Objective:To investigate the application of transoral robotic thyroidectomy (TORT) in overweight patients.Methods:Clinical data of 109 thyroid tumor patients who underwent TORT at 960th Hospital of People’s Liberation Army from May. 2020 to Aug. 2023 were retrospectively collected and analyzed. After excluding 10 patients who underwent prophylactic lateral neck dissection, a total of 99 patients were included in this study. According to the World Health Organization (WHO) guidelines, which define people with BMI:25-29.9 kg/m 2 as overweight, we divided the 99 patients into normal weight group (n=69) and overweight group (n=30) . To make the baseline data consistent between the two groups and ensure comparability, 20 matched pairs were generated using a 1∶1 propensity score matching (PSM) method, considering four clinicopathologic factors: age, gender, diameter of tumor and operation scope. In the normal-weight group, there were 18 females and 2 males, aged (32.82±9.51) years (range: 17-53 years) , and there exhibited 18 females and 2 males in the overweight group, aged (35.14±10.63) years (range: 18-55 years) . Results:All patients successfully underwent the operation without conversions to open surgery. After matching, both groups had 2 cases of thyroid adenoma and 18 cases of papillary thyroid carcinoma ( P=1) , with no statistically significant difference in the surgical scope between the two groups ( P=0.376) . There was no statistically significant difference in the mean tumor diameter between the normal-weight group and the overweight group (5.38±1.79 mm vs. 5.61±3.32 mm, P=0.575) . All malignant tumor cases in both groups were classified as T1 stage, and there was no statistically significant difference in N stage ( P=0.186) . All patients with malignant tumors underwent central lymph node dissection, there was no significant difference in the number of central lymph nodes dissected ( P=0.623) and metastatic lymph nodes ( P=0.109) between the two groups. There were no statistically significant differences in operative duration (217.53±62.83 min vs. 220.67±73.73 min, P=0.808) , median postoperative hospital stay [6 (6,7.75) days vs. 6 (6,7) days, P=0.682], or 24-hour drainage volume (78.52±30.49 mL vs. 68.23±29.11 mL, P=0.180) between the normal-weight group and the overweight group. There was no permanent hypoparathyroidism, postoperative hemorrhage, lymphatic fistula, mental nerve injury, postoperative infection in both groups. In both groups, there occurred one case of transient hypoparathyroidism. As for other complications, 1 case of temporary recurrent laryngeal nerve injury and oral tearing occurred in the overweight group, while the normal-weight group had 1 case of skin scald. Conclusions:Among patients who underwent TORT, the overweight group exhibited comparable surgical outcomes and postoperative complications to those in the normal-weight group. TORT is a safe and feasible surgical option for overweight patients, which provides more surgical options for this patient population.

Objective:To investigate the application of transoral robotic thyroidectomy (TORT) in overweight patients.Methods:Clinical data of 109 thyroid tumor patients who underwent TORT at 960th Hospital of People’s Liberation Army from May. 2020 to Aug. 2023 were retrospectively collected and analyzed. After excluding 10 patients who underwent prophylactic lateral neck dissection, a total of 99 patients were included in this study. According to the World Health Organization (WHO) guidelines, which define people with BMI:25-29.9 kg/m 2 as overweight, we divided the 99 patients into normal weight group (n=69) and overweight group (n=30) . To make the baseline data consistent between the two groups and ensure comparability, 20 matched pairs were generated using a 1∶1 propensity score matching (PSM) method, considering four clinicopathologic factors: age, gender, diameter of tumor and operation scope. In the normal-weight group, there were 18 females and 2 males, aged (32.82±9.51) years (range: 17-53 years) , and there exhibited 18 females and 2 males in the overweight group, aged (35.14±10.63) years (range: 18-55 years) . Results:All patients successfully underwent the operation without conversions to open surgery. After matching, both groups had 2 cases of thyroid adenoma and 18 cases of papillary thyroid carcinoma ( P=1) , with no statistically significant difference in the surgical scope between the two groups ( P=0.376) . There was no statistically significant difference in the mean tumor diameter between the normal-weight group and the overweight group (5.38±1.79 mm vs. 5.61±3.32 mm, P=0.575) . All malignant tumor cases in both groups were classified as T1 stage, and there was no statistically significant difference in N stage ( P=0.186) . All patients with malignant tumors underwent central lymph node dissection, there was no significant difference in the number of central lymph nodes dissected ( P=0.623) and metastatic lymph nodes ( P=0.109) between the two groups. There were no statistically significant differences in operative duration (217.53±62.83 min vs. 220.67±73.73 min, P=0.808) , median postoperative hospital stay [6 (6,7.75) days vs. 6 (6,7) days, P=0.682], or 24-hour drainage volume (78.52±30.49 mL vs. 68.23±29.11 mL, P=0.180) between the normal-weight group and the overweight group. There was no permanent hypoparathyroidism, postoperative hemorrhage, lymphatic fistula, mental nerve injury, postoperative infection in both groups. In both groups, there occurred one case of transient hypoparathyroidism. As for other complications, 1 case of temporary recurrent laryngeal nerve injury and oral tearing occurred in the overweight group, while the normal-weight group had 1 case of skin scald. Conclusions:Among patients who underwent TORT, the overweight group exhibited comparable surgical outcomes and postoperative complications to those in the normal-weight group. TORT is a safe and feasible surgical option for overweight patients, which provides more surgical options for this patient population.

