Objective:To explore the value of serum P-selectin,Interleukin-18(IL-18),and Homocysteine(Hcy)levels in predicting the adverse outcomes of interventional therapy in elderly patients with deep vein thrombosis(DVT)in the lower extremities.Methods:A total of 165 elderly patients with DVT from January 2020 to August 2023 were se-lected.All patients underwent transcatheter intervention thrombolysis therapy.Patients were divided into good outcome group and poor outcome group according to the clinical treatment outcome.Serum P-selectin,IL-18,and Hcy levels were compared between the two groups.The correlation between serum P-selectin,IL-18,and Hcy levels and disease indicators,as well as the outcomes of interventional therapy was analyzed.The predictive value of serum P-selectin,IL-18,and Hcy levels for the outcomes of interventional therapy was evaluated.Results:The total effective rate of catheter-based interventional thrombolysis in 165 patients was 81.82%(135/165).The patients with good outcomes were included in the good outcome group,and the patients with poor outcomes were included in the poor outcome group.The difference in circumference between the affected side and the healthy side of the thigh and the difference in circumference between the affected side and the healthy side of the calf in the poor outcome group were greater than those in the good outcome group(P<0.05).The levels of serum P-selectin,IL-18,and Hcy in the poor outcome group were higher than those in the good outcome group(P<0.05).The levels of serum P-selectin,IL-18,and Hcy were posi-tively correlated with the difference in circumference between the affected and healthy thighs and the difference in cir-cumference between the affected and healthy calves,and negatively correlated with the outcome of interventional therapy(P<0.05).Before and after correcting other factors,serum P-selectin,IL-18,and Hcy were all independent risk factors for the outcome of interventional therapy in elderly patients with DVT(P<0.05).The area under the curve(AUC)of serum P-selectin,IL-18,and Hcy for predicting the outcome of interventional therapy for elderly DVT was 0.789(95%CI:0.718-0.848),0.812(95%CI:0.744-0.868),and 0.792(95%CI:0.722-0.851),respectively.The cutoff values were 44.21 ng/mL,185.73 ng/L,and 23.60 μmol/L,with sensitivities of 70.00%,70.00%,and 80.00%,and specificities of 82.22%,82.96%,and 68.15%,respectively.The AUC of the combined prediction of the outcomes of interventional therapy for elderly DVT was 0.935(95%CI:0.886-0.967),with a cutoff value of 44.08 ng/mL,185.16 ng/L,and 23.37 μmol/L for the three variables,with a sensitivity of 86.67%and a specificity of 88.15%.This was significantly better than the individual prediction values of the three variables(Z=5.817,4.753,5.206,all P<0.001).Conclusion:Serum P-selectin,IL-18,and Hcy are significantly correlated with disease indicators and interventional treatment outcomes in el-derly patients with DVT,and can effectively predict the outcome of interventional treatment,with a high combined pre-dictive value.

Objective:To observe the relationship between the expression of cytotoxic T lymphocyte antigen-4(CTLA-4),programmed death receptor-1(PD-1),and T lymphocyte attenuator(BTLA)in peripheral blood cells and the pathological characteristics and prognosis of patients with moderate and advanced liver cancer.Methods:A total of 120 patients with moderate and advanced liver cancer and 120 physical examination subjects admitted to our hospital were selected as the liver cancer group and control group.The levels of CTLA-4,PD-1,and BTLA in the two groups and dif-ferent clinical pathological characteristics of the liver cancer group were compared,and the correlation between periph-eral blood indicators and clinical pathological characteristics was analyzed;The liver cancer group was followed up for 2 years and divided into poor prognosis and good prognosis groups based on prognosis.The expression of various indica-tors in patients with different prognoses was compared,and the predictive value of peripheral blood indicators combined for the prognosis and survival relationship of advanced liver cancer was analyzed.Result:The levels of CTLA-4,PD-1,and BTLA mRNA in the peripheral blood of the liver cancer group were higher than those in the control group(P<0.05);Comparison of peripheral blood CTLA-4,PD-1 and BTLA mRNA levels in patients with different tumour numbers,differ-entiation,clinical stage,tumour size and vascular invasion in the liver cancer group,there were statistically significant dif-ferences(P<0.05);the levels of CTLA-4,PD-1,and BTLA mRNA in peripheral blood were positively correlated with tu-mor number,differentiation degree,clinical stage,and vascular invasion(P<0.05);the mRNA levels of CTLA-4,PD-1,and BTLA in peripheral blood of patients with poor prognosis in moderate and advanced liver cancer were higher than those of patients with good prognosis(P<0.05);the AUC of peripheral blood CTLA-4,PD-1,and BTLA mRNA combined to predict the prognosis of moderate and advanced liver cancer was 0.935;the overall survival rate of patients with high expression of CTLA-4,PD-1,and BTLA mRNA was lower than that of patients with low expression of CTLA-4,PD-1,and BTLA mRNA(P<0.05).Conclusion:The expression of CTLA-4,PD-1,and BTLA in peripheral blood is associated with the pathological characteristics and prognosis of patients with moderate and advanced liver cancer,have high com-bined predictive value of patient progsosis.

