Objective:To investigate the predictive value of early thyroid function changes on the efficacy of patients with Graves′ disease (GD) after 131I therapy. Methods:Data of patients with GD (59 males, 214 females; age (37.4±11.4) years) who underwent single therapy of 131I in Tianjin Medical University General Hospital from November 2017 to January 2019 were retrospectively analyzed. Symptoms, signs and laboratory tests (serum free triiodothyronine (FT 3) and serum free thyroxine (FT 4)) of patients were observed to assess the efficacy of 131I treatment. Efficacy was divided into complete remission (CR), partial remission (PR), non-remission (NR) or relapse. The changes of thyroid function (ΔFT 3=FT 3 before treatment-FT 3 after treatment)/FT 3 before treatment×100%; ΔFT 4=FT 4 before treatment-FT 4 after treatment)/FT 4 before treatment×100%) 1 month after 131I therapy in each efficacy group and differences among them were compared by using independent-sample t test, χ2 test, one-way analysis of variance and the least significant difference t test. ROC curves were drawn to analyze the predictive values of early thyroid function changes on the efficacy of 131I treatment for GD. Logistic regression analyses were performed to identify the influencing factors for the efficacy of 131I therapy. Results:CR rate and total effective rate of 273 GD patients after single therapy of 131I were 67.03%(183/273) and 92.67%(253/273), respectively. After 1 month, CR rate of euthyroidism group ( n=95) was significantly higher than that of hyperthyroidism group ( n=178; 81.05%(77/95) vs 59.55%(106/178); χ2=4.60, P=0.032). ΔFT 3 and ΔFT 4 at the first month were statistically significant and decreased sequentially in the CR group ( n=183), PR group ( n=70), NR or relapse groups ( n=20; F values: 15.40, 12.54, both P<0.001). ROC curve analysis showed that patients with ΔFT 3≥73.64% and (or) ΔFT 4≥59.03% had a higher probability of achieving CR, with sensitivities of 84.3% and 86.7%, and specificities of 62.6% and 62.6%, respectively. Logistic regression analysis showed that 24 h radioactive iodine uptake (odds ratio ( OR)=1.095, 95% CI: 1.031-1.139), dose of 131I given per gram of thyroid tissue ( OR=1.562, 95% CI: 1.321-1.694), ΔFT 3 ( OR=1.354, 95% CI: 1.295-1.482), ΔFT 4 ( OR=1.498, 95% CI: 1.384-1.608) were factors affecting the outcome of patients with GD treated with 131I treatment (all P<0.05). Conclusion:Effects of 131I treatment can be predicted based on the change of the thyroid function at the first month after 131I treatment in patients with GD.

Objective To analyze the clinicopathological data of patients with papillary thyroid microcarcinoma(PTMC)and papillary thyroid non-microcarcinoma(non-PTMC)who received 131I therapy retrospectively,and compare the therapeutic response of the two groups of patients,so as to guide 131I therapy decisions for PTMC patients.Methods A total of 1 118 patients with papillary thyroid carcinoma(PTC)underwent 131I therapy in the Department of Nuclear Medicine,Tianjin Medical University General Hospital from January 2015 to December 2020 were enrolled.Chi-square test and Mann-Whitney U test were used to compare the differences of clinicopathological features and 131I therapy,therapeutic response between two groups.The incomplete response(IR)rate curves of the two groups were plotted by Kaplan-Meier analysis.Results The proportion of patients with multifocal,involvement of bilateral thyroid lobes in PTMC group were higher than those in non-PTMC group,and the proportion of patients with extra-thyroid extension,T4,N1b,stimulated thyroglobulin(sTg)>10 μg/L,and high risk stratified were lower than those in non-PTMC group(P<0.05).Most patients in PTMC group received remnant ablation for the first time,while more patients in non-PTMC group received adjuvant therapy and therapy for known disease(P<0.05).There was no statistically significant difference in 131I therapeutic response,the rates of excellent response(ER)and IR in two groups,and the differences in curves of IR rate between the two groups were also no statistically significance(P>0.05).Conclusions PTMC has a certain degree of invasiveness.As long as the patients were comprehensively evaluated and the standard 131I therapy was adopted,the treatment outcomes of patients with PTMC and non-PTMC were roughly the same.Therefore,the clinical value of the definition of PTMC is extremely limited in the formulation of 131I therapeutic dose regimens.

