Prognostic Significance of the Preoperative Lymphocyte to Monocyte Ratio in Patients With Stage I Non-Small Cell Lung Cancer Undergoing Complete Resection.

In this study, we investigated the correlation between lymphocyte to monocyte ratio (LMR) and clinical outcomes in stage I non-small cell lung cancer (NSCLC) patients. A total of 439 stage I NSCLC patients were enrolled in this study. Multivariate analyses identified LMR as an independent prognostic factor for recurrence-free survival and overall survival (hazard ratio (HR: 0.469, 95% Confidence Interval (CI): 0.325-0.677, and p < 0.001, and HR: 0.478, 95% CI: 0.332-0.688, and p < 0.001; respectively). Compared with the high LMR group, the proportion of patients who developed distant metastasis was significantly higher in the low LMR group.

Repair of Underwater Concrete Cracks on Dam Surface: Optimization Analysis of the Grouting Process with Surface Sealing.

The grouting repair process of the sealing baffle on the surface of dam cracks can improve the repair slurry diffusion distance in the cracks; however, the process must be optimized. To address the problem of crack repair technology of underwater dam concrete with one section open and the other closed, a grouting analysis model was established. By adjusting various parameters in the grouting process, the influences of the grouting pressure, position of the grouting hole, diameter of the grouting hole, and water pressure on the diffusion of the Bingham fluid repair slurry in these cracks were studied. The results show that the grouting pressure and diameter of the grouting hole significantly influence the limited diffusion distance of Bingham fluid cement slurry in cracks. With an increase in grouting pressure and grouting hole diameter, the limiting distance of the front surface increases. The influences of the water pressure and position of the grouting hole are small. In addition, through correlation analysis, the degrees of influence of different factors can be sorted, providing the priority factors for actual operation construction.

A biomechanical study of a polymer material bundled rib fracture fixator.

BACKGROUND: Rib fractures are one of the most common blunt injuries, accounting for approximately 10% of all trauma patients and 60% of thoracic injuries. Multiple rib fractures, especially flail chest, can cause local chest wall softening due to the loss of rib support, leading to paradoxical breathing, severe pain, and a high likelihood of accompanying lung contusions. OBJECTIVE: This study investigates the mechanical properties of a new polymer material rib internal fixator to provide theoretical data for its clinical use. METHODS: We conducted in vitro mechanical tests on 20 fresh caudal fin sheep ribs, using different fracture models across four randomly assigned groups (five ribs per group). The fixators were assessed using non-destructive three-point bending, torsion, and unilateral compression tests, with results averaged. Additionally, finite element analysis compared stress and strain in the polymer fixators and titanium alloy rib plates during bending and torsion tests. RESULTS: In vitro tests showed that the polymer fixators handled loads effectively up to a maximum without increase beyond a certain displacement. Bending and torsion tests via finite element analysis showed the polymer material sustained lower maximum equivalent stresses (84.455 MPa and 14.426 MPa) compared to titanium alloy plates (219.88 MPa and 46.47 MPa). CONCLUSION: The polymer rib fixator demonstrated sufficient strength for rib fracture fixation and was superior in stress management compared to titanium alloy plates in both bending and torsion tests, supporting its potential clinical application.

Hyaluronic acid and chitosan-based injectable and self-healing hydrogel with inherent antibacterial and antioxidant bioactivities.

Injectable dressings offering intrinsic antibacterial activity and antioxidation are required, because persistent bacterial infection and oxidative damage are common issues associated with chronic non-healing wounds. Herein, a versatile QCS-l-TA-l-OHA hydrogel is fabricated using ubiquitous nature derived biological macromolecules, quaternized chitosan (QCS), tannic acid (TA) and oxidant hyaluronic acid (OHA), driving by multiple dynamic interactions under physiological conditions. The hydrogel can serve as multiple functional wound dress with injectable and self-healing capabilities coupling with attractive antibacterial activity and antioxidation. The biocompatible and self-biodegradable hydrogel augments free radical scavenging capacity, antibacterial, angiogenesis, mature granulation tissue and collagen disposition, enabling fast wound healing of rat skin full-thickness incision model. This study highlights a wound dressing platform of hyaluronic acid and chitosan based injectable and self-healing hydrogel with inherent antibacterial and antioxidant bioactivities, thereby avoiding the use of antibiotics or antioxidant agents.

