Traditional open thyroid surgery often leaves a scar on the neck,which can affect cosmetic outcomes.Therefore,various endoscopic thyroidectomy approaches via extra-cervical approaches have been developed.However,due to the unique anatomical characteristics of the neck and limitations of endoscopic instruments,conventional endoscopic techniques have certain drawbacks.Robot-assisted endoscopic thyroid surgery can help overcome these limitations.At present,robotic surgical systems remain expensive and the associated surgical costs are high,limiting their widespread adoption.Most surgeons are still relatively unfamiliar with the technique.Nevertheless,with ongoing technological advancements and cost reductions,robot-assisted surgery holds great promise for broader application.Based on years of large-scale experience in endoscopic thyroid surgery at our center,and drawing upon both domestic and international experiences with robotic thyroidectomy,this paper summarizes and proposes a seven-step protocol for robot-assisted endoscopic thyroidectomy via the bilateral axillo-breast approach,aiming to provide a practical reference for the clinical adoption of this technique.

Locally advanced thyroid cancer (LATC) can seriously invade the important organs of the neck, such as the trachea, esophagus and carotid artery, and has a poor prognosis. It is one of the leading causes of death in thyroid cancer. Diagnosis and treatment for LATC often involve multidisciplinary fields, the difficulty and risk of surgical are very high, and high-quality multidisciplinary comprehensive diagnosis and treatment can obtain a better prognosis. In order to realize the proceduralization, standardization and normalization of the LATC diagnosis and treatment model, the seven-step method for diagnosis and treatment of LATC is summarized by our center.

Locally advanced thyroid cancer (LATC) can seriously invade the important organs of the neck, such as the trachea, esophagus and carotid artery, and has a poor prognosis. It is one of the leading causes of death in thyroid cancer. Diagnosis and treatment for LATC often involve multidisciplinary fields, the difficulty and risk of surgical are very high, and high-quality multidisciplinary comprehensive diagnosis and treatment can obtain a better prognosis. In order to realize the proceduralization, standardization and normalization of the LATC diagnosis and treatment model, the seven-step method for diagnosis and treatment of LATC is summarized by our center.

Traditional open thyroid surgery often leaves a scar on the neck,which can affect cosmetic outcomes.Therefore,various endoscopic thyroidectomy approaches via extra-cervical approaches have been developed.However,due to the unique anatomical characteristics of the neck and limitations of endoscopic instruments,conventional endoscopic techniques have certain drawbacks.Robot-assisted endoscopic thyroid surgery can help overcome these limitations.At present,robotic surgical systems remain expensive and the associated surgical costs are high,limiting their widespread adoption.Most surgeons are still relatively unfamiliar with the technique.Nevertheless,with ongoing technological advancements and cost reductions,robot-assisted surgery holds great promise for broader application.Based on years of large-scale experience in endoscopic thyroid surgery at our center,and drawing upon both domestic and international experiences with robotic thyroidectomy,this paper summarizes and proposes a seven-step protocol for robot-assisted endoscopic thyroidectomy via the bilateral axillo-breast approach,aiming to provide a practical reference for the clinical adoption of this technique.

AIM: To investigate the effect of Rho kinase inhibitor Y-27632 on acute liver injury in sepsis. METHODS: Thirty-two healthy adult male SD rats were randomly divided into sham operation group (Sham group), sham operation+Y-27632 group (Sham+Y group), cecal ligation and perforation group (CLP group) and CLP+Y-27632 group (CLP+Y-27632 group), 8 animals in each group. The rat sepsis model was established by the CLP method, and the rat was euthanized 24 hours after the model was established, and the serum and liver tissue were collected. Hematoxylin-eosin (HE) staining was used to observe the pathological changes in the liver tissue of the rats in each group; Western Blot was used to detect the expressions of ROCK1 and downstream NF-κB proteins in the liver tissue of the rats in each group; immunohistochemical method The expression of ROCK1 protein in liver tissue of rats was detected; enzyme-linked immunosorbent assay (ELISA) method was used to detect the levels of serum liver function indexes ALT and AST, and the changes of IL-18, IL-10 and GSH contents in liver tissue homogenate. RESULTS: Compared with the Sham group, there was no significant change in the histopathology of the liver in the Sham+Y group. In the CLP group, the arrangement of hepatocytes was disordered, with a large number of inflammatory cells infiltrating. Compared with the Sham group, the expression of ROCK1 protein in the CLP and CLP+Y groups was increased (P<0.05); compared with the CLP group, the ROCK1 protein expression in the CLP+Y group was decreased (P<0.05). Compared with the Sham group, the expression of NF-κB protein in the CLP and CLP+Y groups increased (P<0.05); compared with the CLP group, the NF-κB protein expression in the CLP+Y group decreased (P<0.05); A small amount of expression was found in the liver Sham group, and a large amount was expressed in the CLP group and CLP+Y group; compared with the Sham group, the serum ALT and AST levels in the CLP and CLP+Y groups were increased (P<0.05). The levels of ALT and AST in +Y group decreased (P<0.05). Compared with the Sham group, the contents of IL-18 in the liver tissue homogenate of the CLP and CLP+Y groups increased (P<0.05), while the contents of IL-10 and GSH in the liver tissue homogenate of the CLP group decreased (P<0.05). The changes of IL-10 and GSH in the group were similar (P>0.05); compared with the CLP group, the content of IL-18 in the CLP+Y group was decreased (P<0.05), and the content of IL-10 and GSH was increased (P<0.05). CONCLUSION: Rho kinase inhibitor can alleviate acute liver injury in septic rats, which may be related to inhibiting the expression of ROCK1 and NF-κB proteins, reducing the inflammatory response of liver tissue, and reducing the level of liver oxidative stress.

