Objective To evaluate the safety,efficacy,and long-term outcomes of transoral ro-botic surgery(TORS)for the resection of parapharyngeal space tumors(PPST).Methods A retro-spective analysis was conducted on clinical data from 16 patients who underwent TORS for PPST re-section.Surgical outcomes,postoperative pathological findings,and complication rates were ob-served.Follow-up evaluations were performed to assess patient satisfaction,swallowing function re-covery,and tumor recurrence.Results Except for one patient who required an additional neck inci-sion,the remaining 15 patients successfully completed the surgery via the oral route.None of the pa-tients underwent tracheotomy or mandibulotomy.The mean surgical duration was 43.9 minutes,with an average tumor diameter of 4.5 cm resected.The mean intraoperative blood loss was 35.3 mL.Patients resumed oral intake after an average of 3.8 days and had a mean postoperative hospital stay of 8.3 days.Postoperative pathological examination revealed that the most common tumor type was pleomorphic adenoma(56.2％,9/16),followed by schwannoma(25.0％,4/16),with one case of basal cell adenoma,cyst,and lipoma,respectively.One patient experienced transient Horner's syndrome,two had wound dehiscence that healed spontaneously,and one had spontaneous wound healing after drainage tube dislodgement.With a mean follow-up of 79.5 months,no tumor recurrence or severe complications were observed.All patients had good swallowing function and were satisfied with the surgical outcomes.Conclusion TORS for PPST resection offers advantages such as clear surgical visualization,direct surgical access,minimal blood loss,reduced trauma,favorable cosmetic re-sults,and rapid postoperative recovery.It also demonstrates good long-term outcomes,with high safety and efficacy.

Aim To explore the influence of demethy-lase fat mass and obesity-related genes(FTO)on the abnormal contractile function of diabetic coronary smooth muscle.Methods Smooth muscle specific FTO knockout mice(FTOSMKO)were prepared by Cre-loxP recombinant technology.They were divided into four groups:control(WT)group,diabetes model group(DM),FTO knockout group(FTOSMKO),and FTOSMKO diabetic group(FTOSMKO-DM),with 15 mice in each group.Diabetic mice were prepared by intraperitoneal injection of streptozotocin(STZ);the remaining mice were injected with an equal amount of citric acid-sodi-um citrate buffer.The effects of 5-HTon the contractile response of coronary artery smooth muscle in the four groups of mice were observed by the technique of small-vessel ring tensiometry.Western blot and Dot blot were used to detect the changes of FTO protein and N6-methyladenine(m6A)methylation modification levels in mouse vascular tissues.Results Compared with the WT group,the DM group had significantly higher blood glucose(P＜0.01)and lower body weight(P＜0.05);the level of FTO protein in aorta of DM group increased(P＜0.01),and the level of m6A methylation modification decreased(P＜0.01).The 5-HT-induced contractile response significantly de-creased in the DM group compared with the WT group(P＜0.01),whereas the contractile response signifi-cantly increased in the FTOSMKO-DM group compared with the DM group(P＜0.01);the non-L-type calci-um channel-mediated vascular smooth muscle contrac-tile response was enhanced in the FTOSMKO-DM group,among which,the contractions induced by 1,4,5-triphosphate inositol receptor(IP3R)and caffeine-ac-tivated ranine receptor(RyR)mediated by sarcoplas-mic reticulum calcium release both significantly in-creased(P＜0.05).Conclusions Specific knock-down of smooth muscle FTO improves coronary artery responsiveness to the vasoconstrictor 5-HT in diabetic mice,which may be related to abnormalities in the FTO-mediated 5-HT receptor signaling pathway.

