As a patented characteristic medicine of Yi ethnic minority， Pingxuan capsules have the effects of nourishing the liver and kidney， pacifying the liver， and subduing Yang. With the main indications of dizziness， headache， palpitations， tinnitus， insomnia， dreaminess， waist and knee soreness caused by liver-kidney deficiency and liver Yang upward disturbance， Pingxuan capsules are widely used in the treatment of posterior circulation ischemic vertigo， vestibular migraine， benign paroxysmal positional vertigo. However， the current knowledge is limited regarding the efficacy， syndrome differentiation， and safety of this medicine. On the basis of summarizing the experience of clinicians and the existing evidence， this study invites clinical experts of traditional Chinese and Western medicine， pharmaceutical experts， and methodological experts from relevant fields across China to conduct evidence-based evaluation of Pingxuan capsules. The evaluation follows the Specifications for the Development of Clinical Expert Consensus on Chinese Patent Medicines issued by the Standardization Office of the China Association of Chinese Medicine， and reaches 5 recommendations and 16 consensus suggestions. The consensus clarifies the clinical applications， efficacy， dose， course of treatment， combination of medicines， precautions， and contraindications of Pingxuan capsules in the treatment of vertigo and explains the safety of clinical application. This consensus is applicable to clinicians （traditional Chinese medicine， Western medicine， and integrated traditional Chinese and Western medicine） and pharmacists in tertiary hospitals， secondary hospitals， and community-level medical and health institutions across China， providing a reference for the rational use of Pingxuan capsules in the treatment of vertigo. It is hoped that the promotion of this consensus can facilitate the rational use of drugs in clinical practice， reduce the risk of drug use， and give full play to the advantages of Pingxuan capsules in the treatment of vertigo diseases. This consensus has been reviewed and published by the China Association of Chinese Medicine， with the number GS/CACM330-2023.

Objective:To compare the efficacy of gasless robotic surgery via transaxillary approach and combined axillary-retroauricular approach for unilateral N1b PTC, and to explore the safety and effectiveness of gasless robotic surgery via transaxillary approach for unilateral N1b PTC. Methods:Unilateral N1b PTC patients who underwent surgery in the Department of Otolaryngology, Sun Yat Sen Memorial Hospital, Sun Yat sen University between July 2016 and December 2024 were included and analyzed. According to the inclusion and exclusion criteria and the differences of surgical approaches, the patients were divided into the transaxillary approach（TA） group and the combined axillary-retroauricular approach（TARA） group. The demographic data, operation time, intraoperative blood loss, postoperative drainage volume, postoperative complications, shoulder function evaluation, postoperative visual analogue scale（VAS） of neck aesthetics and recurrence of the two groups were statistically analyzed. Results:A total of 88 patients undergoing gasless robotic surgery were included in this study, including 23 cases in the TA group and 65 cases in the TARA group. The proportion of males in the TA group was significantly higher than that in the TARA group（56.5% vs 21.5%, χ²=9.776, P=0.002）. The total operation time in the TA group was significantly lower than that in the TARA Group（180.00[155.00, 220.00]min vs 220.00[177.50, 272.50]min, z=-2.775, P=0.006）, and the postoperative blood loss in the TA group was significantly lower than that in the TARA Group（30.00[20.00, 50.00]ml vs 50.00[30.00, 60.00]ml, Z=-2.127, P=0.033）. The proportion of area Ⅱ-Ⅴ in the TA group and the TARA group was 87.0% and 70.8%, respectively, and there was no significant difference between the two groups（P>0.05）. There was no significant difference in lateral cervical lymph node dissection and central lymph node dissection between the two groups（P>0.05）. During the follow-up period, no recurrence was found in the two groups, and there was no significant difference in the incidence of complications between the two groups（P>0.05）. According to the stratification of dynamic recurrence risk assessment, it can be seen that the proportion of curative effect satisfaction in the TA group was as high as 95.7%, and that in the TARA group was as high as 81.5%, with no significant difference between the two groups. There was no significant difference in VAS score of neck, Constant Shoulder Score and NDⅡ scale between the two groups（P>0.05）. Conclusion:Gasless robotic surgery via transaxillary approach for unilateral N1b PTC is safe and feasible, and the amount postoperative lymph node acquisition is equivalent to that of combined axillary-retroauricular approach, which can provide a new choice for the treatment of unilateral N1b PTC patients.
Humans ; Robotic Surgical Procedures/methods* ; Axilla/surgery* ; Male ; Female ; Operative Time ; Middle Aged ; Adult ; Treatment Outcome ; Postoperative Complications