Objective:To observe the anatomy of the recurrent branch of median nerve, summarize the injury mechanism of the recurrent branch of median nerve, and explore the surgical method and clinical effect of the compression.Methods:From February 2018 to October 2021, 12 fresh hand specimens were used in Department of Hand Surgery in the Second Hospital of Tangshan, including 6 male specimens, 3 left and 3 right hands, and 6 female specimens, 3 left and 3 right hands. Anatomy of the recurrent branch of median nerve and observation of its location, measurement of the length of each muscle branch innervating thenar muscle and the easy-to-jam position of the recurrent branch of median nerve in the course of running. The measurement results uses nonparametric test of statistical analysis by side and gender. P<0.05 was considered statistically significant. From January 2020 to January 2022, 21 patients with entrapment of the recurrent median nerve of wrist were treated, 14 males and 7 females. The age ranged from 31 to 65 years old, with an average of 46.2 years old. All patients developed thenar muscular atrophy. Before operation, the recurrent branch of median nerve was marked into the muscle point, and the thenar projection on palm surface was pressed, which caused fatigue and soreness. Electromyography examination: the motor latency of median nerve endings was more than 4.5 ms, and both fibrillation potential and positive potential appeared. The motor conduction velocity of all patients was less than 30 m/s, and the motor nerve amplitude was less than 10 mV. Surgical exploration of the recurrent branch of median nerve revealed that the trunk of the recurrent branch of median nerve made the tendon arch thickened at the starting point of the superficial head of flexor pollicis brevis, and there was compression between the deep layer of the palmar aponeurosis and the thenar musculocutaneous membrane, which was completely released during the operation to relieve the compression factor. All 21 patients had followed-up in outpatient. Results:Distance from the origin of the recurrent branch of median nerve to the distal edge of transverse carpal ligament. The distance from the origin of the recurrent branch of median nerve to the distal edge of transverse carpal ligament were (0.30, 0.31, 0.32) cm and (0.31, 0.32, 0.32) cm in male left and right groups, respectively, with no statistical significance ( Z=-0.943, P=0.346); The female left and right groups were (0.28, 0.28, 0.28) cm and (0.29, 0.30, 0.30) cm, respectively, and the difference was statistically significant ( Z=-2.121, P=0.034). The length and transverse diameter of the trunk of the recurrent branch of the median nerve, the length of the superficial head branch of flexor pollicis brevis and the length of the palmar muscle branch of the thumb had no significant difference between the left and right sides of males and females( P > 0.05). The length of abductor pollicis brevis muscle branch: the male left and right groups were (1.45, 1.27, 1.31) cm and (1.54, 1.38, 1.47) cm, respectively, and there was no statistical difference ( Z=-1.528, P = 0.127); The female left and right groups were (1.21, 1.18, 1.15) cm and (1.25, 1.24, 1.25) cm respectively, and the difference was statistically significant ( Z=-1.993, P=0.046). All the 21 patients were entered in follow-up for 9-24 (average 15) months. After operation, the wounds of all patients healed in the first stage, the soreness at thenar disappeared, and the thenar muscle was full in appearance. In 21 patients, the thumb abduction function returned to normal, the thumb to palm opposition returned to normal in 19 cases, and was slightly limited in 2 cases. After operation, thenar muscle strength recovered to grade 5 in 19 cases and grade 4 in 2 cases. At the last follow-up, electromyography showed that the motor latency of median nerve endings was less than 4.5 ms, and the motor conduction velocity was greater than 40 m/s; Motor nerve amplitudes were all greater than 10 mV. According to the functional evaluation standard of carpal tunnel syndrome recommended by Gu Yudong, 19 cases were excellent, 2 cases were good, and the excellent and good rate was 100%. Conclusion:The length of each nerve branch of the recurrent median nerve innervates thenar muscle is different, and there are many factors that cause the recurrent median nerve to get stuck. It is of high clinical value to master the anatomical structure of the recurrent median nerve and the mechanism of the entrapment, and to completely loosen vulnerable parts by surgery.