AIM:To investigate the effects of glutathione-S-transferase(GST)gene polymorphism on the concentration of 6-thioguanine nucleotides(6-TGN),an active metabolite of azathioprine(AZA),in patients with inflammatory bowel disease(IBD),in order to provide reference for the optimization of AZA treatment in patients.METHODS:The clini-cal data of patients with IBD treated by AZA were collected prospectively,the genotypes of GST-A1,GST-M1,GST-P1 and GST-T1 were detected by tar-geted sequencing of multiplex PCR combined with high-throughput sequencing technology before ad-ministration,and the steady-state trough concen-trations of 6-TGN in patients' red blood cells were determined by HPLC.Statistical analysis was carried out by SPSS 26.0 software.RESULTS:A total of 90 patients were included in this study.The alleles fre-quencies of GST-A1,GST-M1,GST-P1 and GST-T1 were consistent with Hardy-Weinberg equilibrium law.Logistic regression analysis showed that carry-ing GST-A1 mutant gene was an independent risk factor for the increase of trough concentration of 6-TGN(low concentration OR=17.50,P=0.030;high concentration OR=3.60,P=0.033),while the gene polymorphism of GST-M1,GST-P1,GST-T1 had no significant correlation with the concentration of 6-TGN(P＞0.05).CONCLUSION:The gene polymor-phism of GST-A1 may affect the concentration of 6-TGN,an active metabolite of AZA,and detection of GST-A1 genotype before AZA treatment will contrib-ute to clinical individualized medication.

Objective:To explore the efficacy of Qingjin Huatan Decoction combined with conventional Western medicine for the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with phlegm-heat obstructing lung syndrome.Methods:A randomized controlled trial was conducted. Totally 90 hospitalized patients with AECOPD phlegm-heat obstructing lung syndrome in the respiratory department of Shunyi Hospital, Beijing Traditional Chinese Medicine Hospital from January 2023 to June 2024 were selected as the observation subjects. According to the simplified randomization method (single-double number method), the patients were divided into two groups, with 45 cases in each group. The conventional Western medicine group was given conventional Western medicine treatment, and the combined Chinese materia medica group was given Qingjin Huatan Decoction on the basis of the conventional Western medicine group. The treatment for both groups lasted for 7 d. TCM symptoms were scored before and after treatment; FEV 1 and FVC were detected by pulmonary function analyzer, PaO 2, PaCO 2, PaO 2/FiO 2 were detected by blood gas biochemical analyzer, CRP and PCT were detected by ELISA, and white blood cell count (WBC) was detected by automatic blood cell analyzer. Adverse reactions were recorded, and the clinical efficacy was evaluated. Results:The total effective rate was 93.33% (42/45) in the combined Chinese materia medica group and 77.78% (35/45) in the conventional Western medicine group, with statistical significance ( χ2=4.41, P=0.036). After treatment, the scores of cough, wheezing, chest tightness and shortness of breath and fever and the total score in the combined Chinese materia medica group were lower than those in the conventional Western medicine group ( t=4.83, 2.26, 5.36, 10.43, 5.27,respectively, P<0.01 or P<0.05); the levels of FEV 1 and FVC in the combined Chinese materia medica group were higher than those in the conventional Western medicine group ( t=3.03, 2.64, respectively, P<0.01); the levels of PaO 2 and PaO 2/FiO 2 in the combined Chinese materia medica group were higher than those in the conventional Western medicine group ( t=4.83, 5.36, P<0.01), while the level of PaCO 2 in the combined Chinese materia medica group was lower than that in the conventional Western medicine group ( t=2.26, P<0.05); the levels of CRP, PCT and WBC in the combined Chinese materia medica group were lower than those in the conventional western medicine group ( t=10.53, 11.29 and 2.59, respectively, P<0.01 or P<0.05). During the treatment, the incidence of adverse reactions was 6.67% (3/45) in the combined Chinese materia medica and 8.89% (4/45) in the conventional Western medicine group, without statistical significance ( χ2=0.16, P=0.694). Conclusion:Qingjin Huatan Decoction can effectively improve the lung function and blood gas indicators of AECOPD with phlegm-heat obstructing lung syndrome, and relieve the inflammation, with safety and effectiveness.

