How to accurately locate pulmonary nodules in thoracic surgery is a key challenge in surgery. "Chinese expert consensus on preoperative assisted positioning technology of small pulmonary nodules (2025 edition)" (hereafter referred to as the consensus) is an update version incorporating the latest evidence and clinical practice based on the 2019 edition, aiming to provide reference for clinical practice. The consensus summarizes commonly used preoperative assisted positioning technologies, such as percutaneous lung puncture positioning (Hookwire positioning needles, metal spring coils, etc.), transbronchial puncture positioning (electromagnetic navigation bronchoscopes, etc.), and virtual reality and 3D printing positioning, and introduces the application indications, operating specifications and potential complications of different positioning technologies, analyzes the existing technical advantages and shortcomings, and emphasizes the selection of the most appropriate positioning method according to the specific situation of the patient, so as to improve the success rate and safety of the surgery, and promotes the minimally invasive and precise development of thoracic surgery.

So far, the monoclonal hypothesis of tumor occurrence and development cannot be justified. The genetic diversity selection hypothesis for the occurrence and development of lung cancer links Mendelian genetics with Darwin's theory of evolution, suggesting that the genetic diversity of tumor cell populations with polyclonal origins-monoclonal selection-subclonal expansion is the result of selection pressure. Normal cells acquire mutations in oncogenic driver genes and have a selective advantage over other cells, becoming tumor initiating cells; In the interaction with the tumor microenvironment (TME), the vast majority of initiating cells are recognized and killed by the human immune system. If immune escape occurs, the incidence of malignant tumors will greatly increase, and subclonal expansion, intratumour heterogeneity, etc. will occur. This article proposed the hypothesis of genetic diversity selection and analyzed its clinical significance.
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Humans ; Lung Neoplasms/genetics* ; Clinical Relevance ; Evolution, Molecular ; Mutation ; Tumor Microenvironment

In recent years,with the increasing proportion of pulmonary nodules,preoperative percutaneous lung puncture biopsy and bronchoscopic biopsy have received more and more attention.A large amount of clinical evidences indicate that lung puncture biopsy of stageⅠnon-small cell lung cancer(NSCLC)is safe and feasible.However,due to the histological characteristics of pulmonary ground-glass nodule(GGN),puncture biopsy of GGNs is more likely to cause bleeding and cough,and the tumor cells may be implanted along the alveolar wall or needle tract under the impact of blood flow or airflow,leading to the pleural recurrence and tumor spread through air spaces(STAS),when compared with puncture biopsy of solid nodules.Therefore,percutaneous lung puncture biopsy should be carefully adopted,especially for the patients who have subpleural nodules with visceral pleura invasion and lymphocyte infiltration.(J Intervent Radiol,2024,32:7-11)

Objective To analyze the clinical outcomes of extended thymectomy for myasthenia gravis (MG) patients under different surgical approaches, and to determine the factors affecting the prognosis of MG. Methods The MG patients who underwent extended thymectomy from January 2014 to March 2021 in our hospital were retrospectively collected. According to the surgical approach, they were divided into a subxiphoid group and an intercostal group, and the perioperative results and prognosis were compared between the two groups. A “good outcome” was defined as complete stable remission (CSR), pharmacological remission (PR) or minimal manifestations state (MMS); a “poor outcome” was defined as outcomes worse than MMS. Univariate and multivariate logistic regression analyses were performed to assess the factors associated with the good outcomes. Results A total of 187 MG patients were included in the study, including 82 males and 105 females, with a median age of 50 (36, 60) years. There were 134 patients in the intercostal group and 53 patients in the subxiphoid group. Compared with the intercostal group, although the operation time of the subxiphoid group was longer [200.0 (172.0, 232.0) min vs. 141.0 (118.0, 169.0) min, P<0.001], the intraoperative blood loss was less [10.0 (10.0, 20.0) mL vs. 20.0 (10.0, 50.0) mL, P<0.001], the postoperative hospital stay was shorter [3.0 (2.5, 4.0) d vs. 5.0 (3.0, 7.0) d, P<0.001], and the incidence of complications was lower [1 (1.9%) vs. 26 (19.4%), P=0.001]. A total of 159 (85.0%) patients were followed up for a median period of 46 (13, 99) months, with a good outcome rate of 90.6% and CSR rate of 33.3%. There were no statistical differences in PR, MMS or overall good outcome rates between the two groups (P>0.05). Multivariate logistic analysis showed that age≤50 years was an independent predictor for "good outcome" of MG patients. Conclusion Extended thymectomy via subxiphoid for MG is a safe, feasible and effective surgical approach.