Objective:To analyze the dynamic changes of serum exosome miR-552 and miR-653 levels in pa-tients with gastric cancer before and after chemotherapy and their relationship with clinical benefit.Methods:IA total of 128 patients with gastric cancer received chemotherapy from January 2022 to January 2024.According to the chemo-therapy effect,the two groups were divided into disease progression group and disease remission group.The levels of serum exosome miR-552 and miR-653 before and after chemotherapy were detected in the two groups,the risk fac-tors affecting the chemotherapy effect of gastric cancer patients were screened,the risk nomogram model was con-structed,and the efficacy was evaluated.Results:The proportion of TNM stage(Ⅲ+Ⅳ),lymph node metastasis,dis-tant metastasis,tumor size(>5 cm),invasion depth(T3/T4)and tumor growth pattern(invasive type)in disease progres-sion group was higher than that in disease remission group(P<0.05).The levels of serum exosomes miR-552 and miR-653 in disease progression group were higher than those in remission group before and after chemotherapy(P<0.05).Compared with before chemotherapy,miR-552 and miR-653 levels in both groups decreased(P<0.05).Logistic regres-sion analysis showed that TNM stage,lymph node metastasis,distant metastasis,tumor size,invasion depth,miR-552 and miR-653 were all risk factors affecting the chemotherapy efficacy of gastric cancer(P<0.05).ROC curve results showed that the AUC,95%CI,sensitivity and specificity of risk nomogram model to predict chemotherapy efficacy of gastric cancer were 0.867,0.672～0.991,92.80%and 80.40%,respectively(P<0.001).Calibration curve results showed that both predicted and actual predicted values were near the ideal curve,and the Hosmer-Lemeshow goodness of fit curve test χ2=1.869,P=0.782.Conclusion:The levels of serum exosomes miR-552 and miR-653 are closely related to the chemotherapy efficacy of gastric cancer,and dynamic monitoring of the above indexes is helpful for the evaluation of the disease and prognosis of gastric cancer.In this study,the risk nomogram model constructed based on the above indexes and other risk factors has high predictive value and clinical practicability for chemotherapy efficacy in patients with gastric cancer.

Objective:To evaluate the advantages of modified ultrasound-guided microwave ablation in the treat-ment of thyroid micropapillary carcinoma(PTMC)based on immune function,traumatic stress status and complications.Methods:A total of 129 patients with PTMC who underwent surgery in Harbin 242nd hospital from January 2021 to March 2024 were selected as test subjects,and the test subjects were randomly divided into the control group(64 cases)and the test group(65 cases).The control group was treated with traditional surgery,and the experimental group was treated with improved ultrasound-guided microwave ablation.The immune function measures of CD3+,CD4+,CD8+,CD4+/CD8+and interleukin-2(IL-2),interferon-γ(IFN-γ),interleukin-4(IL-4)and interleukin-10(IL-10)were compared between the two groups.Traumatic stress indicators:interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and the occurrence of complications.Results:Before surgery,there was no significant difference in all T lymphocyte subsets between the two groups(P>0.05).CD3+,CD4+and CD4+/CD8+in both groups were higher on the 1st day and 2 weeks after surgery compared with presurgery leves,and CD8+was lower(P<0.05),and the difference between the two groups was statistically significant(P<0.05).Before operation,there was no significant difference in Th1 cytokines(IL-2,IFN-γ)and Th2 cytokines(IL-4,IL-10)between the two groups(P>0.05).The levels of IL-2,IFN-γ,IL-4 and IL-10 in 2 groups were higher than those before surgery(P<0.05).At 2 weeks after surgery,IL-2 and IFN-γ were lower than that at 1d after surgery,but still higher than before surgery(P<0.05),IL-4 and IL-10 were lower than that at 1d after surgery and before surgery(P<0.05),and the difference between the two groups was statistically significant(P<0.05).There was no significant difference in Th1/Th2 between the two groups before surgery(P>0.05).On the first day and 2 weeks after surgery,Th1/Th2 in both groups was increased(P<0.05),and the degree of increase in test group was higher than that in control group(P<0.05).Before operation,there was no significant difference in IL-6 and TNF-α be-tween the two groups(P>0.05).On the first day after operation,IL-6 and TNF-α were increased in both groups,and the increase degree in control group was greater than that in observation group(P<0.05).On day 3 after surgery,IL-6 and TNF-α decreased in both groups compared with day 1 after surgery,but the experimental group was still higher than the control group(P<0.05).There was no significant difference in IL-6 and TNF-α 3 days after operation in the experimen-tal group,while there was significant difference in IL-6 and TNF-α 3 days after operation in the control group(P<0.05).After 12 months of follow-up,the complication rate of the experimental group was 16.92%,and 39.06%in the control group,the former was significantly lower than the latter(P<0.05).Conclusion:Compared with traditional surgery,modified ultrasound-guided microwave ablation has advantages in immune function,traumatic stress state and compli-cations of PTMC.

