Background and objective Current studies suggest that for early-stage lung cancers with a component of ground-glass opacity measuring ≤2 cm,sublobar resection is suitable if it ensures adequate margins.However,lobectomy may be necessary for some cases to achieve this.The aim of this study was to explore the impact of size and depth on surgical techniques for wedge resection,segmentectomy,and lobectomy in early-stage lung cancer ≤2 cm,and to determine methods for ensuring a safe resection margin during sublobar resections.Methods Clinical data from 385 patients with early-stage lung can-cer ≤2 cm,who underwent lung resection in 2022,were subject to a retrospective analysis,covering three types of procedures:wedge resection,segmentectomy and lobectomy.The depth indicator as the OA value,which is the shortest distance from the inner edge of a pulmonary nodule to the opening of the corresponding bronchus,and the AB value,which is the distance from the inner edge of the nodule to the pleura,were measured.For cases undergoing lobectomy and segmentectomy,three-dimensional computed tomography bronchography and angiography(3D-CTBA)was performed to statistically determine the number of subsegments required for segmentectomy.The cutting margin width for wedge resection and segmentectomy was recorded,as well as the specific subsegments and their quantities removed during lung segmentectomy were documented.Results In wedge resection,segmentectomy,and lobectomy,the sizes of pulmonary nodules were(1.08±0.29)cm,(1.31±0.34)cm and(1.50±0.35)cm,respectively,while the depth of the nodules(OA values)was 6.05(5.26,6.85)cm,4.43(3.27,5.43)cm and 3.04(1.80,4.18)cm for each procedure,showing a progressive increasing trend(P＜0.001).The median resec-tion margin width obtained from segmentectomy was 2.50(1.50,3.00)cm,significantly greater than the 1.50(1.15,2.00)cm from wedge resection(P＜0.001).In wedge resections,cases where AB value＞2 cm demonstrated a higher proportion of cases with resection margins less than 2 cm compared to those with margins greater than 2 cm(29.03％vs 12.90％,P=0.019).When utilizing the size of the nodule as the criterion for resection margin,the instances with AB value＞2 cm continued to show a higher proportion in the ratio of margin distance to tumor size less than 1(37.50％vs 17.39％,P=0.009).The median number of subsegments for segmentectomy was three,whereas lobectomy cases requiring segmentectomy involved five subsegments(P＜0.001).Conclusion The selection of the surgical approach for lung resection is influenced by both the size and depth of pulmonary nodules.This study first confirms that larger portions of lung tissue must be removed for nodules that are deeper and larger to achieve a safe margin.A distance of ≤2 cm from the inner edge of the pulmonary nodule to the nearest pleura may be the ideal indication for performing wedge resection.

Objective:To explore the access mechanism of medical consumables in public medical institutions and to improve the top-level designs of medical consumables access based on the perspective of healthcare security management.Methods:From five dimensions of healthcare security supervision,implementation of coding standards(referred to as standard implementation),centralized procurement,medical service items and prices,and evaluation technologies,the access process of medical consumables was designed and targeted exploration strategies were proposed.Results:The access process for medical consumables is designed from five dimensions:strengthening the supervision of medical consumables and medical insurance,implementing the healthcare security standards for medical consumables,promoting the implementation of medical consumables healthcare security centralized procurement,promoting the development of healthcare security medical service projects and medical service price projects,and actively carrying out health technology assessment.The targeted strategies for the access of medical consumables were proposed of strengthening the learning and training of healthcare security business,building a multidisciplinary collaborative management system for medical consumables access in hospitals,exploring the establishment of health technology evaluation methods suitable for medical institutions in China and promoting the integration of medical consumables access information.Conclusion:Based on the perspective of healthcare security management,the core position of medical insurance in the access of medical consumables in public medical institutions was theoretically emphasized,which provides new ideas for the research of medical consumables access,and enriches the dimension of medical consumables access management.

