Objective:To explore the reoperation cause and molecular classification of patients reoperated for papillary thyroid carcinoma (PTC).Methods:This is a retrospective case series study. Clinical data from 102 PTC patients who underwent reoperation at the Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center were collected between February 2019 and December 2024. The cohort comprised 26 males (25.5%) and 76 females (74.5%), with initial age of (33.1±12.2) years (range: 9 to 67 years). At initial surgery, 25.5% (26/102) exhibited extrathyroidal extension, 52.0% (53/102) had multifocal tumors, and 19.6% (20/102) had metastatic lymph nodes with extranodal extension. AJCC staging classified 95.1% (97/102) as stage Ⅰ, 2.9% (3/102) as stage Ⅱ, and 2.0% (2/102) as stage Ⅲ. Standardized primary tumor resection was performed in 81.4% (83/102), prophylactic central compartment lymph node dissection (LND) in 89.2% (91/102), and therapeutic lateral LND in 47.1% (48/102). Data on recurrence, genetic alterations, reoperation intervals, and clinical features of multiple recurrent PTC cases were analyzed.Results:Among 102 patients, 81.4% (83/102) presented with lateral neck metastases, 48.0% (49/102) with central compartment metastases, and 22.6% (23/102) with residual thyroid lobe recurrence at reoperation. Reoperation occurred within 6 months postoperatively in 18.6% (19/102) and after 6 months in 81.4% (83/102). Genetic detection revealed BRAF mutation in 63.7% (65/102), RET fusions in 19.6% (20/102), and TERT promoter mutations in 8.8% (9/102). During reoperation, 88.2% (90/102) underwent therapeutic lateral LND, and 39.2% (40/102) required residual gland resection. Twelve patients received multiple surgeries, including 4 cases with BRAF+TERT mutations, 4 with RET fusions, and 4 with BRAF mutation alone. Conclusions:The reasons for the reoperation of PTC mainly include recurrence and complementary surgery. Genetic alterations such as BRAF mutation and RET fusion are common in PTC patients requiring reoperation.

Objective:To explore the reoperation cause and molecular classification of patients reoperated for papillary thyroid carcinoma (PTC).Methods:This is a retrospective case series study. Clinical data from 102 PTC patients who underwent reoperation at the Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center were collected between February 2019 and December 2024. The cohort comprised 26 males (25.5%) and 76 females (74.5%), with initial age of (33.1±12.2) years (range: 9 to 67 years). At initial surgery, 25.5% (26/102) exhibited extrathyroidal extension, 52.0% (53/102) had multifocal tumors, and 19.6% (20/102) had metastatic lymph nodes with extranodal extension. AJCC staging classified 95.1% (97/102) as stage Ⅰ, 2.9% (3/102) as stage Ⅱ, and 2.0% (2/102) as stage Ⅲ. Standardized primary tumor resection was performed in 81.4% (83/102), prophylactic central compartment lymph node dissection (LND) in 89.2% (91/102), and therapeutic lateral LND in 47.1% (48/102). Data on recurrence, genetic alterations, reoperation intervals, and clinical features of multiple recurrent PTC cases were analyzed.Results:Among 102 patients, 81.4% (83/102) presented with lateral neck metastases, 48.0% (49/102) with central compartment metastases, and 22.6% (23/102) with residual thyroid lobe recurrence at reoperation. Reoperation occurred within 6 months postoperatively in 18.6% (19/102) and after 6 months in 81.4% (83/102). Genetic detection revealed BRAF mutation in 63.7% (65/102), RET fusions in 19.6% (20/102), and TERT promoter mutations in 8.8% (9/102). During reoperation, 88.2% (90/102) underwent therapeutic lateral LND, and 39.2% (40/102) required residual gland resection. Twelve patients received multiple surgeries, including 4 cases with BRAF+TERT mutations, 4 with RET fusions, and 4 with BRAF mutation alone. Conclusions:The reasons for the reoperation of PTC mainly include recurrence and complementary surgery. Genetic alterations such as BRAF mutation and RET fusion are common in PTC patients requiring reoperation.

