Volume 101 ·  Issue 33 ·  2021

At present, the detection rate of pulmonary nodules is higher and higher in clinic. From three perspectives of clinical characteristics of patients with pathology confirmed benign pulmonary nodules in which malignancy could not be excluded preoperatively, short-term efficacy of CT-guided percutaneous and electromagnetic navigation bronchoscope-guided microwave ablation for pulmonary ground-glass nodules,and the application of hybrid operating room and traditional preoperative CT in the localization of pulmonary nodules, this paper proposes that further research on pulmonary nodules needs to be done aiming at the difficulties and hot issues in the diagnosis and treatment of pulmonary nodules in thoracic surgery.

To compare the safety and feasibility of Discovery^TM IGS 7 hybrid operating room and traditional preoperative CT in the localization of pulmonary nodules in video-assisted thoracic surgery.

A retrospective study was conducted to collect and analyze the data of 92 patients with pulmonary nodules who underwent thoracoscopic lung resection after localization via percutaneous puncture. All participants, including 38 males and 54 females aged from 26 to 72 years with an average age of (47±12) years, were treated at the Department of Thoracic Surgery of the Third People′s Hospital of Shenzhen. Among them, 47 patients accepted Discovery^TM IGS 7 hybrid operating room localization (hybrid operating room group), while 45 patients accepted CT scan localization (CT room group). The time from the start of localization to the beginning of surgery, the decoupling rate, pain score and the duration of hospital stay were compared to evaluate the safety and feasibility.

There was no significant difference in age, gender, smoking history, family history of tumours, nodule characteristics (including texture) between the two groups (all P>0.05). Compared with the CT room group, the time from localization to the start of the operation in the hybrid operating room group was shorter [(34.8±18.2) min vs (250.7±141.2) min], with fewer cases of decoupling (0 cases vs 5 cases). Furthermore, the patient′s pain score in the hybrid operating room group was lower than that in CT room group[ 0 vs (4.00±1.31) ] (allP<0.05).

Our study confirms that the localization of pulmonary nodules via percutaneous puncture in the Discovery^TM IGS 7 hybrid operating room is safe and effective. The time from localization to the start of the operation was shorter, with fewer cases of decoupling and no pain.

To compare the efficacy and the safety of computed tomography(CT)-guided percutaneous and electromagnetic navigation bronchoscope-guided microwave ablation in the treatment of pulmonary ground-glass nodules.

A retrospective study was conducted to collect the data of 22 patients with pulmonary ground-glass nodules (GGN) who were intolerant of lung resection. The participants, including 6 males and 16 females aged from 57 to 86 years with an average age of (70.5±9.0) years, were treated in the Department of Thoracic Surgery or Respiration Department of Beijing Chaoyang Hospital from January 2018 to October 2020. All of them were pathologically diagnosed as non-small cell lung cancer stage ⅠA. According to the nodule location and the distance to the small airway, the participants were divided into two groups: CT group(n=17) and electromagnetic navigation group(n=5). Patients in the CT group underwent computed tomography-guided percutaneous microwave ablation, and patients in the electromagnetic navigation group were treated with electromagnetic navigation bronchoscope-guided microwave ablation therapy. The local control rate was used to evaluate the effectiveness of the treatment by reexamination of chest CT. Surgical complications such as pneumothorax, hemoptysis, and postoperative pain between two groups were compared to assess the safety.

There was no statistically significant differences in age, gender, lesion size, solid component and lesion location between the two groups (all P>0.05). No significant differences were found in postoperative pain, pneumothorax and hemoptysis and other common surgical complications between the two groups (allP>0.05). In terms of short-term efficacy evaluation, when Chest CT was re-performed one month after surgery, the nodule shrink rate of patients in the electromagnetic navigation group was higher than that in the CT group (4/5 vs 2/17), and the difference was statistically significant (P=0.003); when Chest CT was re-performed three months after surgery, no significant difference was observed in the nodule shrink rate between the two groups (15/17 (88.2%) vs 5/5 (100.0%), P=0.420).

