Objective:To investigate the clinicopathological characteristics and diagnostic criteria of cutaneous melanocytic tumor with CRTC1::TRIM11 fusion (CMTCT), and to improve understanding of this entity.Methods:The clinical features, histology, immunohistochemistry (IHC) and molecular characteristics of 3 CMTCT cases were analyzed, supplemented by a literature review.Results:All patients were female, aged 53, 46 and 46 years, respectively. Grossly, the lesions presented as dermal/subcutaneous nodules protruding from the skin surface. Histologically, tumor cells were arranged in nested and fascicular patterns separated by delicate fibrous septa. Tumor cell infiltration was observed in the epidermis of case 1, but not in that of cases 2 and 3. Tumor cells exhibited epithelioid, spindle-shaped, or oval morphology, with eosinophilic or pale cytoplasm and mild to moderate nuclear atypia. Tumor mitotic figure was <5/10 HPF. Scant melanin pigment was observed in case 2. IHC demonstrated diffuse and strong positivity for SOX-10, S-100 protein and MITF. HMB45 was negative in two cases (case 1 and case 3) and focally positive in case 2; Melan A was negative in two cases (case 1 and case 3) and partially positive in case 2. The Ki-67 proliferation index was approximately 5%-8%. Molecular analysis revealed CRTC1::TRIM11 fusion in three cases via RNA sequencing, and CRTC1 rearrangement in two cases (case 1 and case 3) via fluorescence in situ hybridization.Conclusions:CMTCT shares histological and immunophenotypic features with melanoma and clear cell sarcoma but is defined by the presence of CRTC1::TRIM11 fusion, necessitating molecular confirmation for definitive diagnosis. Complete excision with clear margins is recommended. While most of the CMTCTs exhibit indolent biological behaviors, rare cases may recur locally or metastasize, warranting close follow-up.

Background and Aims:To overcome the limitations of the transoral endoscopic thyroidectomy vestibular approach,such as restricted operative space and high complication risks,our team proposed a modified technique—endoscopic thyroidectomy via oral vestibule and submandibular approach(ETOSA).Preliminary studies have confirmed its safety and feasibility.This study aims to systematically evaluate the key factors affecting postoperative complications and operative time in ETOSA,explore the interactions among these variables,and construct a learning curve model to support its broader clinical adoption.Methods:A retrospective analysis was conducted on 125 patients with papillary thyroid carcinoma who underwent ETOSA at Xiangya Hospital,Central South University,between March 2022 and March 2023.Clinical characteristics,surgical parameters,and postoperative complications were extracted.A random forest model was employed to identify the major influencing factors for complications and operative time,as well as their interaction effects.Partial dependence plots based on case sequence were used to generate the learning curve.Results:All 125 patients successfully underwent ETOSA with no conversion to open surgery.The median operative time was 95.0 min,and the median intraoperative blood loss was 15.0 mL.The overall postoperative complication rate was 16.0%,with no cases of permanent hypoparathyroidism or hypocalcemia.The average neck appearance score was 1.05,indicating high patient satisfaction.The random forest analysis identified case number,surgical extent,lymph node yield(LNY),Hashimoto's thyroiditis(HT),and body mass index(BMI)as the key predictors of postoperative complications,while surgical extent,case number,LNY,HT,and blood loss were the key factors affecting operative time.A significant positive interaction was observed between case number and both surgical extent and HT,particularly in the first 20 cases,suggesting a higher risk during the early learning phase.The learning curve analysis indicated that surgical proficiency stabilized after 20 cases.Operative time and complication rate in the proficient phase were significantly lower than those in the learning phase(90.0 min vs.102.5 min;11.4%vs.40.0%,both P<0.05).Conclusion:ETOSA is a safe and feasible technique characterized by minimal invasiveness,favorable cosmetic outcomes,and a relatively short learning curve.case number,surgical extent,LNY,HT,BMI,and blood loss are key factors affecting complications and operation time.

