Objective:To compare the benefits and prognostic risks of unilateral lobectomy (with or without isthmusectomy) or total (or near-total) thyroidectomy for primary foci of unilateral papillary thyroid cancer (PTC) patients with ipsilateral lateral cervical lymph node metastasis (LLNM) , so as to find out the optimal surgery for these patients.Methods:A total of 505 unilateral PTC patients with ipsilateral LLNM who underwent initial surgical treatment at the Thyroid Surgery Department of Zhejiang Cancer Hospital from Feb. 2012 to Jan. 2020 were retrospectively reviewed. The patients were divided into unilateral lobectomy group ( n=314) and total thyroidectomy group ( n=191) according to the extent of resection of primary foci. Then 177 pairs of cases were screened out after eliminating the potential confounding bias between the two groups by using propensity score matching (PSM) , analyzing the differences in clinical outcomes such as recurrence-free survival (RFS) , overall survival (OS) , hospitalization costs, and postoperative complications between the two groups. Results:After PSM, the postoperative complication rate was 37.3% ( n=66) in the total thyroidectomy group and 3.4% ( n=6) in the unilateral lobectomy group. The complication was mainly characterized by temporary hypoparathyroidism (HP) . Although the difference in length of hospitalization between the two groups was not statistically significant ( P=0.792) , patients in the unilateral lobectomy group used less surgical time ( P<0.001) , had lower hospitalization and surgical costs ( P<0.0001) , and took a relatively smaller dose of levothyroxine (L-T4) one month after the operation ( P<0.0001) , as compared with the total thyroidectomy group. Univariate analysis showed that the number of LLNM total lymph node metastasis (LNM) rate, LLNM rate, and T stage were significant risk factors for relapse. Multi-factor regression analysis indicated that T-staging was a risk factor for recurrence. After a median follow-up of 60 (3-138) months, 19 patients (10.7%) in the unilateral lobectomy group and 11 patients (6.2%) in the total thyroidectomy group recurred, with no statistical difference between the two groups ( P=0.133) . The OS curve displayed no significant difference between the unilateral lobectomy and total thyroidectomy groups ( P=0.740) . Conclusion:For unilateral PTC patients with ipsilateral LLNM without other high-risk features, unilateral lobectomy could be a better option.

Objective:To compare the benefits and prognostic risks of unilateral lobectomy (with or without isthmusectomy) or total (or near-total) thyroidectomy for primary foci of unilateral papillary thyroid cancer (PTC) patients with ipsilateral lateral cervical lymph node metastasis (LLNM) , so as to find out the optimal surgery for these patients.Methods:A total of 505 unilateral PTC patients with ipsilateral LLNM who underwent initial surgical treatment at the Thyroid Surgery Department of Zhejiang Cancer Hospital from Feb. 2012 to Jan. 2020 were retrospectively reviewed. The patients were divided into unilateral lobectomy group ( n=314) and total thyroidectomy group ( n=191) according to the extent of resection of primary foci. Then 177 pairs of cases were screened out after eliminating the potential confounding bias between the two groups by using propensity score matching (PSM) , analyzing the differences in clinical outcomes such as recurrence-free survival (RFS) , overall survival (OS) , hospitalization costs, and postoperative complications between the two groups. Results:After PSM, the postoperative complication rate was 37.3% ( n=66) in the total thyroidectomy group and 3.4% ( n=6) in the unilateral lobectomy group. The complication was mainly characterized by temporary hypoparathyroidism (HP) . Although the difference in length of hospitalization between the two groups was not statistically significant ( P=0.792) , patients in the unilateral lobectomy group used less surgical time ( P<0.001) , had lower hospitalization and surgical costs ( P<0.0001) , and took a relatively smaller dose of levothyroxine (L-T4) one month after the operation ( P<0.0001) , as compared with the total thyroidectomy group. Univariate analysis showed that the number of LLNM total lymph node metastasis (LNM) rate, LLNM rate, and T stage were significant risk factors for relapse. Multi-factor regression analysis indicated that T-staging was a risk factor for recurrence. After a median follow-up of 60 (3-138) months, 19 patients (10.7%) in the unilateral lobectomy group and 11 patients (6.2%) in the total thyroidectomy group recurred, with no statistical difference between the two groups ( P=0.133) . The OS curve displayed no significant difference between the unilateral lobectomy and total thyroidectomy groups ( P=0.740) . Conclusion:For unilateral PTC patients with ipsilateral LLNM without other high-risk features, unilateral lobectomy could be a better option.