Two paths of microwave ablation treatment can achieve good local control of the pathology-confirmed stage ⅠA malignant pulmonary GGN. The treatment effect in the electromagnetic navigation group can be determined earlier after the operation (one month postoperation). There is no statistically significant difference in common complications between the two groups.

To analyze the clinical characteristics of patients with pathology confirmed benign pulmonary nodules in which malignancy could not be excluded preoperatively, to provide high-quality evidence of evidence-based medicine for reducing the resection rate of benign lung nodules.

This study adopts the method of retrospective analysis to collect the clinical data of 281 patients with lung lesions that malignancy could not be ruled out in preoperative assessment and pathological findings confirmed benign lung lesion. There were 151 males and 130 females aged from 18 to 80 years with an average age of (53.8±11.4) years. All of them were treated in the Department of Thoracic Surgery, Beijing Chest Hospital from January 2015 to December 2020. The clinical information, imaging and histopathologic features of patients were analyzed.

A total of 281 patients were enrolled, accounting for 4.8% (281/5 868) of the total lung operations during the same period. Among them, 210 cases of lung lesions (210/281, 74.7%) were detected by CT screening in physical examination. The major diameter of the main lesion was 4.3-99.3 (20.7±15.9) mm, and 87.2% (245/281) of which were greater than 8 mm. A total of 314 lesions were resected. The solid nodules were the most common among the resected lesions, accounting for 67.2% (211/314). The common imaging characteristics suggesting malignancy included spicule sign(189/314), lobulation(122/314), pleural indentation(106/314). 79.7% of patients(224/281) underwent video-assisted thoracoscopic surgery(VATS). 59.1% of patients (166/281) accepted lung wedge resection, 5.3% (15/281) lung segment resection, and 35.6% (100/281) lobectomy. Pathological findings were mainly inflammatory lesions 52.2% (164/281), tuberculosis 22.0% (69/281), and hamartoma 14.6% (46/281).

In patients with the resected benign lung nodules in which malignancy could not be excluded preoperatively, solid nodules accounted for most of these benign pulmonary lesions, but always with one or more imaging characteristics suggesting malignancy. For those highly suspected malignant lesions, a surgical biopsy can be used as the alternative clinical strategy. Still, it is necessary to choose the VATS lung resection and the smallest resection area as much as possible.

To investigate the differentially expressed proteins between ossified posterior longitudinal ligament and adjacent non-ossified posterior longitudinal ligament in patients with cervical ossification of the posterior longitudinal ligament (OPLL), and to explore the pathophysiological mechanism of OPLL.

Five patients with cervical OPLL who underwent anterior cervical decompression surgery in the Department of Orthopedics, Peking University Third Hospital from January 2018 to March 2018 were selected. The ossified posterior longitudinal ligament tissue resected during surgery was used as the OPLL group, and the adjacent non-ossified posterior longitudinal ligament tissue resected during surgery was used as the control group. Data-independent acquisition-based quantitative proteomics were performed to identify the differentially expressed proteins. The functions of differentially expressed proteins were clarified through literature search to find the proteins that play a role in the occurrence and development of OPLL.

Nine differentially expressed proteins were found, all of which were up-regulated in OPLL group (fold change≥2 and P<0.05) compared with control group. The proteins were associated with nucleotide transport and metabolism, extracellular structures, translation, ribosomal structure and biogenesis, general function prediction, and signal transduction mechanisms, etc. According to papers published, 5 proteins may play important role in the occurrence and development of OPLL, including collagen alpha-1(Ⅱ) chain (COL2A1), matrix Gla protein (MGP), signal peptide, CUB and EGF-like domain-containing protein (SCUBE1), osteomodulin (OMD) and fibroblast growth factor-binding protein 2 (FGFBP2).

The differentially expressed proteins obtained in this study provide a basis for the pathophysiology of OPLL and the discovery of its biomarkers.

To compare the positive detection rates, sensitivity and specificity of Metrohealth dysphagia screen (MDS) and Kubota water swallowing test in screening of dysphagia in patients with acute ischemic stroke.

