Objective To investigate the effects of Ginkgo biloba extract EGb761 on the expressions of XIAP and Smac following focal cerebral ischemia in rats. Methods A total of 40 male Wistar rats were randomized into 4 groups: sham-operation group, cerebral ischemi-a/reperfusion group, low-dose EGb761 group, and high-dose EGb761 group (n=10 in each group). A rat model of middle cerebral artery occlusion (MCAO) for 1.5 hours and reperfusion for 24 hours was built. EGb761 50 mg/kg and 100 mg/kg were injected intraperitoneally at one hour before the model building in the low-dose EGb761 and high-dose EGb761 groups. The expressions of XIAP and Smac in brain tissue were detected by immunohistochemistry method. Results The expressions of XIAP were 18. 33±4. 01 and 26. 7±3.27 respectively in the low-dose EGb761 and high-dose EGb761 groups, and they were significantly higher than 12. 13±3.44 in the cerebral ischemia/reperfusion group (all P<0.01), and the high-dose EGb761group was higher than the low-dose EGb761 group (P<0.01). 1he expressions of Smac in brain tissue were 21.33±3.15 and 11.33±2. 10 respectively in the low-dose EGb761 and high-dose EGb761 groups, and they were significantly lower than 28.93±4. 96 in the cerebral ischemia/reperfusion group (all P<0.05). The high-dose EGb761 group was significantly lower than the low-dose EGb761 group (P<0.05). Conclusions Cerebral ischemia/reperfusion could induce the expressions of XIAP and Smac. EGb761 intervention could inhibit the expressions of Smac while upregulating the expression of XIAP, and increase the XIAP/Smac ratio. 1his may be one of the protective mechanisms of EGb761 intervention.

Objective:To compare the postoperative neck pain, discomfort and swallowing difficulty in patients with papillary thyroid cancer (PTC) after conventional open thyroidectomy (COT) and endoscopic thyroidectomy using the gasless unilateral axillary approach (ET-UA) .Methods:The study included 117 female patients with PTC who underwent unilateral thyroid lobectomy plus central neck dissection using COT ( n=68) or ET-UA ( n=48) performed by the same experienced surgeon. Subjective neck pain, discomfort and swallowing alterations were assessed by questionnaire 3 day and 6 months postoperatively. Surgical scar and cosmetic satisfaction evaluation were implemented 6 months postoperatively. SPSS 20.0 was used for statistical analysis, the rate or composition ratio was compared by the χ2 test or the exact probability method, and the significance test of the difference in sample means was tested by analysis of variance. Results:Three days after surgery, the neck pain scores of COT group and ET-UA group were (2.13±1.07) and (2.31±1.07) ( P=0.368) ; the neck injury index was (5.13±3.02) and (5.31±3.00) ( P=0.748) ; the dysphagia index was 5 (0.49±3.47) and (3.77±2.96) ( P=0.006) . At 6 months postoperatively, the neck pain scores in COT group and ET-UA group group were (0.52±0.61) and (0.60±0.74) ( P=0.510) ; the neck injury index was (2.10±1.71) and (2.38±2.35) ( P=0.467) ; the dysphagia index was (2.68±2.36) and (1.81±1.83) ( P=0.034) , respectively. Conclusion:Our preliminary study shows that there is no significant differences in postoperative neck pain or discomfort between COT groups and ET-UA group, whereas the impact of ET-UA on swallow function is relatively small than COT.

Objective To establish a citrate pharmacokinetics model which is applied to evaluate the risk of citrate accumulation in patients with liver dysfunction in the continuous renal replacement treatment (CRRT) with regional citrate anticoagulation (RCA). Methods The source of citrate for extracorporeal anticoagulation, the body clearance and filter elimination of citrate, which were the three major citrate fluxes of systemic citrate level, were combined into a single-pool, first order kinetic equation. The data from a published clinical study of systemic citrate kinetics in the intensive care unit patients with or without liver cirrhosis were adapted and the citrate kinetic equation was applied to predict the risk of systemic citrate accumulation in patients with normal, impaired and absent liver clearance while different RCA-CRRT protocols were carried out. Results The single pool, first order citrate kinetic modeling equation was as follows:Csys=C(0)·e-[(clb+clf)·t/V]+G/CLb+CLf×(1-e-[(clb+clf)·t/V])There was excellent agreement between published citrate measurements and our predictions. Kinetic modeling showed that the plasma citrate concentration of patients with normal citrate body clearance was no more than 1 mmol/L during common RCA-CRRT. The model predicted that when the single pass fractional extraction of citrate on the artificial kidney was above 66％, systemic steady citrate concentration would be among the safe range even in patients of impaired body metabolism of citrate.Conclusions The citrate kinetic model of RCA-CRRT can predict the risk of systemic citrate accumulation and provide the basis for designing the safe RCA-protocols for the patients with impaired body clearance of citrate.