Objective To analyze the awareness of retinopathy of prematurity (ROP) among medical workers in Neonatal Intensive Care Unit (NICU) and obstetrical department, and parents of premature infants in Xiangyang area of Hubei Province. Methods This study used a questionnaire survey to select 115 parents of premature infants who underwent ROP screening from October 2020 to October 2022 and 85 neonatologists and obstetricians in NICU and obstetrics departments of Xiangyang Central Hospital in Hubei Province. The basic situation of premature infants was recorded, and the questionnaires were used to investigate the cognitive status of parents of premature infants, neonatologists, and obstetricians on ROP-related knowledge, and the results were recorded. Results A total of 115 valid questionnaires were collected from parents. Fifty-four parents (46.96%) had heard of ROP, and 61 parents (53.04%) had never heard of ROP. Among all parents who had heard of ROP, 10 parents (18.52%) learned through online queries or friends, 41 parents (75.93%) learned through NCIU doctors, and 1 guardian learned through NCIU nurses, 1 through obstetricians, and 1 through obstetric nurses. There were significant differences in the ways parents heard about ROP (χ²=122.709, P < 0.001). A total of 95 valid questionnaires were collected from medical staff, and only 7 medical staff could correctly write the ROP screening criteria, all of whom were NICU doctors. The NICU doctors had a higher rate of informing parents of premature infants about ROP than NICU nurses, obstetricians, and obstetric nurses (P < 0.05). Conclusion Parents of premature infants who undergo ROP screening in Xiangyang, Hubei Province have a serious lack of knowledge about ROP-related knowledge, and education level is an important factor influencing parents' understanding of ROP-related knowledge. Medical staff in relevant departments should also strengthen their learning of ROP-related knowledge. NICU doctors play the most important role in promoting ROP, and the publicity of ROP-related knowledge should be strengthened.

Objective:To construct a plasmid for expression Mycobacterium tuberculosis ( Mtb) Rv3133c and to evaluate the immunogenicity of Rv3133c through population and mice experiments. Methods:The recombinant expression plasmid pPROEX-Rv3133c was constructed. The transformed E. coli BL21 (DE3) carrying expression plasmid was induced by IPTG to express the recombinant Rv3133c (rRv3133c). Western blot was used to identify the expressed protein. Whole-blood IFN-γ release assay (WBIA) was preformed to assess the immunogenicity of rRv3133c in Mtb-infected population. Antigen-specific antibodies in serum, Th1 type cytokines in splenocytes, functional T cell subset responses in splenocytes and the expression of cytokines at mRNA level in lung tissues were detected after immunizing mice subcutaneously with rRv3133c and adjuvant DC. Results:The rRv3133c was constructed and expressed successfully. Stimulation with rRv3133c promoted the production of IFN-γ in Mtb-infected population, especially in patients with latent tuberculosis infections. After immunizing mice with rRv3133c+ DC, the levels of IFN-γ, TNF-α and IL-2, the number of IFN-γ + TNF-α + CD4 + T cells in spleen and the expression of antigen-specific IFN-γ, TNF-α and iNOS at mRNA level in lung tissues were higher than those in BCG-immunized mice, but lower than those in BCG+ rRv3133c+ DC group. The serum IgG2a/IgG1 ratios in the rRv3133c+ DC group and the BCG+ rRv3133c+ DC group were greater than 1, and significantly higher than that of the BCG group. Conclusions:The rRv3133c had good immunogenicity and could induce strong Th1 immune response, suggesting that it was a potential candidate antigen for subunit vaccine against tuberculosis.

Objective:To analyze the epidemiological and clinical characteristics of imported COVID-19 cases after SARS-CoV-2 vaccination and to provide evidence for the prevention and control of COVID-19.Methods:The imported COVID-19 cases in Chengdu as of April 15, 2021 were divided into the vaccinated group and unvaccinated group according to the history of SARS-CoV-2 vaccination. The epidemiological and clinical data of the cases were collected retrospectively, and the differences in epidemiological and clinical characteristics of the two groups were compared. Laboratory tests consisted of nucleic acid test, clinical index test, serum antibody test and lymphocyte test. Software WPS2019 was used for data management and software R 4.0.3 was used for statistical analysis.Results:A total of 75 COVID-19 cases were included in the analysis, in which 20 had received SARS-CoV-2 vaccination and only 4 with clinical symptoms, 55 patients did not receive SARS-CoV-2 vaccination, and 16 had clinical symptoms. In vaccinated group, the first injection time of vaccination ranged from July to November 2020, and 10 cases received two doses of vaccine simultaneously and 10 cases received two doses of vaccine at intervals of 14-57 days. The intervals between the completion of vaccination and the onset ranged from 87 days to 224 days. The differences in classification and clinical type between the two groups were significant. Significant differences were observed in case classification and clinical type between vaccinated group and unvaccinated group ( P<0.05). The vaccinated group had a relatively high proportion of asymptomatic infections (40.00%, 8/20), while mild infections were mainly observed in the unvaccinated group(76.36%,42/55). The differences in Ct values (ORF1ab gene and N gene) at the diagnosis were not significant between vaccinated group and unvaccinated group ( P>0.05), similar results were also observed in lymphocyte subtypes, procalcitonin and C-reactive protein level comparisons. Serum amyloid A level was higher in unvaccinated group than in vaccinated group ( P<0.05). However, the SARS-CoV-2 related serum antibody of IgM, IgG and total antibody levels were significantly higher in vaccinated group ( P<0.05). Conclusions:Risk of infection still exists with SARS-CoV-2 after vaccination, which can facilitate the production of specific serum antibody of IgM and IgG when people are exposed to the virus. It has a certain protective effect on SARS-CoV-2 infected persons. Vaccination can reduce the clinical symptoms and mitigate disease severity.