Over the past two decades,the field of thyroid oncology in China has undergone rapid development.Through improvements in standardization processes,continuous innovations in treatment methods,and in-depth basic research,the 5-year survival rate of thyroid cancer has significantly increased from 67.5%to 92.9%.In diagnostics,advancements in color Doppler ultrasound technology,the establishment of the TI-RADS classification system,and innovations in fine-needle aspiration biopsy methods,particularly the integration of molecular diagnostics,have greatly improved the accuracy of preoperative diagnosis.In terms of treatment,there has been a gradual shift from traditional surgery to individualized precision therapy.Combined with radioactive iodine therapy,endocrine regulation,targeted therapy,and immunotherapy,a multidisciplinary comprehensive diagnosis and treatment system has been formed,providing patients with more precise and effective treatment options.Significant progress has also been made in the treatment of advanced thyroid cancer,with the application of targeted drugs bringing new hope to patients.In research,Chinese scholars have greatly increased their publications in the field of thyroid cancer,with high-quality studies emerging continuously,reflecting China's rapid rise in this area.Meanwhile,the establishment of academic organizations and the promotion of professional guidelines have substantially enhanced the diagnostic and treatment capabilities of primary care physicians.Looking ahead,efforts will continue to focus on the development of next-generation targeted drugs,the application of artificial intelligence and intelligent decision-making systems in diagnosis and treatment,the construction of prognosis prediction models based on big data,and the popularization of 5G-enabled remote medical care.These advances will drive the development of thyroid oncology toward more precise,minimally invasive,and personalized directions,creating new brilliance once again.

Background and Aims:Papillary thyroid carcinoma(PTC)is the most common endocrine malignancy in China,with cervical lymph node metastasis being a frequent and critical clinical feature that directly affects patient prognosis and recurrence risk.In recent years,with the rapid increase in the prevalence of overweight and obesity in China,the role of body mass index(BMI)in various tumors has attracted growing attention.This study aimed to investigate the association between overweight and cervical LNM in PTC,analyze sex-specific differences and influencing factors,and provide evidence for precise clinical management.Methods:A retrospective analysis was conducted on the clinicopathologic data of 1 445 patients with classical PTC treated at Xiangya Hospital of Central South University between August 2021 and June 2022.Patients were divided into groups based on the presence or absence of lymph node metastasis.Restricted cubic spline analysis explored the nonlinear relationship between BMI and lymph node metastasis risk.Univariate and multivariate Logistic regression analyses were applied to identify independent risk factors.Furthermore,sex-stratified analysis was performed among overweight patients(BMI≥24 kg/m2)to determine sex-specific risk factors for lymph node metastasis.Results:Among all patients,716(49.6%)had lymph node metastasis.Univariate analysis showed that BMI,sex,age,tumor diameter,multifocality,and extrathyroidal extension were significantly associated with cervical lymph node metastasis in PTC patients(all P<0.05).A nonlinear positive correlation was observed between BMI and lymph node metastasis risk,which was more pronounced in male patients.Additionally,BMI was positively correlated with triglyceride levels and negatively correlated with high-density lipoprotein cholesterol.Sex-stratified analysis revealed that in overweight male patients,younger age(OR=0.954),larger tumor diameter(OR=1.085),and multifocality(OR=2.776)were independent risk factors for LNM;in overweight female patients,younger age(OR=0.943)and larger tumor diameter(OR=1.074)were the main influencing factors.Conclusion:Overweight is closely associated with cervical lymph node metastasis in PTC,and the high-risk factors for LNM differ between male and female overweight patients.Young age,larger tumor size,and multifocality in overweight males,and young age and larger tumors in overweight females indicate a higher risk of metastasis.It is recommended that high-risk populations receive enhanced preoperative evaluation and individualized lymph node dissection strategies to achieve precise treatment and improved risk control.

