Sinonasal adenoid cystic carcinoma (SNACC) is the second most common sinonasal malignancy, following squamous cell carcinoma. Most patients present with advanced stage disease (T3-T4) at the time of diagnosis, with a propensity for perineural invasion, bone invasion, anterior skull base involvement, and high probability of positive margins. After initial treatment, local recurrence and distant metastasis are common, sometimes occurring years later. Imaging studies are valuable for determining the extent of the tumor, but a pathological biopsy remains essential for a definitive diagnosis. Surgical resection is currently the primary treatment modality. Endoscopic surgery offers advantages in reducing complications and improving quality of life while providing comparable survival outcomes to open surgery. For unresectable cases, radiotherapy combined with or without chemotherapy is recommended. Long-term close follow-up is crucial for comprehensive management of the disease. A multidisciplinary team (MDT) provides the core strategy for the diagnosis and treatment of SNACC. The MDT focuses on precise staging and personalized treatment, aiming to balance tumor control, functional preservation, and quality of life improvement. It represents the optimal current management pathway for SNACC.

Patients with differentiated thyroid cancer have a good prognosis after surgical treatment, but there are still some patients with recurrence or metastasis.Local/regional recurrent lesions invade or compress the surrounding organs such as esophagus and trachea,and appear fistula,obstruction,bleeding and other manifestations. For such patients,local treatment should be preferred to effectively control tumor growth and alleviate symptoms. Local treatment is an important means to control local lesions and has an important position in the treatment of malignant tumors. It can be used for local treatment of recurrent thyroid cancer,including reoperation,ablation, 125I seed implantation,external beam radiotherapy. This review reviews the local treatment effects and complications of local/regional recurrence of differentiated thyroid cancer according to the guidelines and related literature.

Objective:To investigate the efficacy and influencing factors of iodine-125 seed implantation in the treatment of recurrent radioiodine refractory differentiated thyroid carcinoma (RAIR-DTC) .Methods:Retrospective analysis of 18 patients with recurrent RAIR-DTC treated with iodine-125 particle implantation at Ward One, Department of Oncology, Hebei General Hospital from Sept. 2015 to Mar. 2022 was performed. A total of 35 lesions were involved, all permanently implanted with iodine-125 particles under image guidance, with particle activity ranging from 0.3mCi to 0.8mCi, and prescription doses ranging from 80 to 140 Gy. The study observed the objective response rate, local control rate, survival rate, adverse reactions, and factors influencing treatment efficacy.Results:After a follow-up period of 8 to 115 months,according to the objective efficacy evaluation criteria of solid tumors 1.1,the objective response rates were 51.4% (18/35) ,80.0% (28/35) ,68.6% (24/35) ,60.0% (21/35) ,42.9% (15/35) at 3,6,12,24,36 months postoperatively,respectively.The local control rates were 100% (35/35) ,100% (35/35) ,80.0% (28/35) ,62.9% (22/35) ,51.4% (18/35) at 3,6,12,24,36 months postoperatively,respectively.The 1-,2-, and 3-year postoperative survival rates were 83.3% (15/18) ,72.2% (13/18) ,61.1% (11/18) ,respectively.During the follow-up period,4 patients developed progressive lesions in the target area.One grade I radioactive skin injury,one grade Ⅱ radioactive skin injury,and no residual particle-related adverse reactions.The results of multivariate analysis showed that D90,tumor involvement of the esophagus were the factors influencing the recent efficacy.The area under the ROC curve for D90 was 0.804 with the best bound of 106.5Gy.Conclusion:Iodine-125 particle implantation is safe and effective for recurrent RAIR-DTC.D90,tumor involvement of the esophagus are the influencing factors of the recent efficacy,and the D90≥106.5Gy treatment effect is better.