Traditional Chinese medicine(TCM)plays a unique role in preventive treatment of disease,treatment of chronic disease and recovery.Integrating modern science and technology and methods to carry out integrated and innovative research will help to bring the value of traditional Chinese medicine into full play.In recent years,with the rapid development of digital therapeutics such as artificial intelligence and wearable devices,digital therapeutics have emerged.Under the guidance of TCM theory,TCM integrates digital therapeutics technology methods,personalized treatment of patients through advanced program-driven software or combined with hardware devices,and improves patient compliance,gives full play to the advantages of TCM.This paper uses CiteSpace to visualize the research hotspots of digital therapeutics,combined with the literature and the website data of the Food and Drug Administration and the National Medical Products Administration,to sort out the application of digital therapeutics in the prevention,treatment and recovery of diseases,analyze the key technologies and core theories in the current application of digital therapeutics.And taking TCM pentatotherapy,kinesiatrics and aromatherapy as examples,this paper discusses the application forms of digital therapeutics under the guidance of TCM theory,and provides a preliminary paradigm for TCM digital therapeutics.

Objective:To explore the feasibility and clinical efficacy of resection of jugular foramen schwannomas via anterolateral approach. Methods:A retrospective analysis was conducted on clinical data of 15 patients with jugular foramen schwannomas admitted to Department of Neurosurgery, First Affiliated Hospital of Xinxiang Medical College from January 2018 to July 2022. Three patients had Samii type B, 7 had type C and 5 had type D. Resection of the schwannomas was performed via anterolateral approach. After surgery, regular follow-up was performed through outpatient review, telephone, or WeChat to evaluate tumor progression and neurological functions. Results:Adequate surgical exposure was obtained in all 15 patients. Total resection was obtained in 14 patients and subtotal resection in 1 patient. Posterior cranial nerve palsy was worsened in 1 patient and new-onset facial paralysis (House-Brackmann grading Ⅲ) was noted in 1 patient, without cerebrospinal fluid leakage, subcutaneous effusion or death. Choking and cough during drinking water, and dysphagia disappeared or relieved 3 months after surgery in patients with aggravated posterior cranial nerve palsy, but no significant recovery from hoarseness was noted 6 months after surgery. A patient with new-onset facial paralysis improved to House-Brackmann grading I 3 months after surgery. Up to the last follow-up, no tumor recurrence was observed in 15 patients.Conclusion:Resection via anterolateral approach is effective in jugular foramen schwannomas for its adequate surgical exposure, high total resection rate, and low postoperative complications.

Objective:To explore the feasibility and clinical efficacy of watertight suture technique in skull base reconstruction after expanded endoscopic endonasal excision of tuberculum sellae meningioma.Methods:Fourteen patients with tuberculum sellae meningioma accepted expanded endoscopic endonasal excision of tuberculum sellae meningioma in Department of Neurosurgery, First Affiliated Hospital of Xinxiang Medical University from January 2018 to May 2022 were chosen. During reconstruction of skull base, femoral fascia was used to repair the dural defect of sellar base with watertight suture, and then the sellar base was covered with a larger layer of femoral fascia for reinforcement; no nasal septum mucosal flap was used. The clinical data and treatment efficacy of these patients were retrospectively analyzed.Results:Total resection showed by imaging was achieved in all 14 patients. During the surgery, Valsalva ventilation test confirmed that at least 12 stitches were needed to achieve watertight suture status; watertight suture status was achieved in 13 of the 14 patients, without cerebrospinal fluid (CSF) leakage; watertight suture status was not achieved in one patient due to tumor invasion of the sella floor dura and having an extensive excision, and CSF leakage appeared transiently after surgery but disappeared 2 weeks after surgery (bed rest). Among the 11 patients with visual damage and optic field defect, 9 patients improved obviously and 2 patients did not improve. Follow-up was performed for 5-53 months, with an average of (26.8±8.4) months; no tumor recurrence or CSF leakage were found in these patients; up to the last follow-up, the 2 patients with visual damage and optic field defect did not improve.Conclusion:Skull base reconstruction using watertight suture technique after expanded endoscopic endonasal excision of tuberculum sellae meningioma is reliable.

Pulmonary blast injury has become the main type of trauma in modern warfare, characterized by externally mild injuries but internally severe injuries, rapid disease progression, and a high rate of early death. The injury is complicated in clinical practice, often with multiple and compound injuries. Currently, there is a lack of effective protective materials, accurate injury detection instrument and portable monitoring and transportation equipment, standardized clinical treatment guidelines in various medical centers, and evidence-based guidelines at home and abroad, resulting in a high mortality in clinlcal practice. Therefore, the Trauma Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Trauma organized military and civilian experts in related fields such as thoracic surgery and traumatic surgery to jointly develop the Clinical treatment guideline for pulmonary blast injury ( version 2023) by combining evidence for effectiveness and clinical first-line treatment experience. This guideline provided 16 recommended opinions surrounding definition, characteristics, pre-hospital diagnosis and treatment, and in-hospital treatment of pulmonary blast injury, hoping to provide a basis for the clinical treatment in hospitals at different levels.

