Objective:To investigate the safety, feasibility, and efficacy of pneumoperitoneum-assisted laparoscopic thyroidectomy via the subclavian approach (PSTSA) .Methods:Retrospective analysis of the clinical data of 24 papillary thyroid carcinoma (PTC) patients who underwent PSTSA,from Nov. 1,2024 to Dec. 31,2024 in Zhongshan Hospital of Xiamen University was performed. Data including the maximum tumor diameter,surgical duration,volume of drainage fluid,number of lymph nodes cleared,postoperative complications,cosmetic outcomes, and total hospitalization time were recorded.Results:All 24 cases were preoperatively diagnosed with PTC, with 12 female and 12 male patients.All cases were successfully completed without conversion to open surgery.The maximum tumor diameter in the pathological sections was 0.51±0.21 cm,the surgical duration was 71.54±11.62 minutes, the number of central compartment lymph nodes retrieved was 6.29±2.82 units,and the number of positive lymph nodes was 0.46±0.93.No CO2 gas embolism occurred during the surgery,and no postoperative complications such as hoarseness,numbness of hands and feet,or postoperative bleeding were observed.Conclusions:Pneumoperitoneum-assisted laparoscopic thyroidectomy via the subclavian approach (pneumoperitoneum-assisted laparoscopic thyroidectomy via the subclavian approach, PSTSA) is a safe and feasible surgical method for thyroidectomy.

Objective:To investigate the safety, feasibility, and efficacy of pneumoperitoneum-assisted laparoscopic thyroidectomy via the subclavian approach (PSTSA) .Methods:Retrospective analysis of the clinical data of 24 papillary thyroid carcinoma (PTC) patients who underwent PSTSA,from Nov. 1,2024 to Dec. 31,2024 in Zhongshan Hospital of Xiamen University was performed. Data including the maximum tumor diameter,surgical duration,volume of drainage fluid,number of lymph nodes cleared,postoperative complications,cosmetic outcomes, and total hospitalization time were recorded.Results:All 24 cases were preoperatively diagnosed with PTC, with 12 female and 12 male patients.All cases were successfully completed without conversion to open surgery.The maximum tumor diameter in the pathological sections was 0.51±0.21 cm,the surgical duration was 71.54±11.62 minutes, the number of central compartment lymph nodes retrieved was 6.29±2.82 units,and the number of positive lymph nodes was 0.46±0.93.No CO2 gas embolism occurred during the surgery,and no postoperative complications such as hoarseness,numbness of hands and feet,or postoperative bleeding were observed.Conclusions:Pneumoperitoneum-assisted laparoscopic thyroidectomy via the subclavian approach (pneumoperitoneum-assisted laparoscopic thyroidectomy via the subclavian approach, PSTSA) is a safe and feasible surgical method for thyroidectomy.

Objective To investigate the association between cerebral small vessel disease （CSVD） and mild cognitive impairment （MCI） in the elderly. Methods A total of 109 elderly patients who were diagnosed with MCI from March 2022 to February 2023 were enrolled as experimental group， and 89 healthy controls with normal cognitive function were enrolled as control group. Demographic data and general clinical data were collected from all subjects， and the onset of CSVD was evaluated based on cranial MRI findings. The two groups were compared in terms of baseline data， general clinical data， and CSVD manifestations. The ordered multi-classification logistic regression model was used to identify the independent influencing factors for MCI in the elderly. Results There were 109 patients with MCI and 89 controls in this study. Compared with the experimental group， the control group had significantly longer education years， a significantly better economic status， a significantly higher degree of participation in social activities， and a significantly lower alcohol consumption rate （P<0.05）. There were 90 subjects （82.57%） in the experimental group and 62 （69.66%） in the control group who had different CSVD phenotypes. The experimental group had significantly higher detection rates of LI and moderate-to-severe WMH than the control group （P<0.05）， while there were no significant differences between the two groups in the detection rates of moderate-to-severe EPVS and CMB （P>0.05）. There were significant differences between the two groups in the total load score of CSVD and the total load degree of CSVD （P<0.05）. The logistic regression analysis showed that education years， participation in social activities， detection rate of CSVD， moderate-to-severe WMH， total load score of CSVD， and total load degree of CSVD were independent influencing factors for MCI in the elderly. Conclusion There is an increase in the detection rate of CSVD in the elderly patients with MCI， especially LI and moderate-to-severe WMH. The total load score of CSVD and the total load degree of CSVD are independently associated with MCI in the elderly.

Objective　To explore the relationship between the total burden of cerebral small vessel disease (CSVD) and the progression of large artery atherosclerosis (LAA) cerebral infarction in acute stage.Methods　One hundred and forty-three patients with acute LAA cerebral infarction were collected.The CSVD total load score (0~4 points) was calculated according to MRI and CSVD total load scale.According to the progress of the disease in the acute phase,the patients were divided into two groups:non progressive cerebral infarction group (NPCI) and progressive cerebral infarction group (PCI).The baseline data,CSVD sub items and total load scores were compared between two groups.Logistic regression analysis was used to analyze the relationship between CSVD total load score and the progression of LAA type cerebral infarction.Results　There was significant difference in CSVD total load score between PCI group and NPCI group (P<0.05).In group PCI,smoking history,diabetes history,baseline diastolic blood pressure,fasting blood glucose,vascular lacuna,moderate and severe WMH,CMBs and CSVD total load score were all higher than those in NPCI group (P<0.05),and LDL-C level was lower than that in NPCI group (P<0.05).Logistic regression analysis showed that fasting blood glucose,moderate and severe WMH and CSVD total load score were independent risk factors for the progression of LAA cerebral infarction in acute stage (P<0.05).Conclusion　The severity of CSVD in patients with LAA type cerebral infarction is closely related to the progress of the disease in acute phase.

