Background and Aims:To overcome the limitations of the transoral endoscopic thyroidectomy vestibular approach,such as restricted operative space and high complication risks,our team proposed a modified technique—endoscopic thyroidectomy via oral vestibule and submandibular approach(ETOSA).Preliminary studies have confirmed its safety and feasibility.This study aims to systematically evaluate the key factors affecting postoperative complications and operative time in ETOSA,explore the interactions among these variables,and construct a learning curve model to support its broader clinical adoption.Methods:A retrospective analysis was conducted on 125 patients with papillary thyroid carcinoma who underwent ETOSA at Xiangya Hospital,Central South University,between March 2022 and March 2023.Clinical characteristics,surgical parameters,and postoperative complications were extracted.A random forest model was employed to identify the major influencing factors for complications and operative time,as well as their interaction effects.Partial dependence plots based on case sequence were used to generate the learning curve.Results:All 125 patients successfully underwent ETOSA with no conversion to open surgery.The median operative time was 95.0 min,and the median intraoperative blood loss was 15.0 mL.The overall postoperative complication rate was 16.0%,with no cases of permanent hypoparathyroidism or hypocalcemia.The average neck appearance score was 1.05,indicating high patient satisfaction.The random forest analysis identified case number,surgical extent,lymph node yield(LNY),Hashimoto's thyroiditis(HT),and body mass index(BMI)as the key predictors of postoperative complications,while surgical extent,case number,LNY,HT,and blood loss were the key factors affecting operative time.A significant positive interaction was observed between case number and both surgical extent and HT,particularly in the first 20 cases,suggesting a higher risk during the early learning phase.The learning curve analysis indicated that surgical proficiency stabilized after 20 cases.Operative time and complication rate in the proficient phase were significantly lower than those in the learning phase(90.0 min vs.102.5 min;11.4%vs.40.0%,both P<0.05).Conclusion:ETOSA is a safe and feasible technique characterized by minimal invasiveness,favorable cosmetic outcomes,and a relatively short learning curve.case number,surgical extent,LNY,HT,BMI,and blood loss are key factors affecting complications and operation time.

Background and Aims:To overcome the limitations of the transoral endoscopic thyroidectomy vestibular approach,such as restricted operative space and high complication risks,our team proposed a modified technique—endoscopic thyroidectomy via oral vestibule and submandibular approach(ETOSA).Preliminary studies have confirmed its safety and feasibility.This study aims to systematically evaluate the key factors affecting postoperative complications and operative time in ETOSA,explore the interactions among these variables,and construct a learning curve model to support its broader clinical adoption.Methods:A retrospective analysis was conducted on 125 patients with papillary thyroid carcinoma who underwent ETOSA at Xiangya Hospital,Central South University,between March 2022 and March 2023.Clinical characteristics,surgical parameters,and postoperative complications were extracted.A random forest model was employed to identify the major influencing factors for complications and operative time,as well as their interaction effects.Partial dependence plots based on case sequence were used to generate the learning curve.Results:All 125 patients successfully underwent ETOSA with no conversion to open surgery.The median operative time was 95.0 min,and the median intraoperative blood loss was 15.0 mL.The overall postoperative complication rate was 16.0%,with no cases of permanent hypoparathyroidism or hypocalcemia.The average neck appearance score was 1.05,indicating high patient satisfaction.The random forest analysis identified case number,surgical extent,lymph node yield(LNY),Hashimoto's thyroiditis(HT),and body mass index(BMI)as the key predictors of postoperative complications,while surgical extent,case number,LNY,HT,and blood loss were the key factors affecting operative time.A significant positive interaction was observed between case number and both surgical extent and HT,particularly in the first 20 cases,suggesting a higher risk during the early learning phase.The learning curve analysis indicated that surgical proficiency stabilized after 20 cases.Operative time and complication rate in the proficient phase were significantly lower than those in the learning phase(90.0 min vs.102.5 min;11.4%vs.40.0%,both P<0.05).Conclusion:ETOSA is a safe and feasible technique characterized by minimal invasiveness,favorable cosmetic outcomes,and a relatively short learning curve.case number,surgical extent,LNY,HT,BMI,and blood loss are key factors affecting complications and operation time.