Background and Aims:To overcome the limitations of the transoral endoscopic thyroidectomy vestibular approach,such as restricted operative space and high complication risks,our team proposed a modified technique—endoscopic thyroidectomy via oral vestibule and submandibular approach(ETOSA).Preliminary studies have confirmed its safety and feasibility.This study aims to systematically evaluate the key factors affecting postoperative complications and operative time in ETOSA,explore the interactions among these variables,and construct a learning curve model to support its broader clinical adoption.Methods:A retrospective analysis was conducted on 125 patients with papillary thyroid carcinoma who underwent ETOSA at Xiangya Hospital,Central South University,between March 2022 and March 2023.Clinical characteristics,surgical parameters,and postoperative complications were extracted.A random forest model was employed to identify the major influencing factors for complications and operative time,as well as their interaction effects.Partial dependence plots based on case sequence were used to generate the learning curve.Results:All 125 patients successfully underwent ETOSA with no conversion to open surgery.The median operative time was 95.0 min,and the median intraoperative blood loss was 15.0 mL.The overall postoperative complication rate was 16.0%,with no cases of permanent hypoparathyroidism or hypocalcemia.The average neck appearance score was 1.05,indicating high patient satisfaction.The random forest analysis identified case number,surgical extent,lymph node yield(LNY),Hashimoto's thyroiditis(HT),and body mass index(BMI)as the key predictors of postoperative complications,while surgical extent,case number,LNY,HT,and blood loss were the key factors affecting operative time.A significant positive interaction was observed between case number and both surgical extent and HT,particularly in the first 20 cases,suggesting a higher risk during the early learning phase.The learning curve analysis indicated that surgical proficiency stabilized after 20 cases.Operative time and complication rate in the proficient phase were significantly lower than those in the learning phase(90.0 min vs.102.5 min;11.4%vs.40.0%,both P<0.05).Conclusion:ETOSA is a safe and feasible technique characterized by minimal invasiveness,favorable cosmetic outcomes,and a relatively short learning curve.case number,surgical extent,LNY,HT,BMI,and blood loss are key factors affecting complications and operation time.

Objective:To analyze and summarize the clinical features and short-medium term follow-up results of children with multisystem inflammatory syndrome（MIS-C）following coronavirus infection.Methods:The data of six children with MIS-C admitted to the Intensive Care Unit of Shanghai Children's Medical Center from January to March 2023 were retrospectively analyzed.Results:All six cases were in shock，requiring vasoactive drugs，and one case required invasive mechanical ventilation.All the six patients had multiple organ function injury and increased inflammation indicators.After admission，they received organ support，glucocorticoids and gamma globulin treatment.Two patients were treated with biological agents.Both organ function and inflammation indicators showed significantly improvement after therapy.Six patients had mild coronary artery widening.All patients had good prognosis following short-medium term follow-up.Conclusion:Children with severe MIS-C may suffer life-threatening hemodynamic instability.Timely assessment，active anti-inflammatory and organ support therapy can obtain favorable prognosis.

Objective:To analyze and summarize the clinical features and short-medium term follow-up results of children with multisystem inflammatory syndrome（MIS-C）following coronavirus infection.Methods:The data of six children with MIS-C admitted to the Intensive Care Unit of Shanghai Children's Medical Center from January to March 2023 were retrospectively analyzed.Results:All six cases were in shock，requiring vasoactive drugs，and one case required invasive mechanical ventilation.All the six patients had multiple organ function injury and increased inflammation indicators.After admission，they received organ support，glucocorticoids and gamma globulin treatment.Two patients were treated with biological agents.Both organ function and inflammation indicators showed significantly improvement after therapy.Six patients had mild coronary artery widening.All patients had good prognosis following short-medium term follow-up.Conclusion:Children with severe MIS-C may suffer life-threatening hemodynamic instability.Timely assessment，active anti-inflammatory and organ support therapy can obtain favorable prognosis.