Objective:To compare the efficacy of forceful reduction percutaneous pedicle screw and ordinary percutaneous pedicle screw in the treatment of osteoporotic thoracolumbar burst fracture with kyphosis.Methods:A retrospective cohort study was conducted to analyze the clinical data of 566 patients with osteoporotic thoracolumbar burst fracture with kyphosis admitted to Honghui Hospital, Xi ′an Jiaotong University from January 2015 to December 2018, including 191 males and 375 females, with age range of 48-79 years [(61.7±10.7)years]. Fracture segments were located at T 11 in 134 patients, T 12 in 154, L 1 in 160, and L 2 in 118. All fractures were type IIIA according to the acute symptomatic osteoporotic thoracolumbar fracture classification (ASOTLF). The thoracolumbar osteoporotic fracture severity score assessment system (TLOFSAS) score was ≥5 points. A total of 275 patients underwent forceful reduction and percutaneous pedicle screw internal fixation (forceful reduction screw group), and 291 patients underwent common percutaneous pedicle screw internal fixation (common screw group). The operation time, intraoperative blood loss, times of X-ray exposure on patients and measures documented before operation, at 3 days after operation and at 2 years after operation including anterior height ratio of the injured vertebrae, sagittal Cobb angle of the injured vertebrae, Japanese Orthopaedic Association (JOA) score and visual analog scale (VAS) were compared between the two groups. Moreover, degree of correction of Cobb angle at 3 days after operation, loss of correction of Cobb angle at 2 years after operation and postoperative complications were observed. Results:All patients were followed up for 25-34 months [(29.9±3.4)months]. The operation time, intraoperative blood loss and times of X-ray exposure on patients in forceful reduction screw group were (69.4±10.2)minutes, (60.3±13.1)ml and (26.8±3.7)times, less than (80.6±11.9)minutes, (80.7±15.4)ml and (30.4±3.4)times in common screw group (all P<0.01). There was no significant difference in anterior height ratio of the injured vertebrae between the two groups before operation and at 3 days after operation (all P>0.05). The anterior height ratio of the injured vertebrae in forceful reduction screw group was (95.5±2.3)% at 2 years after operation, significantly higher than (85.4±1.7)% in common screw group ( P<0.01). There was no significant difference in sagittal Cobb angle of the injured vertebrae between the two groups before operation ( P>0.05). The sagittal Cobb of the injured vertebrae in forceful reduction screw group at 3 days and 2 years after operation were (7.9±1.6)° and (8.8±1.5)°, lower than (10.6±1.1)° and (12.3±1.2)° in common screw group ( P<0.05 or 0.01). There were no significant difference in JOA score and VAS between the two groups before operation, at 3 days and at 2 years after operation (all P>0.05). The degree of correction of Cobb angle in forceful reduction screw group was (19.4±2.5)°, higher than (17.3±2.6)° in common screw group ( P<0.05). The loss of correction of Cobb angle in forceful reduction group was less than that in common screw group at 2 years after operation, but the difference was not statistically significant ( P>0.05). The incidence of postoperative complications in forceful reduction screw group was 12.4% (34/275), compared to 14.1% (41/291) in common screw group ( P>0.05). There were no complications such as iatrogenic nerve injury, fracture or loosening of internal fixator or leakage of bone cement in the spinal canal in both groups. Conclusions:For osteoporotic thoracolumbar burst fracture with kyphosis, forceful reduction and percutaneous pedicle screw internal fixation can significantly shorten operation time, reduce intraoperative blood loss and times of X-ray exposure on patients, restore height of the injured vertebrae, correct kyphosis and maintain reduction height of the injured vertebrae in contrast with conventional percutaneous pedicle screw internal fixation.

