With the continuous advancement of diagnostic technologies, the detection rate of thyroid nodules in the population is steadily increasing. Diagnosis primarily relies on the Thyroid Imaging Reporting and Data System (TIRADS) and fine needle aspiration biopsy (FNAB) of thyroid nodules. High-resolution ultrasound is the most important imaging modality for diagnosing thyroid nodules, offering advantages such as convenience, flexibility, non-invasiveness, and no radiation. Ultrasound-guided fine needle aspiration biopsy is the most accurate and effective method for preoperative diagnosis of thyroid nodules. Artificial intelligence (AI), a branch of computer science, aims to enable machines to simulate or perform cognitive functions similar to human intelligence. AI is gradually being applied in the medical field and has gained significant attention in the diagnosis of thyroid nodules, significantly improving the efficiency and accuracy of diagnosis. This article will explore the research progress and application value of AI in the diagnosis of thyroid nodules from aspects such as thyroid nodule ultrasound imaging and cytopathology. The goal is to summarize the latest advancements in AI for the diagnosis of thyroid nodules, assist clinicians in understanding the current state of the field, and provide more accurate and comprehensive reference information for clinical decision-making in the diagnosis and treatment of thyroid nodules.

Papillary thyroid carcinoma (PTC) is prone to lateral lymph node metastasis (LLNM). It is crucial to assess the status of lateral lymph nodes accurately before surgery, determine the appropriate surgical scope and minimize trauma to patients while thoroughly cleaning. Preoperative evaluation is constantly advancing towards intelligence and precision, and the use of contrast enhanced ultrasound, detection of fine needle aspiration eluent, three-dimensional visualization technology, and contrast enhanced CT-based deep learning model in clinical practice can improve the accuracy of diagnosing LLNM. The new directions for the development of preoperative evaluation include contrast enhanced US, new fine needle aspiration eluent markers, rapid detection of eluent, the combination of radiomics and artificial intelligence. The exploration of risk factors for LLNM has been a hot research topic in recent years, and clinical prediction models can be constructed based on different risk factors and applied in clinical practice. This article presents the top ten risk factors commonly used in clinical research and lists multiple new predictive indicators, which are combined with nomograms for personalized prediction. At the same time, the controversial points in the clinical management of occult LLNM are discussed, as well as the latest progress in the treatment of lateral lymph nodes in PTC.

Thyroid nodule, especially thyroid cancer, is one of the most common endocrine surgical diseases at present. Its incidence is increasing, and the demand for surgery is also increasing.The neck scar caused by traditional surgery cannot satisfy the patients′ demand for aesthetics.Therefore, endoscopic techniques, including da Vinci robotic surgery, have gradually become a hot spot for clinical exploration.This article reviews the application and advances of endoscopic techniques in thyroid surgery.

Objective:To investigate the feasibility and effectiveness of three-dimensional visualization technology in the precise diagnosis and treatment of locally advanced differentiated thyroid cancer(DTC).Methods:A retrospective analysis was conducted on the clinical data of 196 patients with locally advanced DTC treated at the 960th Hospital of the PLA from December 2021 to August 2023. The cohort included 71 male and 125 female patients, with a mean age of 43.7 years (rangd from 18 to 77 years). All patients underwent neck-enhanced CT scans and were divided into two groups: the study group( n=102), which underwent preoperative three-dimensional visualization of CT data, and the control group( n=94), which did not. Baseline data for both groups were matched using SPSS27.0 with 1∶1 propensity score matching (PSM) and the caliper value was 0.02. A total of 49 patients were included in each group, including 35 first-time surgeries and 14 reoperation. Among the 70 first-time surgeries, 29 patients underwent robotic surgery and 41 underwent open surgery. Among the 28 reoperations, 4 underwent robotic surgery and 24 underwent open surgery. In the study group, three-dimensional visual models were used to comprehensively evaluate the tumor and metastatic lesion size, spatial location, and adjacent relationship with surrounding organs, surgical treatments were guided by these models, whereas the control group relied on two-dimensional imaging for guidance. The clinical data were statistically analyzed using SPSS27.0. Results:All operations were successfully completed. There were no statistical differences in baseline data between the two groups( P>0.05). Among first-time surgeries, the study group showed shorter operation times [175(145, 200) min vs 205(182, 249) min, P<0.001], a lower incidence of postoperative chyle leak (0 vs 8.57%, P=0.027), a higher rate of robotic surgery (48.57% vs 34.28%, P=0.225), a greater number of harvested lymph nodes [46(40, 62) vs 37(28, 56), P=0.032], a greater number of cervical lymph node metastasis[15(7, 22) vs 5(1, 14), P=0.004] and a larger diameter of metastasis lymph nodes[12(10, 16) mm vs 4(1, 10) mm, P<0.001]. There were no significant differences in intraoperative blood loss, postoperative drainage days and incidence of hypoparathyroidism( P>0.05). During the reoperation, the study group had shorter operation times[103.5(95.0, 122.5) min vs 146.50(133.25, 172.25) min, P<0.001], less intraoperative blood loss[12.50(8.75, 22.50) mL vs 30.00(17.50, 35.00) mL, P=0.021], fewer postoperative drainage days[5.00(4.00, 6.00) d vs 6.00(5.00, 7.25) d, P=0.016] and a lower incidence of hypoparathyroidism(7.14% vs 42.86%, P=0.038).The robotic surgery rate was higher in the study group (21.42% vs 7.14%, P=0.596). There were no significant differences in lymph node dissection numbers, metastatic lymph node counts, or chyle leak incidences between the two groups ( P>0.05). No acute bleeding or incision infection occurred in any patient postoperatively. Conclusion:Three-dimensional visualization technology is an effective preoperative assessment method for evaluating the resectability of tumors and metastases lesions in locally advanced DTC. It enhances the accuracy and safety of surgery for locally advanced DTC.