Objective To explore the application value of low-temperature plasma bipolar forceps in open thyroid cancer surgery.Methods The clinical data of 30 patients with differentiated thyroid cancer treated with low-temperature plasma bipolar forceps by our team from May 2021 to October 2024 were retrospectively analyzed.And 30 patients with differentiated thyroid cancer treated with monopolar electrocautery+ultrasonic scalpel were selected as the control group.The surgical procedures for both groups were thyroid lobectomy,isthmus resection+ipsilateral level Ⅵ lymph node dissection.The age,gender,body mass index(BMI),tumor TNM stage,operation time,intraoperative blood loss,48 h postoperative drainage volume,and surgical complications of the two groups were compared.Results There were no significant differences in age,gender,BMI,and tumor TNM stage between the two groups.The operation time,intraoperative blood loss,48 h postoperative drainage volume,and the incidence of postoperative transient hypoparathyroidism in the low-temperature plasma bipolar forceps group were significantly less than those in the control group(P＜0.05).There were no occurrences of postoperative subcutaneous hematoma,permanent recurrent laryngeal nerve palsy,and permanent hypoparathyroidism in both groups.Conclusion In thyroid cancer surgery,low-temperature plasma bipolar forceps can not only achieve fine detailed operations,but also effectively protect the blood supply of the recurrent laryngeal nerve,superior laryngeal nerve,and parathyroid glands.It has less trauma and a faster postoperative recovery,and is worthy of clinical promotion and application.

Nichrome(NiCr)wire with strong mechanical properties,excellent flexibility,good corrosion resistance and high thermal stability was selected as a promising fiber substrate to replace the fragile fused-silica counterpart.The NiCr layered double hydroxide nanosheets(NiCr LDHs NSs)were in-situ grown on the NiCr fiber substrate.Then,the extraction performance of the NiCr@NiCr LDHs NSs fiber was evaluated using four kinds of chlorophenol(CPs)as model compounds combined with high performance liquid chromatography-ultraviolet detection(HPLC-UV).The results showed that the assembled fibers exhibited superior extraction selectivity and enhanced extraction efficiency for CPs in comparison to commercial PA,PDMS,and PDMS/DVB fibers.Under the optimized experimental conditions,the established method showed good linearity in the range of 0.2-200 μg/L,with coefficient of determination(R2)>0.9989.The limits of detection(LODs)and limits of quantification(LOQs)were 0.050-0.157 μg/L and 0.165-0.502 μg/L,respectively.Relative standard deviations(RSDs)for intra-day and inter-day analyses ranged from 2.85%to 4.05%and from 3.16%to 4.96%,respectively.The developed method with the constructed fiber was applied to preconcentration and detection of different types of CPs in real water samples,showing satisfactory recoveries ranging from 80.0%to 106.9%,with RSDs of 3.12%-7.81%.Moreover,the NiCr@NiCr LDHs NSs fiber could maintain good extraction performance even after 240 extraction-desorption cycles.

Objective:To investigate the clinicopathological features, immunophenotype, molecular characteristics, and differential diagnosis of MED15-TFE3 gene fusion renal cell carcinoma (MED15-TFE3 RCC).Methods:A total of 12 MED15-TFE3 RCCs, diagnosed from 2016 to 2023, were collected from the Department of Pathology of Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, China for clinicopathologic, immunohistochemical, fluorescence in situ hybridization (FISH) and RNA sequencing (RNA-seq) analyses and follow-up. In addition, its diagnosis and differential diagnosis were also explored.Results:There were five males and seven females. The patients′ ages ranged from 16 to 60 years, with an average age of 40.4 years. The follow-up time ranged from 15 to 92 months, and no recurrence or metastasis was observed. Histologically, 6 cases exhibited extensive cystic structures with almost no solid sheet components, while the remaining 6 cases displayed a cysto-solid growth pattern. The cytoplasm of the tumor cells appeared flocculent, with a clear or faintly eosinophilic appearance, and nucleoli were inconspicuous. Psammoma bodies were observed in 12 cases. There was deposition of basement membrane-like material in 5 cases. All cases showed strong expression of TFE3, GPNMB, Cathepsin K, Melan A, and PAX8, while no expression of CAⅨ or CK7. FISH analyses showed that all 12 cases were positive for the MED15-TFE3 fusion, while the MED15-TFE3 fusion gene and specific fusion sites were detected in 2 cases using RNA-seq.Conclusions:MED15-TFE3 RCC is a type of TFE3-rearranged renal cell carcinoma that exhibits both identifiable diagnostic characteristics and highly deceptive morphology. Its distinct extensive cystic structure can be easily confused with multilocular cystic renal neoplasm of low malignant potential, necessitating careful differentiation in routine practice.

