Papillary thyroid carcinoma (PTC) is a common tumor in endocrine system with unclear pathogenesis. The study has shown that the stimulation of cell growth, differentiation and gene mutation factors act together on the thyroid gland cells to transform into tumor cells from normal cells. A variety of oncogenes and tumor suppressor genes are involved in the development of PTC. In recent years, the study has found that BRAF gene mutation has a close relationship with the pathogenesis and prognosis of PTC. Mutated BRAF gene affects the occurrence and development of PTC owing to the regulation by RAS protein kinase and the application of biological function by activating MAPK signaling pathways.

Hypoxia exists in a wide range of advanced solid tumors and is often associated with poor prognosis.Hypoxia can enhance tumor invasion, promote tumor angiogenesis, impact genomic stability and change the tumor microenvironment by activating expression of relevant genes through hypoxia-induced factors (HIFs).Hypoxia provides favorable conditions for tumor metastasis and relapse, and it is involved in all aspects of tumor development.The study of hypoxia in tumors may provide useful information for pre-clinical evaluation, individualized treatment and clinical prognosis.Positron emission tomography (PET) is a non-invasive imaging method, which can be used for assessing and quantifying tumor hypoxic microenvironment.This article reviews the mechanisms of hypoxia-induced tumor biological behavior changes and the research progress of the application of radiotracers for PET imaging of tumor hypoxia.

Objective To explore the influencing factors of type 2 diabetes mellitus(T2DM)complicated with metabolic syndrome(MS)and investigate the correlation between the level of 25(OH)D3 and T2DM combined with MS.Methods 592 in patients with T2DM admitted to the Department of Endocrinology of Shenzhen Second People's Hospital were selected from January to December 2020.They were divided into simple T2DM group(T2DM,n=194)and T2DM combined with MS group(MS,n=398).Results Compared with the T2DM group,the MS group had lower 25(OH)D3 levels[26.30(20.50,32.39)vs 24.20(20.16,29.47),P<0.05].Spearman correlation analysis showed that 25(OH)D3 was negatively correlated with MS,FPG,TG,LDL-C,and 24 hUAlb(P<0.05 or P<0.01).Logistic regression analysis showed that 25(OH)D3 was a protective factor for T2DM combined with MS.Conclusions Patients with T2DM and MS have lower 25(OH)D3 levels.25(OH)D3 is a protective factor for T2DM combined with MS.

Objective:To investigate the value of an MRI and digital pathology images based omics nomogram for the prediction of recurrence risk in soft tissue sarcoma (STS).Methods:This was a retrospective cohort study. From January 2016 to March 2021, 192 patients with STS confirmed by pathology in the Affiliated Hospital of Qingdao University were enrolled, among which 112 patients in the Laoshan campus were enrolled as training set, and 80 patients in the Shinan campus were enrolled as validation set. The patients were divided into recurrence group ( n=87) and no recurrence group ( n=105) during follow-up. The clinical and MRI features of patients were collected. The radiomics features based on fat saturated T 2WI images and pathomics features based on digital pathology images of the lesions were extracted respectively. The clinical model, radiomics model, pathomics model, radiomics-pathomics combined model, and omics nomogram which combined the optimal prediction model and the clinical model were established by multivariate Cox regression analysis. The concordance index (C index) and time-dependent area under the receiver operating characteristic curve (t-AUC) were used to evaluate the performance of each model in predicting STS postoperative recurrence. The DeLong test was used for comparison of t-AUC between every two models. The X-tile software was used to determine the cut-off value of the omics nomogram, then the patients were divided into low risk ( n=106), medium risk ( n=64), and high risk ( n=22) groups. Three groups′ cumulative recurrence-free survival (RFS) rates were calculated and compared by the Kaplan-Meier survival curve and log-rank test. Results:The performance of the radiomics-pathomics combined model was superior to the radiomics model and pathomics model, with C index of 0.727 (95% CI 0.632-0.823) and medium t-AUC value of 0.737 (95% CI0.584-0.891) in the validation set. The omics nomogram was established by combining the clinical model and the radiomics-pathomics combined model, with C index of 0.763 (95% CI 0.685-0.842) and medium t-AUC value of 0.783 (95% CI0.639-0.927) in the validation set. The t-AUC value of omics nomogram was significantly higher than that of clinical model, TNM model, radiomics model, and pathomics model in the validation set ( Z=3.33, 2.18, 2.08, 2.72, P=0.001, 0.029, 0.037, 0.007). There was no statistical difference in t-AUC between the omics nomogram and radiomics-pathomics combined model ( Z=0.70, P=0.487). In the validation set, the 1-year RFS rates of STS patients in the low, medium, and high recurrence risk groups were 92.0% (95% CI 81.5%-100%), 55.9% (95% CI 40.8%-76.6%), and 37.5% (95% CI 15.3%-91.7%). In the training and validation sets, there were statistically significant in cumulative RFS rates among the low, medium, and high groups of STS patients (training set χ2=73.90, P<0.001; validation set χ2=18.70, P<0.001). Conclusion:The omics nomogram based on MRI and digital pathology images has favorable performance for the prediction of STS recurrence risk.

