Objective:To investigate the clinical predictive value of Ki67 proliferation index combined with preoperative serum Ctn for postoperative biochemical cure of medullary thyroid carcinoma (MTC) .Methods:Clinical data were collected from Dec. 2008 to Dec. 2024 from 90 patients with surgically confirmed MTC at China-Japan Union Hospital of Jilin University. The optimal cut-off value for preoperative Ctn prediction of biochemical cure (171.18pg/mL) was determined by the ROC curve; the Ki67 proliferation index cut-off value was adopted from the international MTC grading system standard (5%). Patients were divided into three groups based on the above cutoff values: double-low group (Ki67 <5% and Ctn <171.18pg/mL, n=23), single-high group (Ki67 ≥5% and Ctn <171.18pg/mL or Ki67 <5% and Ctn ≥171.18pg/mL, n=49), and double-high group (Ki67 ≥5% and Ctn ≥171.18pg/mL, n=18). The Kaplan-Meier method (Log-Rank and Trend test) was used to compare the differences in biochemical cure rates between groups, and the Cox proportional risk model was used to analyze the risk factors affecting biochemical cure. Results:The correlation between preoperative Ctn and Ki67 proliferation index was not significant. The three groups differed significantly in gender, tumor distribution, tumor size, vascular invasion, N stage, TNM stage, and biochemical cure ( P<0.05), with the double-high group being significantly associated with larger tumors, later N stage and TNM stage, and lower biochemical cure ( P<0.001). Kaplan-Meier analysis showed that the biochemical cure rate in the double-high, single-high, and double-low groups showed a stepwise improvement.Cox univariate analysis showed that tumor size, N stage, TNM stage, preoperative Ctn, and Ki67 combined with Ctn were risk factors for failure to biochemically cure; multivariate analysis confirmed that the double-high group was an independent risk factor ( P<0.05). In the single-high group, the biochemical cure rate of patients in the low Ki67-high Ctn group was lower than that of the high Ki67-low Ctn group and more malignant. Ki67 had less effect on biochemical cure and disease-free survival at the low Ctn level, and Ki67 was an independent risk factor for failure to biochemically cure at the high Ctn level ( P=0.023) and was significantly associated with disease-free survival ( P=0.004) . Conclusions:Serum Ctn is more sensitive than Ki67 index in predicting biochemical cure after MTC, and the correlation between the two was weak. Ki67 proliferation index alone has limited prognostic value, but combines with preoperative Ctn significantly optimize the prognostic assessment of patients.The role of Ki67 index varied at different Ctn levels.

Objective:To study and analyze the brain networks of hemiplegic stroke patients in a resting state or during virtual reality(VR)upper limb rehabilitation robot training by functional near-infrared spectroscopy(fNIRS).Method:Fourteen hemiplegic stroke patients were included in this study as the test group,while 14 healthy subjects were recruited as the control group.The fNIRS data of the two groups were collected during the rest-ing state or the VR upper limb rehabilitation robot training.The functional connectivity(FC)index of the brain network was calculated.Result:①No significant difference was found between the test group and the control group in FC in the rest-ing state(P>0.05).②The overall FC of the control group did not increase significantly in the VR task com-pared with the resting state(P>0.05).But the FC of the LSMA-RPFC increased significantly(P<0.05).③The overall FC of the test group decreased in the VR task compared with the resting state(P<0.05),of which the LSMA-RPFC decreased(P<0.05).④The overall FC of the test group was lower than that of the control group(P<0.05),in which there was a significant difference in FC between LSMA-RSMA,LSMA-LM1,LS-MA-RM1,LSMA-RS1,and LM1-RS1(P<0.05)when the test group and the control group performed the VR upper limb rehabilitation robot training task.Conclusion:VR upper limb rehabilitation robot training can induce plastic reorganization of the extensive sen-sorimotor network in hemiplegic patients with stroke.And the mechanism of improving upper limb function may be related to the FC changes between bilateral SMA and SMA and other brain regions.

Calcitonin-negative medullary thyroid carcinoma(CNMTC)is a rare subtype of medullary thyroid carcinoma,characterized by normal serum calcitonin levels,which often leads to misdiagnosis or missed diagnosis.The pathogenesis of CNMTC remains unclear and may involve impaired secretion mechanisms or assay-related false negatives.Diagnostic approaches include ultrasound-guided fine needle aspiration cytology,serum CEA and ProGRP measurements,and RET gene testing.Surgical resection remains the mainstay of treatment,while neoadjuvant therapy may be considered in selected cases.This review summarizes recent advances in the understanding,diagnosis,treatment,and prognosis of CNMTC,aiming to provide clinical guidance for better management of this challenging condition.