Objective:To investigate the efficacy and safety of ultrasound-guided of lumbar square muscle block on the arcuate ligament in laparoscopic surgery for gastrointestinal tumors.Methods:A retrospective study was conducted on 106 patients who underwent laparoscopic gastrointestinal tumor surgery in Rugao Branch of Affiliated Hospital of Nantong University from January 2020 to December 2022, 53 patients(observation group) were given the ultrasound-guided of lumbar square muscle block on the arcuate ligament before general anesthesia, 53 patients(control group) were given only general anesthesia. The sensory block planes were recorded at 5 min and 15 min after the block in the observation group, and the hemodynamic indexes, stress indexes at differences time points and postoperative analgesia were compared between the two groups.Results:Most patients in the observation group could monitor the T 8 - L 1 sensory block plane at 5 min after block, and the T 5 - L 2 sensory block plane could be reached at 15 min after block, and the percentage of block was 100.00%(53/53). The results of repeated measurement variance analysis (ANOVA) showed that the intergroup - time point interaction of heart rate (HR) and mean arterial pressure (MAP) between the two groups had statistical differences ( P<0.05); the intergroup-time point interaction of the levels of noradrenaline (NE), epinephrine (E), adrenocorticotropic hormone (ACTH), cortisol (Cor) between the two groups had statistical differences ( P<0.05); the intergroup - time point interaction of the resting and active visual analog scale (VAS) scores between the two groups had statistical differences ( P<0.05). The amount of propofol, remifentanil, the number of effective patient-controlled intravenous analgesia (PCIA) compressions, and the total number of PCIA compressions in the observation group were lower than those in the control group: (1 128.36 ± 137.95) mg vs. (1 415.18 ± 153.24) mg, (1.47 ± 0.49) mg vs. (2.76 ± 0.74) mg, (4.25 ± 0.87) times vs. (8.63 ± 0.94) times, (10.27 ± 1.25) times vs. (15.75 ± 1.47) times, there were statistical differences ( P<0.05). The rate of remedial analgesia within 48 h after surgery between the two groups had no statistical difference ( P>0.05). The awakening time, first time out of bed, first time exhaust and hospitalization time in the observation group were shorter than those in the control group: (4.75 ± 0.57) min vs. (7.02 ± 0.64) min, (11.65 ± 1.47) h vs. (15.87 ± 1.94) h, (14.79 ± 2.12) h vs. (19.59 ± 3.30) h, (4.78 ± 0.72) d vs. (7.14 ± 0.98) d, there were statistical differences ( P<0.05). The incidence of adverse reactions between the two groups had no statistical difference ( P>0.05). Conclusions:Ultrasound-guided of lumbar square muscle block on the arcuate ligament in laparoscopic surgery for gastrointestinal tumors has significant analgesic effects, can reduce intraoperative anesthetic maintenance dose, maintain intraoperative hemodynamic stability, reduce postoperative pain sensation and stress response, reduce postoperative analgesic injection dose, shorten postoperative wakefulness time, and accelerate recovery.

Objective:To evaluate the clinical significance of commonly used clinical inflammatory indicators in children with infectious diseases.Methods:A total of 354 children diagnosed with infectious diseases in our hospital from December 2018 to October 2020 were selected and divided into viral infection group(83 cases), sepsis group (65 cases), atypical pathogen infection group(23 cases), fungal infection group (11 cases), and bacterial infection group(172 cases). The data of serum amyloid A(SAA), procalcitonin(PCT), C-reactive protein(CRP), SAA/CRP, and interleukin (IL) in each group were collected.The fever peak, duration of fever, and fever subsidence time after admission were recorded.The receiver operating characteristic (ROC) curve was plotted, and the area under the curve(AUC), cut-off value, sensitivity and specificity were recorded.The correlation between fever and inflammatory indicators was analyzed.Results:The duration of fever in the atypical pathogen infection group was significantly higher than that in the other groups.Compared with the sepsis group, the differences regarding the levels of SAA, CRP, PCT, and IL-6 were statistically significant compared with those in the bacterial infection group, the atypical pathogen infection group, and the viral infection group (all P<0.05). SAA/CRP was the highest in the viral infection group, and its mean value was nearly twice compared with that in the sepsis group ( P<0.05). IL-10 was significantly different between bacterial infection group and viral infection group( P<0.05). Compared with the fungal infection group, the difference of interferon-γ was statistically significant compared with that in the bacterial infection group, viral infection group and sepsis group (all P<0.05). The ROC curves suggested that the AUC of SAA/CRP and IL-10 was the largest and the same in the viral infection group.The AUC of PCT in the sepsis group was the largest of 0.877, and the specificity was the highest at 91.7% when the PCT was 1.055 ng/mL.Correlation analysis found that SAA and CRP detected for the first time at admission were positively correlated with the time to heat remission. Conclusion:SAA/CRP has significant significance in differentiating sepsis and virus infection, and significantly increased PCT is an important sign of sepsis.