Objective:To investigate the feasibility and safety of implementing a domestic vehicle-mounted remote mobile robotic surgical system in thyroid surgery applications, integrated with 5G communication technology.Methods:Using the main system located on the vehicle-mounted mobile robot operating platform of the 960th Hospital of PLA Joint Logistics Support Force and the slave system of Weifang Traditional Chinese Hospital, the remote radical thyroidectomy 5G communication technology, and analyze the clinical and information transmission data of two female patients who underwent remote mobile robot thyroid cancer surgery on October 21, 2024 at Weifang Traditional Chinese Medicine Hospital.Results:The remote radical thyroidectomy was conducted by the robosurgeons utilizing a vehicle-mounted mobile robotic surgical system, and the procedure was successfully completed without necessitating intermediate open surgery. The operation durations for patient 1 and patient 2 were 135 minutes and 108 minutes, respectively, with 7 and 13 lymph nodes dissected, respectively. The average delay in surgical data transmission was recorded at 61.9 milliseconds, with no instances of signal interruption or frame loss. The procedure proceeded smoothly, without any jamming, and the audio and video transmissions were consistently clear. Follow up for 21 days after surgery showed no complications such as hoarseness, skin damage, or lymphatic fistula.Conclusion:The implementation of a vehicle-mounted remote mobile robotic surgery system for thyroid surgery has demonstrated safety and feasibility. Furthermore, the utilization of the 5G network offers rapid data transmission and minimal latency, closely approximating the therapeutic efficacy of traditional robotic thyroidectomy.

Objective:To evaluate the potential value of gut microbiota metabolites in predicting the efficacy of neoadjuvant chemoradiotherapy combined with immunotherapy in patients with locally advanced rectal cancer.Methods:Prospectively collected case data from 32 patients with locally advanced rectal patients, who underwent total mesorectal excision at Beijing Friendship Hospital, Capital Medical University, between October 2021 and August 2022. Among these patients, 18 (56.25%) were male and 14 (43.75%) were female, with ages ranging from 37 to 79 years and a mean age of (61.69±8.73) years. Postoperative pathological response was evaluated using the Tumor Regression Grade (TRG), dividing the patients into two groups: an efficacious group (ypT 0N 0, n=14) and a non-efficacious group (non-ypT 0N 0, n=18). Stools from 14 patients in the efficacious group and 18 patients in the non-efficacious group, who had experienced neoadjuvant chemoradiotherapy combined with immunotherapy, were collected before treatment. Metabolites were analyzed using high-performance liquid chromatography-tandem mass spectrometry, and pathway enrichment analysis was performed. A random forest model was constructed based on the differential metabolites. The data were analyzed by using R4.1.1 and 26.0 software. Results:Through untargeted metabolomics analysis, 2′-Deoxyinosine and albiflorin were enriched in the responders, while Sorbitan monooleate, 2-(Formylamino) Benzoic Acid, and 12-Hydroxydodecanoic acid were enriched in the non-responders ( P<0.05); Arachidonic acid metabolism and tryptophan metabolism were enriched, and the AUC for the model was 0.976. Conclusions:Rectal cancer patients with or without complete postoperative pathological remission exhibit differences in the metabolites of their intestinal microbiome prior to undergoing neoadjuvant chemoradiotherapy combined with immunotherapy. The identified differential metabolites have the potential to serve as predictive biomarkers for treatment efficacy.

