Objective:To evaluate the efficacy and safety of interventional treatment of advanced portal vein occlusion indifferent stages after liver transplantation.Methods:The clinical data of 13 patients with advanced portal vein occlusion after liver transplantation in Tianjin First Central Hospital from March 2016 to June 2022 were retrospectively analyzed, including 8 males and 5 females, with a median age of 47 (2 to 68) years. Based on the Yerdel’s Classification of portal vein thrombosis and Department of Radiology, Tianjin First Central Hospital practice experience, the classification of portal vein occlusion was further modified for a classification-base interventional treatment. The changes of portal vein pressure gradient, complications and protal vein after interventional treatment were analyzed.Results:All 13 cases underwent successful interventional treatment. A total of 15 stents were implanted in the 13 patients. The treatment time was (63.1±18.4) min. The pressure gradient at both ends of portal vein occlusion before treatment was [ M ( Q1, Q3)] 14.0 (9.5, 18.0) mmHg (1 mmHg=0.133 kPa), which declined after interventional treatment 1.0 (1.0, 2.5) mmHg ( Z=-3.19, P<0.001). Portal vein and right portal branch thrombosis recurred in one patient six days after interventional treatment, which was managed with re-interventional treatment. One patient underwent intrahepatic portal shunt through jugular vein 111 days after interventional treatment due to recurrent portal vein thrombosis. The other patients recovered uneventfully without recurrent portal vein thrombosis or occlusion during follow-ups. No intervention-related complications such as puncture point and intraperitoneal hemorrhage occurred in the patients. Conclusion:A modified classification-based interventional treatment could be safe and feasible for patients with advanced portal vein occlusion after liver transplantation.

With the widespread adoption of low-dose CT screening and the extensive application of high-resolution CT, the detection rate of sub-centimeter lung nodules has significantly increased. How to scientifically manage these nodules while avoiding overtreatment and diagnostic delays has become an important clinical issue. Among them, lung nodules with a consolidation tumor ratio less than 0.25, dominated by ground-glass shadows, are particularly worthy of attention. The therapeutic challenge for this group is how to achieve precise and complete resection of nodules during surgery while maximizing the preservation of the patient's lung function. The "watershed topography map" is a new technology based on big data and artificial intelligence algorithms. This method uses Dicom data from conventional dose CT scans, combined with microscopic (22-24 levels) capillary network anatomical watershed features, to generate high-precision simulated natural segmentation planes of lung sub-segments through specific textures and forms. This technology forms fluorescent watershed boundaries on the lung surface, which highly fit the actual lung anatomical structure. By analyzing the adjacent relationship between the nodule and the watershed boundary, real-time, visually accurate positioning of the nodule can be achieved. This innovative technology provides a new solution for the intraoperative positioning and resection of lung nodules. This consensus was led by four major domestic societies, jointly with expert teams in related fields, oriented to clinical practical needs, referring to domestic and foreign guidelines and consensus, and finally formed after multiple rounds of consultation, discussion, and voting. The main content covers the theoretical basis of the "watershed topography map" technology, indications, operation procedures, surgical planning details, and postoperative evaluation standards, aiming to provide scientific guidance and exploration directions for clinical peers who are currently or plan to carry out lung nodule resection using the fluorescent microscope watershed analysis method.

BACKGROUND: Perioperative treatment has become an increasingly important aspect of the management of patients with non-small cell lung cancer (NSCLC). Small-scale clinical studies performed in recent years have shown improvements in the major pathological remission rate after neoadjuvant therapy, suggesting that it will soon become an important part of NSCLC treatment. Nevertheless, neoadjuvant immunotherapy may be accompanied by serious adverse reactions that lead to delay or cancelation of surgery, additional illness, and even death, and have therefore attracted much attention. The purpose of the clinical recommendations is to form a diagnosis and treatment plan suitable for the current domestic medical situation for the immune-related adverse event (irAE). METHODS: This recommendation is composed of experts in thoracic surgery, oncologists, thoracic medicine and irAE related departments (gastroenterology, respirology, cardiology, infectious medicine, hematology, endocrinology, rheumatology, neurology, dermatology, emergency section) to jointly complete the formulation. Experts make full reference to the irAE guidelines, large-scale clinical research data published by thoracic surgery, and the clinical experience of domestic doctors and publicly published cases, and repeated discussions in multiple disciplines to form this recommendation for perioperative irAE. RESULTS: This clinical recommendation covers the whole process of prevention, evaluation, examination, treatment and monitoring related to irAE, so as to guide the clinical work comprehensively and effectively. CONCLUSIONS Perioperative irAE management is an important part of immune perioperative treatment of lung cancer. With the continuous development of immune perioperative treatment, more research is needed in the future to optimize the diagnosis and treatment of perioperative irAE.