With the wide popularization of low-dose computed tomography screening for lung cancer, the proportion of early detection of lung cancer has increased significantly. Due to the favorable prognosis of ground-glass nodule-lung cancer, a prospective multicenter clinical trial in Japan has confirmed the safety and efficacy of segmentectomy. Identification of the intersegmental plane is one of the key steps in segmentectomy. Understanding its physiological mechanism can provide a theoretical basis for optimizing the identification technique, identifying intersegmental plane more accurately and quickly, improving the surgical effect and reducing complications. This article mainly introduces the identification technology of the intersegmental plane and its physiological mechanism in pulmonary segmentectomy.

With the popularization of chest computed tomography(CT)lung cancer screening,the detection rate of peripheral pulmonary nodules is increasing day by day.Some patients could make clear diagnoses and receive early treatment by obtaining biopsy specimens.Transbronchial lung biopsy(TBLB)is one of the non-surgical biopsy methods for peripheral pulmonary nodules,which has less trauma and lower incidence of complications compared to percutaneous thoracic needle bi-opsy(PTNB).However,the diagnostic rate of TBLB is about 70%,which is still inferior to that of PTNB,which is about 90%.Since 2018,robot assisted bronchoscopy systems have been applied in clinical practice.This article reviews their application in further improving the diagnostic rate of peripheral pulmonary nodules by TBLB.

With the widespread application of high-resolution and low-dose computed tomography (CT), especially the increasing number of people participating in lung cancer screening projects or health examinations, the detection of pulmonary nodules is increasing. At present, the relevant guidelines for pulmonary nodules focus on how to follow up and diagnose, but the treatment is vague. And the guidelines of European and American countries are not suitable for East Asia. In order to standardize the diagnosis and treatment of pulmonary nodules and address the issue of disconnection between existing guidelines and clinical practice, the Lung Cancer Medical Education Committee of the Chinese Medicine Education Association has organized domestic multidisciplinary experts, based on literature published by experts from East Asia, and referring to international guidelines or consensus, the "Chinese expert consensus on multi-disciplinary minimally invasive diagnosis and treatment of plmonary nodules" has been formed through repeated consultations and thorough discussions. The main content includes epidemiology, natural course, malignancy probability, follow-up strategies, imaging diagnosis, pathological biopsy, surgical resection, thermal ablation, and postoperative management of pulmonary nodules.

Objective    To explore and analyze the related influencing factors for common intraoperative complications during CT-guided percutaneous radiofrequency ablation of pulmonary tumor. Methods    We retrospectively analyzed the clinical data of the patients who underwent CT-guided percutaneous radiofrequency ablation of pulmonary tumor in our hospital from December 2018 to December 2019, and analyzed the influencing factors for complications. Results    A total of 106 patients were enrolled. There were 58 (54.7%) males and 48 (45.3%) females aged 46-81 (68.05±8.05) years. All patients successfully completed the operation. The operation time was 47.67±16.47 min, and the hospital stay time was 2.45±1.35 d. The main intraoperative complications were pneumothorax (16.0%, 17/106) and intrapulmonary hemorrhage (22.6%, 24/106). Univariate analysis showed that the number of pleural punctures had an impact on the occurrence of pneumothorax (P=0.00). The length of the puncture path (P=0.00), ablation range (P=0.03) and ablation time (P=0.00) had an impact on the occurrence of intrapulmonary hemorrhage. Multivariate logistic regression analysis showed that the size of the lesion (OR=17.85, 95%CI 3.41-93.28, P=0.00) and the number of pleural punctures (OR=0.02, 95%CI 0.00-0.11, P=0.00) were independent influencing factors for the occurrence of pneumothorax. The length of the puncture path (OR=15.76, 95%CI 5.34-46.57, P=0.00) was the independent influencing factor for the occurrence of intrapulmonary hemorrhage. Conclusion    Percutaneous radiofrequency ablation of pulmonary tumor is safe and with a high success rate, but intraoperative complications are affected by many factors, so the surgeons should be proficient in operating skills to avoid complications.