Objective:To investigate the changes of respiratory function and lung volume after bariatric surgery using spiral CT three-dimensional imaging technology.Methods:Using the prospective study method, the medical records of 30 subjects undergoing sleeve gastrectomy (LSG) in the Eighth Department of General Surgery, the Second Hospital of Hebei Medical University from Jan. 2023 to Jun. 2024 were collected. Among them, 12 were males and 18 were females, aged from 20 to 45 years, with the average age of 31.1 years old. Chest CT scans were completed within 1 week before surgery and 6 months after surgery. The subject′s CT plain scan reconstructed thin-layer images of the mediastinal window were transferred to a GE workstation, and the lung volumes of both lungs and each lobe and the tracheal wall area of the five bronchial segments (RB1, RB4, RB10, LB1 + 2 and LB10) were calculated as a percentage of the airway cross-sectional area (WA%), and the posterior intercostal position corresponding to the diaphragm was recorded. Paired t-test and rank-sum test were used to compare preoperative and postoperative differences.Results:Compared with pre-operation, the subject′s body mass index decreased significantly 6 months after bariatric surgery [(42.22±7.31) kg/m 2vs (30.12±5.59) kg/m 2,t=7.31, P<0.001)]. Except for left lower lobe [(1.15±0.23) L vs (1.27±0.24) L, t=1.97, P=0.054] and right middle lobe [(0.57±0.16) L vs (0.83±0.16) L, t=1.38, P=0.172], the remaining lung parts were significantly larger after surgery than before surgery: right upper lobe [(0.80±0.17) L vs (0.94±0.19) L, t=2.79, P=0.007], right lower lobe [(1.08±0.14) L vs (1.22±0.19) L, t=3.23, P=0.002], left upper lobe [(1.12±0.20) L vs (1.24±0.23) L, t=2.26, P=0.014]. Overall, right lung volume [(2.44±0.33) L vs (2.79±0.41) L, t=3.62, P=0.001], left lung volume [(2.27±0.36) L vs (2.52±0.39) L, t=2.53, P=0.014] and total lung volume [(4.71±0.60) L vs (5.30±0.71) L, t=3.48, P=0.001] all increased significantly at 6 months after surgery compared with before surgery. All five segments of bronchus (WA%) were significantly reduced after surgery than before surgery: RB1: [(62.82±4.66) vs (66.85±3.99), t=3.60, P=0.001]; RB4: [(61.24±5.28) vs (64.31±5.51), t=2.20, P=0.031]; RB10: [(60.03±4.64) vs (62.97±5.73), t=2.18, P=0.033]; LB1+ 2: [(63.61±5.05) vs (67.90±4.30), t=3.54, P=0.001]; LB10: [(58.73±6.49) vs (62.01±5.06), t=2.17, P=0.034)]. The posterior intercostal position corresponding to the diaphragm dropped from an average of 7-8 intercostal spaces to 8-9 intercostal spaces, with a significant difference (rank mean 22.77 vs 38.23, Z=-3.67, P<0.001). Conclusion:Bariatric surgery can significantly reduce weight, reduce the pressure of chest and abdominal, improve lung compliance, reduce the internal pressure of the chest, lower the diaphragm, expand the lung volume and airway cross-sectional area, restore the original airway anatomy and respiratory physiology, so it can effectively improve the respiratory function and lung structure abnormalities caused by obesity.

Objective:To compare the clinical efficacy of laparoscopic Miles surgery through extraperitoneal stoma and intraperitoneal stoma.Methods:The medical records of 140 patients with low rectal cancer after laparoscopic Miles surgery admitted to Gastrointestinal Surgery of Northern Jiangsu People′s Hospital of Jiangsu Province from January 2018 to December 2022 were retrospectively analyzed. Among them, 80 were males and 60 were females, aged 50 to 75 years old, with an average age of 63.95 years old. They were divided into observation group (extraperitoneal stoma, n=70) and control group (intraperitoneal stoma, n=70) based on the stoma method. Through telephone, WeChat, outpatient follow-up and other contact methods, the intraoperative and postoperative recovery, the incidence of perioperative complications (stoma edema, stoma ischemia, peristoma inflammation, perineal/pelvic infection, lung infection) and the incidence of complications at 6 months and 1 year after surgery (stoma stricture, parastoma hernia/internal hernia, stoma prolapse/retraction), and the difference in the ability of artificial anus to control defecation at 1 year after surgery were compared between the two groups. SPSS27.0 statistical software was used for data analysis and processing. Results:(1) Incidence of individual complications such as lung infection between the two groups of patients during the perioperative period (4.3% vs 4.3%, χ2=0.17, P=0.676), stoma edema (25.7% vs 21.4%, χ2=0.36, P=0.550), stoma ischemia (7.1% vs 7.1%, χ2=0.00, P=1.000), peristomal inflammation (20.0% vs. 18.6%, χ2=0.05, P=0.830), perineal/pelvic infection (15.7% vs 27.1%, χ2=2.72, P=0.099), there was no difference between the two groups. There was still no difference in the overall complication rate between the two groups (72.9% vs 78.6%, χ2=0.62, P=0.430). (2) After follow-up to 6 months after surgery, the overall complication rate was 5.7% in the observation group compared with 22.9% in the control group ( χ2=7.06, P=0.008). In particular, the incidence of post-operative parastomal hernia/internal hernia did not occur in the observation group, while 8.6% of patients in the control group occurred (18.6% vs 42.9%, χ2=4.35, P=0.037). (3) After follow-up to 1 year after surgery, the overall complication rate in the observation group was lower than that in the control group ( χ2=8.59, P=0.003). The incidence of parastomal hernia/internal hernia after operation in the observation group was lower than that in the control group (2.9% vs 14.3%, χ2=4.47, P=0.034). (4) At the one-year follow-up, the overall excellent and good rate in the evaluation of bowel function in the observation group was higher than that in the control group (71.4% vs 48.6%, χ2=7.62, P=0.006). Conclusions:In laparoscopic Miles surgery for patients with rectal cancer, choosing extraperitoneal stoma has achieved good results, which can reduce the risk of complications 6 months or even 1 year after surgery, especially in preventing and controlling parastomal hernia/internal hernia. It has significant advantages, and at the same time, it can also promote the recovery of patients′ bowel function and reduce other related complications, thereby ensuring patient safety.

