To assess the perinatal outcomes following selective feticide through radiofrequency ablation (RFA) in complex monochorionic pregnancies. Methods In this retrospective observational study, 34 cases of complex monochorionic pregnancies treated with RFA for selective feticide and delivered at the Shanghai First Maternity and Infant Hospital between January 1, 2012 and December 31, 2013, were included. Gestational age at RFA, the number of RFA cycles, maternal and fetal complications, gestational age at delivery, neonatal outcomes at 28 days after birth and neonatal development after birth were recorded. Fetal survival rate were defined as the number of survivors at 28 days after birth divided by the number of remaining fetuses after RFA. Factors affecting fetal survival rate were also analyzed. Statistical analysis was performed using Fisher's exact test. Results (1) The process for RFA:The gestatinal age for the procedure was (20.7±3.1) weeks(16+1-27+6 weeks). The successful rate of procedures was 100%(34/34) and the cycle number for RFA was 1-6 times. (2)Fetal complications and survival rate of remaining fetuses after RFA:there were six pregnant women suffering from premature rupture of membrane (PROM) before 28 weeks. Among those women, one had miscarriaged at 25 weeks, one chose to terminate at 26 weeks and the remaining four chose to continue the pregnancy. There were three remaining fetuses developing fetal severe anemia with hydrops after RFA. Two of them had fetal demises 2 days after the procedures and one chose to have termination. Another two cases with discordant fetal anomalies had fetal demises with unknown reasons one day after RFA. There were 27 remaining fetuses after RFA who survived until 28 days after birth. The mean gestational age at delivery was(36.4±4.1)weeks (26+4-40 weeks) and the mean birth weight was (2 913± 978) g (1 080-4 600 g). The overall fetal survival rate 28 days after birth was 79%(27/34). There were no abnormal findings in antenatal magnetic resonance imaging (MRI) four weeks after the procedure and no abnormal development of nervous system in the surviving neonates between 3 months old and 1.5 years old. (3) Factors affecting fetal survival rate :There were no significant differences identified in the rate of fetal severe anemia and fetal demise (2/15, 2/13 and 1/6), the rate of PROM before 28 weeks (1/15, 4/13 and 1/6) and survival rate of 28 days after birth (13/15, 10/13 and 4/6)among three groups with different gestational age (16+1-, 20- and 24-27+6 weeks) for RFA(all P>0.05). The indications for RFA included severe selective intrauterine growth restriction (50%, 17/34), discordant for fetal abnormalities(24%, 8/34) , twin reversed arterial perfusion sequence(18%, 6/34)and dichorionic or monochorionic triamniotic pregnancy (9%, 3/34). There were also no significant differences noted in the rate of fetal complications and fetal demise(3/17, 2/8, 0/6, 0/3), the rate of PROM before 28 weeks (3/17, 0/8, 2/6, 1/3)and survival rate of 28 days after birth among different groups (12/17, 6/8, 6/6, 3/3) with different indications for RFA(all P>0.05) . No significant differences observed in the rate of fetal complications and fetal demise(10% and 2/5)and the rate of PROM before 28 weeks (17%and 2/5)between two groups with different cycle numbers for RFA (<3 times and≥3 times, all P<0.05), while the group with cycle number ≥ 3 times had lower survival rate 28 days after birth than the group with cycle number<3 times for RFA (2/5 vs 86%, P<0.05). Conclusions RFA is one of effective and safe procedures for selective feticide in complex monochorionic pregnancies.