Unilateral pedicle screw fixation of lumber spine: A safe internal fixation method.

Background: Unilateral pedicle screw fixation several advantages, including reduced trauma and low cost. However, its stability and safety have not been widely recognized. In this study, the biomechanical differences in the vertebral body and screw-rod system after unilateral and bilateral pedicle screw fixation were compared using both the finite element model and calf lumbar model. Method: We used the verified finite element model to establish unilateral and bilateral posterior lumbar surgery models. The biomechanical data of different parts of the models were recorded under different working states. Then, three calf lumbar models were selected to simulate different working states with the help of a universal testing machine and other instruments. Finally, the biomechanical data of the screw-rod system were obtained from a static strain test and analysis system. Results: By analyzing and comparing biomechanical data obtained using two different methods, this study found that unilateral pedicle screw fixation does not bring excessive loads to the lumbar spine and screw-rod system. Conclusion: From the perspective of biomechanics, unilateral pedicle screw fixation is considered a safe and reliable implantation technique.

Transthyretin Suppressed Tumor Progression in Nonsmall Cell Lung Cancer by Inactivating MAPK/ERK Pathway.

Background: Lung malignancy is a main source of disease passing all throughout the planet, whereas the transthyretin (TTR) is a specific biomarker for clinical diagnosis. However, its role in lung malignancy stays to be obscure. Materials and Methods: In the current examination, the authors made an endeavor to research impact of abnormal expression of TTR on nonsmall cell lung carcinoma (NSCLC) by overexpression or knockdown of TTR. To further explore the instruments' fundamental mechanism part of TTR in NSCLC, several signal pathways were searched and verified. To confirm the effect of TTR overexpression on tumors, in vivo experiments were conducted. Result: It was found that upregulated TTR clearly stifled cell proliferation, migration, invasion, and expanded apoptosis. Significant suppression of phosphor-extracellular signal-regulated kinase (ERK) was observed in TTR-treated NSCLC cells, implying that TTR was important for cellular progress by regulating mitogen-activated protein kinase/ERK signaling pathway. In in vivo experiment, overexpression of TTR promoted cell apoptosis and inhibited tumor growth. Conclusion: Overall, the results suggest that TTR has a potential antitumor effect in human NSCLC progression, which provides theoretical basis for the diagnosis and treatment of NSCLC. Above all, further understanding of TTR was useful for clinical care. Clinical Trial Registration Number: 2016-08.

Effect and Mechanism of Transthyretin over-Expression on Proliferation and Cell Cycle of Lung Cancer A549 Cells.

BACKGROUND: The effects of transthyretin (TTR) over-expression on the proliferation and cell cycle of non-small cell lung cancer (NSCLC) A549 cells and its possible mechanism were verified. METHODS: A total of 196 LC patients and 20 healthy controls were enrolled at Tianjin Hospital, Tianjin, China between Apr 2017 and Oct 2017. The serum TTR content was detected by ELISA. Through lentiviral transfection method, NSCLC cells were divided into non-transfected group (group A), negative control group (group B) transfected with empty vector and experimental group (group C) transfected with TTR over-expression. Cell proliferation was detected by CCK-8 method, TTR mRNA expression was detected by real-time quantitative polymerase chain reaction (RT-qPCR), and TTR protein expression was tested by Western blot (WB). Cell cycle was detected by flow cytometry, Wnt3a/ß-catenin protein expression was detected by WB, and mRNA expression was detected by RT-qPCR. RESULTS: The serum TTR content in early, middle and late LC group was remarkably lower than that in healthy group (P<0.05). Compared with late stage, TTR content in early and middle stages of LC group was higher, and the difference was statistically marked (P < 0.05). The absorbance value of group C was lower than that of groups A and B, indicating that the cell proliferation activity dramatically decreased, with statistically marked difference (P<0.05). LC A549 cells in group C were obviously blocked in G2M, with statistical significance (P<0.05). CONCLUSION: TTR over-expression can inhibit the proliferation of NSCLC A549 cells, and the expression is related to Wnt3a/ß-catenin pathway. TTR in serum of patients was helpful for diagnosing LC and has certain clinical value.

Current status and research progress of minimally invasive surgery for flail chest.