Objective:To investigate the distant metastasis after primary treatment of papillary thyroid cancer (PTC) in children and adolescents.Methods:A retrospective analysis of 180 cases (54 boys and 126 girls, with an age range of 6-18 years) with PTC treated at the Chinese Medical Academy Cancer Hospital and Zhejiang Cancer Hospital from January 1, 2001 to December 31, 2014 was performed. Patients’ clinical and pathological data were collected. The follow-up results were statistically analyzed. The distant metastasis rate during the follow-up period was analyzed by the Kaplan-Meier method. Log-Rank test was used for univariate analysis and Cox regression model was established in multivariate analysis.Results:Twenty-four cases (13.3%) had distant metastases during following-up with a median of 92 months. The Log-Rank test showed that the younger age ≤15 years old (χ 2=11.803, P=0.001), the larger tumor diameter >20 mm (χ 2=5.776, P=0.016), multifocal (χ 2=11.205, P=0.001), bilateral tumor distribution (χ 2=19.804, P=0.001), invaded capsule (χ 2=10.808, P=0.001), and bilateral lymph nodes metastasis (χ 2=6.278, P=0.012) were risk factors for distant metastasis after initial treatment. The Cox regression analysis showed that age ≤15 years (hazard ratio [95% confidence interval]: 4.08[1.504-11.111], P=0.006) and bilateral tumor distribution (hazard ratio [95% confidence interval]: 4.77[1.903-11.966], P=0.001) were independent risk factors for distant metastasis after initial treatment. The risk factors for local recurrence and distant metastasis were similar, but the local recurrence could not be a significant predictor for distant metastasis. It was indicated that distant metastasis rate was lower in patients with total thyroidectomy in multifocal lesions groups (χ 2=5.891, P=0.015). Conclusions:Age, tumor size, invaded capsule, bilateral lymph nodes metastasis, multifocal and bilateral lesions are factors for predicting distant metastasis after primary treatment of PTC in children and adolescents. Total thyroidectomy is recommended for patients with multifocal and bilateral lesions.

Objective To evaluate the efficacy of endoscopic nasopharyngectomy in the management of recurrent nasopharyngeal cancers (NPC) and to identify the prognostic factors.Methods Between september 2010 and october 2016,31 patients who received endoscopic nasopharyngectomy in our hospital for recurrent NPC were retrospectively reviewed.The clinical and pathological features of the patients,such as sex,age,T stage,pathological type,recurrence location,operation time,bleeding volume,perioperative complications,postoperative recurrence time,location and survival were recorded and analyzed,and the prognosis was observed.Results All patients underwent endoscopic resection of nasopharyngeal carcinoma locally,and no 1 cases received external nasal route surgery.All patients underwent successful endoscopic nasopharyngectomy.No patient was transferred to open approach.The mean operative time was (108.55 ± 34.36)min.The average blood loss was (23.05 ± 16.11)rnl.No serious postoperative complications occurred,no surgical deaths,and 1 cases had positive edge.Postoperative follow-up time was 3-82 months.During follow-up,29 cases survired,including that 9 patients survived with disease,1 patient concurrent oropharyngeal carcinoma,1 patient lost and 1 patient died.There were 6 cases of local recurrence,1 cases of liver metastasis and 2 cases of cervical lymph node metastasis after operation,2 patients with recurrent postoperative received endoscopic nasopharyngectomy and no recurrence of postoperative follow-up.One-year overall survival rate,disease-free survival rate and no local recurrence survival rate were 96.67％,80.00％ and 86.67％ respectively.Five-year disease-free survival rate was 61.80％.The progression free survival time was 2-82 (31.87 ± 23.26) months.Multivariate analysis showed that sex,age,first diagnosed T stage,and tumor necrosis were not the independent prognostic factor for survival in recurrent nasopharyngeal carcinoma patients.Conclusions Endoscopic nasopharyngectomy is a safe and effective procedure for the treatment of recurrent nasopharyngeal carcinoma.