Osteoporotic vertebral compression fractures(OVCFs)are common orthopedic conditions that can lead to spinal pain and deformity,which greatly affects the quality of life of patients.Currently,there are various treatment methods for OVCFs,but there is still a lack of standards for optimal treatment modalities.Therefore,this article introduces the current treatment methods and character-istics of epidemiology for OVCFs,in order to improve the awareness of this disease among clinicians and provide a reference for select-ing more appropriate treatment regimens.Conservative treatment measures,such as bracing and analgesia,are the basic treatment mea-sures for OVCFs,and anti-osteoporosis drugs play a crucial role in management.Minimally invasive procedures,including percutane-ous vertebroplasty and percutaneous balloon kyphoplasty,remain the primary surgical interventions,and traditional open surgeries are also an important part of treatment,such as anterior spinal fusion,combined anterior and posterior spinal fusion,posterior spinal fusion with three-column osteotomy,and posterior spinal fusion with vertebroplasty.Furthermore,surgeons should focus on the accumulation of related surgical techniques and skills during surgery to effectively address the challenges and complications associated with surgical interventions.Finally,scientific and appropriate treatment methods should be selected for patients,in order to improve long-term treat-ment outcomes and increase the degree of satisfaction among pa-tients.

Objective To investigate the clinical effect of free electromyography(fEMG)monitoring as-sisted unilateral biportal endoscopy(UBE)in the treatment of lumbar disc herniation.Methods Forty pa-tients with lumbar disc herniation were included.The UBE lumbar nucleus pulposus resection under general anesthesia was performed.The operation whole process was completed under the fEMG monitor.The recorded potential was displayed on the monitor screen and the myoelectrical activity was played through speaker.The treatment effect was evaluated by the Visual Analogue Scale(VAS)score and Oswestry Disability Index(ODI).Results All 40 patients completed the surgery successfully,and the postoperative symptoms were im-proved significantly.The VAS scores before operation and in postoperative 3 months were 7(6,8)points and 0(0,1)points respectively,and the difference between the two time points was statistically significant(P＜0.05).The ODI before operation and in postoperative 3 months were(58.30±11.58)and(13.28±5.20)re-spectively,and the difference between the two time points also was statistically significant(P＜0.05).The VAS score and ODI in postoperative 1 year were 1(0,1)points and(13.13±0.40)respectively,showing sta-tistically significant difference compared with before surgery(P＜0.05),but there was no statistically signifi-cant difference compared with postoperative 3 months(P＞0.05).There were 8 cases developing the abnor-mal EMG changes such as spike,burst or tonic fEMG during surgery,with an incidence rate of 20％.After surgery in 8 cases,7 cases had burning radiculalgia and paresthesia of lower extremity,and 1 case had no obvi-ous neuralgia,with a false positive rate of 12.5％.The patients without abnormal fEMG reaction during sur-gery had no significant postoperative neuralgia,and the false negative rate was zero.Conclusion fEMG moni-toring assisted UBE under general anesthesia is a safe and easy method for the treatment of lumbar disc herni-ation.