Objective To expore the effect of fibroblast exosomes from diabetic rats on wound healing.Methods Male SD rats were randomly divided into diabetes mellitus group(DM group,n=12)and normal control group(NC group,n=15).Fibroblast exosomes were extracted and identified.After digestion of human epidermal keratinocyte line(HEK-a)and human epidermal microvascular endothelial cell line(HMEC-1),the cells were divided into diabetes exosomes group(DM-EOXa group),normal exosomes group(N-EXOa group)and normal control group(NCa group).CCK8 was used todetect the proliferation of fibroblast.fifteen male SD rats were randomly divided into diabetes exosomes group(DM-EXOb group),normal exosomes group(N-EXOb group)and normal control group(NCb group),with 5 rats in each group.Full-thickness wounds were created on rats back,and fibroblast exosomes were used to intervene wound healing.The wound healing was compared on 3th,7th,10th,and 14th day in each group.Results The proliferation of HEK-a and HMEC-1 was higher in N-EXOa and DM-EXOa groups than in NCa group(P<0.05).On the 7th,10th and 14th day,the average wound rate was lower in N-EXOb group than in NCb and DM-EXOb groups(P<0.05 or P<0.01).On the 10th day,the average wound rate was lower in NCb group than in DM-EXOb group(P<0.05).Conclusions Normal fibroblast exosomes can promote wound healing,while diabetic fibroblast exosomes from diabetic rats have no effect on wound healing,and even inhibit wound healing.

Objective:To investigate the application prospect of 3D virtual reconstruction and printing technology based on thin-slice CT images in network cloud+dual-track teaching.Methods:A total of 120 medical students who were on probation in The Second Affiliated Hospital of Air Force Medical University from April 2021 to April 2022 were selected as subjects and were randomly divided into experimental group and control group, with 60 students in each group. The students in the experimental group received 3D virtual reconstruction and printing technology combined with network cloud+dual-track teaching, and those in the control group received network cloud+dual-track teaching alone. After 6 months of learning, the teaching effect was compared by closed-book examination, skill operation, speech defense, and questionnaire survey. SPSS 23.0 was used for the t-test and the chi-square test. Results:Compared with the control group in terms of department examination, the experimental group had significantly better scores of theoretical knowledge [(84.25±5.53) vs. (79.43±6.69), P<0.001] and operational skills [(87.68±5.72) vs. (82.97±5.32), P<0.001]. The experimental group had significantly higher scores than the control group in speech [(44.90±2.56) vs. (41.88±2.71), P<0.001] and defense [(45.83±2.62) vs. (43.85±2.56), P<0.001]. The questionnaire survey showed that compared with the control group, the experimental group had significantly higher scores of practical ability, active learning ability, expression ability, practice enthusiasm, and information acquisition ability ( P<0.001). Conclusion:The network cloud+dual-track teaching model assisted by 3D virtual reconstruction and printing technology can significantly improve the objective learning effect and subjective learning initiative of students and has a relatively high value of teaching application and promotion.

Objective:To explore the feasibility and accuracy of three-dimensional (3D) modeling methods based on ultrasound imaging data for normal and abnormal fetal cardiac structures, and to construct a methodology system for 3D printing of fetal heart based on ultrasound.Methods:A total of 93 fetuses examined in Tangdu Hospital of Air Force Military Medical University from January to December 2019 were selected. Fetal echocardiography was obtained using spatio-temporal image correlation (STIC). Ninety-three hearts were 3D modeled by blood flow modeling, blood pool modeling and cavity modeling, and printed by stereolithography technique. The data measured on the 3D digital models and 3D printed solid models were compared with the corresponding fetal echocardiographic images respectively in order to evaluate the accuracy of the modeling methods.Results:The fetal cardiac blood flow models based on Doppler flow image data showed the malformation and trend of small blood vessels. The fetal cardiac structure models printed based on blood pool modeling displayed the malformation of heart and large blood vessels. Models printed based on cavity modeling method accurately displayed valve and structural defects.For 83 normal fetal hearts, the long diameters of left and right ventricles measured on echocardiography [(15.3±1.9)mm, (13.2±1.9)mm] were compared with those measured on digital models [(15.1±1.9)mm, (12.9±1.9)mm] and 3D printed models[(15.1±1.9)mm, (13.0±1.9)mm], respectively, and there were no significant differences between any two groups of them ( P>0.05). Bland-Altman showed good consistency for all measurements within and between operators. Conclusions:The three modeling methods, including blood flow modeling, blood pool modeling and cavity modeling, have their own advantages in displaying different types of fetal heart malformations. Appropriate modeling methods should be selected for 3D modeling and printing to make up for the limitations of single modeling method. The consistency between measurements on 3D models and those on echocardiography is high, and the repeatability between operators is good.