Objective To discuss the effect of different particle activities and tumor shrinkage speed on the dosimetric parameters of the target area at the same prescription dose after 125I particle implantation.Methods A 6cm-sized cube tumor model was outlined by using a computerized three-dimensional treatment planning system(3D-TPS)with a prescription dose(PD)of 100 Gy,and 125I particle activities of 0.4 mCi and 0.8 mCi were selected.Assuming that the tumor shrinks centripetally after seed implantation and that the 125I particles were uniformly and centripetally concentrated without shedding or wandering,the tumor volume shrank at different rates every month after implantation(0,5％,10％,15％,20％,25％,30％,35％,40％,45％and 50％),according to the different activities of 125I particles,the experiments were divided into A1-K1 group(0.4 mCi)and A2-K2 group(0.8 mCi).Based on the 125I particle decay law,the validation program(using TPS simulation of the A1-K1 group and A2-K2 group at postoperative 1,2,3,4,5 and 6 months)obtained the dose received by 90％of the target volume(D90)in the two groups with different 125I particle activities at different postoperative time points,the percentages of the target volume covered by the 100％,150％and 90％prescription dose(V100,V150,V90),and the mean dose(Dmean).By comparing the differences in D90,V100,V150,V90 and Dmean after tumor implantation of 125I particles with different activities,the dosimetric impact of the tumor target area shrinking at a rate of 0～50％after implantation of 125I particles with different activities into tumor tissues was analyzed.Results When the monthly shrinkage rate of the tumor target area was≤30％,there was no obvious difference in D90 between the 0.4 mCi group and 0.8 mCi group in 1～6 months after surgery.When the monthly shrinkage rate of the tumor target area was＞30％,the D90 of 0.8 mCi group was higher than that of 0.4 mCi group;when the monthly shrinkage rate of the tumor target area was＜25％,the V90 of 0.4 mCi group was higher than that of 0.8 mCi group,and the changes of V90 of the two groups tended to be the same in the 5th～6th month after surgery.When the monthly shrinkage rate of the tumor target area was ≥30％,the V90 of 0.8 mCi group was higher than that of 0.4 mCi group,and with the increasing of shrinkage rate,the difference between the two groups become more and more significant,the results of V100 were consistent with those of V90.When the monthly shrinkage rate of tumor target area＜35％,V150 of 0.4 mCi group was higher than that of 0.8 mCi group,when the monthly shrinkage rate of tumor target area ≥35％,V150 of 0.8 mCi group was higher than that of 0.4 mCi group,and with the increasing of shrinkage rate,the difference between the two groups become more and more prominent.When the monthly shrinkage rate of tumor target area＜25％,Dmean of 0.4 mCi group was higher than that of 0.8 mCi group,when the monthly shrinkage rate of tumor target area ≥25％,Dmean of 0.8 mCi group was higher than that of 0.4 mCi group,and with the increasing of shrinkage rate,the difference between the two groups become more and more obvious.Conclusion With the same prescription dose,when the tumor target area shrinks at a rate of＜30％per month,the activity of 125I particles has little effect on D90,and all V90,V100,V150 and Dmean in the low activity group are higher than those in the high activity group,meanwhile the homogeneity of the target area is relatively good;when the monthly shrinkage rate of tumor target area ≥35％,all D90,V90,V100,V150 and Dmean in the high activity group are higher than those in the low activity group,and the duration of the presence of high-dose area is long.This difference becomes more obvious with the increasing of the monthly shrinkage rate of the target area.

Objective:To evaluate the early and mid-term efficacy of physician-modified fenestrated endovascular repair combined with inner branch techniques for aortic pathologies complicated by aberrant subclavian artery (ASA).Methods:A retrospective case series was conducted, including 24 patients with ASA-associated aortic pathologies who underwent thoracic endovascular aortic repair (TEVAR) with physician-modified fenestration and inner branch reconstruction at 7 centers in China from February 2021 to March 2025. The cohort comprised 18 males and 6 females, with an age of (54.4±11.7) years (range:37 to 80 years). Pathological diagnoses included aortic aneurysm in 7 patients (29.2%), aortic dissection in 11 (45.8%; 6 chronic, 4 subacute, 1 acute), and penetrating aortic ulcer in 6 (25.0%; 3 with concomitant intramural hematoma). Preoperative planning was performed using three-dimensional CT angiographic reconstruction, incorporating both the greater-curvature hemodynamic length and the centerline wall-adherent length. Fenestration sites were verified on three-dimensional printed models, and precise fenestrations were created at the covered stent-graft locations corresponding to the subclavian artery and ASA anatomy. Patients subsequently underwent TEVAR combined with supra-aortic revascularization as indicated, followed by completion ascending aortography to evaluate the sealing of the main stent-graft and the patency of fenestrated or branched stents. Perioperative outcomes, complications, and early-to mid-term clinical efficacy were analyzed.Results:All procedures were technically successful. Immediate angiography identified one case of minor type Ⅳ endoleak that resolved spontaneously on 3-month follow-up CT angiography, and one case of mild type Ⅱ endoleak that was left untreated with a stable false lumen during follow-up. One patient died on postoperative day 7 of an undetermined cause. The mean follow-up period was (23.1±11.3)months (range:3 to 37 months). During follow-up, one patient developed mild bilateral lower-limb weakness 1 month after surgery. Vascular occlusion and spinal cord infarction were excluded, and the symptoms were considered related to postoperative spinal hemodynamic changes; the weakness resolved after blood pressure adjustment without recurrence. No other complications, including upper limb ischemia, spinal cord ischemia, or posterior circulation ischemia, were observed. Throughout follow-up, all branch and main stents remained patent with good structural integrity, without migration or device-related complications.Conclusions:Physician-modified fenestration combined with inner branch techniques for ASA-associated aortic pathologies is technically feasible and yields satisfactory early and mid-term results. Long-term outcomes require further follow-up.

