Primary pneumothorax:Should surgery be offered after the first episode?

Surgery is the recommended and most effective means of preventing the recurrence of primary spontaneous pneumothorax(PSP). However, the conventional belief amongst most clinicians is that surgery should not be routinely offered to patients with an uncomplicated first episode of PSP. The view that surgery should be reserved for recurrent episodes of ipsilateral PSP is based on an apprehension regarding traumatic thoracicsurgery combined with a perception that recurrences after a single episode of PSP are unlikely. Modern advances in minimally invasive thoracic surgery have now dramatically reduced the morbidity of PSP surgery. Such surgery is now safe, effective and causes minimal indisposition for patients. On the other hand, modern clinical data suggests that recurrence rate of PSP is perhaps much higher than previously assumed, with more than half of patients experiencing a second episode within several years of the first. With such new appreciations of the current situation, it is appropriate to now consider offering surgery to patients even after the first episode of PSP.

Effect of drainage on CO_2, CH_4, and N_2O fluxes from aquaculture ponds during winter in a subtropical estuary of China

Aquaculture ponds are dominant features of the landscape in the coastal zone of China.Generally,aquaculture ponds are drained during the non-culture period in winter.However,the effects of such drainage on the production and flux of greenhouse gases（GHGs）from aquaculture ponds are largely unknown.In the present study,field-based research was performed to compare the GHG fluxes between one drained pond（DP,with a water depth of 0.05 m）and one undrained pond（UDP,with a water depth of 1.16 m）during one winter in the Min River estuary of southeast China.Over the entire study period,the mean CO2flux in the DP was（0.75±0.12）mmol/（m^2·hr）,which was significantly higher than that in the UDP of（-0.49±0.09）mmol/（m^2·hr）（p0.01）.This indicates that drainage drastically transforms aquaculture ponds from a net sink to a net source of CO2in winter.Mean CH4and N2O emissions were significantly higher in the DP compared to those in the UDP（CH4=（0.66±0.31）vs.（0.07±0.06）mmol/（m^2·hr）and N2O=（19.54±2.08）vs.（0.01±0.04）μmol/（m^2·hr））（p〈0.01）,suggesting that drainage would also significantly enhance CH4and N2O emissions.Changes in environmental variables（including sediment temperature,p H,salinity,redox status,and water depth）contributed significantly to the enhanced GHG emissions following pond drainage.Furthermore,analysis of the sustained-flux global warming and cooling potentials indicated that the combined global warming potentials of the GHG fluxes were significantly higher in the DP than in the UDP（p〈0.01）,with values of739.18 and 26.46 mg CO2-eq/（m^2·hr）,respectively.Our findings suggested that drainage of aquaculture ponds can increase the emissions of potent GHGs from the coastal zone of China to the atmosphere during winter,further aggravating the problem of global warming.