AIM:To investigate the effects of glutathione-S-transferase(GST)gene polymorphism on the concentration of 6-thioguanine nucleotides(6-TGN),an active metabolite of azathioprine(AZA),in patients with inflammatory bowel disease(IBD),in order to provide reference for the optimization of AZA treatment in patients.METHODS:The clini-cal data of patients with IBD treated by AZA were collected prospectively,the genotypes of GST-A1,GST-M1,GST-P1 and GST-T1 were detected by tar-geted sequencing of multiplex PCR combined with high-throughput sequencing technology before ad-ministration,and the steady-state trough concen-trations of 6-TGN in patients' red blood cells were determined by HPLC.Statistical analysis was carried out by SPSS 26.0 software.RESULTS:A total of 90 patients were included in this study.The alleles fre-quencies of GST-A1,GST-M1,GST-P1 and GST-T1 were consistent with Hardy-Weinberg equilibrium law.Logistic regression analysis showed that carry-ing GST-A1 mutant gene was an independent risk factor for the increase of trough concentration of 6-TGN(low concentration OR=17.50,P=0.030;high concentration OR=3.60,P=0.033),while the gene polymorphism of GST-M1,GST-P1,GST-T1 had no significant correlation with the concentration of 6-TGN(P＞0.05).CONCLUSION:The gene polymor-phism of GST-A1 may affect the concentration of 6-TGN,an active metabolite of AZA,and detection of GST-A1 genotype before AZA treatment will contrib-ute to clinical individualized medication.

Objective To investigate the effect of glutaminase 2(GLS2)on the proliferation and invasion ability of intrahepatic cholangiocarcinoma cells and its mechanism.Methods Human intrahepatic cholangiocarcinoma RBE cells in the logarithmic phase were randomly divided into a blank control group(Con group),a GLS2 overexpression negative control group(pcDNA-NC group),a pcDNA-GLS2 group,and a pcDNA-GLS2+phosphorylation Janus kinase(p-JAK)group.RBE cells in the Con group did not transfect any plasmid;RBE cells in the pcDNA-NC group were transfected with pcDNA-NC plasmid;RBE cells in the pcDNA-GLS2 group were transfected with pcDNA-GLS2 plasmid;RBE cells in the pcDNA-GLS2+p-JAK group were transfected with pcDNA-GLS2 plasmid and co-cultured with p-JAK peptide.Real-time fluorescence quantitative polymerase chain reaction was used to detect the expression of GLS2 mRNA in each group of cells;cell counting kit-8 was used to detect the proliferation ability of cells in each group;flow cytometry was used to detect the apoptotic ability of cells in each group;Transwell assay was used to detect the invasion ability of cells in each group;Western blot was used to detect the relative expression levels of Janus kinase 2(JAK2),phosphorylation JAK2(p-JAK2),signal transducer and activator of transcription 3(STAT3),and phosphorylation STAT3(p-STAT3)proteins in cells.Results The relative expression level of GLS2 mRNA in the pcDNA-GLS2 group was significantly higher than that in the Con group and pcDNA-NC group(P＜0.05);the relative expression level of GLS2 mRNA in the pcDNA-GLS2+p-JAK group was significantly lower than that in the pcDNA-GLS2 group(P＜0.05).The survival rate of cells in the pcDNA-GLS2 group was significantly lower than that in the Con group(P＜0.05),and compared with the pcDNA-GLS2 group,the survival rate of cells in the pcDNA-GLS2+p-JAK group was significantly increased(P＜0.05).Compared with the Con group,the apoptosis rate of cells in the pcDNA-GLS2 group significantly increased(P＜0.05);the apoptosis rate of cells in the pcDNA-GLS2+p-JAK group was significantly lower than that in the pcDNA-GLS2 group(P＜0.05).The migration number of cells in the pcDNA-GLS2 group was significantly lower than that in the Con group(P＜0.05);compared with the pcDNA-GLS2 group,the pcDNA-GLS2+p-JAK group showed a significant increase in the cell migration number(P＜0.05).Compared with the Con group,the p-JAK2/JAK2 and p-STAT3/STAT3 ratios in the pcDNA-GLS2 group were significantly reduced(P＜0.05);the p-JAK2/JAK2 and p-STAT3/STAT3 ratios in the pcDNA-GLS2+p-JAK group were significantly higher than those in the pcDNA-GLS2 group(P＜0.05).Conclusion Overexpression of GLS2 can regulate the biological activity of intrahepatic cholangiocarcinoma cells by inhibiting the JAK2/STAT3 signaling pathway,inhibit the proliferation,invasion and migration of intrahepatic cholangiocarcinoma RBE cells,and induce the cell apoptosis.