This paper reports the clinical data and the diagnosis and treatment of a patient with exogenous insulin autoimmune syndrome(EIAS)induced by long-term use of exogenous insulin(Eucrin 50).For diabetes patients with hyperinsulin-induced hypoglycemia,detection of IAA is helpful for diagnosis EIAS.Due to different test methods affect IAA results,if negative,EIAS cannot be completely excluded.The polyethylene glycol precipitation method can assist in early diagnosis.

Background The impact of cold spells on population health can be categorized into an independent main effect of extreme low temperatures and an added effect of prolonged low temperatures. However, studies on the added effects of cold spells on hospitalizations remain limited. Objective To investigate the added effects of cold spells on hospitalizations of residents in Hengyang City, Hunan Province, and to provide a scientific basis for establishing a cold spell early warning system. Methods Daily meteorological data, air pollutant data, and hospitalization data from six tertiary hospitals of four districts in Hengyang City from 2017 to 2023 were collected. A generalized linear model (GLM) combined with a distributed lag nonlinear model (DLNM) was used to assess the added effects of cold spells on non-accidental hospitalizations, as well as hospitalizations for circulatory system diseases and respiratory system diseases, after controlling the main effect of temperature. The modifying effects of cold spell characteristics (intensity and duration) and individual characteristics (gender and age) were also analyzed. Results Compared with non-cold spell periods, the relative risks (RRs) of total non-accidental hospitalizations and hospitalizations across disease categories, genders, and age groups were elevated during cold spells of varying intensities and durations. However, the total effects of cold spells exhibited a "U-shape" nonlinear relationship with intensity and decreased with prolonged duration. During high-intensity cold spells (daily average temperature < P₅ and lasting ≥ 2 d), the RR (95%CI) for non-accidental hospitalizations was 1.71 (1.21, 2.42); the RRs (95%CIs) for males and females were 1.99 (1.38, 2.84) and 1.47 (1.00, 2.16), respectively; for individuals < 65 years and ≥ 65 years, the RRs (95%CIs) were 1.59 (1.12, 2.26) and 1.93 (1.27, 2.92), respectively; and for circulatory and respiratory system diseases, the RRs (95%CIs) were 1.84 (1.22, 2.79) and 1.07 (0.71, 1.60), respectively. No statistically significant differences were observed between the above subgroups. The single-day lagged effects of cold spells displayed a two-peaked pattern. The single-day lag RR for total non-accidental hospitalizations peaked at lag 1 d after cold spell exposure, declined thereafter, and began to rise again after lag 5 d, reaching a second peak at lag 12–13 d before gradually decreasing. The lagged effects remained statistically significant during lag 8–18 d. The lag patterns of cold spell associations across disease categories, genders, and age groups were largely consistent with those of total hospitalizations. Conclusion Cold spells have a significant impact on non-accidental hospitalizations of residents in Hengyang City, with notable lagged effects. The findings provide important theoretical support for establishing a more targeted cold spell early warning system.