Objective:To investigate the clinicopathological characteristics and diagnostic criteria of cutaneous melanocytic tumor with CRTC1::TRIM11 fusion (CMTCT), and to improve understanding of this entity.Methods:The clinical features, histology, immunohistochemistry (IHC) and molecular characteristics of 3 CMTCT cases were analyzed, supplemented by a literature review.Results:All patients were female, aged 53, 46 and 46 years, respectively. Grossly, the lesions presented as dermal/subcutaneous nodules protruding from the skin surface. Histologically, tumor cells were arranged in nested and fascicular patterns separated by delicate fibrous septa. Tumor cell infiltration was observed in the epidermis of case 1, but not in that of cases 2 and 3. Tumor cells exhibited epithelioid, spindle-shaped, or oval morphology, with eosinophilic or pale cytoplasm and mild to moderate nuclear atypia. Tumor mitotic figure was <5/10 HPF. Scant melanin pigment was observed in case 2. IHC demonstrated diffuse and strong positivity for SOX-10, S-100 protein and MITF. HMB45 was negative in two cases (case 1 and case 3) and focally positive in case 2; Melan A was negative in two cases (case 1 and case 3) and partially positive in case 2. The Ki-67 proliferation index was approximately 5%-8%. Molecular analysis revealed CRTC1::TRIM11 fusion in three cases via RNA sequencing, and CRTC1 rearrangement in two cases (case 1 and case 3) via fluorescence in situ hybridization.Conclusions:CMTCT shares histological and immunophenotypic features with melanoma and clear cell sarcoma but is defined by the presence of CRTC1::TRIM11 fusion, necessitating molecular confirmation for definitive diagnosis. Complete excision with clear margins is recommended. While most of the CMTCTs exhibit indolent biological behaviors, rare cases may recur locally or metastasize, warranting close follow-up.

Objective To determine the effects of treadmill training on the structure of hippocampal myelin and cognitive function in rats exposed to acute plateau hypoxia.Methods With 30 SPF-grade female SD rats (aged 6-8 weeks,weighing 200-220 g),6 of them were used for observation of myelin structure after injury,and the remaining 24 rats were randomly divided into control group,hypobaric hypoxia group and treadmill training group (n=8).The rats in above experimental groups were placed in a low-pressure oxygen chamber at an altitude of 6000 m for 7 consecutive days,and the rats of the control group were placed in the confined chamber for the same period without hypoxia.Then,the rats of the treadmill training group received a 4-week treadmill training scheme since the day after hypoxia.Finally,all the rats were tested for cognitive function with open field test (OFT)and Morris water maze (MWM).Transmission electron microscopy (TEM) was used to observe the changes of demyelination in the hippocampus. The expression of oligodendrocyte transcription factor 2 (Olig2)and myelin basic protein (MBP )in the hippocampal CA1 and CA3 regions was measured by immunofluorescence staining and Western blotting.Results Behavioral tests showed that the number into the central area,total distance,distance ratio in OFT and the number of platform crossings and distance to the target area in MWM were reduced in the hypobaric hypoxia group than the control group (P<0.05 ),while these indexes were increased in the treadmill training group than in the hypobaric hypoxia group (P<0.05).Immunofluorescence staining indicated that the number of Olig2 positive cells per unit area and the mean fluorescence intensity of MBP in the CA1 and CA3 regions were significantly lessen in the hypobaric hypoxia group than the control group (P<0.05 ),while these indicators were higher in the treadmill training group than the hypobaric hypoxia group (P<0.05 ).Western blotting displayed that the expression levels of Olig2 and MBP in the hippocampus were obviously lower in the hypobaric hypoxia group than the control group (P<0.01 ),while the levels were increased in the treadmill training group than the hypobaric hypoxia group (P<0.01 ).Conclusion Treadmill training promotes the number of the oligodendrocyte spectrum cells in CA1 and CA3 regions,enhances the expression of myelin-related proteins and improves myelin repair in hippocampus of hypobaric hypoxia rats,and thereby ameliorates hypoxia-induced anxiety-like behaviors and memory dysfunction.