Objective:To investigate the safety and surgical treatment effect of da Vinci robot in male thyroid surgery.Methods:Clinical data of 276 male patients undergoing robotic thyroid surgery with bilateral axillo-breast approach (BABA) admitted to our hospital from Feb. 2014 to Jan. 2020 were retrospectively analyzed. They were compared with 372 male patients (open group) who had open surgery by the same team during the same time. Surgical time, the amount of fluid selitransteise after surgery, the length of hospitalization after surgery, the number of metastatic lymph node (for malignant tumor) , cosmetic effect satisfaction, injury of recurrent laryngeal nerve and decrease of parathyroid function and other related surgical complications were analyzed. SPSS 20.0 software was employed to carry out statistical analysis, the measurement data were compared with t-test, and the counting data were analyzed by χ2 test. Results:All operations were successfully completed and on one in the robot group was converted into open surgery. Compared with the open group, surgical time of the robot group (benign: 96.78±9.67min, malignant: 143.93±15.73min) was significantly longer than that of the open group (benign: 70.40±12.49min, malignant: 112.26±15.72min) ( P<0.05) , but the postoperative beauty effect of the robot group (benign: 9.62±0.33 points, malignant: 9.59±0.31 min) was better than that of the open group (benign: 5.33±0.37 points, malignant: 5.87±1.65 points) ( P<0.05) . In patients with pathological malignancy, the average age of the robot group (40.89±11.45 years) was lower than that of the open group (44.84±11.88 years) (P<0.05) . There was no significant difference in the amount of fluid induced after surgery, the length of hospital stay after surgery or the number of cases with lymph node metastasis in the two groups ( P>0.05) . There were 2 cases in the robot group and 5 cases in the open surgery group had recurrent metastasis in the side of the neck after surgery. None of the patients had permanent larynx reflux nerve damage or permanent parathyroid dysfunction. The average follow-up time was (25.36±16.13) months, ranging from 1 to 72 months. Conclusion:Compared with traditional open surgery, da Vinci robot surgery system is safe and feasible in male thyroid surgery, with better beauty effect, and provides new options for male thyroid surgery patients with neck beauty needs.

Objective:To compare the clinical effects of percutaneous curved vertebroplasty (PCVP) and unilateral percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral compression fracture (OVCF).Methods:A retrospective cohort study was used to analyze the clinical data of 104 patients with single vertebral OVCF treated in Tianjin Hospital from September 2019 to September 2020, including 21 males and 83 females; aged 50-91 years [(70.3±7.7)years]. AO classification of the fracture was type A1 in 65 patients and type A2 in 39. The patients received PCVP (PCVP group, n=51) or unilateral PKP surgery (unilateral PKP group, n=53). The operation time, bone cement injection volume, intraoperative fluoroscopy frequency, effective dispersion times of bone cement and excellent rate of bone cement distribution were compared between the two groups. In evaluation of the therapeutic effects of the two groups, visual analogue scale (VAS) and Oswestry dysfunction index (ODI) were measured preoperatively and at postoperative 24 hours, 3 months and 6 months; Beck index was measured preoperatively and at postoperative 24 hours and 3 months. The rate of bone cement leakage and rate of refracture of adjacent vertebral bodies were compared between the two groups. Results:All patients were followed up for 6-8 months [(6.4±0.7)months]. The operation time, bone cement injection volume and intraoperative fluoroscopy frequency in PCVP group was (12.15±1.63)minutes, (2.13±0.28)ml and (24.74±1.71)times, shorter or less than (22.09±1.62)minutes, (5.30±0.52)ml and (30.09±1.86)times in unilateral PKP group (all P<0.01). The effective dispersion times of bone cement in PCVP group was (1.42±0.04)times, higher than (1.18±0.02)times in unilateral PKP group ( P<0.01). The excellent rate of bone cement distribution in PCVP group was 94%, higher than 70% in unilateral PKP group ( P<0.01). There were no significant differences in VAS, ODI and Beck index between the two groups before operation and at 24 hours and 3 months after operation (all P>0.05). VAS and ODI in PCVP group were (1.20±0.49)points and 16.52±5.22 at 6 months after operation, lower than (1.49±0.58)points and 20.16±5.16 in unilateral PKP group (all P<0.01). VAS and ODI in the two groups were significantly improved at 24 hours, 3 months and 6 months after operation when compared with those before operation (all P<0.05). Beck index in the two groups detected at 24 hours and 3 months after operation was improved from that before operation (all P<0.05). Unilateral PKP group showed Beck index was 0.75±0.07 at 3 months after operation, significantly lower than 0.79±0.07 at 24 hours after operation ( P<0.05), but there was no significant change in PCVP group ( P>0.05). The leakage rate of bone cement in PCVP group was 16% (8/51), lower than 47% (25/53) in unilateral PKP group ( P<0.01). There was no significant difference in the incidence of refracture of adjacent vertebral bodies between the two groups during follow-up ( P>0.05). Conclusion:For OVCF, PCVP is superior to unilateral PKP in terms of operation time, amount of bone cement injection, intraoperative fluoroscopy frequency, dispersion effect of bone cement in vertebral body, pain, function improvement, maintenance of injured vertebral height and incidence of bone cement leakage.