Objective:To explore the safety, effectiveness, and short-term outcomes of transoral robotic surgery (TORS) for supraglottic laryngeal cancer.Methods:A retrospective analysis was conducted on patients with supraglottic laryngeal cancer who underwent TORS at Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Eye Ear Nose and Throat Hospital of Fudan University, and the First Affiliated Hospital of China Medical University between January 2018 and April 2024. Data on operative time, intraoperative blood loss, postoperative hospital stay, perioperative tracheostomy, nasogastric feeding, complications, and short-term follow-up were analyzed. Statistical analysis was performed using Python.Results:A total of 27 patients with supraglottic laryngeal cancer were included from the four centers, including 24 males and 3 females, with a median age of 66 (65, 68) years [ M( Q1, Q3), same below]. There were 26 cases of squamous cell carcinoma and 1 case of adenoid cystic carcinoma.The TNM staging included T1 in 10 cases (37.04%), T2 in 13 cases (48.15%), and T3 in 4 cases (14.81%); N0 in 14 cases (51.85%), N1 in 7 cases (25.93%), and N2 in 6 cases (22.22%). The Da Vinci Si system was used in 23 cases, and the Da Vinci Xi in 4 cases. The robotic surgical time was 53 (30, 58) min. Concurrent neck dissection was performed in 25 cases, neoadjuvant therapy was given preoperatively in 8 cases (29.63%), and postoperative radiotherapy was administered in 13 cases (48.15%). Tracheostomy was performed in 11 cases (40.74%). Nasogastric tube placement was required in 23 cases (85.19%), with a median duration of 16 (12, 21) days. The postoperative hospital stay was 9.19±4.07 days. The median follow-up time was 12 (3, 30) months. Local recurrence occurred in 2 cases. The 3-year overall survival rate was 100%, and the 3-year disease-free survival rate was 94.1%. Conclusion:With appropriate patient selection, TORS for supraglottic laryngeal cancer demonstrates satisfactory short-term outcomes, thereby offering advantages in safety, efficacy, and minimal invasiveness, which can be considered a new treatment option for this condition.

Objective:To compare the clinical efficacies of gasless transoral vestibular robotic surgery and open surgery for the treatment of thyroglossal duct cysts.Methods:A retrospective analysis was conducted on patients with thyroglossal duct cysts who underwent surgical treatment in the Department of Otolaryngology at Sun Yat-sen Memorial Hospital, Sun Yat-sen University from August 2020 to October 2023. According to the differences in surgical methods, patients were divided into a robotic surgery group and an open surgery group. Statistical analysis was conducted on demographic data, surgical time, bleeding volumes, drainage volumes, postoperative complications, scar conditions, postoperative aesthetic scores, and recurrence rates of the two groups of patients. For normally distributed measurement data, inter-group comparison was done via independent-sample t-test. For non-normally distributed data, Mann-Whitney U test was applied. Comparisons of composition ratios or rates were performed using the χ2 test or Fisher′s exact probability method. Results:A total of 44 patients with thyroglossal duct cysts who met the inclusion and exclusion criteria were included, including 22 males and 22 females, aged from 3 to 73 years old. Both the robotic surgery group and the open surgery group had respectively 22 cases. The maximum diameter of tumors of the open surgery group was 3.45(2.50, 4.00) cm, while the robotic surgery group measured 2.50 (2.10, 3.20) cm, with the open group demonstrating significantly larger tumor dimensions compared to the robotic group ( Z=-2.329, P<0.05). Compared to the open surgery group, the robotic surgery group showed significantly more surgical time [105.00 (95.00, 135.00) min vs. 65.00(58.75, 76.25) min, Z=-5.377, P<0.05], postoperative hospitalization time [4.00 (3.75, 5.00) days vs. 3.00(2.00, 4.00) days, Z=-3.202, P<0.05] and bleeding volume [20.00 (10.00, 20.00) ml vs. 5.00 (5.00, 10.00) ml, Z=-4.769, P<0.05], but had less scar length [0 cm vs. 4.00 (2.00, 5.00) cm, Z=-6.097, P<0.05] and better postoperative cosmetic satisfaction [10.00 (10.00, 10.00) vs. 8.00 (6.75, 8.00), Z=-5.221, P<0.05]. With follow-up of 10.0-48.0 months, both the robotic surgery group and the open surgery group showed no recurrence. There was no significant difference in the follow-up time between the two groups ( Z=-0.224, P=0.823). Conclusion:Gasless transoral vestibular robotic surgery is safe and feasible for the treatment of thyroglossal duct cysts, with efficacy comparable to traditional surgery, which can provide a new option for the treatment of thyroglossal duct cysts.