Objective:To determine the technical feasibility,intraoperative safety,and efficacy of endoscopic thyroidectomy using the gasless unilateral axillary approach.Methods:We analyzed 11 patients diagnosed with papillary thyroid carcinoma who underwent an endoscopic thyroidectomy between February and April 2017 using a gasless unilateral axillary approach at the Department of Head and Neck Surgical Oncology,Zhejiang Cancer Hospital.Additionally,we compared the clinical features,early surgical outcomes,surgi-cal complications and postoperative satisfaction of endoscopic thyroidectomy with those of 11 patients who underwent conventional open thyroidectomies during the same period.Result:In the endoscopic group,the mean age of patients((35.6±2.6)years was young-er than that of the open thyroidectomy group[(48.5±2.3)years,(P=0.002)].The endoscopic thyroidectomy(unilateral lobectomy)pro-cedure was successfully completed in all patients. The rate of central compartment neck dissection was not different between the groups[(2.4±1.7)vs.(2.8±1.6),P>0.05].The operative time was longer and the amount of drainage was higher in the endoscopic than in the open group[(123.9±28.1)min vs.(48.6±9.8)min,P<0.01;(145.9±81.8)mL vs.(87.7±18.9)mL,P<0.01].Everage length of hospi-talizntion was 1 day longer in the endoscopic group. The complication rate was not statistically significantly different between the groups.The postoperative pain score of the neck and anterior chest was not different between the groups except the anterior chest pain score at day 3 after operation.The cosmetic satisfaction was greater in the endoscopic group(P<0.01).Conclusions:Endoscopic thyroidectomy using a gasless unilateral axillary approach for the management of selected patients presenting with papillary thyroid carcinoma is a safe,feasible,and cosmetically superior procedure.

Objective To explore the efficacy and safety of glucocorticoids+cyclophosphamide+tacrolimus capsules (GC+CTX+FK506) in the treatment of patients with type Ⅲ+V and Ⅳ+Vlupus nephritis. Methods The 31 cases with first diagnosis as systemic lupus erythematosus (SLE) with type Ⅲ+V and Ⅳ+Vlupus nephritis (LN) were selected, then divided into group A (CTX+GC) with 16 cases and group B (FK506+CTX+GC) with 15 cases. The group A received CTX+GC during treatment, group B received GC+CTX+FK506 for the first three months, and received FK506+GC for the last three months. The patients were followed up once monthly to observe the efficacy and safety,the efficacy was analysed after 6 months. Results After treatment, the total efficacy in group B was significantly higher than group A (86.7%vs.50.0%, P<0.05). The 24 h urine protein of group B was lower than group A(P<0.05). The plasma albumin of group B was higher than group A (P<0.05). After treatment, the systemic lupus erythematosus disease activity index (SLEDAI) in two groups were lower and C3 level was higher than those pre-treatment(P<0.05), but there was no significant difference in above indicators between two groups. There was one case menelipsis in group A, and one case with transient increasing of creatinine. Conclusion The FK506+CTX+GC could reduce urine protein sifnificantly compared with CTX+GC without serious adverse reaction.

Objective: To investigate the effect of 21-gene recurrence score on adjuvant chemotherapy decisions for patients with estrogen receptor (ER)-positive, epidermal growth factor receptor 2 (HER-2)-negative and lymph node (LN)-negative early stage-breast cancer. Methods: One hundred and forty-eight patients with ER+ , HER-2- and LN- early stage breast cancer were recruited in the Ruijin hospital, Shanghai Jiao Tong University School of Medicine. The 21-gene recurrence score (RS)assay was performed and systemic therapeutic decisions were made before and after knowing the RS results under multidisciplinary discussion. The effects of RS assay and the other influential factors on adjuvant chemotherapy decision were further analyzed. Results: After knowing the RS results, treatment decisions were changed in 26 out of 148 patients(17.6%). Among them, 9 out of 26 patients were not recommended for chemotherapy; 16 of 26 had treatment recommendation changed to chemotherapy, and chemotherapy regimen was changed in the last one patient. Multivariate analysis showed that RS, age and histological grade were independent factors of decision-making for adjuvant chemotherapy. Conclusion Our results suggest that 21-gene recurrence score significantly influences decision making for adjuvant chemotherapy in patients with ER+ , HER-2- and LN- early stage breast cancer.