Objective To elucidate the malnutrition in patients with hospital-acquired acute kidney injury(AKI), and to examine the association betweensubjective global assessment (SGA) and prognosis.Methods Adult patients with hospital-acquired AKI were prospectively enrolled in this cohort study.Nutritional evaluations, including SGA, anthropometric and serum nutritional markers were conducted at enrollment.Overall survival at 90 days among different SGA scores was analyzed using Kaplan-Meier methods, and differences were tested using the log-rank test.The Cox model was used to analyze the relationship between SGA scores and all-cause mortality after adjusting for confounders.Results A total of 170 patients were enrolled.The prevalence of moderate malnutrition(SGA B) and severe malnutrition(SGA C) was 51.8％ and 22.9％ respectively, while patients with normal nutrition(SGA A) accounted for 25.3％.After 90 days follow-up, all-cause mortality was 9.8％ in SGA A group, 34.9％ in SGA B group and 56.8％inSGACgrouprespectively. Afteradjustingforage,sex,dialysis,ventilation, hemoglobin, platelets and bilirubin, the hazard ratio(HR) of 90 days all-cause mortality was 4.0(95％ CI 1.42-11.22, P=0.008) in malnutrition group (SGA B group and SGA C group) compared with SGA A group.The Kaplan-Meier curve also revealed that the worse the SGA score was, the lower the cumulative survival became (P＜0.01).Conclusion SGA score is an independent risk factor for all-cause mortality within 90 days in patients with hospital-acquired acute kidney injury.

Objective:To investigate the feasibility and safety of endoscopic thyroidectomy by gasless unilateral axillary approach.Methods:A matching study was conducted to analyze 21 patients with etgua of Zhejiang Provincial People’s Hospital from Mar. 2019 to Sep. 2021, including 8 cases of bilateral radical thyroidectomy and 13 cases of unilateral radical thyroidectomy + contralateral lobectomy (benign) . At the same time, 23 patients who underwent conventional thyroidectomy were matched as controls, including 8 cases of bilateral radical thyroidectomy and 15 cases of unilateral radical thyroidectomy + contralateral lobectomy (benign) . The operation process was recorded, and the differences in operation safety, postoperative recovery and incision satisfaction between endoscopic group and open group were compared.Results:The operation time in the endoscopy group was longer than that in the open group. The postoperative drainage volume in the endoscopy group was larger than that in the open group. There was no significant difference in the amount of intraoperative bleeding, postoperative stay in hospital or the incidence of complications. The neck pain scores in the endoscopic group were lowter than those in the open group. In terms of postoperative cosmetic satisfaction, the endoscopic group was higher than the open group.Conclusion:Endoscopic bilateral thyroidectomy by gasless unilateral axillary approach is a safe and effective surgical method, and has high cosmetic satisfaction.

Objective To analyze the clinical values of super early enteral nutrition combined with microecopharmaceutics and delayed enteral nutrition on patients with severe acute pancreatitis. Methods Clinical data of thirty patients diagnosed as severe acute pancreatitis in our emergency department during January 2013 and December 2017 were reviewed retrospectively. Patients were divided into the treatment group (n=15, patients given enteral nutrition combined with microecopharmaceutics within 24 h after admission) and the control group (n=15, patients given delayed enteral nutrition after 48 h of admission). Two weeks after the treatment, the serum variables of C-reactive protein, total protein, albumin, recovery time of urine and blood amylase, length of hospital stay and APACHE Ⅱ score were compared between the two groups by using paired samples t test. Results The C-reactive protein [(46.7±13.1) mg/L vs. (190.72±19.3) mg/L, t=10.4, P<0.01] and APACHE Ⅱ score [(7.2±1.9) vs.(9.3±2.4),t=2.7,P<0.05] of the treatment group were significantly lower than those in the control group. The total protein [(58.1±6.3)g/L vs.(52.6±5.4)g/L, t=2.5, P<0.05] and albumin [(29.9±3.2)g/L vs.(22.0±2.8)g/L, t=7.12, P<0.01] of the treatment group were significantly higher than those in the control group. The recovery time of urine amylase [(13.2±2.1)d vs.(18.7±3.9)d, t=4.9, P<0.01] and blood amylase [(7.5±3.0)d vs.(11.1±3.4)d, t=3.1, P<0.01], and length of hospital stay[(14.9±4.5)d vs.(27.1±5.3)d, t=6.9, P<0.01] were significantly shorter in the treatment group compared with those in the control group. Conclusions Ultra-early enteral nutrition combined with microecopharmaceutics can shorten the length of hospital stay of patients with severe acute pancreatitis, and is safe and effective.