Chest trauma accounts for ~13.5% of all traumas, and direct death from chest trauma accounts for 20-25% of all traumatic deaths. Chest trauma is the second cause of death from trauma. Frequent rib fractures, especially in patients with flail chest, often cause severe pain, chest wall softening, abnormal breathing and severe lung contusion and laceration, usually requiring thoracic surgery. In recent years, the open reduction and internal fixation treatment of rib fractures with flail chest has achieved satisfactory results, and some surgical indications have reached consensus. A number of scholars and medical centers have demonstrated the practicality and cost-effectiveness of rib fixation in flail chest, including the small incidence of pulmonary complications, the short ICU mechanical ventilation time, and the reduction of digestive tract inhibition. Open reduction and internal fixation of rib fractures involves multiple ribs. Conventional rib fractures require a large incision to achieve satisfactory exposure. Chest wall muscles, blood vessels and nerves (long thoracic and thoracodorsal nerves) are injured, resulting in a high infection rate of the incision and postoperative dysfunctions, such as limited upper limb, shoulder and back function, and long time numbness on the affected side of the chest. Therefore, the damage of muscles and nerves caused by conventional surgical methods limits the development of such surgical technique. Although the video-assisted thoracoscopic technique has become a necessary technical means for the treatment of thoracic trauma and has been applied to thoracic exploration and hemostasis, there is no report on the application of open reduction and internal fixation for rib fracture. The difficulty lies in the tightly combined bony thorax and the soft tissue of the chest wall. Therefore, experts have explored a variety of minimally invasive surgical methods for the flail chest. The current status and research progress of minimally invasive surgery for thoracic surgery are reviewed.

Application of rib surface positioning ruler combined with volumetric CT measurement technique in endoscopic minimally invasive thoracic wall fixation surgery.

Application value of rib surface positioning ruler combined with volumetric CT measurement in selection of the incision for minimally invasive internal fixation of rib fracture was investigated. A total of 80 patients who received internal fixation of rib fractures in Tianjin Hospital Affiliated to Tianjin University (Tianjin, China) from May 2018 to April 2019 were selected. Patients were treated with the rib surface positioning ruler combined with volumetric CT measurement method (n=42) or traditional positioning method (n=38). The following parameters were compared between the two groups: Preset incision accuracy, operation incision length, operation time, intraoperative bleeding volume, postoperative wound drainage volume and postoperative pain score. Compared with the traditional positioning method, rib surface positioning ruler combined with volumetric CT measurement method can improve preset incision accuracy, reduce operation time, incision length, intraoperative bleeding volume, postoperative wound drainage volume, and postoperative pain score, with statistically significant differences (P<0.05). In conclusion, the application of rib surface positioning ruler combined with volumetric CT measurement technique has obvious effect on the selection of incision for internal fixation of rib fracture, and is an effective method worth promoting.

Manual aspiration versus chest tube drainage in primary spontaneous pneumothorax without underlying lung diseases: a meta-analysis of randomized controlled trials.

OBJECTIVES: Although primary spontaneous pneumothorax (PSP) is an extremely frequent pathology, there is still no clear consensus on the treatment for these patients. We performed a strict meta-analysis on the effectiveness of manual aspiration (MA) compared to chest tube drainage (CTD) for the treatment of PSP. METHODS: A literature search was performed on PubMed, EMBASE and the Cochrane Library to identify randomized controlled trials comparing MA with CTD for the treatment of PSP. Independent reviewers evaluated the methodological quality of the included randomized controlled trials. Statistical heterogeneity among studies was quantitatively evaluated using the I-squared index. RESULTS: Five randomized controlled trials were included, and a total of 358 subjects were reported on. We found that MA was related to significantly shorter hospital stays [in days; mean difference -1.70, 95% confidence interval (CI) -2.36 to -1.04; P < 0.00001, fixed effect model] compared with CTD. However, no significant differences were found between the 2 treatments for immediate success rate (risk ratio 1.15, 95% CI 0.73-1.81; P = 0.54), 1-year recurrence rate, 1-week success rate, time of recurrence, chest surgery rate or complication rate. Subgroup analysis showed that MA can provide a significantly lower hospitalization rate than CTD with a tube size of >12 Fr or a water seal drainage system. CONCLUSIONS: On the basis of the currently available literature, MA is advantageous in the treatment of PSP because of shorter hospital stays. The subgroup analysis also indicates that MA can provide a lower hospitalization rate than CTD with a tube size of >12 Fr or a water seal drainage system. However, there are no significant differences between the 2 interventions with respect to immediate success rate, 1-year recurrence rate, 1-week success rate, time of recurrence, chest surgery rate or complication rate.