Objective:To investigate the expression of TSC2 in gastric cancer and its correlation with prognostic value and immune infiltration. Methods:Through Utilizing bioinformatics and experimental validation, analyzed RNA sequencing data from 624 gastric cancer patients in the TCGA-STAD dataset and the TCGA-GTEx-STAD dataset from the Cancer Genome Atlas (TCGA) database. Immunohistochemical (IHC) images of TSC2 expression in normal and gastric cancer tissues were obtained from the Human Protein Atlas (HPA). Evaluated the relationship between TSC2 expression and clinicopathological features, prognosis, immune infiltration, and immune subtypes in gastric cancer. Additionally, the expression of TSC2 in gastric cell lines was assessed by quantitative real-time PCR (qRT-PCR). Statistical analysis was conducted using SPSS 26.0 and R4.2.1 software. Results:TSC2 expression was significantly downregulated in gastric cancer tissues and cell lines compared to normal tissues. Lower expression of TSC2 correlated with worse overall survival, first progression, and progression-free survival in gastric cancer patients. TSC2 expression positively correlated with the infiltration levels of B cells, CD8 + T cells, CD4 + T cells, and macrophages, while it negatively correlated with the levels of NK cells and eosinophils. Functional enrichment analysis indicated that TSC2 was involved in pathways related to cell cycle regulation, protein transport, and immune response. TSC2 expression also associated with different immune subtypes within gastric cancer. Conclusions:TSC2 expression is downregulated in gastric cancer and is associated with poor prognosis and immune infiltration. TSC2 may act as a potential prognostic biomarker and a therapeutic target for gastric cancer.

Objective:To explore the correlation between lactylation-related gene and the treatment, prognosis and tumor microenvironment of gastric cancer.Methods:The gene expression profile and clinical data of gastric cancer and normal tissues in The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) datasets were used to analyze the characteristics of gastric cancer Lactylation-related gene (gLRG). The molecular subtypes of gLRG were identified by consensus cluster analysis. LASSO regression analysis was used to construct gLRG risk score model, and to analyze the differences in immune infiltration in tumor microenvironment and predict prognosis.Single-cell RNA sequencing (ScRNA-seq) data were used to evaluate the expression of key genes in different cells. Finally, immunohistochemistry was used to further explore the expression and prognosis of key gene AADAC in gastric cancer tissues. Statistical analysis was conducted using R4.3.1 and SPSS 27.0 software. Results:Based on the expression levels of gastric cancer Lactylation-related gene, two clusters of lactylation-related molecular subtypes of gastric cancer were identified by consensus cluster analysis. A gLRG risk score model containing 14 key prognostic genes was constructed, and gastric cancer patients were divided into high lactylation score group and low lactylation score group according to the risk score. In the high lactylation score group, patients had short survival time, poor prognosis, and infiltration of M2 macrophages and other immune cells. ScRNA-seq analysis revealed that AADAC was enriched in all cell types.Prognostic analysis of fourteen key genes showed that AADAC was associated with the prognosis of gastric cancer. Immunohistochemistry showed that AADAC was highly expressed in gastric cancer tissues, and was related to pathological stage and differentiation degree. Conclusions:The lactylation-related genes are closely related to the tumor microenvironment of gastric cancer. The model based on gastric cancer Lactylation-related gene has good prognostic prediction performance. Among them, the expression of AADCA is significantly up-regulated in gastric cancer tissues, which is expected to become a prognostic marker and potential therapeutic target of gastric cancer.