This paper reports the clinical data and the diagnosis and treatment of a patient with exogenous insulin autoimmune syndrome(EIAS)induced by long-term use of exogenous insulin(Eucrin 50).For diabetes patients with hyperinsulin-induced hypoglycemia,detection of IAA is helpful for diagnosis EIAS.Due to different test methods affect IAA results,if negative,EIAS cannot be completely excluded.The polyethylene glycol precipitation method can assist in early diagnosis.

Objective:To explore the safety, effectiveness, and short-term outcomes of transoral robotic surgery (TORS) for supraglottic laryngeal cancer.Methods:A retrospective analysis was conducted on patients with supraglottic laryngeal cancer who underwent TORS at Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Eye Ear Nose and Throat Hospital of Fudan University, and the First Affiliated Hospital of China Medical University between January 2018 and April 2024. Data on operative time, intraoperative blood loss, postoperative hospital stay, perioperative tracheostomy, nasogastric feeding, complications, and short-term follow-up were analyzed. Statistical analysis was performed using Python.Results:A total of 27 patients with supraglottic laryngeal cancer were included from the four centers, including 24 males and 3 females, with a median age of 66 (65, 68) years [ M( Q1, Q3), same below]. There were 26 cases of squamous cell carcinoma and 1 case of adenoid cystic carcinoma.The TNM staging included T1 in 10 cases (37.04%), T2 in 13 cases (48.15%), and T3 in 4 cases (14.81%); N0 in 14 cases (51.85%), N1 in 7 cases (25.93%), and N2 in 6 cases (22.22%). The Da Vinci Si system was used in 23 cases, and the Da Vinci Xi in 4 cases. The robotic surgical time was 53 (30, 58) min. Concurrent neck dissection was performed in 25 cases, neoadjuvant therapy was given preoperatively in 8 cases (29.63%), and postoperative radiotherapy was administered in 13 cases (48.15%). Tracheostomy was performed in 11 cases (40.74%). Nasogastric tube placement was required in 23 cases (85.19%), with a median duration of 16 (12, 21) days. The postoperative hospital stay was 9.19±4.07 days. The median follow-up time was 12 (3, 30) months. Local recurrence occurred in 2 cases. The 3-year overall survival rate was 100%, and the 3-year disease-free survival rate was 94.1%. Conclusion:With appropriate patient selection, TORS for supraglottic laryngeal cancer demonstrates satisfactory short-term outcomes, thereby offering advantages in safety, efficacy, and minimal invasiveness, which can be considered a new treatment option for this condition.