Single-cell RNA-seq (scRNA-seq) can describe the changes of gene expression in a single tumor cell. And it can reveal the status and function of tumor cells, and capture the extensive transcriptome heterogeneity in the cell population. The application of scRNA-seq can monitor the specific highly expressed genes in esophageal squamous cell carcinoma (ESCC) , and it can also monitor genes related to radio chemotherapy resistance in tumor cells, which is helpful to provide more accurate auxiliary diagnosis for ESCC. Besides, scRNA-seq can evaluate the recurrence risk and survival time of patients. An in-depth study of the relationship between tumor cells and tumor microenvironment in ESCC will provide a theoretical basis for developing a new immunotherapy scheme for ESCC.

Objective    In this study, three-dimensional printed (3DP) titanium implants were used for skeletal reconstructions after wide excision of chest wall. 3DP titanium implants were expected to provide a valid option with perfect anatomic fitting and personalized design in chest wall reconstruction. Methods    There were 13 patients [mean age of 46 (24-78) years with 9 males and 4 females] who underwent adequate radical wide excision for tumors and chest wall reconstruction using 3DP titanium implants. Surgical data including patient demographic characteristics, perioperative clinical data and data from 1-year follow-up were collected and analyzed. Results    Six patients of rib tumors, six patients of sternal tumors and one patient of sternal pyogenic osteomyelitis were finally selected for the study. The chest wall defect area was 221.0±206.0 cm2. All patients were able to maintain the integrity of the chest wall after surgery, and no abnormal breathing was found, achieving personalized and anatomical repair. Thirteen patients were successfully discharged from the hospital. Two patients developed pneumonia in the perioperative period. During the follow-up period in the first year after surgery, no implant related adverse reaction was observed, including implant rupture, implant shift, rejection reaction and allergies. One patient had wound ulcer after chemotherapy. Three patients had tumor recurrence, with the recurrence rate of 25.0%. Two patients died of tumor recurrence, with a mortality rate of 16.7%. Conclusion    3DP titanium implant is a safe and effective material for chest wall reconstruction. 

Objective To systematically assess the diagnostic performance of CTA for lower extremity peripheral arterial disease (PAD) using a Meta analysis method. Methods Studies were located through electronic searching of the PubMed, EBSCO, Springer, Ovid, CNKI, Cochrane library (from the date of establishment of the databases to October 2009 ). Bibliographies of the retrieved articles were also checked. All the studies concerning the diagnosis of PAD using CTA had been searched and reviewed, and the studies with the DSA as the gold standard were adopted as eligible. Subsequently, the characteristics of the included articles were appraised and extracted. Data on accuracy of included studies were extracted for further heterogeneity exploring, statistical pooling and SROC ( summary receiver operating characteristics)analyzing using the Meta Disc 1.4 software. Results Totally 24 studies met the inclusion criteria with a total of 1096 patients. The heterogeneity was found in these studies. The pooled accuracy indicators like sensitivity, specificity, and diagnostic odds ratio (DOR) were 0.95 ( 95% CI:0.94-0.95 ), 0.96 ( 95% CI:0.95-0.96), and 471.13 (95% CI:242. 92-913.71 ), respectively. The area under of SROC curve was 0.9888 and the Q index was 0.9555. Subgroup analysis demonstrated significant difference on diagnostic performance for various CT slices (P ＜ 0.05 ). Conclusion CTA can be regarded as an effective and feasible method for PAD diagnosis and screening, based on the results of this systematic review. However,more rigorous evaluations of CTA in patients with critical limb ischemia are needed.

Objective To assess the value of MSCT in the follow-up of patients with small hepatocelluar carcinoma(sHCC) treated with RFA. Methods Twenty-eight patients with sHCC underwent MSCT scanning 1, 3 and 6 months after RFA. Results One month after RFA, 25 tumors were completely necrotized, among which 19 presented no enhancement on dual-phase contrast CT scans and 6 showed thin ring-shaped enhancement on artery-phase contrast. Three cases with residual tumor manifested as nodular enhancement in margin of lesion. Three and 6 months after RFA, all 25 tumors, which were completely necrotized, became small and presented no enhancement. New tumors were found in the liver in 2 cases six months after RFA. Conclusion RFA is an effective therapeutic method for sHCC, and MSCT dual-phase enhanced scanning is a good way for evaluating the curative effect and follow-up.

Based on the analysis of the status quo and development trends of disaster medicine system abroad along with a summary of the present conditions and inadequacies of the same system in China, this paper proposes to build such a system in Hainan Province. It studied, with reference to the specifics of Hainan Province, the characteristics of such a system in the province, involving such aspects as hospital setup, human resource development, construction of research centers, professional training,management of disease control centers, improvement of the hospital self-rescue system, reliable supply of drugs and medical devices, maintenance of disaster medicine information system, logistics support,improvement of assessment system, establishment of rescue-oriented culture, and psychology crisis intervention and promotions.