Objective To evaluate the injury of optic radiation after ischemic stroke with diffusion tensor imaging (DTI). Methods From September, 2014 to September, 2015, twenty-one ischemic stroke inpatients with visual field defects were tested with DTI, and measured the fractional anisotropy (FA) and apparent diffusion coefficient (ADC) of both sides in different time. The correlation of FA and ADC to visual field mean defect (MD) in the same time was analyzed. Results The FA of affected sides was lower than that of healthy sides twenty-four hours (t=2.38, P<0.05), one week (t=15.60, P<0.01) and four weeks (t=19.13, P<0.01) after stroke, and the ADC was also lower twenty-four hours (t=10.13, P<0.01) and one week (t=6.06, P<0.01) after stroke. The FA correlated with MD one (r=0.581, P<0.01) and four weeks (r=0.703, P<0.01) after stroke, and the ADC correlated with MD twenty-four hours after stroke (r=0.519, P<0.05). The FA of one (r=0.525, P<0.05) and four weeks (r=0.762, P<0.01) after stroke correlated with MD six months after stroke. Conclusion DTI can be used to evaluate the injury of optic radiation after ischemic stroke.

Objective To investigate the relationship between white matter lesions(WML) and cognitive impairment in migraine with and without aura.Methods 56 migraine without aura patients (MwoA group),22 migraine with aura patients(MA group) and 30 normal controls were recruited.All of them were performed head MRI examination and were evaluated by operational definitions of ARWMC and Mattis Dementia Ratiing Scale(DRS),and compare among three groups,discuss the relationship between WML and cognitive impairment.Results (1) Compared with control group,the occurrence rate of WML in MA group was significantly higher(40.9％ vs 13.3％,x2=22.74,P＜0.01).The OD-ARWMC score was significantly higher in both MA and MwoA groups((0.73±l.12) vs (0.13±0.35),t=2.76,P＜0.01;(0.36±0.67) vs (0.13±0.35),t=1.75,P＜0.05).Compared with MwoA group,the occurrence rate of WML and the OD-ARWMC score of MA group was significantly higher(t=22.80,P＜0.01;t=1.79,P＜0.05).(2) During the attack period,the DRS total scale and its 5 factors (attention,initiation/perseveration,concept formation,construction and memory) were significantly lower in both MwoA and MA group(P＜0.05 or 0.01) than control group,while the DRS total scale and its two factors (attention,concept formation) of MA group were significantly lower than that of MwoA group (P＜ 0.01).During the intermission period,the concept formation and memory scale in MA group was significantly lower than control group(P＜0.05),only memory factor in MwoA group was significantly lower than control group(P＜0.05),while the initiation/perseveration factor scale of MA group was significantly lower than MwoA group(P＜0.05).(3) There Was a negative correlation between OD-ARWMC scale and the total DRS scale as well as its three factors (attention,concept formation,memory)during attack period in MA group(r=-0.584,P＜0.01;r=-0.465,P＜0.05;r=-0.558,P＜0.01;r=-0.439,P＜0.05).There was a negative correlation between OD-ARWMC scale and the total DRS scale as well as concept formation factor during attack period in MwoA group (r=-0.328,P＜ 0.05;r =-0.276,P＜ 0.05).Conclusion Migraine patients may have white matter lesions and cognitive impairment,especially in MA patients and during attack period.

Objective To investigate the relationship between the cerebral microbleeds (CMBs) and changes of cognitive function,and the possible mechanism of cognitive impairment caused by CMBs.Methods Sixty-eight micro-hemorrhage patients on susceptibility weighted imagine (SWI) sequences composed positive group,and sixty-eight patients selected without micro-hemorrhage in the SWI sequence and meeting the selection criteria as control group.At the same time,both two groups were assessed by MoCA and CDT scale inspection.Results CDT scores of CMBs group (2.00±0.88) were significantly lower than those of control group (3.76±0.53),and there was significantly different in the two groups (t=-3.27,P=0.00).At the same time,MoCA total scores and executive functions,naming,calculation,language,abstraction,recall scores of CMBs group were significantly lower than those of control group,and all of the groups were significantly different (t=-5.48,P=0.00; t=-4.36,P=0.00; t=-2.35,P=0.01 ; t=-2.49,P=0.02; t=-4.09,P=0.00; t=-4.63,P=0.00).CDT scores,MoCA total scores,executive functions,language,abstraction,memory scores between CMBs groups and control group were significantly different at all levels (P＜0.05).Executive functions,languages and calculated inter-group of mild CMBs,moderate CMBs,severe CMBs were significantly different (P＜0.05).The number of CMBs was negative correlation with total scores,executive function,language,and abstract (r=-0.675,P=0.000; r=-0.689,P=0.000; r=-0.536,P=0.000; r=-0.636,P=0.000).Conclusion The existence of CMBs and the number of CMBs are closely related to cognitive dysfunction.The more of CMBs,the more of obvious cognitive impairment.