Objective:To investigate the efficacy and safety of the modified gasless unilateral axillary approach (MGUAA) endoscopic thyroid surgery in treatment of papillary thyroid microcarcinoma (PTMC) .Methods:From Jan. 2019 to Dec. 2019, 90 patients receiving PTMC (cT1N0M0, cI stage, 8th, 2017 AJCC) therapy by modified gasless unilateral axillary approach endoscopic thyroid surgery (MGUAA group, n=41) , and conventional open thyroid surgery (OS group, n=49) were retrospectively analyzed. Ninety patients were enrolled in the study, including 14 males and 76 females,with the mean age (42.1±12.0) years.The effectiveness of central lymph node dissection (CLND) , the operation time, the types of operation, the amount of drainage, the duration of hospital stay, the related complications, the postoperative pain of neck and axillary and the cosmetic satisfaction were compared between the two groups.SPSS 25.0 statistical software was used for statistical analysis, the measurement data was expressed by ±s, paired t test was used to compare the measurement data between groups, and Chi-square test was used to campare the count date between groups. Results:The mean age (35.0±8.6) years and the amount of surgical bleeding (12.3±7.3) ml in the MGUAA group were significantly lower than those (48.1±11.1) years and (16.1±4.3) ml in the OS group ( P<0.01) , while the mean operation time (99.1±19.5) min, the mean amount of drainage (221.4±67.9) ml and the postoperative drainage tube placement time (5.0±0.8) days were significantly higher than those of (70.6±17.8) min, (98.3±63.7) ml and (3.8±1.0) days in the MGUAA ( P<0.01) . There was no significant difference in the number of lymph nodes of CLND or the duration of hospital stay between the two groups ( P>0.05) . In terms of surgical complications, the transient recurrent laryngeal nerve injury, the postoperative hematoma, the postoperative infection, and the lymphatic leakage had no significant difference between the two groups ( P>0.05) . The MGUAA group had significant advantages in avoiding the postoperative dysphagia in front of neck, the postoperative pain of neck, and cosmetic satisfaction over the OS group [ (0.0% vs 28.6%) , (14.6% vs 71.4%) , (1.1±0.3) score vs (2.4±0.5) score ( P<0.01) ]. Whereas in axillary area pain on the surgical side, the MGUAA group was inferior to the OS group ( P<0.01) . Conclusion:The modified gasless unilateral axillary approach endoscopic thyroid surgery is a feasible, safe and cosmetically operation for PTMC (cT1N0M0, cI stage, 8th, 2017 AJCC) .

Objectives The aim of this study is to compare efficacy and safety of radiofrequency ablation versus operation for overmuch residual thyroid removal before 131I treatment in differentiated thyroid cancer.Methods Clinical data from 52 newly diagnosed differentiated thyroid cancer patients who treated with operation at Zhejiang Cancer Hospital from January 2014 to December 2016 were retrospectively reviewed.The serum TSH was less than 30 IU/ml,and 99mTc thyroid imaging and ultrasound examination showed obviously residual thyroid tissue after 3 weeks of low iodine diet and discontinuation of euthyrox.Of these patients,28 cases received radiofrequency,while 24 cases treated with operation.The operation time,the waiting time of 131I treatment and the efficacy of residual thyroid tissue clearance were compared between two groups.At the same time,the complications of the two groups were observed.Results The mean values of operation time between two groups were(22.14±7.12)min and(55.45±13.56)min,respectively,and there was a statistically significant difference(t=11.822,P＜0.05).The mean waiting time of 131I treatment in patients received radiofrequency was(9.40±4.14)days,while the mean waiting time in operation group was(13.53±4.55)days,and the differences were statistically significant(t=9.144,P＜0.05).In RFA group,hoarseness,temporary parathyroid injury and permanent parathyroid injury were observed in 2 cases,0 case and 1 case,respectively.While there were 2 cases,3 cases and 0 case in the operative group.There were no significant differences between the two groups(all P ＞ 0.05).85.7%(24/28)of patients in RFA group and 91.7%(22/24)in operation group showed favorable efficacy of residual thyroid removal,and there were no significant differences between the two groups(P＞0.05).Conclusion Compared with operation,postsurgical residual thyroid tissue removal in differentiated thyroid cancer by ultrasound guided radiofrequency ablation by ultrasound guided is safe and effective,and provides a new minimally invasive treatment for patients who are reluctant to undergo surgery.