Background and Aims:To overcome the limitations of the transoral endoscopic thyroidectomy vestibular approach,such as restricted operative space and high complication risks,our team proposed a modified technique—endoscopic thyroidectomy via oral vestibule and submandibular approach(ETOSA).Preliminary studies have confirmed its safety and feasibility.This study aims to systematically evaluate the key factors affecting postoperative complications and operative time in ETOSA,explore the interactions among these variables,and construct a learning curve model to support its broader clinical adoption.Methods:A retrospective analysis was conducted on 125 patients with papillary thyroid carcinoma who underwent ETOSA at Xiangya Hospital,Central South University,between March 2022 and March 2023.Clinical characteristics,surgical parameters,and postoperative complications were extracted.A random forest model was employed to identify the major influencing factors for complications and operative time,as well as their interaction effects.Partial dependence plots based on case sequence were used to generate the learning curve.Results:All 125 patients successfully underwent ETOSA with no conversion to open surgery.The median operative time was 95.0 min,and the median intraoperative blood loss was 15.0 mL.The overall postoperative complication rate was 16.0%,with no cases of permanent hypoparathyroidism or hypocalcemia.The average neck appearance score was 1.05,indicating high patient satisfaction.The random forest analysis identified case number,surgical extent,lymph node yield(LNY),Hashimoto's thyroiditis(HT),and body mass index(BMI)as the key predictors of postoperative complications,while surgical extent,case number,LNY,HT,and blood loss were the key factors affecting operative time.A significant positive interaction was observed between case number and both surgical extent and HT,particularly in the first 20 cases,suggesting a higher risk during the early learning phase.The learning curve analysis indicated that surgical proficiency stabilized after 20 cases.Operative time and complication rate in the proficient phase were significantly lower than those in the learning phase(90.0 min vs.102.5 min;11.4%vs.40.0%,both P<0.05).Conclusion:ETOSA is a safe and feasible technique characterized by minimal invasiveness,favorable cosmetic outcomes,and a relatively short learning curve.case number,surgical extent,LNY,HT,BMI,and blood loss are key factors affecting complications and operation time.

Background and Aims:As a core data source in the development of medical informatization,the front page of inpatient medical records plays a crucial role in determining the usability of research data and the scientific quality of clinical decision-making.Given the relatively standardized diagnostic and treatment protocols for thyroid malignancies,this disease serves as a representative model for evaluating the data quality of medical record front sheets.This study aimed to systematically assess the accuracy of diagnostic and surgical procedure coding for thyroid malignancies on the medical record front page,identify existing problems,and explore strategies for improvement and the potential for future application in clinical research.Methods:A total of 3 361 patients who underwent initial surgical treatment and were pathologically confirmed with thyroid cancer at the Department of Thyroid Surgery,the First Affiliated Hospital of Kunming Medical University from January 2018 to December 2020 were retrospectively included.Postoperative pathology reports and surgical records were used as reference standards to evaluate the accuracy of primary and secondary diagnosis codes,as well as primary and secondary surgical procedure codes on the medical record front page.Results:The accuracy rate of primary diagnosis coding reached 98.8%.However,among 1 368 patients with cervical lymph node metastasis,only 31.2%had correctly recorded secondary diagnosis codes and metastatic sites,with an omission rate as high as 67.8%.The overall accuracy rate for primary surgical procedure coding was 90.4%,with thyroid lobectomy(TL)and total thyroidectomy(TT)coding accuracies of 85.5%and 96.0%,respectively.Among the coding errors,70.0%involved TL procedures being incorrectly coded as TT.Secondary surgical procedure codes—mainly for lymph node dissection—were highly inconsistent,with up to 14 different coding types,reflecting a lack of standardization and unified input criteria.Notably,the error rate for primary surgical coding in 2020 increased significantly compared with the previous two years,suggesting subjectivity and variability in manual data entry.Conclusion:This study highlights major accuracy deficiencies in surgical procedure coding for thyroid malignancies on the medical record front page,which may compromise the scientific validity of real-world data.Going forward,leveraging artificial intelligence technologies to support structured documentation and automated coding,alongside establishing a proactive quality control system through multidisciplinary collaboration,may significantly improve data accuracy.These efforts are essential for strengthening data foundations for precision treatment,performance evaluation,insurance payment,and clinical research on thyroid cancer.

