Chronic post-surgical pain (CPSP) is a common long-term complication following lung surgery. Its high incidence significantly impacts patients’ quality of life and functional recovery, and imposes a substantial socioeconomic burden. This consensus aims to systematically establish a standardized integrated Chinese and Western medicine diagnostic and treatment framework for chronic post-lung surgery pain (CPLSP). Based on the latest domestic and international evidence-based medical research and multidisciplinary clinical experience, the working group comprehensively elaborates on core issues regarding CPLSP, including its definition, epidemiology, pathogenesis, clinical assessment, Western medical treatment, traditional Chinese medicine (TCM) treatment, and integrated strategies. The consensus emphasizes a patient-centered approach, adhering to the principles of multimodality, individualization, and stepwise management, highlighting the synergistic advantages of integrating Chinese and Western medicine throughout the entire perioperative management cycle encompassing "perioperative anti-inflammation, acute analgesia, and chronic rehabilitation." Through systematic literature retrieval and evidence integration, a total of 9 core recommendations were established to provide scientifically sound and clinically practical guidance.

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 discuss the protective effect of ginsenoside Rh1(G-Rh1)on kidney injury in the diabetic mellitus(DM)mice,and to clarify its mechanism.Methods:The diabetic kidney disease(DKD)model was prepared by using the high-fat,high-sugar diet combined with intraperitoneal injection of streptozotocin(STZ).A total of 48 C57/BL6 model mice were randomly divided into model group,nuclear factor erythroid 2-related factor 2(Nrf2)inhibitor ML385 group(ML385 group)(30 mg·kg-1),G-Rh1 group(30 mg·kg-1),and G-Rh1+ML385 group(30 mg·kg-1 G-Rh1+30 mg·kg-1 ML385),and there were 12 mice in each group.Additionally,12 C57/BL6 mice were selected as control group.After treated for 8 weeks,automatic analyzer was used to detect the levels of fasting blood glucose(FBG),blood urea nitrogen(BUN),and serum creatinine(Scr)in serum of the mice in various groups,as well as 24 h urinary protein(24 h UP)levels in urine,and the kidney index was calculated;kits were used to detect the activities of superoxide dismutase(SOD)and lactate dehydrogenase(LDH),and the levels of malondialdehyde(MDA)in kidney tissue of the mice in various groups;Western blotting method was used to detect the expression levels of Nrf2 and heme oxygenase-1(HO-1)proteins in kidney tissue of the mice in various groups.Results:Compared with control group,the levels of FBG and kidney indexes in serum of the mice in model group,ML385 group,and G-Rh1+ML385 group were significantly increased(P<0.01),and the level of FBG in serum of the mice in G-Rh1 group was significantly increased(P<0.01);compared with model group,the kidney index of the mice in ML385 group was significantly increased(P<0.05),while the levels of FBG and kidney index of the mice in G-Rh1 group were significantly decreased(P<0.05 or P<0.01);compared with G-Rh1 group,the level of FBG and kidney index of the mice in G-Rh1+ML385 group were significantly increased(P<0.01).Compared with control group,the levels of BUN and Scr in serum,and 24 h UP in urine of the mice in model group,ML385 group,G-Rh1 group,and G-Rh1+ML385 group were significantly increased(P<0.01);compared with model group,the level of BUN in serum and 24 h UP in urine of the mice in ML385 group were significantly increased(P<0.05),while the levels of BUN and Scr in serum,and 24 h UP in urine of the mice in G-Rh1 group were significantly decreased(P<0.01);compared with G-Rh1 group,the levels of BUN and Scr in serum,and 24 h UP in urine of the mice in G-Rh1+ML385 group were significantly increased(P<0.01).Compared with control group,the activities of SOD in kidney tissue of the mice in model group,ML385 group,G-Rh1 group,and G-Rh1+ML385 group were significantly decreased(P<0.01),while the levels of MDA and LDH activities were significantly increased(P<0.01);compared with model group,the activity of SOD in kidney tissue of the mice in ML385 group was significantly decreased(P<0.05),and the level of MDA was significantly increased(P<0.05);the activity of SOD in kidney tissue of the mice in of G-Rh1 group was significantly increased(P<0.01),and the level of MDA and activity of LDH were significantly decreased(P<0.01);compared with G-Rh1 group,the activity of SOD in kidney tissue of the mice in G-Rh1+ML385 group was significantly decreased(P<0.01),and the level of MDA and activity of LDH were significantly increased(P<0.01).Compared with control group,the expression levels of Nrf2 and HO-1 proteins in kidney tissue of the mice in model group,ML385 group,G-Rh1 group,and G-Rh1+ML385 group were significantly decreased(P<0.05 or P<0.01);compared with model group,the expression levels of Nrf2 and HO-1 proteins in kidney tissue of the mice in ML385 group and G-Rh1+ML385 group were significantly decreased(P<0.05),while the expression levels of Nrf2 and HO-1 proteins in kidney tissue of the mice in G-Rh1 group were significantly increased(P<0.01);compared with G-Rh1 group,the expression levels of Nrf2 and HO-1 proteins in kidney tissue of the mice in G-Rh1+ML385 group were significantly decreased(P<0.01).Conclusion:Ginsenoside Rh1 reduces the oxidative stress and improves the kidney function,providing protective effects on kidney injury in the DM mice,and its mechanism may be related to the activation of the Nrf2/HO-1 signaling pathway.