Two hundred and seventy patients with acute ischemic stroke with Glasgow Coma Scale (GCS) score of 15 in the Department of Neurology, Zhongshan Hospital, Fudan university, from May 2017 to January 2020 were enrolled, including 200 males and 70 females, aged (65±12) years. All patients underwent MDS and Kubota water swallowing test respectively and the positive rates of the two methods were compared for different stroke subtypes and different onset periods. Fifty-five patients completed the golden standard test for dysphagia, flexible endoscopic examination of swallowing (FEES). Specificity and sensitivity of the two methods validated against FEES were calculated and compared.

Eighty-three (30.7%) patients with acute ischemic stroke were detected with dysphagia by MDS and 76(28.1%) cases by Kubota water swallowing test, there was no statistical difference between two methods (P>0.05). Among them, 53 cases (35.1%) were positive in MDS in the anterior circulation stroke group and 30 cases (25.2%) were positive in the posterior circulation stroke group, compared with 50 cases (33.1%) and 26 cases (21.8%) in Kubota water swallowing test respectively, and no statistically significant difference was observed between the two methods (bothP>0.05). The positive rates of MDS in patients with acute ischemic stroke within 3 days, 4-7 days, 8-14 days after onset were 33.7%, 29.8% and 27.8%, respectively, and it was 31.7%, 26.6%, 25.0% with Kubota water swallowing test (allP>0.05). Fifty-five patients completed FEES, the sensitivity, specificity of MDS for dysphagia screening against FEES was 76.9% and 73.8%, respectively. The Kappa value of the consistency test for MDS and FEES was 0.418 (P=0.001). The sensitivity, specificity of Kubota water swallowing test was 53.8% and 78.6%, respectively. And the Kappa value of the consistency test for Kubota water swallowing test and FEES was 0.300 (P=0.025). The receiver operating characteristic curve showed that area under the curve of MDS was 0.775 while it was 0.686 in the Kubota water swallowing test, there was no statistical difference between the two methods (P=0.275).

Metrohealth dysphagia screen has no significant difference in screening ability with Kubota water swallowing test, and it is much safer and easier to perform without drinking water. It can be applied to screen dysphagia at early stage of onset in patients with acute ischemic stroke.

To evaluate the changes of bone turnover markers and bone remodeling balance in acromegaly patients and their associations with disease activity.

A total of 68 patients diagnosed with acromegaly in Nanjing Drum Tower Hospital from September 2012 to October 2019 were collected (39 patients had complete follow-up data after treatment). Meanwhile, 30 patients with non-functional adrenal adenoma matched for age, sex, and body mass index (BMI) were also included as controls. Serum calcium, phosphorus, parathyroid hormone (PTH), bone turnover markers [osteocalcin, C-terminal telopeptide of type 1 collagen (CTX) and procollagen type 1 N-terminal propeptide (P1NP)], and bone remodeling index were detected and compared between the two groups. Further, acromegaly patients were subdivided into remission and non-remission groups according to whether the patient achieved complete remission after treatment. Univariate and multivariate linear regression analysis was used to determine the independent predictors of bone turnover markers.

At baseline, acromegaly patients had higher serum calcium, phosphorus and lower PTH levels than controls (all P<0.01). Moreover, Acromegaly patients had higher serum osteocalcin [45.98(31.98, 60.27) ng/ml vs 15.83(12.74, 19.96) ng/ml,P<0.01], P1NP [115.50 (72.64, 145.90) ng/ml vs 36.45(30.45, 44.28) ng/ml,P<0.01] and CTX than controls [1.12 (0.79, 1.56) ng/ml vs 0.37(0.30, 0.50) ng/ml,P<0.01]. Meanwhile, the bone remodeling index in acromegaly patients was significantly increased compared with controls [4.27(1.31, 5.99) vs 0.03(-0.38, 0.63),P<0.01]. Multivariate linear regression analysis revealed that serum insulin-like growth factor 1 (IGF-1) was an independent predictor for osteocalcin (β=0.610,P=0.000), P1NP (β=0.601, P=0.000) and CTX (β=0.596, P=0.000). After treatment, serum calcium and phosphorus in both remission group and non-remission group decreased (all P<0.05). Likewise, serum level of PTH increased, while osteocalcin, PINP, CTX, and bone remodeling index decreased in remission and non-remission groups, but the differences were only statistically significant in remission group (allP<0.05). The bone turnover markers and bone remodeling index in remission group almost decreased to control levels (allP>0.05).