Objective:To explore the clinical effect on reconstruction of the soft tissue defects after resection of mucous cysts of distal interphalangeal joint (DIP) with transfer of the flap of dorsal branch of proper palmar digital artery.Methods:From September 2021 to September 2023, 8 patients (8 digits) with mucous cysts on DIP were treated in the Department of Hand and Microsurgery, the Affiliated Hospital of Binzhou Medical University. All 8 cases were females, aged 55-65 years old, with an average age of 60 years old. The cyst was located in the thumb in 1 case, in the index finger in 3 cases, in the middle finger in 3 cases, and in the ring finger in 1 case. After extensive resection of the mucous cysts, the size of soft tissue defects was at 0.8 cm×0.6 cm-1.7 cm×0.9 cm. Pedicled with the dorsal branch of proper palmar digital artery, the flaps adjacent to the defects were designed to cover the wounds. The size of the flaps was 1.2 cm×1.0 cm-2.0 cm×1.2 cm. Donor sites of the flap were covered by the full thickness skin grafts of medial upper arm. The postoperative follow-up was conducted by the combination of outpatient revisits and telephone reviews to observe the survival of the flap, and the functional recovery was evaluated according to the Evaluation Standard of Upper Limb Functional of Hand Surgery of Chinese Medical Association.Results:All flaps survived well after surgery. Postoperative follow-up ranged from 4 to 12 months, with a mean of 10 months. At the final follow-up, there was no recurrence of mucous cyst and all symptoms disappeared. All flaps healed well, with good appearance, soft texture and without obvious difference in colour from the surrounding skin. All skin grafts healed in one stage. The range of motion of the affected DIP was 0°-70°, and the TPD was at 7-8 mm, both caused no impact on daily life. The outcomes were excellent according to the evaluation criteria set by the Evaluation Standard of Upper Limb Functional of Hand Surgery of Chinese Medical Association.Conclusion:The flap pedicled with dorsal branch of proper palmar digital artery has obvious advantages with less damage and simple operation in the treatment of a mucous cyst of DIP. It is an ideal surgical procedure.

Objective:To investigate the clinical effect of fascial sling of flexor-pronator teres origin and anterior subcutaneous transposition of ulnar nerve in the treatment of severe cubital tunnel syndrome.Methods:30 patients with severe cubital tunnel syndrome were prospectively enrolled, who underwent surgical treatment at the Affiliated Hospital of Binzhou Medical University from December 2021 to February 2022. Randomized drawing divided the patients into two groups: the fascial sling group and the anterior subcutaneous transposition group with 15 cases on each group. In the fascial sling group, there were 11 males and 4 females, with an average age of 59 years (range 51-73 years), who underwent fascial suspension after ulnar nerve decompression. In the anterior subcutaneous transposition group, there were 10 males and 5 females, with an average age of 56 years (range 41-72 years), who underwent where the ulnar nerve was subcutaneous transposition after ulnar nerve decompression. The dynamic two-point discrimination and grip strength of the little finger on the affected limb were measured at 6, 12, and 24 months postoperatively. The postoperative improvement between the two groups were compared. Functional assessment and patient satisfaction surveys were conducted and compared at 24 months.Results:Neither groups had incision-related complications. The surgical duration for the fascial sling group was longer than that for the anterior subcutaneous transposition group (46.80±1.86 min and 43.87±2.00 min) with significant difference ( t=4.166, P<0.001). Blood loss during surgery in the fascial sling group was greater than that in the anterior subcutaneous transposition group (3.53±0.52 ml and 2.53±0.52 ml) with significant difference ( t=5.303, P<0.001). No significant difference was found in the improvement of dynamic two-point discrimination of the little finger in the affected limb at 6, 12, and 24 months postoperatively between the fascial sling group and the anterior subcutaneous transposition group (5.87±1.41 mm, 4.27±1.16 mm, 3.13±1.06 mm and 5.73±1.98 mm, 4.40±1.45mm, 3.20±1.15 mm), ( t=0.213, P=0.833; t=-0.277, P=0.784; t=-0.165, P=0.870). There was no significant difference in grip strength improvement in the affected limb at 6 and 12 months postoperatively between the fascial sling group and the anterior subcutaneous transposition group (24.62±4.94 kg, 25.88±4.72 kg and 21.94±3.76 kg, 23.62±4.00kg), ( t=1.448, P=0.159; t=1.404, P=0.171). At 24 months postoperatively, the fascial sling group showed better grip strength improvement compared to the anterior subcutaneous transposition group (27.58±4.92 kg and 23.62±4.00 kg) with significant difference ( t=2.425, P=0.033). The functional assessment revealed that the fascial sling group included 4 excellent, 8 good, and 3 acceptable cases, while the anterior subcutaneous transposition group had 3 excellent, 8 good, and 4 acceptable cases. One case in the fascial sling group was unsatisfied with the improvement in function. Four cases in the anterior subcutaneous transposition group were unsatisfied with functional improvement due to significant discomfort in the surgical area. Conclusion:The fascial sling technique of the flexor-pronator muscle origin yielded better clinical results on postoperative grip strength improvement and patient satisfaction compared to the anterior subcutaneous transposition.