Patients with differentiated thyroid cancer have a good prognosis after surgical treatment, but there are still some patients with recurrence or metastasis.Local/regional recurrent lesions invade or compress the surrounding organs such as esophagus and trachea,and appear fistula,obstruction,bleeding and other manifestations. For such patients,local treatment should be preferred to effectively control tumor growth and alleviate symptoms. Local treatment is an important means to control local lesions and has an important position in the treatment of malignant tumors. It can be used for local treatment of recurrent thyroid cancer,including reoperation,ablation, 125I seed implantation,external beam radiotherapy. This review reviews the local treatment effects and complications of local/regional recurrence of differentiated thyroid cancer according to the guidelines and related literature.

Objective:To investigate the efficacy and influencing factors of iodine-125 seed implantation in the treatment of recurrent radioiodine refractory differentiated thyroid carcinoma (RAIR-DTC) .Methods:Retrospective analysis of 18 patients with recurrent RAIR-DTC treated with iodine-125 particle implantation at Ward One, Department of Oncology, Hebei General Hospital from Sept. 2015 to Mar. 2022 was performed. A total of 35 lesions were involved, all permanently implanted with iodine-125 particles under image guidance, with particle activity ranging from 0.3mCi to 0.8mCi, and prescription doses ranging from 80 to 140 Gy. The study observed the objective response rate, local control rate, survival rate, adverse reactions, and factors influencing treatment efficacy.Results:After a follow-up period of 8 to 115 months,according to the objective efficacy evaluation criteria of solid tumors 1.1,the objective response rates were 51.4% (18/35) ,80.0% (28/35) ,68.6% (24/35) ,60.0% (21/35) ,42.9% (15/35) at 3,6,12,24,36 months postoperatively,respectively.The local control rates were 100% (35/35) ,100% (35/35) ,80.0% (28/35) ,62.9% (22/35) ,51.4% (18/35) at 3,6,12,24,36 months postoperatively,respectively.The 1-,2-, and 3-year postoperative survival rates were 83.3% (15/18) ,72.2% (13/18) ,61.1% (11/18) ,respectively.During the follow-up period,4 patients developed progressive lesions in the target area.One grade I radioactive skin injury,one grade Ⅱ radioactive skin injury,and no residual particle-related adverse reactions.The results of multivariate analysis showed that D90,tumor involvement of the esophagus were the factors influencing the recent efficacy.The area under the ROC curve for D90 was 0.804 with the best bound of 106.5Gy.Conclusion:Iodine-125 particle implantation is safe and effective for recurrent RAIR-DTC.D90,tumor involvement of the esophagus are the influencing factors of the recent efficacy,and the D90≥106.5Gy treatment effect is better.