Objective    To evaluate the learning curve of CT-guided medical glue localization for pulmonary nodule before video-assisted thoracic surgery (VATS). Methods    The clinical data of the patients with pulmonary nodules who underwent CT-guided medical glue localization before VATS in our hospital from July 2018 to March 2021 were retrospectively analyzed. The patients were divided into 3 groups: a group A (from July 2018 to August 2019), a group B (from September 2019 to June 2020) and a group C (from July 2020 to March 2021). The localization time, morbidity, complete resection rate and other indexes were compared among the three groups. Results    A total of 77 patients were enrolled, including 24 males and 53 females aged 57.4±10.1 years. There were 25 patients in the group A, 21 patients in the group B, and 31 patients in the group C. 77 pulmonary nodules were localized. There was no significant difference among the groups in the basic data (P>0.05). The localization time in the group C was 10.6±2.0 min, which was statistically shorter than that in the group A (15.4±4.4 min) and group B (12.9±4.3 min) (P<0.01). The incidence of complications in the group C was lower than that in the group A and group B (25.8% vs. 52.0% vs. 47.6%, P=0.04). The success rate of localization of the three groups was not statistically different (P=0.12). Conclusion    There is a learning curve in CT-guided medical glue localization for single pulmonary nodule before VATS. After the first 46 cases, the operation time can be shortened, and the incidence of complications can be decreased.

Objective:To investigate the role of miR-765 in papillary thyroid carcinoma (PTC) cells and further uncover the associated signaling mechanism.Methods:qPCR was used to assess miR-765 expression in normal human thyroid cell line (Nthy-ori 3-1) and human PTC cell lines (B-CPAP and TPC-1). PTC cells were divided into blank control group (BC) without special treatment, negative control group (NC) that was transfected with negative control sequences, and miR-mimic group that was transfected with miR-mimic. Transfection with miR-mimic was used to up-regulate the expression of miR-765 in PTC cells. CCK-8, plate colony formation, wound-healing, and Transwell invasion assays were used to assess the proliferation, migration, and invasion of PTC cells, respectively. Western blot assay was used to assess the level of nuclear β-catenin, the key protein of the Wnt/β-catenin pathway, in PTC cells.Results:The level of miR-765 expression of PTC cells was significantly lower than that of Nthy-ori 3-1 cells (B-CPAP, P=0.0003; TPC-1, P=0.0003). Transfection with miR-mimic significantly up-regulated miR-765 expression in PTC cells (B-CPAP, P<0.0001; TPC-1, P<0.0001). Results of CCK-8 assay (B-CPAP, P<0.05; TPC-1, P<0.05), plate colony formation assay (B-CPAP, P=0.0001; TPC-1, P<0.0001), wound-healing assay, and Transwell invasion assay (B-CPAP, P=0.001; TPC-1, P=0.0014) showed that up-regulating the expression of miR-765 significantly inhibited the proliferation, migration, and invasion of PTC cells. Western blot results showed that up-regulating the expression of miR-765 significantly reduced nuclear β-catenin (B-CPAP, P=0.0039; TPC-1, P=0.0004) . Conclusion:up-regulating the expression of miR-765 inhibits the proliferation, migration, and invasion of PTC cells and the Wnt/β-catenin signaling pathway, which not only proposes miR-765 as a novel potential therapeutic target for PTC, but also further revealed the associated mechanism.