Objective To examine short-term outcomes and long-term survival of elderly patients (aged over 80 years) with colorectal cancer who received laparoscopic versus open surgery. Methods A total of 313 patients over 80 years old with colorectal cancer who underwent radical surgery were included.According to the surgical method, all patients were divided into open-surgery group (n=143) and laparoscopic surgery group (n=170).Baseline data were balanced between the two groups by using propensity score matching.Kaplan-Meier was used to draw the survival curve, and survival was compared by Log rank tests.Cox proportional risk model was used to analyze the effects of all factors on overall survival (OS) and disease-free survival (DFS). Results After matching, 93 patients were included in each group.The mean intraoperative blood loss, the incidence of overall postoperative complications and gradeⅠ-Ⅱ complications in the laparoscopic surgery group were significantly lower than those in the open surgery group (all P < 0.05).The time to first flatus, the time to oral feeding, and postoperative hospital stays in the laparoscopic surgery group were significantly shorter than those in the open surgery group (all P < 0.05).The mean number of lymph-node dissection was also significantly higher in the laparoscopic surgery group than in the open surgery group (P=0.030).Patients in both groups had similar 5-year OS (P=0.594) and DFS (P=0.295).Multivariate Cox prognostic analysis showed that CEA level > 5 ng/ml, pathological TNM stage Ⅲ, and perineural invasion were independent risk factors for poor OS and DFS. Conclusion Compared with open surgery, laparoscopic surgery can provide better short-term advantages and similar long-term outcomes for colorectal cancer patients over 80 years of age.

【Objective】 To study the expressions of BMAL1 and CerbB-2 genes in nasopharyngeal carcinoma (NPC) and their related mechanisms. 【Methods】 Plasmid transfection, MTT, RT-PCR and Western blotting were used to detect the proliferation of NPC cells, the expressions of BMAL1 and CerbB-2 genes and proteins, and the expression of NF-κB signaling pathway. 【Results】 The MTT results showed that BMAL1 and CerbB-2 could affect the proliferation of NPC cells. RT-PCR results showed that BMAL1 gene was significantly down-regulated in NPC (CK: 2.24±0.22, NPC: 0.63±0.11, P<0.01), while CerbB-2 gene expression was significantly up-regulated (CK: 0.89±0.13, NPC: 2.65±0.25, P<0.01). The p50 and p65 genes in the NF-κB signaling pathway were up-regulated in NPC cells (p50, CK: 0.48±0.12, NPC: 1.45±0.25; p65, CK: 0.52±0.12, NPC: 2.33±0.35, P<0.01). The results of Western blotting were consistent with gene expression, which further confirmed the reliability of the results. 【Conclusion】 This study reveals that BMAL1 and CerbB-2 regulate the invasion and metastasis of NPC cells through the inflammatory pathway NF-κB, providing further theoretical support for the treatment and prevention of NPC.

Objective To avoid complications associated with the complete Senning procedures and to assist right-heart hemodynamics, this study was undertaken to assess the risks and benefits of the double-switch operation using a hemi-Mustard atrial switch procedure and the bidirectional Glenn operation for congenitally corrected transposition of the great arteries. we fa-vor a modified atrial switch procedure. Methods Between January 2014 and March 2016, anatomic repair was achieved in 26 patients. A hemi-Mustard procedure was the atrial switch procedure for 26. 9％(7/26). The Rastelli-atrial switch procedure was performed in 5 patients( RAS) and the arterial-atrial switch procedure was performed in 2 patients( AAS) . Results There was no in-hospital death after anatomic repair. There were no late deaths in a median follow-up of 7-21 months. Glenn opera-tion complications were uncommon limited to the perioperative period, atrial baffle-related reoperations or sinus node dysfunc-tion had not been observed. Tricuspid regurgitation decreased to mild for 1 case and mild to moderate for 6 cases. Right ventri-cle-pulmonary artery conduit longevity was significantly improved. Conclusion We recentely describe an experience with the double-switch operation using a modified atrial switch procedure with favorable earlyterm results. The risks of the hemi-mustard and bidirectional Glenn operation are minimal and are limited to a well-defined patient subset. The benefits include reduced baffle-and sinus node-related complications, technical simplicity and inspiring results.

OBJECTIVETo investigate the efficacy of allogeneic hematopoietic stem cell transplantation（allo-HSCT）in the treatment of patients with Ⅲ,Ⅳ non-Hodgkin lymphoma（NHL）, and compared the efficacy between Cy- fractionated to talbody irradiation（fTBI）based conditioning regimen and Maryland, horse flange and mitoxantrone（BMM）.

METHODSThe clinical data of 47 patients with Ⅲ, Ⅳ NHL after allo- HSCT from November 1998 to May 2014 were collected and retrospectively analyzed. To observe the hematopoietic reconstruction recovery after transplantation, cumulative incidence of acute graft- versus- host- disease （aGVHD） and chronic graft- versus- host- disease （cGVHD）, transplantation related mortality （TRM）, recurrence rate （RR）, disease- free survival （DFS）, overall survival（OS）. Compare the efficacy of fTBI and BMM conditioning regimen at the same time.