Thoracoscope combined with internal support system of chest wall in open reduction and internal fixation for multiple rib fractures.

This study aimed to investigate the feasibility of applying thoracoscope combined with internal support system of chest wall (ISSW) in minimally invasive internal fixation for rib fracture on patients with multiple rib fractures. A total of 84 patients undergoing open reduction and internal fixation for rib fracture from January 2017 to December 2017 in the Department of Cardiothoracic Surgery, Tianjin Hospital were selected into the study, and retrospective analyses were carried out. The clinical data, pain score, operating time, intraoperative blood loss, indwelling time of thoracic tube, total drainage volume of thoracic tube for 3 days after operation, indwelling time of wound drainage tube, total drainage volume of wound drainage tube, length of stay, hospitalization costs, postoperative complications, C-reactive protein (CRP) and pulmonary function of patients in the groups were compared. The patients were followed up for prognosis for 2-4 months via re-examination, and chest numbness at 1 month after operation was recorded. Compared with that (145.27±18.80 min) in the traditional group, the operating time in the minimally invasive group (112.20±21.40 min) was shorter (p<0.05). The total drainage volume of wound drainage tube was 145.75±61.03 ml in the minimally invasive group and 248.91±93.95 ml in the traditional group (p<0.05). In addition, the chest numbness at 1 month after operation (11.8%) in the minimally invasive group was better than that (34.00%) in the traditional group (p<0.05). Postoperative pain score, CRP and pulmonary function tests were also significantly different between the two groups (p<0.05). The results indicated that the application of thoracoscope combined with ISSW in minimally invasive internal fixation for rib fracture can effectively improve the prognosis of patients and reduce the length of stay and adverse reactions, and has high economic benefits, which is worthy of promotion and use in clinical practice.

Elevated HBXIP expression is associated with aggressive phenotype and poor prognosis in esophageal squamous cell carcinoma.

The oncoprotein hepatitis B virus X-interacting protein (HBXIP) has been suggested to play an essential role in several malignancies. However, the clinicopathological significance and prognostic value of HBXIP expression in esophageal squamous cell carcinoma (ESCC) is still unknown. Therefore the aim of this study was to characterize HBXIP expression and its prognostic value in ESCC. Quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot were performed to assess the mRNA and protein expression of HBXIP in ESCC tissues and cell lines. Immunohistochemistry (IHC) was conducted to characterize the expression pattern of HBXIP in 152 archived paraffin-embedded ESCC and matched nontumorous tissues. The mRNA and protein expression of HBXIP in ESCC tissues was significantly higher than those in adjacent nontumorous tissues. High HBXIP expression was associated with histological grade (P=0.016), depth of tumor invasion (P=0.012), lymph node metastasis (P<0.001) and TNM stage (P=0.002). Kaplan-Meier analysis indicated that ESCC patients with high HBXIP expression had poor disease-free survival (DFS) and overall survival (OS). Furthermore, multivariate Cox regression analyses demonstrated that HBXIP expression remained an independent prognostic factor for DFS and OS. Collectively, our present study demonstrated that HBXIP may be a candidate molecular prognostic marker for ESCC.

Effects of insulin-like growth factor 1 and basic fibroblast growth factor on the morphology and proliferation of chondrocytes embedded in Matrigel in a microfluidic platform.

