Objective:To investigate the correlations between primary location and other clinical characteristics of papillary thyroid carcinoma (PTC) with cervical lymph node metastasis, providing evidence for optimizing surgical strategies.Methods:A total of 805 patients with unifocal PTC who underwent surgical treatment at the Sixth Medical Center of PLA General Hospital from January 1, 2015 to March 16, 2025, were included. Data on gender, age, tumor location and size, preoperative ultrasound findings, and postoperative pathological diagnosis were collected. The associations between clinical characteristics and lymph node metastasis in the central compartment (Level Ⅵ) and lateral neck (Levels Ⅱ-Ⅳ) were analyzed. Chi-square tests and multivariate logistic regression were used to identify independent risk factors for lymph node metastasis.Results:Among the 805 PTC patients, 363 (45.1%) had lymph node metastasis, including 44 (5.5%) in Level Ⅱ, 64 (8.0%) in Level Ⅲ, 79 (9.8%) in Level Ⅳ, and 345 (42.9%) in Level Ⅵ, with Level Ⅵ showing the highest metastasis rate. Multivariate logistic regression analysis revealed that male sex ( OR=1.43, P=0.031), age <55 years ( OR=2.02, P<0.001), tumor located in the lower pole ( OR=1.88, P<0.001), and tumor size >1.0 cm ( OR=3.15, P<0.001) were independent risk factors for Level Ⅵ metastasis. Male sex ( OR=4.20, P=0.006) and tumor located in the upper pole ( OR=6.78, P<0.001) were independent risk factors for Level Ⅱ metastasis. Tumor size >1.0 cm ( OR=2.77, P=0.006) was an independent risk factor for Level Ⅳ metastasis. Age <55 years ( OR=6.00, P=0.003), tumor located in the upper pole ( OR=2.17, P=0.002), and tumor size >1.0 cm ( OR=3.65, P<0.001) were independent risk factors for metastasis involving >5 lymph nodes. Patients with tumors in the isthmus had a significantly higher Level VI metastasis rate (85.7%, 12/14) compared to those with tumors in the thyroid lobes (42.2%, 334/791, P=0.001), and a higher rate of bilateral Level Ⅵ metastasis (35.7%, 5/14 vs. 5.1%, 40/791, P<0.001). Conclusions:Lymph node metastasis in PTC is closely associated with tumor location and size. Tumors in the lower pole primarily metastasize to Level Ⅵ, whereas those in the upper pole are more likely to metastasize to Level Ⅱ. For low-risk PTC confined to the thyroid lobe, lobectomy with isthmusectomy and central lymph node dissection is recommended. For isthmic tumors, total thyroidectomy with bilateral central lymph node dissection is advised. Male patients with upper pole tumors require careful preoperative evaluation of Level Ⅱ lymph node involvement. For patients aged <55 years with tumors >1.0 cm in the upper pole, individualized treatment strategies should be formulated based on additional high-risk factors.

Objective:To evaluate the efficacy of glottic closure in preventing postoperative aspiration in elderly patients undergoing supraglottic horizontal partial laryngectomy.Methods:A retrospective case series analysis was conducted on the clinical data of 12 elderly patients who underwent supraglottic horizontal partial laryngectomy with concurrent glottic closure at the Sixth Medical Center of Chinese PLA General Hospital from January 1, 2002, to December 31, 2024. Among them, there were 8 males and 4 females, aged from 68 to 80 years, with an average age of 74 years. There were 11 cases of supraglottic laryngeal cancer and 1 case of tongue base cancer. The TNM staging was T2N0M0 in 8 cases, T3N0M0 in 2 cases, T3N1M0 in 1 case, and T3N2M0 in 1 case. All patients existed comorbid cardiovascular dysfunction of varying severity. Pulmonary function tests were impaired in 8 cases. Comorbidities included hypertension ( n=5), prior coronary stent placement ( n=3), and thrombocytopenia ( n=1). Swallowing function was assessed using the EAT-10 (Eating Assessment Tool-10) one month postoperatively. All patients were followed up regularly. Results:The mean EAT-10 score at one month postoperatively was 2.42±1.71. Eleven patients successfully resumed oral feeding without obvious aspiration. Voice quality was intelligible when the tracheostomy tube was blocked. In the early stage, in 1 case, due to the suture technique problem of the glottis closure, the suture site of the glottis completely split open after the operation. The patient′s breathing was normal when the tube was blocked, and the tracheostomy tube was removed. As arytenoid edema resolved, the patient developed varying degrees of dysphagia with recurrent aspiration. This patient was hospitalized twice due to aspiration pneumonia, at 5 months and 19 months, postoperatively. The remaining 11 patients exhibited no signs of significant aspiration during follow-up. The 3-year and 5-year postoperative survival rates were 7/8 and 5/7, respectively.Conclusion:For elderly patients with supraglottic laryngeal cancer or tongue base cancer, and those who are at high risk for persistent postoperative aspiration after fully evaluated systematically, glottis closure during supraglottic horizontal partial laryngectomy is an effective strategy to prevent aspiration and to facilitate safe oral intake.