OBJECTIVETo evaluate surgical outcomes and the feasibility of robotic thyroidectomy and central neck dissection (CND).

METHODSThe clinical data of 40 patients of papillary thyroid microcarcinoma underwent total thyroidectomy (or lobectomy and isthmusectomy) and CND using the Da Vinci system through axillo-bilateral-breast approach in Jinan Military General Hospital of People's Liberation Army from February to December 2014 were analyzed retrospectively (robotic group). Other forty patients of papillary thyroid microcarcinoma underwent total thyroidectomy (or lobectomy and isthmusectomy) and CND by open approach were selected as the control (open group). Cosmetic satisfaction was assessed after a month postoperation by the numerical score system. t-test and χ(2) test were used to compare the clinical characters, total operative time, intraoperative estimated blood loss, postoperative hospital stay, number of lymph nodes removed, visual analogue scale for pain, postoperative complications, and cosmetic effect between the 2 groups.

RESULTSAll 80 patients were diagnosed of papillary thyroid microcarcinoma. The total thyroidectomy (or lobectomy/isthmusectomy) with CND of 40 patients were successfully performed by da Vinci Si surgical system. The numbers of total thyroidectomy of robotic group and the open group were 36 and 37, respectively. The numbers of metastatic lymph nodes of robotic group and open group were 14 and 15, respectively. The operation time of the robotic group was (130±12) minutes, which was longer than that of open group (98±11) minutes (t=12.432, P<0.05). The study showed statistical significant difference between the two groups regarding the visual analog scale pain assessment (1.9±0.9 vs.3.9±1.1, t=8.900, P<0.05). There were no statistical significant difference of intraoperative estimated blood loss, postoperative hospital stay, number of lymph nodes removed, and the complication rate between the 2 groups.Postoperative cosmetic result was more satisfying on the robotic group (9.1±0.5) than open group (4.8±1.5) (t=17.200, P<0.05).

CONCLUSIONSThe robotic total thyroidectomy (or lobectomy and isthmusectomy) and CND has similar surgery safety and feasibility as open procedures. The robotic thyroidectomy is a good alternative surgical modality for patients with papillary thyroid microcarcinoma who wish to avoid neck scars.

Axilla ; Breast ; Carcinoma, Papillary ; surgery ; Humans ; Length of Stay ; Lymph Nodes ; Neck Dissection ; Operative Time ; Postoperative Complications ; Postoperative Period ; Retrospective Studies ; Robotic Surgical Procedures ; Thyroid Neoplasms ; surgery ; Thyroidectomy ; methods

This study was aimed to discover core agent for the treatment of ulcerative colitis and explore the medication rules . A total of 525 ulcerative colitis medical records in the Jiangsu Province Hospital of TCM were selected from 2009 to 2013 . The records were input into the structured information acquisition system of clinical diagnosis and treatment . The complex network analysis was used to analyze core drugs of prescription and drug compatibility after data mining and rule processing . The results showed that the core drugs are Diyu , Huanglian, Muxiang, Baishao, Xianhecao, Danggui, Chaobaizhu, Huangqin, Zicao, Yiyiren, Fuling, Shanyao. It was concluded that data mining can be an objective method in the analysis of core drugs and compatibility in the treatment of ulcerative colitis. It can also be used to guide the clinical prescription medication.

Objective To evaluate the clinical safety and effectiveness of da Vinci Si surgical system in total parathyroidectomy with autotransplantation of secondary hyperparathyroidism.Methods A retrospective analysis was conducted with da Vinci Si surgical system on 16 patients with secondary hyperparathyroidism who were given total parathyroidectomy with autotransplantation from Mar 2014 to June 2016.The changes of clinical symptoms,parathyroid hormone,calcium and phosphate blood levels were followed up from 6 months to 2 years.Results Surgery was successful in all 16 cases and 62 parathyroid glands were resected.There were no operation-related complications and no conversions to open or endoscopic surgery.Mean operation time was (136 ± 24) minutes.In all postoperative cases the musculoskeletal pain,skin itching were relieved or disappeared.PTH,calcium and phosphate blood levels decreased and no recurrence during follow-up period,The postoperative cosmetic result was satisfatory.Conclusions Da Vinci Si surgical system used in the parathyroid surgery is safe and effective,especially suitable for patients with cosmetic requirements.