ObjectiveTo explain the scientific connotation of Morindae Officinalis Radix （MOR） processed by Glycyrrhizae Radix et Rhizoma （Gly） by comparing the effect of raw products of MOR and processed products of MOR with different proportions of Gly （GMOs） on the improvement of renal function and hypothalamic-pituitary-gonadal （HPG） axis， the protein expression of Wnt/β-catenin and transforming growth factor-β₁ （TGF-β₁）/Smad signal pathways in kidney Yang deficiency model rats induced by adenine. MethodGMOs were prepared according to method under MOR in 2020 edition of Chinese Pharmacopoeia. Rat model of kidney Yang deficiency was established by intragastrical administration of adenine， levels of follicle stimulating hormone （FSH）， luteinizing hormone （LH）， estradiol （E₂） and testosterone （T） were measured by enzyme-linked immunosorbent assay （ELISA）. Levels of urea nitrogen （BUN） and serum creatinine （SCr） were measured by spectrophotometry， hematoxylin-eosin （HE） staining was used to evaluate the pathological changes of kidney， testis and epididymis. Immunohistochemistry （IHC） was used to analyze the protein expression of E-cadherin， α-smooth muscle actin （α-SMA）， Wnt2b， β-catenin， Smad1 and Smad4. ResultMOR processed with 100∶6 and 100∶12 proportions of Gly （short for GMO/100∶6 and GMO/100∶12） had the most obvious improvement on the body posture of kidney Yang deficiency model rats. GMO/100∶12 had the best effect on reducing the levels of BUN， SCr， FSH， LH and the ratio of E₂/T. GMO/100∶6 and GMO/100∶12 had the best effect on regulating the protein expression of E-cadherin， α-SMA， Wnt2b， β-catenin， Smad1 and Smad4. ConclusionGMO/100∶6 and GMO/100∶12 have the a good effect on the improvement of renal function and HPG axis in kidney Yang deficiency model rats induced by adenine， which is related with the fact that they can regulate Wnt/β-catenin pathway in renal and testicular tissue and TGF-β₁/Smads pathway in testicular tissue.

Objective:To investigate the efficacy of flexion-lateral curvature-supination reduction combined with primary anterior surgery for the treatment of lower cervical dislocation with unilateral facet inter-locking.Methods:A retrospective analysis was performed in the 32 patients who had been admitted to Department of Spine Surgery, Honghui Hospital for lower cervical dislocation with unilateral facet interlocking from November 2015 to October 2018. According to their treatments, they were divided into 2 groups. In the emergency group treated by flexion-lateral curvature-supination reduction combined with primary anterior surgery, there were 13 males and 3 females, aged from 24 to 63 years. In the traction group treated by cranial traction reduction combined with secondary anterior surgery, there were 12 males and 4 females, aged from 20 to 64 years. The operation time, intraoperative blood loss, hospital stay, bone graft fusion, American Spinal Injury Association (ASIA) grade and Japanese Orthopaedic Association (JOA) score were compared between the 2 groups.Results:There was no significant difference in the preoperative general data between the 2 groups, showing they were comparable ( P<0.05). All patients were followed up from 26 to 40 months. The hospital stay for the emergency group [(7.2±1.2) d] was significantly shorter than that for the traction group[(10.9±1.2) d] ( P<0.05). There was no significant difference in the operation time, blood loss, ASIA grade or JOA score between the 2 groups ( P>0.05). All patients achieved osseous fusion of intervertebral space. Conclusion:Compared with traditional methods, flexion-lateral curvature-supination reduction combined with primay anterior surgery shows no significant difference in the recovery of neurological function but leads to a shorter hospital stay.