Objective:To investigate the clinical effect of fascial sling of flexor-pronator teres origin and anterior subcutaneous transposition of ulnar nerve in the treatment of severe cubital tunnel syndrome.Methods:30 patients with severe cubital tunnel syndrome were prospectively enrolled, who underwent surgical treatment at the Affiliated Hospital of Binzhou Medical University from December 2021 to February 2022. Randomized drawing divided the patients into two groups: the fascial sling group and the anterior subcutaneous transposition group with 15 cases on each group. In the fascial sling group, there were 11 males and 4 females, with an average age of 59 years (range 51-73 years), who underwent fascial suspension after ulnar nerve decompression. In the anterior subcutaneous transposition group, there were 10 males and 5 females, with an average age of 56 years (range 41-72 years), who underwent where the ulnar nerve was subcutaneous transposition after ulnar nerve decompression. The dynamic two-point discrimination and grip strength of the little finger on the affected limb were measured at 6, 12, and 24 months postoperatively. The postoperative improvement between the two groups were compared. Functional assessment and patient satisfaction surveys were conducted and compared at 24 months.Results:Neither groups had incision-related complications. The surgical duration for the fascial sling group was longer than that for the anterior subcutaneous transposition group (46.80±1.86 min and 43.87±2.00 min) with significant difference ( t=4.166, P<0.001). Blood loss during surgery in the fascial sling group was greater than that in the anterior subcutaneous transposition group (3.53±0.52 ml and 2.53±0.52 ml) with significant difference ( t=5.303, P<0.001). No significant difference was found in the improvement of dynamic two-point discrimination of the little finger in the affected limb at 6, 12, and 24 months postoperatively between the fascial sling group and the anterior subcutaneous transposition group (5.87±1.41 mm, 4.27±1.16 mm, 3.13±1.06 mm and 5.73±1.98 mm, 4.40±1.45mm, 3.20±1.15 mm), ( t=0.213, P=0.833; t=-0.277, P=0.784; t=-0.165, P=0.870). There was no significant difference in grip strength improvement in the affected limb at 6 and 12 months postoperatively between the fascial sling group and the anterior subcutaneous transposition group (24.62±4.94 kg, 25.88±4.72 kg and 21.94±3.76 kg, 23.62±4.00kg), ( t=1.448, P=0.159; t=1.404, P=0.171). At 24 months postoperatively, the fascial sling group showed better grip strength improvement compared to the anterior subcutaneous transposition group (27.58±4.92 kg and 23.62±4.00 kg) with significant difference ( t=2.425, P=0.033). The functional assessment revealed that the fascial sling group included 4 excellent, 8 good, and 3 acceptable cases, while the anterior subcutaneous transposition group had 3 excellent, 8 good, and 4 acceptable cases. One case in the fascial sling group was unsatisfied with the improvement in function. Four cases in the anterior subcutaneous transposition group were unsatisfied with functional improvement due to significant discomfort in the surgical area. Conclusion:The fascial sling technique of the flexor-pronator muscle origin yielded better clinical results on postoperative grip strength improvement and patient satisfaction compared to the anterior subcutaneous transposition.