Objective:To explore the effect of Rho kinase inhibitor on intestinal injury in septic rats and its possible mechanism.Methods:Thirty-two male Sprague-Dawley (SD) rats were randomly divided into sham operation group (Sham group), Rho kinase inhibitor Y-27632 control group (Y+Sham group), sepsis model group [cecal ligation and puncture (CLP) group] and Y-27632 pretreatment group (Y+CLP group), with 8 rats in each group. Rat sepsis model was reproduced by CLP. The rats in the Sham group and Y+Sham group were only separated and moved the cecum without ligation and perforation. The rats in the Y+Sham group and Y+CLP group were pretreated with intraperitoneal injection of Y-27632 solution 5 mg/kg 15 minutes before operation; the rats in the Sham group and CLP group were intraperitoneally injected with the same amount of phosphate buffered saline (PBS). Twenty-four hours after operation, the heart blood was collected and the serum diamine oxidase (DAO) content was determined by enzyme-linked immunosorbent assay (ELISA). Then the small intestine tissue was collected, the pathological changes of the intestinal tissue were observed under the light microscope after hematoxylin-eosin (HE) staining, and Chiu's score was performed. The positive expressions of Rho-related coiled-coil kinase 1 (ROCK1) and nuclear factor-κB (NF-κB) in intestinal tissue were detected by immunohistochemistry. ELISA was used to detect the levels of tumor necrosis factor-α (TNF-α) and interleukin-10 (IL-10) in intestinal tissue homogenate.Results:The intestinal tissue structure of the Sham group and Y+Sham group was intact and the mucosa was arranged neatly. Compared with the Sham group, the intestinal mucosa of the CLP group was arranged disorderly, with a large number of inflammatory cells infiltration, and the Chiu's score was significantly increased (3.83±0.27 vs. 0.12±0.11, P < 0.05), indicating that those rats suffered from septic intestinal injury. Compared with the CLP group, the degree of necrosis of intestinal epithelial cells in the Y+CLP group was reduced, a small amount of inflammatory cells infiltration was seen, and the Chiu's score was significantly decreased (2.85±0.21 vs. 3.83±0.27, P < 0.05), indicating that Y-27632 pretreatment could alleviate intestinal injury in septic rats. Compared with the Sham group, the positive expressions of intestinal tissue ROCK1 and NF-κB, the contents of serum DAO and intestinal homogenate TNF-α in the CLP group were significantly increased [ROCK1 expression ( A value): 0.19 (0.18, 0.22) vs. 0.10 (0.09, 0.11), NF-κB expression ( A value): 0.40±0.02 vs. 0.15±0.01, DAO (ng/L): 287.81±23.31 vs. 144.92±17.72, TNF-α (ng/L): 101.08±5.62 vs. 74.81±5.56, all P < 0.05], the level of intestinal homogenate IL-10 was significantly decreased (μg/L: 55.16±5.20 vs. 95.95±7.53, P < 0.05). Compared with the CLP group, the positive expressions of intestinal tissue ROCK1, NF-κB, the contents of serum DAO and intestinal homogenate TNF-α in the Y+CLP group were significantly decreased [ROCK1 expression ( A value): 0.15 (0.13, 0.18) vs. 0.19 (0.18, 0.22), NF-κB expression ( A value): 0.28±0.01 vs. 0.40±0.02, DAO (ng/L): 243.34±19.76 vs. 287.81±23.31, TNF-α (ng/L): 90.41±8.79 vs. 101.08±5.62, all P < 0.05], while the level of intestinal homogenate IL-10 was significantly increased (μg/L: 66.15±5.74 vs. 55.16±5.20, P < 0.05), indicating that the protective effect of Y-27632 pretreatment on sepsis intestinal injury rats might be related to the regulation of RhoA/ROCK1/NF-κB signaling pathway. Conclusion:Rho kinase inhibitors can reduce intestinal injury in septic rats, and the mechanism may be related to inhibiting RhoA/ROCK1/NF-κB signaling pathway and reducing intestinal inflammation in septic rats.