Objective:To analyze the short-term effect of targeted drugs on quality of life in patients with radioactive iodine-refractory differentiated thyroid cancer (RAIR-DTC).Methods:From February 2020 to April 2022, 19 RAIR-DTC patients (10 males, 9 females; age (54.5±14.5) years) who received targeted drugs therapy (sorafenib, lenvatinib or anlotinib) in Tianjin Medical University General Hospital were prospectively enrolled. The thyroglobulin (Tg) levels prior and 1, 3, 6 months post the targeted treatment, and the adverse events were measured and recorded. Response evaluation criteria in solid tumors (RECIST) 1.1 version was used to evaluate the treatment response. The quality of life based on five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) was monitored prior and 3 months post the targeted treatment, and the prevalence rates of mobility, self-care, usual activities, pain/discomfort, and anxiety/depression were analyzed, and the scores of health assessment were assessed. Paired t test, Kruskal-Wallis rank sum test and χ2 test were used to analyze data. Results:The prevalence rates of mobility (8/19), self-care (6/19), usual activities (10/19), pain/discomfort (10/19), and anxiety/depression (12/19) in 3 months post treatment were higher than those prior treatment (1/19, 1/19, 1/19, 2/19, 2/19; χ2 values: 4.38-11.31, all P<0.05). The score of health assessment prior treatment was (84.37±6.25), which was higher than that at 3 months post treatment (71.63±9.14; t=5.02, P=0.001). After targeted treatment, 10 patients were with skin toxicity, 8 patients were with hypertension, 8 patients were with weight loss, 7 patients were with diarrhea, 6 patients were with fatigue, 5 patients were with hepatic dysfunction, 2 patients were with proteinuria, 2 patients were with muscle pain and 1 patient was with oral ulcer. Of 19 patients, 17 insisted on continuing treatment, and the other two stopped treatment. The Tg levels at 1, 3 and 6 months post treatment were 56.26(44.60, 210.50), 53.36(41.25, 203.07) and 54.35(34.71, 223.52) mg/L, respectively, which were lower than the level prior treatment with no significant difference (110.16(49.63, 294.50) mg/L; H=2.42, P=0.490). After 3 months of targeted treatment, the progression-free survival (PFS) rate was 16/17, including 7 patients with partial response (PR), 9 patients with stable disease (SD), and 1 patient with progression of disease (PD). After 6 months of targeted treatment, the PFS rate was 10/17, including 5 patients with PR, 5 patients with SD, and 7 patients with PD. Conclusion:After 3-6 months of targeted treatment, the tumor markers of most patients are decreased with metastases improved, but the adverse events of targeted drugs have a great impact on quality of life in patients with RAIR-DTC.

Objective:To investigate the correlation between white matter hyperintensities (WMHs) and stroke etiology classification in patients with acute isolated penetrating artery territory infarction.Methods:Patients with first-ever acute isolated penetrating artery territory infarction admitted to the Department of Neurology, the Affiliated Hospital of Xuzhou Medical University from January 2017 to May 2020 were enrolled retrospectively. According to the Chinese Ischemic Stroke Subclassification (CISS) system, they were divided into large artery atherosclerosis (LAA) and perforating artery disease (PAD). According to the distribution of infarcts, they were divided into lenticulostriate artery (LSA) territory infarction and paramedian pontine artery (PPA) territory infarction. The demographics, vascular risk factors, baseline clinical data, WMHs location, and Fazekas Scale scores were documented. Multivariate logistic regression analysis was used to identify the independent influencing factors of stroke etiology classification. Results:A total of 440 patients with acute isolated penetrating artery territory infarction were enrolled, including 120 (27.3%) in the LAA group, and 320 (72.7%) in the PAD group; 213 (48.4%) with LSA territory infarction, and 227 (51.6%) with PPA territory infarction. The proportion of patients with total Fazekas score 3-6 and periventricular WMHs (PWMHs) score 2-3 in the PAD group was significantly higher than those in the LAA group (all P<0.05). In patients with LSA territory infarction, the proportion of the patients with hypertension, WMHs total Fazekas score 3-6 and PWMHs score 2-3 in PAD subgroup was significantly higher than those in the LAA subgroup, while the proportion of the patients with hyperlipidemia was significantly lower than that in LAA subgroup (all P<0.05). In patients with PPA territory infarction, the levels of low-density lipoprotein cholesterol and homocysteine in the PAD subgroup were significantly lower than those in the LAA subgroup. Multivariate logistic regression analysis showed that PWMHs score 2-3 was an independent correlation factor of PAD (odds ratio [ OR] 2.220, 95% confidence interval [ CI] 1.085-4.541; P=0.029). In patients with LSA territory infarction, hyperlipidemia was independently correlated with LAA ( OR 0.432, 95% CI 0.192-0.972; P=0.042), and PWMHs score 2-3 was independently correlated with PAD ( OR 3.846, 95% CI 1.193-12.397; P=0.024). In patients with PPA territory infarction, higher low-density lipoprotein cholesterol ( OR 0.660, 95% CI 0.494-0.883; P=0.005), homocysteine ( OR 0.958, 95% CI 0.930-0.987; P=0.005) and C-reactive protein ( OR 0.987, 95% CI 0.977-0.997; P=0.008) were independently correlated with LAA. Conclusions:WMHs are common in patients with acute isolated perforating territory infarction caused by LAA and PAD, and more severe PWMHs suggest that PAD is more likely to be the cause of the acute isolated perforating territory infarction, especially in patients with LSA territory infarction.