Objectives:This study aims to investigate the features of retrograde cricopharyngeal dysfunction (RCPD) and to evaluate the effectiveness and safety of Botulinum toxin-A as a treatment for RCPD.Methods:Twenty-two RCPD patients admitted between February 2024 and November 2024 were included through online and offline methods in The Sixth Medical Centre of Chinese PLA General Hospital (15 males, 7 females, age range, 14-34 years; mean age 25.0±5.2 years). The general condition, symptoms, severity scores, and auxiliary examinations were summarized and analyzed. Operative results and postoperative complications of RCPD patients treated with Botulinum toxin-A were analyzed.Results:All patients could not burp since early childhood, followed by gurgling noises, abdominal flatulence, laryngopharyngeal foreign body sensation, and cervical constriction. The most severe symptom was the inability to burp with a mean score of 4.8. Seven patients who received botulinum toxin injections under the supporting laryngoscopes started burping six days post-operation. With a median follow-up of 5 months, all patients achieved the ability to belch. In none of these seven cases, intraoperative complications were noted including hoarseness, choking cough when drinking water, or dyspnea. One patient experienced laryngopharyngeal reflux and six patients had dysphagia, which were relieved at 1 week and 24.8 days postoperatively.Conclusion:RCPD is a disease characterized by the inability to burp, cricopharyngeal muscle injection by Botulinum toxin-A is effective and safe.

Mesangial cell proliferation is an early pathological indicator of diabetic nephropathy (DN). Growing evidence highlights the pivotal role of paired-related homeobox 1 (Prrx1), a key regulator of cellular proliferation and tissue differentiation, in various disease pathogenesis. Notably, Prrx1 is highly expressed in mesangial cells under DN conditions. Both in vitro and in vivo studies have demonstrated that Prrx1 overexpression promotes mesangial cell proliferation and contributes to renal fibrosis in db/m mice. Conversely, Prrx1 knockdown markedly suppresses hyperglycemia-induced mesangial cell proliferation and mitigates renal fibrosis in db/db mice. Mechanistically, Prrx1 directly interacts with the Yes-associated protein 1 (YAP) promoter, leading to the upregulation of YAP expression. This upregulation promotes mesangial cell proliferation and exacerbates renal fibrosis. These findings emphasize the crucial role of Prrx1 upregulation in high glucose-induced mesangial cell proliferation, ultimately leading to renal fibrosis in DN. Therefore, targeting Prrx1 to downregulate its expression presents a promising therapeutic strategy for treating renal fibrosis associated with DN.