Objective To evaluate the clinical safety and effectiveness of total parathyroidectomy with autotransplantation on the chronic renal failure (CRF) patients who are suffering from severe secondary hyperparathyroidism (SHPT).Methods A retrospective analysis was performed on 149 patients with secondary hyperparathyroidism who were given total parathyroidectomy with autotransplantation from Apr.2010 to Oct.2015.The changes of clinical symptoms,parathyroid hormone,calcium and phosphate blood levels were followed up during 6 months to 6 years.Results 598 parathyroid glands were obtained form 149 patients who underwent surgical resection.Musculoskeletal pain and skin itching relieved or disappeared in 145 cases the 2nd day after operation,while these symptoms gradually relieved one week after operation for 4 cases.Serum intact parathyroid hormone (iPTH)was 89.67±180.61,serum phosphate 1.74±0.52,and serum calcium 2.07±0.32 the 1st day after operation,and they all decreased compared with those before operation(P＜0.001).Serum calcium,phosphorus and iPTH levels were similar at 6,36 and 60 months after operation (P＞0.05).Two patients had pathological fracture after operation.No persistent bone pain or skin itching was found during the follow-up period.Two patients had secondary hyperparathyroidism.Six patients had recurrence,among whom five underwent surgery again,and one patient had clinical follow-up.One patient died of pulmonary infection at 13 months after operation.Conclusion Total parathyroidectomy with autotransplantation were applied to ineffective medical treatment for advanced secondary hyperparathyroidism in patients with chronic renal failure.

Objective To explore the diagnostic value in fine needle aspiration cytology combined with thyroghobulin measurement of suspected malignant cervical enlarged lymph node in differentiated thyroid carcinoma.Methods The study included 82 patients with differentiated thyroid carcinoma who were found suspected metastatic lymph nodes in neck during follow-up and accepted reoperation from January 2015 to May 2017.Ultrasound-guided fine-needle aspiration was done in 130 suspected malignant lymph nodes,at the same time,thyroghobulin in fine needle aspiration cytology washout fliud was measured with electrochemiluminescence,fine needle aspiration cytology combined with thymglobulin measurement in fine-needle aspiration biopsy.All suspicious malignant lymph nodes were precise positioning preoperative by injection of mnocarbon suspension under guidence of ultrasound.The analyze was performed according to the final pathological diagnosis after operation.The sensitivity,specificity and accuracy of fine needle aspiration cytology,thymglobulin measurement in fine-needle aspiration biopsy,fine needle aspiration cytology and thyroglobulin measurement in fine-needle aspiration biopsy were calculated by Fomage's statistical method and x2 test was used for comparison among groups.Results Eighty-two patients with 130 lymph nodes with definitemarkers and pathological diagnosis,with a pathological examination of 119 and negative 11 cases.The sensitivity of fine needle aspiration cytology,thyroglobulin measurement in fine-needle aspiration biopsy,fine needle aspiration cytology and thyroglobulin measurement in fine-needle aspiration biopsy was 88.2％,94.1％ and 95.8％,with specificity of 54.5％,72.7％ and 81.8％,with accuracy of 85.4％,92.3％ and 94.6％.Conclusion The sensitivity,specificity and accuracy of fine needle aspiration cytology combined thyroglobulin measurement in fine-needle aspiration biopsy were higher than that of fine needle aspiration cytology or thyroglobulin measurement in fine-needle aspiration biopsy alone,which can be used as a method of qualitative diagnosis during differentiated thyroid cancer postoperative follow-up.