Objective:To compare the clinical efficacies of gasless transoral vestibular robotic surgery and open surgery for the treatment of thyroglossal duct cysts.Methods:A retrospective analysis was conducted on patients with thyroglossal duct cysts who underwent surgical treatment in the Department of Otolaryngology at Sun Yat-sen Memorial Hospital, Sun Yat-sen University from August 2020 to October 2023. According to the differences in surgical methods, patients were divided into a robotic surgery group and an open surgery group. Statistical analysis was conducted on demographic data, surgical time, bleeding volumes, drainage volumes, postoperative complications, scar conditions, postoperative aesthetic scores, and recurrence rates of the two groups of patients. For normally distributed measurement data, inter-group comparison was done via independent-sample t-test. For non-normally distributed data, Mann-Whitney U test was applied. Comparisons of composition ratios or rates were performed using the χ2 test or Fisher′s exact probability method. Results:A total of 44 patients with thyroglossal duct cysts who met the inclusion and exclusion criteria were included, including 22 males and 22 females, aged from 3 to 73 years old. Both the robotic surgery group and the open surgery group had respectively 22 cases. The maximum diameter of tumors of the open surgery group was 3.45(2.50, 4.00) cm, while the robotic surgery group measured 2.50 (2.10, 3.20) cm, with the open group demonstrating significantly larger tumor dimensions compared to the robotic group ( Z=-2.329, P<0.05). Compared to the open surgery group, the robotic surgery group showed significantly more surgical time [105.00 (95.00, 135.00) min vs. 65.00(58.75, 76.25) min, Z=-5.377, P<0.05], postoperative hospitalization time [4.00 (3.75, 5.00) days vs. 3.00(2.00, 4.00) days, Z=-3.202, P<0.05] and bleeding volume [20.00 (10.00, 20.00) ml vs. 5.00 (5.00, 10.00) ml, Z=-4.769, P<0.05], but had less scar length [0 cm vs. 4.00 (2.00, 5.00) cm, Z=-6.097, P<0.05] and better postoperative cosmetic satisfaction [10.00 (10.00, 10.00) vs. 8.00 (6.75, 8.00), Z=-5.221, P<0.05]. With follow-up of 10.0-48.0 months, both the robotic surgery group and the open surgery group showed no recurrence. There was no significant difference in the follow-up time between the two groups ( Z=-0.224, P=0.823). Conclusion:Gasless transoral vestibular robotic surgery is safe and feasible for the treatment of thyroglossal duct cysts, with efficacy comparable to traditional surgery, which can provide a new option for the treatment of thyroglossal duct cysts.

Objective: This study aimed to determine the predictive performance of non-contrast CT (NCCT) signs for hemorrhagic growth after intracerebral hemorrhage (ICH) when stratified by onset-to-imaging time (OIT). Materials and Methods: 1488 supratentorial ICH within 6 h of onset were consecutively recruited from six centers between January 2018 and August 2022. NCCT signs were classified according to density (hypodensities, swirl sign, black hole sign, blend sign, fluid level, and heterogeneous density) and shape (island sign, satellite sign, and irregular shape) features. Multivariable logistic regression was used to evaluate the association between NCCT signs and three types of hemorrhagic growth: hematoma expansion (HE), intraventricular hemorrhage growth (IVHG), and revised HE (RHE). The performance of the NCCT signs was evaluated using the positive predictive value (PPV) stratified by OIT. Results: Multivariable analysis showed that hypodensities were an independent predictor of HE (adjusted odds ratio [95% confidence interval] of 7.99 [4.87–13.40]), IVHG (3.64 [2.15–6.24]), and RHE (7.90 [4.93–12.90]). Similarly, OIT (for a 1-h increase) was an independent inverse predictor of HE (0.59 [0.52–0.66]), IVHG (0.72 [0.64–0.81]), and RHE (0.61 [0.54– 0.67]). Blend and island signs were independently associated with HE and RHE (10.60 [7.36–15.30] and 10.10 [7.10–14.60], respectively, for the blend sign and 2.75 [1.64–4.67] and 2.62 [1.60–4.30], respectively, for the island sign). Hypodensities demonstrated low PPVs of 0.41 (110/269) or lower for IVHG when stratified by OIT. When OIT was ≤ 2 h, the PPVs of hypodensities, blend sign, and island sign for RHE were 0.80 (215/269), 0.90 (142/157), and 0.83 (103/124), respectively. Conclusion Hypodensities, blend sign, and island sign were the best NCCT predictors of RHE when OIT was ≤ 2 h. NCCT signs may assist in earlier recognition of the risk of hemorrhagic growth and guide early intervention to prevent neurological deterioration resulting from hemorrhagic growth.