Objective:To identify the bacteria isolated from sepsis patients in a tertiary hospital in Shanghai and analyze their antimicrobial resistance features.Methods:This study included 439 patients with clinically diagnosed sepsis who underwent microbiological culture in a tertiary hospital in Shanghai from July 2021 to October 2024. Results of microbiological culture and antimicrobial susceptibility testing were retrospectively collected and analyzed. Differences between groups were analyzed using Chi-square test and Fisher′s exact test. Results:The positive rate of microbiological culture was 49.0% (215/439). The positive rate of blood culture was 24.1% (93/386) and 100 strains were isolated from the samples, including 57 Gram-negative bacteria (57.0%). The predominant isolates in blood samples were Escherichia coli, Klebsiella pneumoniae, and coagulase-negative staphylococci. The positive rate of bacterial culture from bronchoalveolar lavage fluid samples was 84.1% (37/44), with Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa being the predominant strains. The positive rate of bacterial culture from urine samples was 35.6% (127/357), with Escherichia coli, Klebsiella pneumoniae, and Enterococcus faecium being the most common. Escherichia coli, Klebsiella pneumoniae, Enterococcus faecium, coagulase-negative staphylococci, Pseudomonas aeruginosa, and Acinetobacter baumannii exhibited high resistance rates to fluoroquinolones [46.8% (29/62)-97.0% (32/33)]. The resistance rates of Acinetobacter baumannii to most commonly used antibiotics were >80.0%. The resistance rates of Escherichia coli and Klebsiella pneumoniae to the third-generation cephalosporins ranged from 41.8% (28/67) to 66.0% (31/47). Carbapenem resistance was observed in 38.1% (24/63)-40.3% (25/62) of Klebsiella pneumoniae isolates, and most of the isolates from bronchoalveolar lavage fluid samples showed a higher resistance rate than those from blood or urine samples ( P<0.05). Conclusions:The positive rate of bacterial culture is nearly 50% in this study, with Gram-negative bacteria being the most common. Six major pathogenic bacteria exhibit high resistance rates to fluoroquinolones. Klebsiella pneumoniae isolates have high resistance rates to the third-generation cephalosporins and carbapenems, with significant differences in the resistance rate between isolates from different samples, and it should be cautious to choose the third-generation cephalosporins and carbapenems in clinical practice.

A 37-year-old male patient was admitted to a certain tertiary hospital in Shanghai on May 10, 2024 due to "sudden cough accompanied by chest pain for 2 days". Smear examination of pleural effusion revealed Gram-positive cocci. A positive result was reported after 3.8 days of anaerobic culture, and the isolate was identified as Parvimonas micra by mass spectrometry. Based on the patient′s medical history, imaging and etiological examination results of pleural effusion, the patient was diagnosed with encapsulated empyema caused by Parvimonas micra infection. After anti-infection treatment with imipenem and linezolid and pleural effusion drainage, the patient improved and was discharged. Whole-genome sequencing analysis revealed that this bacterium carried the drug resistance gene tetM and phylogenetic tree analysis showed that it was closely related to a strain from an apical abscess in South Korea.