Acromegaly patients present with PTH-independent calcium-phosphate alterations, enhanced bone turnover state, and positive bone remodeling balance. Overall bone formation is greater than bone resorption and is closely related to the activity of acromegaly. The abnormal bone metabolism is reversible after biochemical control of acromegaly.

To investigate the clinical significance of anti-melanoma differentiation-associated gene 5 (anti-MDA5) antibody in the evaluation of the severity and prognosis of juvenile dermatomyositis (JDM)-associated interstitial lung disease (ILD).

The clinical data of JDM patients admitted to the Children′s Hospital Affiliated to Capital Institute of Pediatrics from May 2016 to July 2019 were retrospectively analyzed. One hundred and one JDM patients met the grouping criteria, with 12 anti-MDA5 antibody-positive cases and 89 anti-MDA5 antibody-negative cases. Twenty JDM patients with negative anti-MDA5 antibody were randomly selected. The incidence of ILD, respiratory failure, pulmonary function and the mortality of those two groups were compared.

The incidence of ILD was 11/12 in the positive group and 3/20 in the negative group, with a statistically significant difference (P<0.001). The abnormal rate of carbon monoxide diffusing capacity (D_LCO) was 6/8 in the positive group and 2/16 in the negative group, and there was a statistically significant difference (P=0.002). The incidence of respiratory failure was 2/12 in the positive group and 0/20 in the negative group, and there was no statistically significant (P=0.133). The mortality rate was 1/12 in the positive group and 0/20 in the negative group, with no statistically significant difference (P=0.375).

JDM patients with positive anti-MDA5 antibody is more likely complicated with ILD, which presents with impaired pulmonary dispersion function and poor response to medication.

To explore the effect of IκB kinase inhibitor PS1145 on vascular function in septic mice and its mechanism.

Male BALB/C mice (n=45) were divided into 3 groups with block random method: control (Con) group, mice were given intraperitoneal injection of equal amount of 0.9% saline; lipopolysaccharide stimulation (LPS) group: mice were intraperitoneal injected of lipopolysaccharide 10 mg/kg; PS1145 treatment (PT) group: mice were given PS1145 (50 mg/kg) injection via tail vein 6 hours before intraperitoneal injection of lipopolysaccharide 10 mg/kg. At 6 hours after LPS injection, mice in each group were again divided into 3 subgroups to monitor the basal systolic blood pressure, the increasing amplitude of systolic blood pressure after the administration of norepinephrine (NE) (300 ng/kg, iv) and the decreasing amplitude of systolic blood pressure after administration of achacetylcholine (Ach) (600 ng/kg, iv), respectively. After the basal systolic blood pressure was checked, the levels of tumor necrosis factor (TNF)-α, nitric oxide (NO) and vascular endothelial glycocalyx(GCX) shedding marker syndecan-1 (SDC-1) in plasma of mice were detected by using ELISA method, and the expression levels of inducible nitric oxide synthase (iNOS) and endothelial nitric oxide synthase (eNOS) in mice mesenteric arteries were detected by western blot method. Another 15 mice were divided into 3 groups (Con group, LPS group, PT group) to detect the vascular permeability of myocardial tissue, lung tissue and mesenteric tissue of mice by using the evans blue dye (EBD) method at 6 h after the models were established.