Objective:To evaluate the efficacy of glottic closure in preventing postoperative aspiration in elderly patients undergoing supraglottic horizontal partial laryngectomy.Methods:A retrospective case series analysis was conducted on the clinical data of 12 elderly patients who underwent supraglottic horizontal partial laryngectomy with concurrent glottic closure at the Sixth Medical Center of Chinese PLA General Hospital from January 1, 2002, to December 31, 2024. Among them, there were 8 males and 4 females, aged from 68 to 80 years, with an average age of 74 years. There were 11 cases of supraglottic laryngeal cancer and 1 case of tongue base cancer. The TNM staging was T2N0M0 in 8 cases, T3N0M0 in 2 cases, T3N1M0 in 1 case, and T3N2M0 in 1 case. All patients existed comorbid cardiovascular dysfunction of varying severity. Pulmonary function tests were impaired in 8 cases. Comorbidities included hypertension ( n=5), prior coronary stent placement ( n=3), and thrombocytopenia ( n=1). Swallowing function was assessed using the EAT-10 (Eating Assessment Tool-10) one month postoperatively. All patients were followed up regularly. Results:The mean EAT-10 score at one month postoperatively was 2.42±1.71. Eleven patients successfully resumed oral feeding without obvious aspiration. Voice quality was intelligible when the tracheostomy tube was blocked. In the early stage, in 1 case, due to the suture technique problem of the glottis closure, the suture site of the glottis completely split open after the operation. The patient′s breathing was normal when the tube was blocked, and the tracheostomy tube was removed. As arytenoid edema resolved, the patient developed varying degrees of dysphagia with recurrent aspiration. This patient was hospitalized twice due to aspiration pneumonia, at 5 months and 19 months, postoperatively. The remaining 11 patients exhibited no signs of significant aspiration during follow-up. The 3-year and 5-year postoperative survival rates were 7/8 and 5/7, respectively.Conclusion:For elderly patients with supraglottic laryngeal cancer or tongue base cancer, and those who are at high risk for persistent postoperative aspiration after fully evaluated systematically, glottis closure during supraglottic horizontal partial laryngectomy is an effective strategy to prevent aspiration and to facilitate safe oral intake.

Objectives:This study aims to investigate the features of retrograde cricopharyngeal dysfunction (RCPD) and to evaluate the effectiveness and safety of Botulinum toxin-A as a treatment for RCPD.Methods:Twenty-two RCPD patients admitted between February 2024 and November 2024 were included through online and offline methods in The Sixth Medical Centre of Chinese PLA General Hospital (15 males, 7 females, age range, 14-34 years; mean age 25.0±5.2 years). The general condition, symptoms, severity scores, and auxiliary examinations were summarized and analyzed. Operative results and postoperative complications of RCPD patients treated with Botulinum toxin-A were analyzed.Results:All patients could not burp since early childhood, followed by gurgling noises, abdominal flatulence, laryngopharyngeal foreign body sensation, and cervical constriction. The most severe symptom was the inability to burp with a mean score of 4.8. Seven patients who received botulinum toxin injections under the supporting laryngoscopes started burping six days post-operation. With a median follow-up of 5 months, all patients achieved the ability to belch. In none of these seven cases, intraoperative complications were noted including hoarseness, choking cough when drinking water, or dyspnea. One patient experienced laryngopharyngeal reflux and six patients had dysphagia, which were relieved at 1 week and 24.8 days postoperatively.Conclusion:RCPD is a disease characterized by the inability to burp, cricopharyngeal muscle injection by Botulinum toxin-A is effective and safe.