Hepatolenticular degeneration is an autosomal recessive hereditary disease characterized by copper metabolism disorder,which affects the liver,kidneys,and brain.In traditional Chinese medicine,this disease is closely associated with dysfunction of the"liver-kidney-brain"axis.The liver,kidney,and brain form a physiological whole through the mutual transformation and distribution of essence and blood,the coordination of qi transformation,and the connection of meridians and collaterals.This article explores the pathogenesis of hepatolenticular degeneration based on the"liver-kidney-brain"axis.The deficiency of liver and kidney essence leads to the malnutrition of brain marrow,which is the fundamental cause of the disease.The internal accumulation of copper toxins generates dampness-heat and phlegm-stasis,which are the key factors causing the disease.In view of the characteristics of this disease with deficiency in nature and excess in superficiality,the principle of dynamic treating both manifestation and root cause of disease is established:treating the manifestation starts with eliminating copper and detoxifying,combined with clearing heat and dampness,and removing phlegm and stasis;treating the root cause follows the concept of the same origin of yi and gui,emphasizing the simultaneous treatment of liver and kidney to nourish the brain marrow.Throughout the treatment process,copper elimination(treating the symptoms)should be taken into account,and stratified measures should be applied based on the primary focus of the lesion:either treating the liver as the main focus and supplemented by tonifying the kidney and filling the marrow;or treating the kidney as the main focus and assisted by regulating the liver and nourishing the brain;or co-regulating the three zang-organs of liver,kidney,and brain,to achieve the therapeutic goal of eliminating pathogenic factors and restoring normal functions,and combining tonification and purgation.

Objective To investigate the peripheral blood cytokine levels in patients with acute myocardial infarction(AMI),and to analyze its correlation with Killip classification,N-terminal brain natriuretic peptide precursor(NT-proBNP),cardiac troponin I(cTnI),creatine kinase isoenzymes(CK-MB),and to provide a theoretical basis for assessing the severity and prognosis of the disease.Methods A total of 312 patients with AMI admitted to Minhang Hospital,Fudan University from Jul 2021 to Oct 2023 were enrolled as the case group,and 201 patients with unstable angina pectoris were selected as the control group.General clinical data of the subjects were collected,and the concentrations of cytokines(IL-5,IFN-α,IFN-γ,IL-10,IL-12p70,IL-17,IL-1β,IL-2,IL-4,IL-6,IL-8,and TNF-α)in peripheral blood were detected by multiplex bead-based flow cytometry.NT-proBNP,cTnI and CK-MB were measured by chemiluminescence methods.The levels of cytokines between the two groups were compared,and their correlations with Killip classification,NT-proBNP,cTnI and CK-MB were analyzed.The predictive efficacy of cytokines for AMI was evaluated by receiver operating characteristic(ROC)curves.Results There were no significant differences in baseline data between the AMI group and the control group(P>0.05),with the exception of age.The levels of IL-6,IL-8 and TNF-α in the AMI group were higher than those in the control group(all P<0.01).The correlation analyses showed that IL-6 was positively correlated with Killip classification,NT-proBNP,cTnI and CK-MB(all P<0.01).ROC analyses showed that IL-6 levels had good predictive efficacy for AMI(AUC=0.882 9,P<0.01).Conclusion The expression of IL-6 was significantly increased in patients with AMI,and it was positively correlated with Killip classification,NT-proBNP,cTnI and CK-MB,suggesting that IL-6 may serve as a potential biomarker for assessing the severity of AMI.

Hepatolenticular degeneration， also known as Wilson disease （WD）， is a hereditary disease caused by mutations in the ATP7B gene， leading to copper metabolism disorders. Gene mutations result in impaired synthesis of copper-binding protein， and abnormal excretion of copper through bile leads to pathological deposition of copper in various organs， ultimately causing multi-organ damage. The insidious onset and low specificity of symptoms make it difficult to diagnose this disease. On the basis of existing studies and the theory of latent toxin， this paper proposes that latent toxin in kidney collaterals is the main pathogenesis of renal injury in WD. It is pointed out that health Qi deficiency and latent pathogen are the premises for the occurrence of this disease， and the transformation of latent pathogen into toxin is the ley pathological process. Toxin damaging kidney collaterals is the ultimate result. According to the pathogenesis， this paper proposes the treatment principle of reinforcing healthy Qi and resolving toxin and treatment based on syndrome differentiation. This review provides new ideas for the diagnosis and treatment of renal injury in WD with traditional Chinese medicine.