An integrated microfluidic device was utilized in the present study to investigate the morphology and proliferation of rabbit articular chondrocytes embedded in Matrigel in the presence of insulin-like growth factor 1 (IGF-1) and/or basic fibroblast growth factor (bFGF). The microfluidic device was composed of two parallel channels and a central perfusion-based three-dimensional cell culture module. The rabbit chondrocytes were cultured for 2 weeks at series of concentration gradients of IGF-1 and/or bFGF, which were generated through a diffusion process. At the end of the experiment, the morphology and quantity of cells were measured. Since high expression of collagen II is essential to the function of hyaline cartilage, immunofluorescent images of collagen II expression prior to and after the experiments were gathered for each group. The mean fluorescence intensity ratio (MIR) of collagen II in each group was calculated. The MIRs of collagen II in chondrocytes treated with IGF-1 ranged from 0.6-0.81, those in the cells treated with bFGF ranged from 0.47-0.52, and those in cells treated with a combination of IGF-1 and bFGF ranged from 0.63-0.83. Chondrocyte aggregations were observed in the group treated with 75-100 ng/ml IGF-1 (3.46-fold proliferation ratio). Similarly, a 3.83-fold proliferation ratio was identified in chondrocytes treated with 2.5-5.0 ng/ml bFGF. The group treated with 50-75 ng/ml IGF-1 and 2.5-5.0 ng/ml bFGF exhibited the optimum increase in proliferation (4.83-fold proliferation ratio). The microfluidic device used in the present study can be easily adapted to investigate other growth factors at any concentration gradient. In addition, parallel experiments can be performed simultaneously with a small quantity of cells, making it an attractive platform for the high-throughput screening of cell culture parameters. This platform will aid in the optimization of culture conditions for the in vitro expansion of chondrocytes while maintaining their in vivo morphology, which will improve autologous chondrocyte implantation capabilities for the treatment of cartilage injury.

Clinical significance of mechanical ventilation on ischemic-reperfusion injury caused by lung chest trauma and VEGF expression levels in peripheral blood.

We investigated the clinical significance of mechanical ventilation on ischemic-reperfusion injury caused by lung chest trauma as well as vascular endothelial growth factor (VEGF) expression levels in peripheral blood. Sixty-eight patients with severe chest trauma complicated with acute respiratory distress syndrome that were treated at our Tianjin Hospital from September 2013 to July 2016 were recruited. These patients were randomly and evenly divided into two groups, the research group and the control group. Thirty-four age and gender matched healthy people were selected as the normal group. Routine treatment was given to both the research and control groups, but mechanical ventilation was used in the research group. We detected pulmonary vascular resistance (PVR) and alveolar-arterial oxygen difference (AaDO2) for patients in both groups before treatment, and after treatment for 1, 3, 6 and 12 h. We also tested PMN, superoxide dismutase (SOD), malondialdehyde (MDA), NO and Ang II value 30 min before and after treatment. We used the ELISA-test to detect VEGF expression levels in peripheral blood, followed by a statistical analysis. PVR levels of different time points in the research group were significantly lower than control group after treatment. The AaDO2 value of the control group is much smaller than research group (P<0.5) after treatment for 1, 3 or 6 h. PMN count difference and MDA level in the research group is significantly lower than the control group after treatment for 30 min, but SOD and NO levels are much higher. Ang II levels of the research group in left atrial blood is significantly lower than control group (P<0.05). By comparing the hospitalization times, we found that patients in the research group have a shorter duration in hospital than the control group; differences are statistically significant (P<0.05). Additionally, compared to control group, research group VEGF expression levels in peripheral blood are significantly lower (P<0.05). Therefore, mechanical ventilation can reduce the high VEGF expression levels in serum caused by ischemic-reperfusion and can be used for clinical application.

Neoadjuvant Chemoradiotherapy Improving Survival Outcomes for Esophageal Carcinoma: An Updated Meta-analysis.

BACKGROUND: The effectiveness of neoadjuvant chemoradiotherapy (NCRT) treatment for patients with esophageal carcinoma (EC) remains controversial. The aim of this study was to compare the effect of NCRT followed by surgery (NCRTS) with surgery alone (SA) for EC. METHODS: The PubMed, EMBASE, and the Cochrane Library databases were electronically searched up to August 2015 for all the published studies that investigated EC patients receiving either NCRTS or SA, and the reference lists were also manually examined for the eligible studies. The risk ratio (RR) with 95% confidence intervals (CI s) as effective size was determined to assess the 1-, 3-, 5-year survival rates (SRs), postoperative morbidity, and postoperative mortality. Heterogeneity was determined using the Q-test. The Begg's test and Egger's test were used for assessing any potential publication bias. RESULTS: Of 1120 identified studies, 16 eligible studies were included in this analysis (involving 2549 patients). Overall, the pooled results suggested that NCRTS was associated with significantly improved 1-year (RR: 1.07, 95% CI: 1.02-1.13), 3-year (RR: 1.26, 95% CI: 1.14-1.39), and 5-year (RR: 1.36, 95% CI: 1.18-1.56) SRs. However, the results also indicated that NCRTS had no or little effect on postoperative morbidity (RR: 0.93, 95% CI: 0.82-1.05) and postoperative mortality (RR: 1.17, 95% CI: 0.56-2.44). CONCLUSIONS: Compared with SA, NCRTS can increase 1-, 3-, and 5-year SRs in patients with EC.