Objective:To explore the clinical effect of a two-staged repair and reconstruction of composite soft tissue defect of dorsal wrist with transfer of free flap (in stage-one) repair and followed by transplantation of allogeneic tendon (in stage-two) reconstruction.Methods:From December 2018 to January 2021, 6 cases with dorsal wrist composite tissue injury and extensor tendon defect were treated in the Department of Hand and Microsurgery of the Fourth People's Hospital of Guiyang City. Four cases were treated with free anterolateral thigh flap (ALTF) combined with allogeneic tendon in the first stage to reconstruct finger dorsiflexion function, and 2 cases were treated with free ilioinguinal flap combined with allogeneic tendon in the second stage to reconstruct finger dorsiflexion function. The age of the patients ranged from 22 to 62 years old. The areas of defect were 5.0 cm×12.0 cm-8.0 cm×20.0 cm. Two cases had 2 extensor tendons defect, 1 had 3 extensor tendons defect, 2 had 4 extensor tendons defect, and 1 had 5 extensor tendons defect. The length of extensor tendon defects was 7.0-22.0 cm. In 5 cases, the wounds were covered by VSD for 5 to 7 days after complete emergenly debridement. Then, after the wounds had been cleared and clean, the wounds of 3 cases were covered with free ALTF, 2 with free ilioinguinal flap, and 1 with free ALTF after skin graft scar resection. At 3-4 months later, the extension function of digit was reconstructed with the transplantation of allogeneic tendons. Postoperative appearance of the flaps and functions of digits were observed at the outpatient clinics during the follow-up.Results:The postoperative follow-up lasted for 10 to 26 (15 in average) months. All 6 flaps surrived completely, and 1 case was further treated with flap thinning at 4 months after the second surgery. During the follow-up, all flaps healed well and were good in appearance and texture. Meanwhile, the donor areas were all healed well with no dysfunction nor sensory disorder. All the transplanted tendons were in good glide without adhesion. The active motion of metacarpophalangeal joints ranged from (10±10) ° to (80±10) °. According to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, at the final follow-up, 4 cases were excellent and 2 cases were good.Conclusion:It is safe and effective that using the two-staged procedure in repair of composite tissue defect of dorsal wrist with stage-one ALTF or ilioinguinal flap transfer combined with stage-two reconstruction with transplantation of allogeneic tendon. It can minimize the adhesion after tendon transplantation and donor site damage

Adipose Tissue ; Cadaver ; Humans ; Vertebral Artery

To explore the main influencing factors of acute ischemic stroke complicated with depression in elderly patients，and to establish an individualized prediction of depression risk histogram model. Methods A total of 330 elderly patients with acute ischemic disease admitted to our hospital from March 2018 to March 2021 were selected as the model group，and 120 patients with depression treated from June 2018 to December 2020 were selected as the validation group. Clinical data of the two groups were collated. Univariate and Logistic multivariate regression models were used to explore the influencing factors of depression in AIS patients. And R software is used to verify the individualized prediction risk histogram model. Results There were significant differences in age，diabetes mellitus，hypertension，chronic kidney disease，serum creatinine，EGFR，BNP，hs-CRP and cardiac function Ⅳ grade between the two groups （P<0.05），and was determined to be related to depression in AIS patients. R software was used to establish a histogram model for predicting the risk of depression in AIS patients. According to the histogram score，the score of cardiac function Ⅳ was 40.30 points，and the score of associated diabetes was 24.00 points. With the increase of age，the decrease of EGFR and the increase of hs-CRP，the corresponding score of the histogram model increased，and the risk of complicated depression also increased. The practicability and feasibility of the model were verified （internal and external）. The C-index value of the model was 0.857 and 0.823 in the model group and the validation group，respectively. When ROC curve was used to analyze the predictive risk efficiency of this model for patients with depression in the model group and the validation group，the AUC of the model group was 0.841，while the AUC of the validation group was 0.817.Conclusion This study showed that the patient’s age，diabetes mellitus，cardiac function grade Ⅳ，EGFR and hs-CRP were independent influencing factors for depression. The individualized predictive histogram model based on this model has good resolution and accuracy，and can be widely used in the prediction of other clinical diseases.