RESULTSNeutrophils achieving 0.5×10⁹/L and platelets achieving 50×10⁹/L on day 17 （range, 10- 72） post transplantation. Acute GVHD occurred in 53.19%, among them, grade Ⅰ-Ⅱ occurred in 42.55%, grade Ⅲ-Ⅳ occurred in 10.65%, and cGVHD occurred in 21.28%. 21 patients were alive with a median follow up of 9.7 months（0.2-149.1 months）. Overall survival（OS）was 73.5%, 49.3%, 40.1% respectively in the first, third and fifth year in Cy-fTBI group; in BMM group it was 67.8%, 32.9% and 31.4% respectively, and disease-free survival（DFS）was 65.3%, 45.6%, 30.2% respectively in the first, third and fifth year. In Cy-fTBI group, the recurrence rate（RR）and transplantation related mortality（TRM）in the first year were 18.9%, 23.0% respectively, the third year were 19.5%, 38.3% and the fifth year were 35.2%, 39.2%. In BMM group, RR and TRM in the first year were 27.4%, 24.5% respectively, the third year were 38.9%, 46.4% and the fifth year were 39.2%, 48.2%. However, there was no significant difference in the indicator of OS, DFS, RR, TRM in the two groups.

CONCLUSIONAllo-HSCT could make some Ⅲ,Ⅳ NHL patients achieve long-term disease- free survival, but the TRM was still high relatively. Moreover, compared with the program of BMM conditioning regimen, Cy-fTBI might reduce the TRM and RR, meanwhile, increase the DFS and OS. However, due to the small number cases of two groups, there was no statistical significant difference.

Disease-Free Survival ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation ; Humans ; Lymphoma, Non-Hodgkin ; therapy ; Neoplasm Recurrence, Local ; Retrospective Studies ; Transplantation Conditioning ; methods ; Transplantation, Homologous

Objective To investigate the expression of Toll-like receptor 4 (TLR4),and explore its relationship with neurological function after fluid percussion brain injury in rats.Methods 56 adult rats were randomly divided into traumatic brain injury group(TBI group,n=48) and sham operation group(SO group,n=8).The experimental models were established.The water content of edematous brain and the expression of TLR4 were measured with dry-wet measure,immunohistochemistry and Western Blot at 1 h,6 h,12 h,24 h,3 d,7 d after shock respectively.Results Compared with SO group,neuronal function score decreased in TBI group from 6 h(3.86±0.42),reached to the lowest level at 24 h(2.65±0.32),and gradually rose at 3rd day (3.25±0.17).TLR4 immunoreactive expression increased from 6 h,reached its maxmum at 24 h,lasted to 3rd day,and then began to drop at 7th day.The linear regression analysis indicated that expression of TLR4 had negative correlation with change of neuronal function score (r 1 =-0.824,r w =-0.867,P＜0.05).Conclusion TLR4 expression is upregulated following fluid percussion injury in rats and involved in neurological function impairment by inducing secondary inflammatory brain injury.

Objective To investigate the expression of inflanmatory cytokines such as interlukin-1β (IL-1 β),interlukin-6 (IL-6),tumor necrosis factor-α (TNF-α) and intercelluar adhesion molecule-1 (ICAM-1),and explore their relationships with neuronal function score after fluid percussion brain injury in rats.Methods The experimental models were established in 48 adult rats.The water content of edematous brain and the expression of IL-Iβ,IL-6,TNF-α and ICAM-1 were measured with dry-wet measure,immunohistochemistry at 6 h,12 h,24 h,3 d,7 d after operation respectively.Results Compared with animals of shame operation (SO) group,neuronal function score decreased in TBI group from 6h (3.78±0.84),reached to the lowest level at 24h (2.65±0.32),and gradually increased at 3d (4.75±0.71).IL-6,IL-1β,TNF-α and ICAM-limmunoreactive expression increased from 6h,reached its maxmum at 24h,lasted to 3th day,and began to decrease at 7d.The linear regression analysis indicated that expression of IL-1β,IL-6,TNF-α and ICAM-1 had negative correlations with change of neuronal function score(r=-0.912,r=-0.892,r=-0.794,r=-0.887 respectively,P＜0.05).Conclusion IL-6,IL-1β,TNF-α and ICAM-1 expression is upregulated following fluid percussion injury in rats,and shows negative correlations with neuronal function score.The possible mechanisms is that inflammatory cytokines are involved in nerve function impairment by inducing secondary brain injury.