Clinical significance of preoperative neutrophil-lymphocyte vs platelet-lymphocyte ratio in primary operable patients with non-small cell lung cancer.

BACKGROUND: Our aim was to determinate the prognostic value of neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in primary operable patients with non-small cell lung cancer (NSCLC). METHODS: Six hundred seventy-eight NSCLC patients were enrolled in this study. The prognostic significance of both markers was determined by both univariate and multivariate Cox survival analysis. The cut-off value for NLR and PLR was selected by using receiver operating characteristic curve analysis. RESULTS: Multivariate analysis showed that NLR was an independent prognostic factor for disease-free survival (hazard ratio = 1.593, 95% confidence interval [CI] 1.277 to 1.988, P < .001) and overall survival (hazard ratio = 1.624, 95% CI 1.304 to 2.022, P < .001). The area under the curve was .640 (95% CI .599 to .682, P < .001) for NLR and .547 (95% CI .503 to .590, P = .036) for PLR, indicating that NLR was superior to PLR as a predictive factor in primary operable NSCLC patients. CONCLUSIONS: Preoperative NLR represents a significant independent prognostic indicator in primary operable NSCLC patients. Our results also demonstrate that high-risk patients based on the NLR do not benefit from adjuvant chemotherapy.

[Effects of cetuximab combined with celecoxib on apoptosis and KDR and AQP1 expression in lung cancer].

BACKGROUND AND OBJECTIVE: Neoadjuvant chemotherapy is a new development in the treatment of lung cancer. In recent years, cetuximab and celecoxib have been commonly used in this procedure. This study aims to explore the effect of cetuximab combined with celecoxib on apoptosis and KDR and AQP1 expression in lung cancer A549 cells. METHODS: The cells were cultured in RPMI-1640 and then divided into four groups: control group, 1 nmol/L cetuximab group, 25 µmol/L celecoxib group, and 1 nmol/L cetuximab+25 µmol/L celecoxib group. The treatment time was 48 h. The mRNA and protein expression levels of KDR and AQP1 were detected by RT-PCR and Western blot, respectively. The apoptosis, proliferation, and invasive ability of A549 cells before and after transfection were examined using flow cytometry, MTT, and transwell methods. RESULTS: Cetuximab and celecoxib inhibited the growth of A549 cells in a dose-dependent manner. Their combination produced a greater growth inhibition than when either was used alone (P<0.01). Cetuximab and celecoxib both induced the apoptosis of A549 cells, and their combination produced a higher apoptosis rate (P<0.01). Cetuximab in combination with celecoxib also induced G1 phase arrest and downregulated the expression of KDR and AQP1 in A549 cells (P<0.05). As a result, the invasion ability of the A549 cells was significantly decreased. CONCLUSIONS: Cetuximab in combination with celecoxib can synergistically inhibit the growth of A549 cells and downregulate the expression of KDR and AQP1 in A549 cells. The combination of cetuximab and celecoxib is a potential strategy for lung cancer therapy.

[Application of the localization technique in video-assisted thoracoscopy for the diagnosis and treatment of solitary pulmonary nodule].

BACKGROUND AND OBJECTIVE: Video-assisted thoracoscopy is widely used in diagnosis and treatment of solitary pulmonary nodule (SPN). However, localization of the nodule during surgery is occasionally difficult. The purpose of the current research is to evaluate the localization technique during diagnosis and treatment of SPN with video-assistant thoracoscopic surgery (VATS). METHODS: Three-dimensional computed tomography is performed for SPN localization. If SPN is less than 1.5 cm or more than 2.0 cm beneath the pleura, Hook-wire localization technique is used. During operation, initial action is palpation with equipment. If this method fails, video-assisted minithoracotomy (VAMS) and direct finger use are applied for localization. Upon successful localization, a linear cutter is used for wedge resectioning. Fast frozen pathology is employed to make the decision for the next procedure. RESULTS: SPNs are resected for 23 cases. Among them, 10 cases are performed with VATS and 13 cases are conducted with VAMS. CONCLUSIONS: The accurate localization of SPN before and during surgery is very significant for the resectioning of SPN by VATS.