Objective To investigate the neuroprotective effect and its mechanism of p38 mitogenactivated protein kinase inhibitor after subarachnoid hemorrhage (SAH).Methods Twenty-seven SPF-grade adult male SD rats were selected to induce a SAH model using the prechiasmal pool blood injection.Three dead rats were excluded.Twenty-four rats were randomly divided into four groups:sham operation group,SAH group,dimethyl sulfoxide (DMSO) group,and DMSO +p38 inhibitor group (n =6 in each group).Western blot was used to detect the expression levels of p38,phosphorylation p38,Parkinson's disease protein 7 (DJ-1),autophagy associated gene 5 (Atg5),autophagy adaptor protein p62,microtubule-associated protein Ⅰ Light Chain 3 (LC3-Ⅰ),microtubule-associated protein Ⅱ light chain 3 Ⅱ (LC3-Ⅱ),and the Garcia neurological function score was used to judge the nerve injury.PC12 cell oxygenated hemoglobin was used to induce an in vitro SAH model.They were completely randomly divided into four groups:sham operative group,SAH group,DMSO group,and DMSO + p38 inhibitor group.Fluorescent probe JC-1 was used to observe the changes of mitochondrial membrane potential.Results (1) There were significant differences in the expression of p38,phosphorylation-p38 and DJ-1 in rat brain tissue among the 4 groups (F values were 94.959,150.293 and 698.476,respectively,all P ＜ 0.01).There were significant differences in mitochondrial membrane potential in PC12 cells among the 4 groups (F value was 24.989,P ＜ 0.01).There were significant differences in the expression levels of autophagy related protein LC3-Ⅱ/LC3-Ⅰ ratio,Atg5 and p62 in rat brain tissue among the 4 groups (F values were 235.319,110.490 and 36.311,respectively,all P ＜ 0.01).There was significant difference in nerve function score among the 4 groups (F value was 25.550,P ＜ 0.01).(2) Compared with the sham operative group,the expression levels of p38,phosphorylation-p38 and DJ-1 were upregulated significantly after SAH (from 0.43 ±0.06,0.41 ±0.02 and 0.07 ±0.01 to 0.61 ± 0.08,0.79 ± 0.07 and 0.17 ± 0.03,respectively,all P ＜ 0.01),mitochondria membrane potential depolarization (from 8.29 ±0.28 to 9.23 ±0.42,P ＜0.01);upregulation of Atg5 expression and increase of LC3-Ⅱ/LC3-Ⅰratio (from 0.23 ± 0.04 and 0.25 ± 0.04 to 0.47 ± 0.04 and 0.46 ± 0.04,respectively,all P ＜ 0.01),down regulation of p62 expression (from 1.09 ± 0.14 to 0.54 ± 0.10,P ＜ 0.01);neurological score was decreased (from 17.5 ± 0.6 to 11.3 ± 2.7,P ＜ 0.01);p38 inhibitor was significantly down regulated the expression of phosphorylation-p38 after SAH (from 0.79 ± 0.07 to 0.47 ± 0.04,P ＜ 0.01),the expression of DJ-1 was up-regulated (from 0.17 ± 0.03 to 1.02 ± 0.06,P ＜ 0.01),mitochondrial membrane potential recovery (from 9.23 ±0.42 to 8.47 ±0.36,P ＜0.01),cell autophagy related protein LC3-Ⅱ/LC3-Ⅰ ratio and Atg5 were upregulated(from 0.46 ±0.04 and 0.47 ±0.04 to 0.77 ± 0.06 and 0.95 ± 0.12,all P ＜ 0.01),p62 expression returned to the levels of SAH group (from 0.57 ± 0.09,to 0.54 ± 0.10,P =0.650),and the neurological score was significantly improved (from 11.3 ± 2.7 to 15.5 ± 1.0,P ＜0.01).Conclusions After SAH,the p38 inhibitor downregulates the activity of2 phosphorylation p38.It may inhibit abnormal autophagy and maintain mitochondrial function by up-regulating the expression of DJ-1 protein,and then play a neuroprotective function.