Background and Aims:With the widespread use of electrosurgical devices in open thyroid surgery,the surgical smoke generated during procedures has become a significant concern,as it compromises surgical visibility,reduces operational efficiency,and poses health risks to medical staff.Currently,local smoke evacuation is commonly performed by an assistant using a handheld suction device,which is limited in range,interferes with surgical procedures,and increases labor costs.This study aimed to evaluate the effectiveness,safety,feasibility,and staff satisfaction associated with a self-made annular smoke evacuation device constructed from readily available materials for use in open thyroid surgery.Methods:A total of 82 patients undergoing open surgery for papillary thyroid carcinoma at Suqian First People's Hospital between March and June 2024 were randomly assigned to an observation group and a control group(41 patients each).During surgery,the observation group used a self-made annular smoke evacuation device for continuous smoke removal,while the control group used conventional manual suction via an assistant.Outcomes compared between the two groups included PM2.5 concentrations 30 cm above the surgical field,operative time,intraoperative blood loss,and medical staff satisfaction with smoke removal.Results:During thyroid tissue dissection,the PM2.5 concentration in the observation group was(63.26±11.71)μg/m3,corresponding to a"good"air quality level,while in the control group it was(126.35±40.12)μg/m3,ranging from"mild to severe pollution"—a statistically significant difference(P<0.05).In the observation group,operative times for unilateral and bilateral procedures were(31.25±11.36)min and(71.13±17.12)min,respectively,with intraoperative blood loss of(10.5±5.3)mL and(18.6±5.5)mL.In the control group,times were(39.27±15.42)min and(78.35±22.35)min,with blood loss of(12.5±5.8)mL and(20.5±6.5)mL,respectively—all differences not statistically significant(all P>0.05).Staff satisfaction was significantly higher in the observation group compared to the control group(97.6%vs.31.7%,P<0.05).Conclusion:The self-made annular smoke evacuation device demonstrated favorable results in open thyroid surgery,effectively reducing surgical smoke concentration,improving visibility,and minimizing health risks to medical staff without compromising surgical efficiency or safety.The device is cost-effective,easy to assemble,and can be repurposed postoperatively as a drainage tube,requiring no additional consumables.Its reusability and ease of integration offer strong practical value and clinical applicability.

Background and Aims:Oncoplastic breast-conserving surgery(OBCS)integrates oncologic and plastic surgical techniques and includes two primary approaches:volume displacement and volume replacement.The pedicled lateral thoracic artery perforator(LTAP)flap is a commonly used technique for volume replacement.Although recent studies in China have confirmed its safety in OBCS,its patient-reported outcomes have not been systematically evaluated,and comparative data with volume displacement techniques remain lacking.Therefore,this study was performed to compare the clinical outcomes and patient satisfaction of LTAP flap versus mammoplasty(volume displacement)in OBCS,to inform surgical decision-making.Methods:A retrospective case-control study was conducted,including 106 patients with unilateral stage 0-Ⅲ breast cancer who underwent OBCS at the Affiliated Hospital of Southwest Medical University from January 2023 to June 2024.Patients were divided into the LTAP flap group(27 cases)and the mammoplasty group(79 cases)based on the surgical technique.Intraoperative variables,cosmetic outcomes,postoperative complications,and Breast-Q scores before and after surgery were compared between the two groups.Results:There were no significant differences between the two groups in clinicopathological characteristics or preoperative Breast-Q scores(all P>0.05).The LTAP group had longer operative times,larger excised tissue volumes,and greater postoperative drainage volumes(all P<0.001).Postoperative cosmetic outcomes were significantly better in the LTAP group,with a higher rate of excellent-to-good cosmetic results(88.9%vs.57.3%)and higher Breast-Q scores in breast satisfaction,psychosocial well-being,and physical well-being(all P<0.05).There were no significant differences in complication rates or local recurrence between the two groups(all P>0.05).Conclusion:In OBCS,the LTAP flap demonstrates comparable safety to mammoplasty while achieving superior cosmetic outcomes and patient satisfaction.It is particularly suitable for patients with small breast volumes requiring large tissue excision and holds promise for broader clinical application.