Expert consensus workshop report: Guidelines for preoperative assisted localization of small pulmonary nodules

Along with increasing incidence of operable small pulmonary nodules, it becomes difficult to localize nodules via palpation. Accurate localization of small pulmonary nodules has remained a big challenge in lung surgery. Therefore, several techniques for preoperative localizing small pulmonary nodules have evolved, but the advantages and disadvantages of each method remain unclear. We reviewed computed tomography-guided percutaneous and bronchoscopic preoperative assisted localization for small pulmonary nodules. Original, peer-reviewed, and full-length articles in English and Chinese were searched with PubMed and Wanfang data. Case reports and case series with <20 patients were excluded. All localization techniques showed good reliability, but some carry a high rate of major or minor complications and drawbacks. No ideal localization technique is available; thus, the choice of preoperative assisted localization technique still depends on surgeons' preference and local availability of both specialists and instruments.

Analysis of risk factors of myasthenia crisis after thymectomy in patients with myasthenia gravis / 中国胸心血管外科临床杂志

@#Objective    To analyze the risk factors of myasthenia gravis crisis after thymectomy with myasthenia gravis (MG). Methods    Sixty-five myasthenia gravis patients who had myasthenia crisis after thymectomy in Xuanwu Hospital, Capital Medical University from June 2006 to June 2019 were retrospectively enrolled, including 31 males and 34 females, aged 15-78 (45.7±17.8) years. The relationship between myasthenia crisis after thymectomy and surgical option, operation time, pathological type, et al. were anylyzed. Results    Operation time and pathological type were the predictive factors of postoperative myasthenic crisis. The area under receiver operating characteristic curve (AUC) of MG type (Osserman) was 0.676, the cut-off value wasⅡB type, the sensitivity was 37.5%, the specificity was 90.5%, and the Youden’s index was 0.280. The AUC of thymoma stage (Masaoka) was 0.682, cut-off value was stageⅡ, sensitivity was 62.5%, specificity was 66.7%, and Youden’s index was 0.292. The AUC of blood loss was 0.658, the cut-off value was 90 mL, the sensitivity was 87.5%, the specificity was 69.6%, and the Youden’s index was 0.304. Conclusion    Preoperative MG classification, pathological type, operation time and blood loss are the risk factors of postoperative myasthenic crisis. Therefore, adequate preoperative preparation, rapid and careful intraoperative operation and active postoperative management can reduce the occurrence of postoperative myasthenic crisis.

Navigation technique for peripheral pulmonary nodules biopsy / 中国胸心血管外科临床杂志

@#Peripheral pulmonary lesions (PPLs) are generally considered as lesions in the peripheral one-third of the lung. A computed tompgraphy (CT) guided transthoracic needle aspiration/biopsy or transbronchial approach using a bronchoscope has been the most generally accepted methods. Navigation technique can effectively improve the diagnosis rate of peripheral pulmonary lesions, reduce the incidence of complications, shorten the time of diagnosis, and make the patients get timely and effective treatment.

Short-term outcome of radiofrequency ablation combined with endostar in the treatment of non-small cell lung cancer: A non-randomized controlled trial / 中国胸心血管外科临床杂志

@#Objective     To study the short-term outcome and safety of radiofrequency ablation (RFA) combined with recombinant human endostatin (endostar) for non-small cell lung cancer (NSCLC) patients. Methods     Between December 2013 and December 2014, 80 consecutive patients (50 males, 30 females) with biopsy-proved NSCLC were divided into two groups: a RFA combined treatment group (RFA combined with endostar, 60 patients, 38 males, 22 females, mean age at 67.77±10.43 years) and a RFA alone group (20 patients, 12 males, 8 females, mean age at 67.35±9.82 years). The RFA combined treatment group was divided into three groups according to vascular normalization window of endostar and 20 patients in each group: a combined treatment group 1 (transfusion of endostar after RFA), a combined treatment group 2 (transfusion of endostar for 1 to 3 d before RFA) and a combined treatment group 3 (transfusion of endostar for 4 to 7 d before RFA). The CT scan of the chest was followed up after the treatment, local recurrence and safety was observed. Results    There was a statistical difference in local recurrence time among groups (χ2 = 11.05, P =0.011). The effect of the combined treatment group is better than that of the radiofrequency ablation therapy alone group. And in the recombinant human endostatin of tumor vascular normalization time best combination therapy was observed in the near future effect compared with the radiofrequency ablation therapy alone. In this study common complications were associated with radiofrequency ablation. No recombinant human endostatin related complication was found. There was no satistical difference in safety between the combined treatment group and the radiofrequency ablation therapy  group (χ2= 0.889, P > 0.05). Conclusion     RFA combined with endostar is safe and effective for non-small cell lung cancer.