Lung resection following pneumonectomy for recurrent lung cancer is a challenging scenario. Peri-operative airway management and choice of surgical procedure are issues to be addressed by both the anesthesiologists and thoracic surgeons. We hereby report a case of anterior segmentectomy of the right upper for recurrent lung cancer, in a patient who had previously underwent pneumonectomy for primary lung cancer one year earlier. A modified conventional tracheal intubation and unique surgical techniques were applied for video-assisted thoracoscopic surgery (VATS) anterior segmentectomy of the right upper lobe in a patient with a notable mediastinal shift (following contralateral pneumonectomy), resulting in a good recovery and clinical outcome. The clinical experience is summarized in detail in this article.

Objective: To explore the special situation in subxiphoid uniportal VATS surgery and summarize the treatment strategies. Methods: In September 2014, the subxiphoid uniportal VATS surgery was carried out. Up to now, our research team has completed more than 300 subxiphoid uniportal VATS operations, especially including 242 cases of subxiphoid uniportal VATS segmentectomy and 22 cases of subxiphoid uniportal VATS mediastinal tumor resection. Some special situations were encountered during the operation, including cardiac arrest, pericardial tamponade, innominate venous injury, severe arrhythmia, difficulty in positioning the lung segment, and difficulty in positioning the small nodule et al. Results: Some patients changed the surgical procedure during surgery due to intraoperative emergencies such as severe arrhythmia, heart problems, intraoperative bleeding. Postoperative complications mainly included thoracotomy and hemostasis, continuous air leak after operation, pulmonary hematoma, arrhythmia, and no perioperative death. Conclusion Under the subxiphoid uniportal VATS surgery is an important manifestation of the minimally invasive technique of the chest. It is safe and feasible to select suitable cases, master the thoracoscopic technique and special surgical techniques. Special situations during subxiphoid uniportal VATS surgery should be known.

Objective Introduce the experience of open window thoracostomy in the treatment of bronchopleural fistula after pulmonary resection.To explore which patients are currently suitable for open window thoracostomy , how to deal with them after open window thoracostomy, and how to treat patients without window drainage.Methods In 2017, the thoracic surgery department of Shanghai Pulmonary Hospital completed 13,341 thoracic surgeries, including 10 cases of open window thoracos-tomy, and patients with BPF after other pulmonary resection were treated with conservative thoracic closed drainage .Thoracic closed drainage therapy is often accompanied by thoracic irrigation.From January 2004 to December 2017, 21 cases of chronic refractory abscess treated with autologous musculocutaneous flap implantation after pulmonary resection and open window drain-age were summarized.The treatment of chronic refractory abscess after 14 years of diagnosis was divided into three stages.The first stage is opening the abscess cavity stage, namely opening the window drainage.The second stage is elimination of abscess cavity and closure of bronchial pleural fistula.The third stage is autologous musculocutaneous flap transplantation or displace-ment to fill the abscess cavity stage.Results Compared with before open window, the 10 patients with open window thoracos-tomy showed obvious improvement in thoracic and pulmonary infection, without perioperative death.Other patients with BPF af-ter pulmonary resection without open window thoracostomy died in 2 of conservative thoracic closed drainage .From January 2004 to December 2017, 19 patients(19/21) were successfully treated with autologous musculocutaneous flap implantation af-ter pulmonary resection and open window thoracostomy, without recurrence of empyema and necrosis of skin flap, and 2 cases (2/21) were not cured due to large bronchial fistula, and local recurrence of empyema, without perioperative death.Conclu-sion Most patients with BPF after pulmonary resection are treated with closed thoracic drainage , especially those with lower lo-bectomy and with pleural irrigation.Most patients can be cured.If patients with upper lobe, middle and upper lobectomy or pneumonectomy, accompanied by BPF, chest infection and poor drainage, it is easy to develop intrapulmonary infection sprea-ding.We should do open window thoracostomy as soon as possible.The removal of the residual cavity by filling musculocutane-ous flap after open window thoracostomy is a great improvement compared with the transthoracic reconstruction .