At 6 hours after the model were established, the basic systolic blood pressure of mice in LPS group and in PT group were both lower than in Con group ((85.8±1.1), (89.2±1.3) and (112.6±1.5)mmHg, respectively, both P<0.01), and it was slightly higher in PT group than that in LPS group (P<0.01); the increasing amplitude of systolic blood pressure of mice after administration of NE in LPS group ((6.40±0.16) mmHg) was lower than that in Con group ((13.75±0.43) mmHg) (P<0.01), and it was (8.93±0.17) mmHg in PT group and was higher than that in LPS group (P<0.01); the decreasing amplitude of systolic blood pressure of mice after administration of Ach in LPS group was lower than that in Con group[(4.16±0.10) mmHg vs (9.52±0.53) mmHg,P<0.01), which was higher in PT group ((6.45±0.17) mmHg) than that in LPS group (P<0.01). At 6 hours after the model were established, the plasma concentrations of TNF-α, SDC-1 and NO in LPS group were all higher than those in Con group (allP<0.01), and these were lower in PT group than those in LPS group (allP<0.01). The levels of SDC-1 and TNF-α were positively correlated (r=0.99, P<0.05). The relative expression level of eNOS protein on arterial endothelium of the mesenteric tissue of mice in LPS group was lower than that in Con group (P<0.01), which was higher in PT group than that in LPS group (P<0.01). The EBD values of heart tissue, lung tissue and mesenteric tissue of mice in LPS group were all significantly higher than those in Con group (allP<0.01), which were lower in PT group than those in LPS group (allP<0.01).

The use of IκB kinase inhibitor PS1145 to inhibit nuclear factor-κB signaling pathway can improve the vascular function of sepsis mouse models. The mechanism is considered to be related to its reductions of NO levels and vascular endothelial GCX damage and shedding, thereby protecting the vascular endothelial barrier function.

The clinical data of 18 patients diagnosed with Lambert-Eaton myasthenic syndrome (LEMS) from Department of Neurology of Peking Union Medical College Hospital from June 2016 to January 2018 were retrospectively analyzed and P/Q-type voltage-gated calcium channel (VGCC) antibodies were detected by radioimmunoprecipitation assay. The VGCC antibody (Ab)-positive rate of LEMS was 15/18, and there were no significant differences in gender, age, disease severity, and tumor prevalence. The disease course was shorter in the antibody-positive group (1.9 years vs 7.6 years, P=0.04), and the clinical manifestation was more complicated in the group with a higher VGCC-Ab. There was a significant correlation between VGCC-Ab and recurrence rate(τ=0.48, P=0.02).

Twenty-six patients with large or giant paraclinoid aneurysms were treated with a visualized balloon occlusion-assisted technique in Zhongnan Hospital of Wuhan University from July 2017 to December 2019. All 26 patients were successfully treated with clip reconstruction after the aneurysm neck was blocked, and the aneurysm tension was fully reduced during the operation. Immediately after surgery, digital subtraction angiography showed that all lesions were completely excluded from the parent vessel with no residual aneurysm, and no parent artery stenosis or major embolism events occurred. Thirteen of 17 patients with previous visual deficits exhibited an improvement in visual acuity. The rate of good modified Rankin Scale (mRS) score after operation was 96.1% (25/26) at discharge. Microsurgical clipping of complicated large or giant paraclinoid aneurysms with the visualized balloon occlusion-assisted technique is a safe and effective compound surgical method to reduce the surgical difficulty and simplify the operation process.

This study summarized the clinical characteristics of 9 patients with anti-glutamic acid decarboxylase(GAD) antibody-associated encephalitis in the Department of Neurology of the Second Hospital of Hebei Medical University from April 2018 to October 2020.Among the 9 patients, 7 cases had epilepsy as the first symptom and 2 cases had memory loss as the first symptom. Four patients were complicated with other autoimmune diseases. The MRI of 4 patients showed abnormal signals of the medial temporal lobe structures. Abnormal EEG discharges were found in 6 patients. The symptoms of 8 patients were relieved after first-line treatment.The main clinical manifestation of anti-GAD antibody-associated encephalitis was epilepsy, and cranial MRI and EEG had clinical significance in guiding its diagnosis. Some of these patients can have autoimmune diseases simultaneously. Therefore, autoimmune antibodies must be tested for those who may have such diseases.Once anti-GAD antibody-associated encephalitis is diagnosed, immunotherapy should be initiated immediately.

Characteristics of ultrasonic image of 4 patients with congenital pyriform sinus fistula (CPSF) which was confirmed by laryngoscope or surgical pathology in Peking University First Hospital between 2016 and 2020 were retrospectively analyzed. All the 4 patients had inflammatory lesions in the left neck, including 3 cases of thyroiditis. Lesions emerging from the posterolateral aspect of the thyroid cartilage were found in all the 4 patients. Bubble-like hyperechogenicity appeared within the lesion in 2 patients, and a hypoechoic tubular lesion across the thyroid gland occurred in 1 patient. Fistula-type and sinus-type lesions were detected in 1 case and 3 cases, respectively. High frequency ultrasound can provide reference for the diagnosis and treatment of CPSF.

