Objective:To investigate the efficacy of endoscopic surgery using a chest-breast approach for thyroid papillary cancer and its effect on stress response and pain transmitters.Methods:A total of 100 patients with thyroid papillary cancer who received treatment at Zhoushan Hospital between January 2022 and January 2023 were retrospectively included in this study. These patients were divided into an endoscopic surgery group and a traditional surgery group according to the surgical method used, with 50 patients in each group. The endoscopic surgery group received endoscopic surgery, while the traditional surgery group underwent traditional open surgery. Surgical indicators, postoperative complications, thyroid function measured before surgery and 5 days after surgery, stress response, and pain transmitters were compared between the two groups.Results:The operative time in the endoscopic surgery group was longer than that in the traditional surgery group [(147.84 ± 27.95) minutes vs. (112.31 ± 23.16) minutes, t = 6.92, P < 0.001]. Intraoperative blood loss in the endoscopic surgery group was less than that in the traditional surgery group [(20.81 ± 4.24) mL vs. (37.74 ± 6.56) mL, t = 15.33, P < 0.001]. Postoperative drainage amount in the endoscopic surgery group was significantly less than that in the traditional surgery group [(32.34 ± 6.84) mL vs. (47.96 ± 12.31) mL, t = 7.84, P < 0.001]. Postoperative length of hospital stay in the endoscopic surgery group was significantly shorter than that in the traditional surgery group [(4.06 ± 1.31) days vs. (6.87 ± 1.54) days, t = 9.83, P < 0.001). The incidence of postoperative complications in the endoscopic surgery group was significantly lower than that in the traditional surgery group (6.00% vs 20.00%, χ2 = 4.33, P = 0.037). At 5 days post-surgery, the levels of triiodothyronine and thyroxine in the endoscopic surgery group were significantly lower than those in the traditional surgery group, while the level of thyroid stimulating hormone was significantly higher ( t = 5.57, 8.69, 10.17, all P < 0.001). At 5 days post-surgery, the levels of cortisol and malondialdehyde in the endoscopic surgery group were significantly lower than those in the traditional surgery group ( t = 9.31, 17.21, both P < 0.001). At 5 days post-surgery, the levels of substance P, neuropeptide Y, and prostaglandin E 2 in the endoscopic surgery group were significantly lower than those in the traditional surgery group ( t = 9.84, 13.65, 10.94, all P < 0.05). Conclusion:The endoscopic surgery using a chest-breast approach is highly effective in treating thyroid papillary cancer, with minimal complications. It greatly enhances thyroid function, elicits a low stress response, and effectively suppresses the release of pain transmitters.

ObjectiveTo observe the effects of Tongmai Kaiqiao pills on the hypoxia-inducible factor-1α （HIF-1α）/adenovirus E1B 19 kD-interacting protein 3 （BNIP3） signaling pathway and mitochondrial autophagy in the hippocampus of the rat model of vascular dementia （VD）. MethodNinety male SD rats underwent adaptive feeding for one week before the study. Ten rats were randomly assigned to the sham group， where the common carotid artery was isolated without ligation. The remaining rats were subjected to sequential ligation of the common carotid artery for the modeling of VD. The successfully modeled rats were randomly assigned into the following groups： model， high-， medium-， and low-dose （27.6， 13.8， 6.9 g·kg^-1， respectively） Tongmai Kaiqiao pills， donepezil hydrochloride （0.45 mg·kg^-1）， and combination （27.6 g·kg^-1 Tongmai Kaiqiao pills + 2.5 mg·kg^-1 HIF-1α inhibitor YC-1） groups. After 4 weeks of treatment， samples were collected. Nissl staining and hematoxylin-eosin staining were performed to observe the loss of neurons and pathological changes， respectively， in the hippocampal region. Western blot was employed to determine the protein levels of HIF-1α， BNIP3， Beclin-1， and microtubule-associated protein 1 light chain 3B （LC3B） in the hippocampal tissue. Transmission electron microscopy was used to observe the mitochondrial ultrastructure and the number of autophagosomes in the hippocampal tissue. Immunofluorescence was employed to observe the fluorescence intensity of HIF-1α， BNIP3， and LC3B in the hippocampal tissue. ResultCompared with the sham group， the model group showed prolonged escape latency （P<0.01）， decreased number of platform crossings （P<0.01）， reduced and disarranged neuronal layers in the hippocampal region， decreased number of Nissl bodies， disrupted mitochondrial cristae， damaged mitochondrial double-membrane structures， increased number of autophagosomes， upregulated expression of HIF-1α， BNIP3， beclin1， and LC3B （P<0.05， P<0.01）， and enhanced fluorescence intensity of HIF-1α， BNIP3， and LC3B （P<0.05， P<0.01）. Compared with the model group， Tongmai Kaiqiao pills and donepezil hydrochloride shortened the searching time for the platform （P<0.01） and increased the number of platform crossings （P<0.01）. Moreover， the drugs increased the number of neurons with normal morphology and orderly arrangement and the number of Nissl bodies， alleviated the damage， increased the number of autophagosomes， upregulated the expression of HIF-1α， BNIP3， Beclin1， and LC3B （P<0.05， P<0.01）， and enhanced the fluorescence intensity of HIF-1α， BNIP3， and LC3B （P<0.05， P<0.01）. Compared with high-dose Tongmai Kaiqiao pills， the combination group prolonged the escape latency （P<0.01）， reduced the number of crossing platforms （P<0.01）， decreased the number of hippocampal neurons， aggravated the damage， decreased the number of Nissl bodies and autophagosomes， downregulated the expression of HIF-1α， BNIP3， beclin1， and LC3B （P<0.01）， and decreased the fluorescence intensity of HIF-1α， BNIP3， and LC3B （P<0.01）. ConclusionTongmai Kaiqiao pills may activate the HIF-1α/BNIP3 signaling pathway to promote the occurrence of mitochondrial autophagy， clear damaged mitochondria， provide energy for healthy cells， reduce neuronal cell death， and restore the brain function， thereby reducing ischemic damage to the hippocampal tissue， improving learning and memory abilities， and exerting therapeutic effects on VD in rats.