Objective:To investigate the clinical features and treatment strategies of acute appendicitis in children with malignant tumors and neutropenia.Methods:This was a case series report.A retrospective review was conducted on the children with malignant tumors complicated by neutropenia, who were admitted to the Beijing Children′s Hospital, Capital Medical University between March 2007 and October 2023 due to acute appendicitis.The clinical data of the patients, including demographic characteristics, clinical manifestations, laboratory tests, and treatment strategies, were collected.The Fisher′s precision probability test was performed for group comparisons of count data.The t-test was performed for normally distributed measurement data, and the non-parametric rank-sum test for non-normally distributed measurement data. Results:Twenty-four patients were included in the study.The age of the patients was 4.3 (2.9, 4.3) years, and the male-to-female ratio was 7︰1.Acute lymphoblastic leukemia (75%) was the most common type of malignancy.The main clinical manifestations were fever (92%) and abdominal pain (75%).Six patients underwent surgical treatment (5 laparoscopic surgeries)(the surgical treatment group), and 18 patients received conservative treatment(the conservative treatment group).The proportion of patients with signs of localized or diffuse peritonitis was significantly higher in the surgical treatment group (83%) than in the conservative treatment group (25%)( P=0.007).The symptomatic relief time of acute appendicitis was significantly shorter in the surgical treatment group [(1.00±0.00) days] than in the conservative treatment group [(5.50±3.60) days]( t=-4.323, P=0.001).The length of hospital stay was significantly shorter in patients who underwent laparoscopic surgery [6.00 (2.00, 8.00) days] than in patients who received conservative treatment [9.50 (6.75, 20.50) days]( Z=-2.136, P=0.033).Acute appendicitis was cured in all patients, and there were no deaths during hospitalization. Conclusions:Both surgical and conservative treatments are safe and effective for acute appendicitis in children with malignant tumors and neutropenia.Surgical treatment can relieve the symptoms of acute appendicitis more quickly, and laparoscopic appendectomy can shorten the length of hospital stay.

Objective:To investigate the short-term outcome of transoral robotic thyroidectomy.Methods:This is a retrospective case series study. The clinicopathologic characteristics and postoperative results of 107 patients who underwent transoral robotic thyroidectomies in the Department of Thyroid and Breast Surgery of the 960 th Hospital of People′s Liberation Army from May 2020 to August 2023 were retrospectively analyzed. There were 12 males and 95 females, with an age of (31.8±9.4) years (range: 11 to 55 years), including 20 benign tumors and 87 thyroid papillary carcinoma. Postoperative follow-up was carried out through returning visit and telephone, mainly to observe the recovery of postoperative complications, cosmetic effects and recurrence results. Results:All transoral robotic thyroidectomy was successfully completed without conversion to open surgery. The tumor size of thyroid papillary carcinoma patients was (5.6±2.7) mm (range: 2 to 15 mm). Furthermore, central cervical lymph node metastasis was found in 45 cases. The number of central cervical lymph nodes retrieved and metastasized ( M(IQR)) were 11 (8) (range: 3 to 26) and 1 (3) (range: 0 to 13), respectively. There was no recurrent laryngeal nerve injury and permanent hypoparathyroidism. The transient hypoparathyroidism after surgery was 8 cases. Other complications occurred as follows: postoperative infection ( n=1), left submandibular perforation ( n=1), skin scald ( n=1), and perioral numbness ( n=1), oral tear ( n=2). The postoperative stay was 6 (2) days (range: 3 to 11 days). No local lymph node recurrence or metastasis occurred after a follow-up of (22.6±10.0) months (range: 1.0 to 37.4 months). All patients were satisfied with the postoperative cosmetic results, the aesthetic effect score was 9.3 (0.2) (range: 8.4 to 9.6) one month after surgery. Conclusion:For highly screened patients with early thyroid cancer, experienced surgeons can perform a transoral robotic thyroidectomy that has excellent cosmetic results.