Objective To investigate the association between baseline depression and the risk of type 2 diabetes mellitus(T2DM)in middle-aged and elderly people in Chengguan District of Lanzhou.Methods A total of 4471 residents who were followed up in Chengguan District,Lanzhou City from August 2014 to July 2016 in the 2011 REACTION study were selected as the research subjects.According to the 9-item patient health questionnaire(PHQ-9),they were divided into the non-depression group with a score of 0～4 points(ND,n=3827),the mild depression group with a score of 5～10 points(MD,n=546)and the moderate to severe depression group with a score of≥10 points(MSD,n=98).The general data and biochemical indicators of the three groups were compared.The correlation between depression status and glycolipid metabolism indicators was analyzed.The follow-up results of the three groups with different baseline glucose metabolism status populations were compared.Logistic regression was used to analyze the influencing factors of progression in different glucose metabolism populations.Results The married rate in the ND,MD and MSD groups decreased sequentially(P<0.05),while the rate of living alone and the PHQ-9 score increased(P<0.05).The female population,family history of DM,coronary heart disease,LDL-C and TC in the MD group were higher than those in the ND group(P<0.05),while the age,BMI,WHR,FPG and 2 hPG in the MD group were lower than those in the ND group(P<0.05).The family history of DM in the MSD group was higher than those in the ND group(P<0.05),drinking and LDL-C in the MSD group were higher than those in the MD group(P<0.05),the BMI was lower than that in the ND group(P<0.05).Spearman correlation analysis showed that the baseline PHQ-9 score was negatively correlated with FPG level(r=-0.039,P<0.05),and positively correlated with HDL-C and TC(r=0.049,0.031,P<0.05).There was no significant difference in the incidence of pre-DM and T2DM at the end of follow-up among the three groups with different baseline glucose metabolism(P>0.05).Logistic regression analysis showed that after adjusting for confounding factors,the risk of pre-DM and T2DM in normal glucose tolerance people with different depression status and the risk of T2DM in pre-DM patients were not increased.Conclusions Depressive state may not be the main factor affecting the occurrence of T2DM in middle-aged and elderly people in Chengguan District of Lanzhou.

This consensus will introduce the characteristics of fillers used in the surgical cavities of domestic nasal surgery patients based on relevant literature and expert opinions. It will also provide recommendations for the selection of cavity fillers for different nasal diseases, with chronic sinusitis as a representative example.
Humans ; Nasal Cavity/surgery* ; Nasal Surgical Procedures ; China ; Consensus ; Sinusitis/surgery* ; Dermal Fillers

Objective To investigate the association between baseline depression and the risk of type 2 diabetes mellitus(T2DM)in middle-aged and elderly people in Chengguan District of Lanzhou.Methods A total of 4471 residents who were followed up in Chengguan District,Lanzhou City from August 2014 to July 2016 in the 2011 REACTION study were selected as the research subjects.According to the 9-item patient health questionnaire(PHQ-9),they were divided into the non-depression group with a score of 0～4 points(ND,n=3827),the mild depression group with a score of 5～10 points(MD,n=546)and the moderate to severe depression group with a score of≥10 points(MSD,n=98).The general data and biochemical indicators of the three groups were compared.The correlation between depression status and glycolipid metabolism indicators was analyzed.The follow-up results of the three groups with different baseline glucose metabolism status populations were compared.Logistic regression was used to analyze the influencing factors of progression in different glucose metabolism populations.Results The married rate in the ND,MD and MSD groups decreased sequentially(P<0.05),while the rate of living alone and the PHQ-9 score increased(P<0.05).The female population,family history of DM,coronary heart disease,LDL-C and TC in the MD group were higher than those in the ND group(P<0.05),while the age,BMI,WHR,FPG and 2 hPG in the MD group were lower than those in the ND group(P<0.05).The family history of DM in the MSD group was higher than those in the ND group(P<0.05),drinking and LDL-C in the MSD group were higher than those in the MD group(P<0.05),the BMI was lower than that in the ND group(P<0.05).Spearman correlation analysis showed that the baseline PHQ-9 score was negatively correlated with FPG level(r=-0.039,P<0.05),and positively correlated with HDL-C and TC(r=0.049,0.031,P<0.05).There was no significant difference in the incidence of pre-DM and T2DM at the end of follow-up among the three groups with different baseline glucose metabolism(P>0.05).Logistic regression analysis showed that after adjusting for confounding factors,the risk of pre-DM and T2DM in normal glucose tolerance people with different depression status and the risk of T2DM in pre-DM patients were not increased.Conclusions Depressive state may not be the main factor affecting the occurrence of T2DM in middle-aged and elderly people in Chengguan District of Lanzhou.