A patient with primary antiphospholipid syndrome with thrombocytopenia, abnormal liver function and positive urine protein during pregnancy was reported. After emergency termination of pregnancy, the platelet level still decreased, and at the same time, he developed hepatic infarction. Catastrophic antiphospholipid syndrome was considered, and it improved after hormone shock, immunosuppressant therapy and multiple plasma exchanges.

Adenoid cystic carcinoma is a rare epithelial malignancy, often originating in the salivary glands, characterized by a long clinical course and high rate of distant metastasis. The common sites of distant metastasis are lung and liver, but craniocerebral metastasis is rare. Simultaneous metastasis of skull and dura mater has not been reported. This paper reports a case of adenoid cystic carcinoma of left palate with multiple metastases to the skull and dura mater 6 years after operation. It is emphasized that patients with adenoid cystic carcinoma should be followed up for a long time after operation.

Dialysis-related stealing blood syndrome is a clinical syndrome such as insufficient blood flow perfusion of distal limb tissue and ischemia of ipsilateral limb due to blood shunt after vascular access is established. This article reports a case of left limb pain during hemodialysis with brachial artery-cephalic vein anastomosis fistula of left upper arm. Imaging examination revealed left subclavian artery occlusion combined with left axillary artery stenosis. After endovascular intervention to open the inflow artery lesion, the patient's symptoms were relieved.

With the popularization of low-dose spiral computed tomography in lung cancer screening, the objects of thoracic surgery have changed significantly. The increase of early ground glass lung adenocarcinoma makes the proportion of sublobectomy increasing day by day. A large number of retrospective studies have shown that sublobectomy is not inferior to lobectomy in oncological prognosis and postoperative lung function preservation for early ground glass lung adenocarcinoma. However, whether sublobectomy can replace anatomical lobectomy as the first choice treatment for early ground glass lung adenocarcinoma still needs to be confirmed by further prospective clinical trials. Therefore, this article will focus on the recent research evidence and remaining problems of sublobectomy in oncology prognosis, perioperative rehabilitation, pulmonary function preservation and future research directions.

Monoclonal antibodies are more and more widely used in the treatment of tumors and other refractory diseases, among which daratumumab is a new method for the treatment of relapsed and refractory multiple myeloma. Daratumumab can bind to CD38 molecules on the surface of red blood cells, and cause extensive agglutination of red blood cells in the transfusion compatibility test, interfere with the pre-transfusion detection and clinical transfusion strategy of myeloma patients, and may lead to delayed transfusion of patients. This article summarizes and expounds the interference of daratumumab on the transfusion compatibility test and the countermeasures, hoping to help formulate clinical transfusion strategies for patients with myeloma.

In recent years, low-dose chest CT has been used to effectively screen pulmonary ground glass nodules, which has improved the detection rate of small pulmonary nodules, promoted the early detection, early diagnosis and treatment of lung malignant tumors, and effectively improved the clinical treatment effect of lung cancer. At present, surgery is still the first choice for early lung cancer treatment, but there is still some controversy for multiple nodules, especially for thoracoscopic surgery of multiple nodules in both lungs. This literature describes a novel approach, a combination of electromagnetic navigation bronchoscopy (ENB) -guided microwave ablation and video-assisted thoracoscopic surgery for the treatment of multiple high-risk pulmonary nodules in patients. This paper describes a patient who received two simultaneous treatments for multiple pulmonary nodules located in different lobes. First, the patient completes ENB, and the doctor delivers the positionable electromagnetic probe to the nodule of the right upper lobe according to the navigation route and indwelling the catheter, quickly diagnoses the right upper lobe lesion as adenocarcinoma in situ, and guides the microwave antenna to the distal end of the lesion through the working channel for microwave ablation treatment; Further thoracoscopic wedge resection of left upper lobe and lower lobe and lingual segment resection were performed. The lesions in the left upper and lower lobes were adenocarcinoma in situ, and the lesions in the left lingual segment were chronic inflammation.