Objective:To explore the efficacy of digital and 3D printing technologies on design of superficial iliac circumflex artery flap for coverage the donor site of anterolateral thigh flap(ALTF).Methods:Clinical data of 8 patients were studied retrospectively for treatment of soft tissue defects of hand in the Department of Hand Surgery, Wuxi NO.9 People's Hospital Affiliated to Soochow University, from April 2017 to October 2021. The patients were 6 males and 2 females, aged from 29 to 59 years(mean, 45.8 years). Cause of injury: 3 patients were crushed, 2 by hot pressing, and 3 by machine strangulation. Site of injury included: 5 cases were dorsal hand defects and 3 cases were palm defects. All the wounds were contaminated to varying degrees with soft tissue defects. The areas of soft tissue defect ranged from 11 cm×10 cm to 22 cm×14 cm. Four patients had combined injuries of open fracture of metacarpals and phalanges and 3 with tendon defects. All wounds were repaired by free ALTF transplantation. And the donor sites in the thigh were repaired by superficial iliac circumflex artery flaps. The secondary wounds caused by flap harvesting on abdominal wall were closed directly. The targeted perforator vessels were detected preoperatively by CTA combined with CDU. 3D printed models of the affected hand were obtained before operation for individualised repairs according to the shape and area of the wounds. After the operation, all patients entered scheduled follow-ups at the outpatient clinic and via internet by observing the flap shape and testing the recovery of sensory and movement of adjacent joint.Results:The shapes and sizes of the wounds and the flaps were found basically in accordance with those in the preoperative simulative designs. All flaps in 8 patients survived and the wounds healed completely. All patients entered follow-ups for 8 to 24(average, 17.5) months. The donor thighs presented good appearance and colour, pliability without bloating. The range of motion of the hips and knees was not affected. Only linear scars remained in the abdominal donor sites, with natural colour and appearance.Conclusion:Digital and 3D printing technologies in preoperative design of flaps can help to locate the perforator vessels intraoperatively and guide the individualised design of the flaps with improved operation efficiency and satisfactory appearance of the flaps.

Objective:To investigate the effectiveness of radial dorsal digital artery flap with part short thumb extensor tendon in repairing dorsal skin defects of the thumb.Methods:The clinical data of patients with thumb wounds complicated with extensor tendon defect who were repaired with radial dorsal digital artery flap with part short thumb extensor tendon in the Department of Hand Surgery, Wuxi No.9 People's Hospital from August 2018 to August 2020 were analyzed retrospectively. After the operation, the shape and function of the thumb were followed up by testing the two-point discrimination of chimeric flap, the sensory function and the thumb opposition function. The function of the thumb was evaluated with the reference of the total active movement (TAM) of fingers of the Chinese Medical Association Hand Surgery Branch.Results:A total of 10 cases with soft tissue defect of thumb were treated, whose tendon defect ranged 1.0-1.7 cm in length. There were 6 males and 4 females, aged from 20 to 67 years (mean, 41 years). The left hand was involved in 6 cases and the right in 4 cases. Radial dorsal digital artery flap with part short thumb extensor tendon were used to reconstruct extensor tendon and wound with the size of 2.0 cm×1.5 cm-3.0 cm×2.5 cm. The size of flap harvest was 2.5 cm× 1.8 cm-3.5 cm× 3.0 cm, and the tendon was 2.0-3.4 cm in length. All flaps in 10 patients were survived with primary healing.All patients were followed-up from 6 to 12 months, with the average of 8 months. Flaps presented good appearance and color, pliability. The two-point discrimination of chimeric flap was 7-10 mm (mean, 9 mm), and the thumb opposition function was good. The flap sensory function reached S3. The interphalangeal joint flexion of thumb was 60°-90 °, and the thumb opposition function was good. According to the total active movement system, excellent result was achieved in 8 cases and good in 2 cases.Conclusions:Radial dorsal digital artery flap with part short thumb extensor tendon was an ideal clinical method for repair of dorsal skin defects of the thumb, which can repair skin and tendon defects in one stage. The operation is simple with reliable blood supply. This method could also restore the appearance and function of fingers.