Objective:To investigate the effectiveness, safety, and advantages of modified radical neck dissection by gasless unilateral axillary approach (GUA-MRND) in the surgical management of selected patients with papillary thyroid cancer.Methods:We retrospectively analyzed patients with papillary thyroid cancer who underwent GUA-MRND (endoscopic group, n=16) versus unilateral open modified radical neck dissection (MRND) (open group, n=32) during the period from Jan. 2019 to Jun. 2021, including the differences in surgical efficiency, complication rate, and incisional satisfaction.Results:Compared MRND with GUA-MRND, the patients were younger ( P<0.05) , operative time and postoperative drainage anterior ( P<0.01) were slightly inferior in the latter, but it had obvious advantages in cervical swallowing discomfort and incision satisfaction evaluation ( P<0.05) . There was no significant difference in the incidence of temporary recurrent laryngeal nerve injury, intraoperative and postoperative bleeding, hematoma, infection, lymphatic or chylous leakage and supraclavicular numbness after surgery ( P>0.05) . The number of dissected lymph nodes in area II in the GUA-MRND was lower ( P<0.05) , but it was significantly higher ( P<0.01) in area III. And the average regional cleaning efficiency in the GUA-MRND was level Ⅲ (35.5%) , level Ⅵ (28.59%) , level Ⅳ (23.21%) , level Ⅱ (7.18%) and level Ⅴ (7.12%) , suggested that GUA-MRND had higher efficacy for level III, level Ⅵ and Level IV. Conclusion:GUA-MRND is safe, effective, and has high cosmetic satisfaction in the treatment of selected patients with lateral cervical lymph node metastases from papillary thyroid cancer.

Objective:To investigate the efficacy, safety and advantages of gasless unilateral axillary approach (GUAA) in endoscopic thyroid surgery.Methods:A total of 334 patients who underwent the GUAA endoscopic thyroid surgery (GUAA group) or conventional open thyroid surgery (OS group) in the Department of Head and Neck Surgery of Zhejiang Cancer Hospital from January 2017 to June 2018 were retrospectively analyzed. There were 45 males and 289 females, aged from 12 to 72 years old, of whom 139 patients were assigned to GUAA group and 195 patients to OS group. Pathological results included papillary thyroid carcinoma (282 cases), nodular goiter (41 cases) and thyroid adenoma (11 cases). Surgical exploration development curve of GUAA group was drawn and was divided into two parts: the technical exploration stage and the technical stable stage. Surgical efficiency, incidences of complications, and incision satisfaction were compared between GUAA group in technical stable stage and OS group. SPSS 25.0 software was adopted for statistical analysis.Results:The mean age in GUAA group was younger than that in OS group, with a significant difference [(35.3±9.5) years vs. (48.1±10.6) years, t=11.31, P<0.01]. The cases in the endoscope group were divided into technical exploration stage for 51 cases and technical stable stage for 88 cases according to the exploration and development curve. In unilateral radical thyroidectomy and unilateral thyroid lobectomy, the mean operation time [(90.6±18.6) min and (93.5±22.0) min] and postoperative drainage volumes [(121.5±87.6) ml and (155.5±69.1) ml] of GUAA group in the stable stage were more than those of OS group [(61.6±15.6) min and (46.5±8.4) min] and [(93.2±42.3) ml and (78.9±48.7) ml]. The difference was statistically significant ( t=12.28, 7.23, 3.35 and 3.05 respectively, all P<0.05), but there were no significant differences in surgical bleeding volumes between two groups [(12.7±6.8) ml vs. (13.5±7.7) ml, t=0.74, P>0.05 and (16.3±14.1) ml vs. (11.9±5.1) ml, t=1.05, P>0.05]. Compared with OS group, GUAA group had the lower incidence of anterior cervical discomfort during swallowing (2.3% vs. 29.2%, P<0.01) and the higher incision satisfaction score (1.1±0.5 vs. 2.8±0.7, t=21.12, P<0.01), however, GUAA group had the higher incidence of supraclavicular (or infraclavicular) numbness after surgery (5.7% vs. 0, P<0.01). And there was no significant difference in the incidences of temporary recurrent laryngeal nerve injury, bleeding, hematoma, infection, lymphatic leakage or chylous leakage after surgery between two groups ( P>0.05). Conclusion:GUAA endoscopic thyroid surgery is a safe method with high cosmetic satisfaction.