Objective:To study and analyze the brain networks of hemiplegic stroke patients in a resting state or during virtual reality(VR)upper limb rehabilitation robot training by functional near-infrared spectroscopy(fNIRS).Method:Fourteen hemiplegic stroke patients were included in this study as the test group,while 14 healthy subjects were recruited as the control group.The fNIRS data of the two groups were collected during the rest-ing state or the VR upper limb rehabilitation robot training.The functional connectivity(FC)index of the brain network was calculated.Result:①No significant difference was found between the test group and the control group in FC in the rest-ing state(P>0.05).②The overall FC of the control group did not increase significantly in the VR task com-pared with the resting state(P>0.05).But the FC of the LSMA-RPFC increased significantly(P<0.05).③The overall FC of the test group decreased in the VR task compared with the resting state(P<0.05),of which the LSMA-RPFC decreased(P<0.05).④The overall FC of the test group was lower than that of the control group(P<0.05),in which there was a significant difference in FC between LSMA-RSMA,LSMA-LM1,LS-MA-RM1,LSMA-RS1,and LM1-RS1(P<0.05)when the test group and the control group performed the VR upper limb rehabilitation robot training task.Conclusion:VR upper limb rehabilitation robot training can induce plastic reorganization of the extensive sen-sorimotor network in hemiplegic patients with stroke.And the mechanism of improving upper limb function may be related to the FC changes between bilateral SMA and SMA and other brain regions.

Calcitonin-negative medullary thyroid carcinoma(CNMTC)is a rare subtype of medullary thyroid carcinoma,characterized by normal serum calcitonin levels,which often leads to misdiagnosis or missed diagnosis.The pathogenesis of CNMTC remains unclear and may involve impaired secretion mechanisms or assay-related false negatives.Diagnostic approaches include ultrasound-guided fine needle aspiration cytology,serum CEA and ProGRP measurements,and RET gene testing.Surgical resection remains the mainstay of treatment,while neoadjuvant therapy may be considered in selected cases.This review summarizes recent advances in the understanding,diagnosis,treatment,and prognosis of CNMTC,aiming to provide clinical guidance for better management of this challenging condition.

Objective:To investigate the clinical predictive value of Ki67 proliferation index combined with preoperative serum Ctn for postoperative biochemical cure of medullary thyroid carcinoma (MTC) .Methods:Clinical data were collected from Dec. 2008 to Dec. 2024 from 90 patients with surgically confirmed MTC at China-Japan Union Hospital of Jilin University. The optimal cut-off value for preoperative Ctn prediction of biochemical cure (171.18pg/mL) was determined by the ROC curve; the Ki67 proliferation index cut-off value was adopted from the international MTC grading system standard (5%). Patients were divided into three groups based on the above cutoff values: double-low group (Ki67 <5% and Ctn <171.18pg/mL, n=23), single-high group (Ki67 ≥5% and Ctn <171.18pg/mL or Ki67 <5% and Ctn ≥171.18pg/mL, n=49), and double-high group (Ki67 ≥5% and Ctn ≥171.18pg/mL, n=18). The Kaplan-Meier method (Log-Rank and Trend test) was used to compare the differences in biochemical cure rates between groups, and the Cox proportional risk model was used to analyze the risk factors affecting biochemical cure. Results:The correlation between preoperative Ctn and Ki67 proliferation index was not significant. The three groups differed significantly in gender, tumor distribution, tumor size, vascular invasion, N stage, TNM stage, and biochemical cure ( P<0.05), with the double-high group being significantly associated with larger tumors, later N stage and TNM stage, and lower biochemical cure ( P<0.001). Kaplan-Meier analysis showed that the biochemical cure rate in the double-high, single-high, and double-low groups showed a stepwise improvement.Cox univariate analysis showed that tumor size, N stage, TNM stage, preoperative Ctn, and Ki67 combined with Ctn were risk factors for failure to biochemically cure; multivariate analysis confirmed that the double-high group was an independent risk factor ( P<0.05). In the single-high group, the biochemical cure rate of patients in the low Ki67-high Ctn group was lower than that of the high Ki67-low Ctn group and more malignant. Ki67 had less effect on biochemical cure and disease-free survival at the low Ctn level, and Ki67 was an independent risk factor for failure to biochemically cure at the high Ctn level ( P=0.023) and was significantly associated with disease-free survival ( P=0.004) . Conclusions:Serum Ctn is more sensitive than Ki67 index in predicting biochemical cure after MTC, and the correlation between the two was weak. Ki67 proliferation index alone has limited prognostic value, but combines with preoperative Ctn significantly optimize the prognostic assessment of patients.The role of Ki67 index varied at different Ctn levels.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Objective:To investigate the efficacy and prognosis of different surgical approaches in sporadic medullary thyroid carcinoma.Methods:A retrospective analysis was conducted on 101 patients with sporadic medullary thyroid carcinoma (MTC) who underwent surgical treatment at the Department of Thyroid Surgery, China-Japan Union Hospital of Jilin University, from Feb. 2009 to Nov. 2023. The patients included 36 males and 75 females, with a male-to-female ratio of 1:2.1. The median age of the patients was 47 years old, with an age range of 21 to 72 years old. The study divided participants into two groups based on their surgical methods: an observation group (78 cases) and a control group (23 cases). The observation group received surgical methods in accordance with expert consensus, while the control group did not. The study compared the efficacy and prognosis of the two groups.Results:Statistical differences were found between the two groups in terms of stage II and III in TNM staging, intraoperative frozen pathological findings, number of lymph node resections in the central group, number of lymph node metastases in the central group, number of lymph node resections in the lateral cervical region, postoperative follow-up time, and five-year postoperative serum procalcitonin (Ctn) levels ( P<0.05) .Both groups of patients obtained a significant decrease in Ctn after surgical treatment. In the observation group, Ctn was at the remission level in 57 cases (73.1%), at the stable level in 13 cases (16.7%), and at the progression level in 8 cases (10.2%), while in the control group, Ctn was at the remission level in 20 cases (86.9%), at the progression level in 3 cases (13.1%), and there were no patients at the stable level after the operation.One patient (1.3 per cent) in the observation group had a recurrence after surgery; Two patients (8.7 per cent) in the control group had a recurrence. Conclusions:Standardised and thorough surgery can maximise the clearance of metastatic lymph nodes, effectively reduce the recurrence rate, achieve better efficacy, and improve the long-term prognosis of patients without increasing the risk of surgery and postoperative complications.