Objective:To investigate the effectiveness of radial dorsal digital artery flap with part short thumb extensor tendon in repairing dorsal skin defects of the thumb.Methods:The clinical data of patients with thumb wounds complicated with extensor tendon defect who were repaired with radial dorsal digital artery flap with part short thumb extensor tendon in the Department of Hand Surgery, Wuxi No.9 People's Hospital from August 2018 to August 2020 were analyzed retrospectively. After the operation, the shape and function of the thumb were followed up by testing the two-point discrimination of chimeric flap, the sensory function and the thumb opposition function. The function of the thumb was evaluated with the reference of the total active movement (TAM) of fingers of the Chinese Medical Association Hand Surgery Branch.Results:A total of 10 cases with soft tissue defect of thumb were treated, whose tendon defect ranged 1.0-1.7 cm in length. There were 6 males and 4 females, aged from 20 to 67 years (mean, 41 years). The left hand was involved in 6 cases and the right in 4 cases. Radial dorsal digital artery flap with part short thumb extensor tendon were used to reconstruct extensor tendon and wound with the size of 2.0 cm×1.5 cm-3.0 cm×2.5 cm. The size of flap harvest was 2.5 cm× 1.8 cm-3.5 cm× 3.0 cm, and the tendon was 2.0-3.4 cm in length. All flaps in 10 patients were survived with primary healing.All patients were followed-up from 6 to 12 months, with the average of 8 months. Flaps presented good appearance and color, pliability. The two-point discrimination of chimeric flap was 7-10 mm (mean, 9 mm), and the thumb opposition function was good. The flap sensory function reached S3. The interphalangeal joint flexion of thumb was 60°-90 °, and the thumb opposition function was good. According to the total active movement system, excellent result was achieved in 8 cases and good in 2 cases.Conclusions:Radial dorsal digital artery flap with part short thumb extensor tendon was an ideal clinical method for repair of dorsal skin defects of the thumb, which can repair skin and tendon defects in one stage. The operation is simple with reliable blood supply. This method could also restore the appearance and function of fingers.

Thyroid cancer is the most common malignant tumor of the endocrine system, and its incidence is increasing year by year showing younger trend. The pathological types of thyroid cancer are papillary carcinoma, follicular carcinoma, medullary carcinoma and undifferentiated carcinoma. Medullary thyroid carcinoma (MTC) and papillary thyroid carcinoma (PTC) are the two common types of thyroid cancer. Since MTC and PTC have different biological origins, invasiveness and prognosis. Therefore, the occurrence of both medullary carcinoma and papillary carcinoma is very rare and rarely reported in China and abroad and the treatment is challenging. In this paper, we review the pathogenesis, ancillary tests, diagnosis and treatment of this disease, with the aim of providing reference for clinical treatment of patients with medullary thyroid carcinoma complicated by papillary carcinoma.

Objective:To evaluate the effect of hierarchical diagnosis and treatment model of childhood bronchial asthma in Shanghai Pudong New Area.Methods:According to the principle of proximity, children aged 6 months-17 years who were diagnosed with bronchial asthma at Shanghai Children′s Medical Center from July 2016 to May 2017 were divided into two cohorts: the specialized hospital group and the community hospital group.Twelve months of treatment and follow-up were conducted.The asthma control level, Childhood Asthma Control Test (C-ACT) score, medication adherence and health economic indicators were collected.Results:A total of 524 children were included for data analysis and divided into the specialized hospital group (300 cases) and the community hospital group (224 cases). According to the Global Initiative for Asthma(GINA) criteria, there was no statistical difference in monthly asthma control level between the two groups (all P>0.05). In the 12 th month, the well-controlled rate of the specialized hospital group increased by 12.4% ( P<0.01), and that of the community hospital group increased by 22.9% ( P= 0.015). According to the C-ACT criteria, there was no statistical difference in the monthly well-controlled rate between the two groups (all P>0.05), and the rate maintained an upward trend.The rates of patients with good compliance in the specialized hospital group and the community hospital group at the 12 th month of hierarchical diagnosis and treatment were 78.3%(235/300 cases) and 75.0%(168/224 cases), respectively, and the difference was not statistically significant ( P=0.370). After 12 months of hierarchical diagnosis and treatment, the number of asthma attacks were 1.0 and 2.0 ( P=0.269), and the hospitalization rates for asthma were 3.0%(9/300 cases) and 4.9%(11/224 cases), respectively in the specialized hospital group and the community hospital group, and the diffe-rence was not statistically significant ( P=0.259); the number of respiratory infections in the specialized hospital group (2.0 times) was lower than that in the community hospital group (3.0 times), and the total cost of treatment in the community hospital group (2 471.5 Yuan) was lower than that in the specialized hospital group (3 445.5 Yuan), and the difference was statistically significant ( Z=-3.308, -3.336, all P<0.01). Twelve months after hierarchical diagnosis and treatment, the number of asthma attacks, the number of respiratory infections and the hospitalization rate for asthma in the two groups were all lower than those in the first 12 months of hierarchical diagnosis and treatment, and the difference was statistically significant (all P<0.01). Conclusions:Hierarchical diagnosis and treatment model of childhood asthma in Shanghai Pudong New Area can improve asthma control level, C-ACT score and asthma medication adherence, and enhance health economic benefits, thus it′s an effective way to manage childhood asthma.

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.