Objectives:To investigate the clinical efficacy of unilateral biportal endoscopy (UBE) in the treatment of degenerative lumbar disease (DLD) and its impact on postoperative lumbar stability.Methods:This is a retrospective case series study. A total of 109 cases of DLD treated with UBE in the Department of Orthopaedic, Beijing Chaoyang Hospital Affiliated to Capital Medical University from July 2020 to June 2022 were analyzed retrospectively. There were 47 males and 62 females, aged (53.3±8.2) years (range: 21 to 80 years). The surgical segments were single segment in 80 cases, two segments in 25 cases, and three segments in 4 cases. The low back pain and leg pain of visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) score and Oswestry disability index (ODI) were evaluated before and after operation. The modified MacNab criteria were used for evaluation of the clinical consequences. Postoperative three-dimensional lumbar CT was performed to observe the preservation of the facet joints and the angle of the medial surface of the facetectomy(β angle). At 12 months after surgery, X ray of the flexion and extension lumbar spine were reviewed. The comparison and analysis of the data were conducted using paired sample t tests or generalized estimation equations. Results:All 109 patients underwent operative procedures successfully. The operation time was (94.5±37.1) minutes (range:56 to 245 minutes), the times of X ray was 6.8±4.0 (range:4 to 16 times), and the days of hospitalization was (5.3±3.7) days (range:4 to 14 days). Complications included dural tears in 4 cases, transient lower limb numbness in 4 cases, epidural hematoma in 2 case. The follow-up time was (19.6±7.2) months (range:12 to 36 months). The postoperative low back pain VAS, leg pain VAS, JOA score and ODI were significantly improved(all P<0.05). According to the modified MacNab criteria, the excellent and good rate was 88.99%(97/109) at 12 months after surgery. One case underwent revision surgery because of recurrent lumbar disc herniation. In term of radiographic evaluation, the area of the surgical side facet joints after UBE surgery was reserved more than 60%. The β angle was less than 90° in all patients. After 12 months of surgery, there was no surgical segment instability or spondylolisthesis by the X-ray of the flexion and extension lumbar spine. Conclusion:UBE can achieve satisfactory clinical efficacy in the treatment of DLD, and maintain the stability of the lumbar spine.

Objectives:To investigate the clinical efficacy of unilateral biportal endoscopy (UBE) in the treatment of degenerative lumbar disease (DLD) and its impact on postoperative lumbar stability.Methods:This is a retrospective case series study. A total of 109 cases of DLD treated with UBE in the Department of Orthopaedic, Beijing Chaoyang Hospital Affiliated to Capital Medical University from July 2020 to June 2022 were analyzed retrospectively. There were 47 males and 62 females, aged (53.3±8.2) years (range: 21 to 80 years). The surgical segments were single segment in 80 cases, two segments in 25 cases, and three segments in 4 cases. The low back pain and leg pain of visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) score and Oswestry disability index (ODI) were evaluated before and after operation. The modified MacNab criteria were used for evaluation of the clinical consequences. Postoperative three-dimensional lumbar CT was performed to observe the preservation of the facet joints and the angle of the medial surface of the facetectomy(β angle). At 12 months after surgery, X ray of the flexion and extension lumbar spine were reviewed. The comparison and analysis of the data were conducted using paired sample t tests or generalized estimation equations. Results:All 109 patients underwent operative procedures successfully. The operation time was (94.5±37.1) minutes (range:56 to 245 minutes), the times of X ray was 6.8±4.0 (range:4 to 16 times), and the days of hospitalization was (5.3±3.7) days (range:4 to 14 days). Complications included dural tears in 4 cases, transient lower limb numbness in 4 cases, epidural hematoma in 2 case. The follow-up time was (19.6±7.2) months (range:12 to 36 months). The postoperative low back pain VAS, leg pain VAS, JOA score and ODI were significantly improved(all P<0.05). According to the modified MacNab criteria, the excellent and good rate was 88.99%(97/109) at 12 months after surgery. One case underwent revision surgery because of recurrent lumbar disc herniation. In term of radiographic evaluation, the area of the surgical side facet joints after UBE surgery was reserved more than 60%. The β angle was less than 90° in all patients. After 12 months of surgery, there was no surgical segment instability or spondylolisthesis by the X-ray of the flexion and extension lumbar spine. Conclusion:UBE can achieve satisfactory clinical efficacy in the treatment of DLD, and maintain the stability of the lumbar spine.