Objective:To analyze the effect of individualized respiratory function training combined with swallowing function training on lung function, dyspnea symptoms, and incidence of aspiration pneumonia in patients with stroke complicated by dysphagia.Methods:A total of 120 patients with stroke complicated by dysphagia who received treatment at Bao Ji People's Hospital from January 2022 to March 2023 were included in this study. These patients were assigned to a control group and a study group, with 60 patients in each group, using simple randomization. The control group received conventional swallowing function training, while the study group underwent individualized respiratory function training combined with swallowing function training. Both groups were treated for 8 weeks. Rehabilitation outcomes, repetitive saliva swallowing times, quality of oral intake (the Functional Oral Intake Scale score), and lung function parameters (peak expiratory flow rate, forced vital capacity, and forced expiratory volume in 1 second, dyspnea symptoms (the Modified Medical Research Council Dyspnea Scale score), respiratory muscle strength (maximum expiratory pressure percentage and maximum inspiratory pressure percentage), quality of life [the Swallowing Quality of Life questionnaire score], psychological status (the Depression, Anxiety and Stress Scale-21 Items score), incidence of aspiration pneumonia, and severity of aspiration (the Rosenbek scale score) were compared between the two groups.Results:The total response rate in the study group was 95.0% (57/60), which was significantly higher than that in the control group [81.7% (49/60), χ2 = 5.18, P = 0.023]. After 4 and 8 weeks of training, repetitive saliva swallowing times [(3.86 ± 0.25) times, (4.35 ± 0.30) times] and Functional Oral Intake Scale scores [(5.29 ± 0.61) points, (5.94 ± 0.50) points] in the study group were significantly higher compared with the control group [(3.45 ± 0.28) times, (3.81 ± 0.32) times, (4.73 ± 0.58) points, (5.18 ± 0.54) points, t = 8.46, 9.54, 5.15, 8.00, all P < 0.05]. The values for forced vital capacity, forced expiratory volume in 1 second, and peak expiratory flow rate in the study group were significantly higher than those in the control group, and the Modified Medical Research Council Dyspnea Scale score in the study group was significantly lower than that in the control group ( t = 4.88, 6.05, 7.34, 7.35, 3.82, 4.32, 4.63, 9.23, all P < 0.05). The maximum expiratory pressure percentage and maximum inspiratory pressure percentage in the study group were significantly higher than those in the control group ( t = 3.84, 3.82, 0.65, 3.69, all P < 0.05). The Swallowing Quality of Life questionnaire scores in the study group [(179.26 ± 20.17) points, (189.54 ± 21.06) points] were significantly higher than those in the control group [(162.75 ± 18.43) points, (170.61 ± 20.35) points, t = 4.68, 5.01, both P < 0.05]. The scores for the Depression, Anxiety and Stress Scale-21 Items in the study group [(28.03 ± 2.74) points, (25.71 ± 2.68) points] were significantly lower than those in the control group [(30.15 ± 2.96) points, (28.20 ± 3.17) points, t = 4.07, 4.65, both P < 0.05]. During the training period, the incidence of aspiration pneumonia in the study group was significantly lower than that in the control group [3.3% (2/60) vs. 15.0% (9/60), χ2 = 4.90, P = 0.027]. After 8 weeks of training, the severity of aspiration in the study group was milder than that in the control group ( Z = 2.54, P = 0.011). Conclusion:Individualized respiratory function training combined with swallowing function training can effectively improve lung function, reduce dyspnea symptoms, and decrease the incidence of aspiration pneumonia in patients with stroke who are experiencing dyspnea.