With the increase of the detection rate of pulmonary nodules, thoracoscopic wedge resection is a reliable way to detect some small nodules. If the small nodules cannot be located, thoracoscopic surgery may convert to thoracotomy. A total of 39 image-guided thoracoscopic surgeries (iVATS) from April 2016 to November 2019 were included in this study. Study reports experience with simultaneous localization and thoracoscopic resection of non-palpable undiagnosed pulmonary nodules. The inclusion criteria were: small lesions (<1 cm), deep (>1 cm from the surface), subsolid or located within a dystrophic area. Conical beam CT was used for scanning and intraoperative marking with positioning hooks and coils. The size of the localized nodule was (12 ± 6) mm, and the distance from the deep edge of the lesion to the pleural surface was (24 ± 9) mm. A total of 20 positioning hooks and 19 coils were used for localization. Of these, 36 patients were successfully positioned (92.3%), 37 wedge resections were completed thoracoscopically, of which 2 (5%) were converted to thoracotomy, 9 patients with intraoperative diagnosis of lung cancer underwent lobectomy (7 thoracoscopic and 2 thoracotomy), the time of iVATS positioning was (30±13) min, and the postoperative hospital stay was 4 (3,5) d. These results suggest that iVATS appears feasible to reduce the conversion rate of thoracotomy in thoracoscopic surgery.

The treatment of adult spinal deformity (ASD) mainly aims to relieve symptoms, improve spinal function, reestablish stability and restore spinal balance. With the development of posterior spinal orthopedic instruments and the need to preserve spinal motor segments, spinal doctors are increasingly adopting the surgical strategy of selective posterior segmental fusion. Although good clinical results can be achieved, the occurrence of proximal junctional kyphosis (PJK) of postoperative fusion segments has gradually become one of the hot research topics in this field. PJK is a common complication after ASD surgery, mainly manifested by the decline of neurological function, worsening of spinal deformity and spinal instability, which requires reoperation. The incidence of PJK after ASD surgery can be as high as 69.4%. PJK was first proposed by Professor Lowe in 1994. Professor Kim et al. defined it as the Cobb angle in the sagittal plane of the proximal junction area after operation, that is, the angle (PJA) between the proximal fusion inferior vertebral endplate and the upper endplate of the proximal second vertebral body>10° and increased by 10° compared with that before operation. There are many studies on the mechanism of PJK after ADS, but the exact mechanism is not fully understood.

Small pulmonary nodules are located by CT in the radiology department and then go to the operating room for surgical resection. The stepwise method presents great risks, such as pneumothorax, hemothorax, and detachment of positioning hooks. Theoretically, these problems can be circumvented by simultaneous positioning and thoracoscopic surgery (VATS) in a composite operating room equipped with a suitable positioning system. This study included 12 patients with solitary pulmonary nodules who underwent image-guided thoracoscopic surgery (iVATS) from October 2016 to January 2017, and analyzed the feasibility of simultaneous localization followed by thoracoscopic surgery. The solitary pulmonary nodule observed in the study was 5.5 (4,6) mm in size and its distance from the pleural surface was 11.7 (6.0, 11.3) mm. All lesions were visible on intraoperative C-arm cone beam computed tomography images, 10 patients were successfully localized and complete thoracoscopic resection was successfully performed, the time required for localization was 45.5 (36, 60) min, whereas radiation exposure (expressed by skin absorbed dose) was 223.2 (180.3, 321.3) mGy. Focal localization failed in 2 cases due to pneumothorax caused by acupuncture, in which case practical thoracotomy was required to identify solitary pulmonary nodules. There were no surgical deaths and postoperative hospital stay was 4 (3.8, 4.0) d. This study shows that simultaneous positioning followed by thoracoscopic surgery can reduce the complications of this method. However, in the future, it is necessary to further apply other composite operating rooms with different equipment for comparison, and at the same time, it is necessary to further compare with thoracoscopic surgery after step-by-step positioning.