Objective:To investigate the correlations between primary location and other clinical characteristics of papillary thyroid carcinoma (PTC) with cervical lymph node metastasis, providing evidence for optimizing surgical strategies.Methods:A total of 805 patients with unifocal PTC who underwent surgical treatment at the Sixth Medical Center of PLA General Hospital from January 1, 2015 to March 16, 2025, were included. Data on gender, age, tumor location and size, preoperative ultrasound findings, and postoperative pathological diagnosis were collected. The associations between clinical characteristics and lymph node metastasis in the central compartment (Level Ⅵ) and lateral neck (Levels Ⅱ-Ⅳ) were analyzed. Chi-square tests and multivariate logistic regression were used to identify independent risk factors for lymph node metastasis.Results:Among the 805 PTC patients, 363 (45.1%) had lymph node metastasis, including 44 (5.5%) in Level Ⅱ, 64 (8.0%) in Level Ⅲ, 79 (9.8%) in Level Ⅳ, and 345 (42.9%) in Level Ⅵ, with Level Ⅵ showing the highest metastasis rate. Multivariate logistic regression analysis revealed that male sex ( OR=1.43, P=0.031), age <55 years ( OR=2.02, P<0.001), tumor located in the lower pole ( OR=1.88, P<0.001), and tumor size >1.0 cm ( OR=3.15, P<0.001) were independent risk factors for Level Ⅵ metastasis. Male sex ( OR=4.20, P=0.006) and tumor located in the upper pole ( OR=6.78, P<0.001) were independent risk factors for Level Ⅱ metastasis. Tumor size >1.0 cm ( OR=2.77, P=0.006) was an independent risk factor for Level Ⅳ metastasis. Age <55 years ( OR=6.00, P=0.003), tumor located in the upper pole ( OR=2.17, P=0.002), and tumor size >1.0 cm ( OR=3.65, P<0.001) were independent risk factors for metastasis involving >5 lymph nodes. Patients with tumors in the isthmus had a significantly higher Level VI metastasis rate (85.7%, 12/14) compared to those with tumors in the thyroid lobes (42.2%, 334/791, P=0.001), and a higher rate of bilateral Level Ⅵ metastasis (35.7%, 5/14 vs. 5.1%, 40/791, P<0.001). Conclusions:Lymph node metastasis in PTC is closely associated with tumor location and size. Tumors in the lower pole primarily metastasize to Level Ⅵ, whereas those in the upper pole are more likely to metastasize to Level Ⅱ. For low-risk PTC confined to the thyroid lobe, lobectomy with isthmusectomy and central lymph node dissection is recommended. For isthmic tumors, total thyroidectomy with bilateral central lymph node dissection is advised. Male patients with upper pole tumors require careful preoperative evaluation of Level Ⅱ lymph node involvement. For patients aged <55 years with tumors >1.0 cm in the upper pole, individualized treatment strategies should be formulated based on additional high-risk factors.

Diabetic foot(DF)is a common chronic complication in patients with diabetes.Fibrosis and degeneration occurred in fasciae in long term hyperglycemia and inflammatory environment.Fibrosis in fasciae may aggravate the development of diabetic foot due to the special cellular and molecular structure,physiological and biomechanical effects.Thus,we aimed at reviewing the research progress of fascial fibrosis in diabetic foot.

Pharyngology and laryngology is an important subspecialty of Otolaryngology Head and Neck Surgery. It involves congenital diseases, trauma and foreign bodies, inflammatory diseases, obstructive sleep apnea, benign lesions, laryngeal nerve and cricoarytenoid joint diseases, swallowing disorders, laryngopharyngeal reflux diseases, voice medicine, as well as laryngeal microsurgery and endoscopic surgical treatment of benign and malignant tumors of this area. The disease spectrum is wide and involves many surgical techniques and methods.
Humans ; Otolaryngology ; Larynx/surgery*

Objective:To investigate the prognosis and influencing factors of endoscopic surgery for early glottic carcinoma.Methods:In this retrospective study, we applied the Cox proportional hazards regression model and the random survival forest model to analyze the clinical characteristics of 385 patients [362 males, 23 females, age ranging from 33 to 91 years (62.0±9.6)] who visited the Sixth Medical Center of the General Hospital of the People's Liberation Army from January 2009, to December 2022 and diagnosed with early glottic carcinoma, encompassing variables such as age, gender, T stage, surgical approach, pathological typing, etc. The primary evaluation indicators were overall survival(OS) and disease-free survival rates (DFS). The follow-up duration ranged from 30 to 5,557 days (with a median follow-up time of 1,596 days).Results:After a three-year follow-up, the OS rate for the 385 patients was 95.83%, while the DSF rate was 82.98%. The Cox proportional hazards regression analysis revealed age ( HR=2.35, 95% CI: 1.75 to 3.15, P<0.001) and T staging ( HR=1.59, 95% CI: 1.13 to 2.23, P=0.019) as predominant factors affecting the OS and DFS. The random survival forest model identified poor tumor differentiation, and high expression of P53 and Ki-67 as predictors of inferior prognosis. Conclusion:Endoscopic surgery for early glottic carcinoma yields favorable short-term OS and reduces short-term recurrence rates, with T-stage emerging as a pivotal factor influencing recurrence. Tumors with poor differentiation and elevated expression of P53 may be indicative of an increased risk of recurrence.