than that in the control groups (P = 0.005 & 0.032 ). There was no significant difference in the incidence of CHF and MACCE events between the observation group and the control groups (P > 0.05). Conclusions The treatment strategy of prophylactic autologous pericardium TVA at the time of left heart valve surgery for patients with RHD doesn′t increase operation costs ,perioperative complications and mortality ,but effectively prevent postoperative FTR recurrence or progression.

Objective To summarize clinical outcomes of subxiphoid uniportal video-assisted thoracoscopic surgery for bilateral chest diseases simultaneously. Methods The clinical data of 60 patients with bilateral chest diseases treated by uniportal thoracoscopic surgery via subxiphoid approach in the Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical College from August 2016 to December 2017 were retrospectively analyzed. There were 35 males and 25 females, aged 25.5±8.8 years ranging from 13 to 51 years. There were 40 patients wtih palmar hyperhidrosis, and 20 patients with bilateral pulmonary bullae and onset of one-side pneumothorax. All patients adopted subxiphoid uniportal video-assisted thoracoscopic surgery. Among them 36 patients with palmar hyperhidrosis underwent resection of R3 bilateral sympathetic nerves, 1 resection of R4 bilateral sympathetic nerves, 3 resection of R3+R4 bilateral sympathetic nerves, and 20 patients with pulmonary bullae underwent bilateral bullectomy and pleurodesis. Results Fifty-five patients cured within 1 to 4 days and discharged after surgery. One patient with incision infection and pulmonary infection after bullectomy, cured and discharged after 3 weeks anti-inflammation and incision dressing change. Four patients with Grade B healing recovered after 1 to 2 weeks dressing change. During the follow-up, no pneumothorax or hand perspiration relapsed. Conclusion Subxiphoid uniportal video-assisted thoracoscopic surgery for simple bilateral chest disease simultaneously is safe and feasible, which not only avoids simultaneous trauma of bilateral punch, but also alleviates the pain of patients.

Post operational recovery from cardiac surgery can be affected by many factors, including preoperative, intraoperative, and postoperative factors. Prolonged mechanical ventilation (PMV) , one of the major complications, has been widely accepted as a measure to evaluate the performance and outcomes of cardiac surgeries. Great progress has been made in the studies of risk factors contributing to PMV following cardiac surgeries in recent years. However, no clear and effective measures and approaches are available yet to prevent PMV. In this review, the authors try to summarize the risk factors that are associated with PMV throughout the perioperative period of cardiac surgery, as well as possible interventions when applicable.

OBJECTIVE:To explore the effects of acadesine on myocardial energy metabolism of model dogs with myocardial ischemia-reperfusion injury (MIRI) after cardiopulmonary bypass (CPB). METHODS:Dogs were randomly divided into control group,model group,acadesine low-dose,high-dose groups(0.8,3.2 mg/kg),6 in each group. All dogs received CPB. Except for control group,dogs in other groups were reduced for MIRI model,and perfused St.Thomas cardiac cardioplegia lipid containing rel-evant drugs 60 min after main artery block. The uptake rates of myocardial glucose and free fatty acid(FFA),creatine kinase isoen-zyme(CK-MB)concent in venous sinus plasma and adenosine triphosphate(ATP)content in mitochondria were detected and calcu-lated before bypass and after 15,60,90 min of reperfusion. Left ventricular systolic pressure(LVSP)and left ventricular end dia-stolic pressure(LVEDP)were analyzed,and mRNA expression of adenylate-activated protein kinase(AMPK)and protein expres-sion of phosphorylated AMPK(p-AMPK)in myocardial tissue were detected. RESULTS:Before bypass,all indexes in each group had no statistic significances(P>0.05). After bypass,compared with control group,uptake rates of myocardial glucose and FAA, ATP content,mRNA expression of AMPK and protein expression of p-AMPK and LVSP in 3 time points in model group and each administration group were obviously decreased(P<0.05);LVEDP and CK-MB concent in plasma were obviously increased(P<0.05). Compared with model group,uptake rates of myocardial glucose and FAA,ATP content,mRNA expression of AMPK and protein expression of p-AMPK and LVSP in 3 time points in each administration group were obviously increased (P<0.05);LVEDP and CK-MB concent in plasma were obviously decreased (P<0.05);and high-dose group showed more obvious change than that of low-dose group (P<0.05). CONCLUSIONS:Acadesine can promote the AMPK phosphorylation,contribute to the myocardial glucose and FFA uptake to promote the increase of ATP in myocardial mitochondria and relieve MIRI after CPB.

Objective To investigate the feasibility and superiority of local anaesthesia video-assisted thoracoscopic surgery (LA-VATS) in diagnosis and treatment of open thoracic trauma (OTT).Methods Seventy-eight patients with OTT emergently admitted from February 2007 and June 2012 were randomized into LA-VATS group (n =37) and conventional treatment group (n =41) by the toss of a coin.In the LA-VATS group,further treatment was determined following LA-VATS.Volume of chest tube drainage,duration of chest tube placement,average length of hospital stay,and postoperative complications were measured and compared between groups.Results In the LA-VATS group,23 patients completed LA-VATS and 14 were transferred for simple VATS-assisted mini-thoracotomy under general anesthesia.In the conventional treatment group,24 cases completed debridement and chest drainage and 17 cases were transferred for thoracotomy under general anesthesia.Volume of chest tube drainage [(195.0 ± 150.8) ml/d∶ (480.0 ±212.3)ml/d] (t =-2.675,P ＜0.05),duration of chest tube placement [(2.6 ± 1.4) d∶ (3.8 ± 1.9) d] (t =-2.318,P ＜ 0.05),average length of hospital stay [(6.4 ±2.3) d ∶ (10.9 ± 3.3) d] (t =-2.471,P ＜ 0.05),and incidence rate of postoperative complications (10.8％ ∶22.0％) (x2 =4.132,P ＜0.05) were all significantly different between LA-VATS and conventional treatment groups.Conclusion LA-VATS is safe and feasible for diagnostic exploration and simple treatment of OTT.