Objective To summarize experience in the treatment of chronic refractory empyema with autologous myocutaneous flap implantation.Methods From January 2004 to December 2017,26 patients had been treated with autologous myocutaneous flap implantation in Shanghai Pulmonary Hospital for chronic refractory empyema.Among them,24 were men and 2 were women.The mediam age was 50.1 years(14-74 years).21 of them had medical histories of lung resection because of basic diseases(most of which accepted surgeries in other hospitals).Complications appeared after surgeries.15 of them had bronchopleural fistula while windowing,which could not be cured by conservative treatments such as drainage.Then we performed open-window thoracostomy and long-time dressing.6 of 21 had experienced pneumonectomy.Other 5 patients did not have primary operational histories.They experienced dressing by windowing because of chronic refractory empyema after the in effective conservative treatments like drainage without pulmonary re-expansion.Results No respiratory complications occurred in these patients.The catheters were successfully removed within 5 days and the patients were discharged within 3-6 weeks after the operations.The median follow-up period was 9 months.24 cases were successful with no recurrence of empyema or flap necrosis,the other 2 cases underwent recurrence of empyema.Conclusion The application of autologous myocutaneous flaps for the treatment of chronic refractory empyema is an effective and continuously improving method.

Objective With the popularization of low dose chest CT examination,a large number of patients with pulmonary nodules(10 mm ＜ D≤20 mm) or small nodules(4 mm ＜ D≤10 mm) emerged.How to accurately position pulmonary nodules especially small nodules in video-assisted thoracoscopic surgery(VATS) is the key.This study explores the positioning method for small pulmonary nodules in VATS.Methods From January 2012 to June 2014,we used a method named clock dial integrated positioning in 316 patients with pulmonary nodules who underwent limited resection or lobectomy in VATS,obtained satisfactory results.Results The accuracy of clock dial integrated positioning method in judgments was 99％ (313/316).296 cases underwent thoracoscopic sublobectomy,including thoracoscopic pulmonary segmental resection in 141 cases and thoracoscopic wedge resection in 155 cases.20 cases underwent thoracoscopic lobectomy.Among them 17 cases had multinodules which were in the different pulmonary segments of the same lobe.Underwent thoracoscopic lobectomy.The positions of 3 cases were error during early cases,underwent VATS lobectomy.The postoperative pathology:194 cases were lung cancer.37 cases were metastatic tumor.85 cases were benign lesions.Conclusion Combined with the clinical treatment experience,we believe that the clock dial integrated positioning method is effective for positioning in VATS.Clinical VATS experiences accumulations are also needed.

Objective To investigate the CT manifestations of hepatocellular adenoma,and improve the CT diagnostic accuracy of the disease.Methods CT manifestations of 10 cases with hepatocellular adenoma proved by pathology were analyzed retrospectively.Results On plain CT scan,the lesions were isodensity or slight hypodensity in 10 cases,which was hardly distinguished from the normal tissue.In all 10 cases,the lesions showed marked enhancement in the arterial phase.the mean CT value of hepatocellular adenoma in the arterial phase was much higher than that in portal venous and delay phase.Conclusion CT scan is helpful for the diagnosis of hepatocellular adenoma.