Objective:To investigate the method and outcome of reconstruction of thumb soft tissue defect by index finger proximal dorsal island flap supplied by the second dorsal metacarpal artery (SDMA).Methods:From August, 2015 to December, 2017, 12 cases of thumb soft tissue defect were treated by index finger proximal dorsal island flap supplied by SDMA. The site of defect ranged from 2.0 cm×2.4 cm to 5.5 cm×3.0 cm, and the flap area ranged from 2.2 cm×2.6 cm to 6.0 cm×3.3 cm. The donor site was repaired by split-thickness skin graft from the forearm of the injured limb. All patients received regular outpatient follow-up after surgery. The appearance, texture, sensory recovery and donor site of the flap were observed.Results:All the 12 flaps had 5-16 (8.8 in average) months follow-up and survived, the donor site and wounds healed in primary stage. The appearance, sensory and function of the flaps were good. There were no scar contracture on the donor sites, and no pain and limitation of motion in the joints. At the last follow-up, according to the Criteria for Function Assessment of Upper Limbs by the Branch of Hand Surgery of Chinese Medicine Association, the thumb functions were excellent in 11 cases and good in 1 case.Conclusion:Index finger proximal dorsal island flap supplied by SDMA is easy to operate, and has constant blood supply, improved rotation angle of the flap vessel base. It is a good method to repair the soft tissue defect of thumb.

Objective:To investigate the correlation between 131I uptake and therapeutic efficacy in metastatic differentiated thyroid carcinoma (DTC). Methods:The clinical data of 138 patients with metastatic DTC (42 males, 96 females, age range: 8-74 years) treated with 131I in nuclear medicine departments of 31 centers all over China were retrospectively analyzed. The lesional 131I uptake was quantitatively analyzed with target-to-nontarget (T/NT) ratio through the regions of interest in metastatic lesions confirmed by either planar or tomographic 131I SPECT/CT imaging. The efficacies of 131I treatment on the metastatic DTC were divided into complete remission (CR), partial remission (PR), stable disease (SD) and progress disease (PD) based on the change of the lesion diameter before and after the treatment. Factors which may affect therapeutic efficacy were assessed by the univariate (Kruskal-Wallis rank sum test, χ2 test and one-way analysis of variance) and binary logistic regression analyses. The receiver operating characteristic (ROC) curve of lesional T/NT ratio to predict the ineffectiveness of 131I therapy was performed. Results:A total of 1 165 efficacies were evaluated. The planar imaging results ( n=653) showed that there was no statistically significant difference of T/NT ratio among CR, PR, SD and PD groups ( χ2=4.15, P>0.05). The tomographic imaging results ( n=512) suggested CR, PR, SD and PD in 7.6%(39/512), 65.8%(337/512), 22.9%(117/512), and 3.7%(19/512) of individuals, respectively, and the T/NT ratio among the four groups was significantly different ( χ2=30.46, P<0.01). The univariate analysis also showed that age, stimulated thyroglobulin(sTg), 131I dose were the factors affecting therapeutic efficacy ( F or χ2 values: 2.561, 7.095 and 8.799, all P<0.05). Furthermore, binary logistic regression analysis revealed that older patients (odds ratio ( OR)=1.034, P=0.022) or patients with lower lesional T/NT ( OR=1.086, P=0.006) had a higher probability of ineffectiveness. The area under ROC curve for T/NT ratio to predict ineffectiveness was 0.726, and the cut-off value was 6.2, with a sensitivity of 78.7%(107/136) and a specificity of 73.1%(275/376). Conclusions:131I therapy is an effective treatment for metastatic DTC. The age at the time of metastatic diagnosis and the lesional T/NT ratio are independent influential factors for ineffectiveness of 131I therapy. When the leisonal T/NT ratio is lower than 6.2, the inefficiency of 131I is higher.