The occurrence and progression of thyroid cancer are related to a series of molecular changes and the activation of signaling pathways, which is the basis of targeted therapy. For inoperable locally advanced, metastatic and refractory thyroid cancer, especially anaplastic thyroid cancer, the efficacy of targeted therapies, particularly tyrosine kinase inhibitors (TKIs) , has been demonstrated in clinical trials. TKIs can relieve clinical symptoms, improve patients’quality of life, prolong the progress free survival, and even create opportunities for radical operation or reoperation. This article reviews and summarizes the key molecular events in tumorigenesis and progression of thyroid cancer, and analyzes the results of clinical studies on the efficacy and safety of different TKIs in refractory advanced thyroid cancer, in order to provide reference and assistance for individualized targeted therapy of patients.

Hypercalcemic crisis (HC) is a rare but critical electrolyte disorder, which may result in death if rapid correct management is not given due to the injury of the neurologic, cardiovascular and renal systems. Severe primary hyperthyroidism (PHPT) is listed as the most common cause of hypercalcemic crisis. Prompt surgical removal of the parathyroid glands is the most effective cure for HC. Nevertheless, hypercalcemic crisis after a successful parathyroidectomy is infrequent. Now, we report a case admitted to the Department of General Surgery of the Shanghai Jiao Tong University Affiliated Sixth People’s Hospital about a successful therapy of hypercalcemic crisis postparathyroidectomy in Sep. 2019, aiming to remind clinicians of the individualized program of calcium supplement after surgery of hyperparathyroidism and emphasize the value of renal dialysis in HC.

Objective:To analyze the relationship between surgical resection range and prognosis of medullary thyroid carcinoma.Methods:Clinical data of 39 patients with medullary thyroid carcinoma treated in Shanghai Sixth People′s Hospital from Jan 2017 to Mar 2020 were retrospectively analyzed.Results:There were 13 males and 26 females, age ranging from 26 to 72 years old. Preoperative calcitonin levels increased from 21.5 to 20 000 ng/L. Tumor stage: stage Ⅰ was 35.9%, stage Ⅱ 23.1%, stage Ⅲ 25.6%, stage Ⅳ 15.4%. The proportion of lymph node metastasis in central region was 53.8% (21/39). The proportion of lateral cervical lymph node metastasis was 43.6% (17/39), which was statistically related with the preoperative calcitonin level ≥200 ng/L. The median follow-up was 10 months, and the biochemical and anatomical cure rates were 66.7% and 33.3% respectively. Transient recurrent laryngeal nerve palsy, temporary and permanent hypothyroidism were 2.6%, 23% and 2.6%, respectively. There was no postoperative hemorrhage, infection, lymphatic leak or death.Conclusions:Bilateral total thyroidectomy, and at least ispilateral central lymph node dissection were advocated for patients with MTC. When preoperative calcitonin level ≥200 ng/L, lateral cervical lymph node dissection is advised.

Objective To discuss the feasibility of totally transoral video-assisted thyroidectomy (TO-VAT).Methods Data of 30 hyperthyroidism patients treated with TOVAT from Jan.2014 to Dec.2016 were retrospectively analyzed.Index such as operative time,intraoperative blood loss,hospital stay,complication were recorded.Results No neck scar was found,and patients were satisfied with the cosmetic effects.The average surgical time was (97.3±13.4) min,blood loss 24.0(12.3～28.3)ml,hospital stay (2.0±0.5)d,cosmetic score 8.2± 0.3.No hoarse voice,drinking cough,bleeding,convulsion,or parathyroid injury happened.Two patients had swelling in the anterior cervicaarea,2 patients showed lower jaw numbness and 1 patient showed temporary hypoparathyroidism.During the follow up of 1 to 35 months,all were subjected to symptomatic management and recovered.Conclusion TOVAT is a safe and effective technique with the advantages of minor iniury,quicker recovery,fewer complications and good cosmetic effect.