Cushing’s syndrome is associated with a spectrum of systemic complications, including under-recognised effects on the musculoskeletal system. We present a case of a 37-year-old male with recurrent Cushing’s Disease who developed progressive lumbar radiculopathy secondary to severe Degenerative Disc Disease. Despite bilateral adrenalectomy, the patient exhibited persistent hypercortisolaemia and classical Cushingoid features. Imaging confirmed L4 disc herniation with nerve root compression. A multidisciplinary team initiated endocrine therapy and performed a successful minimally invasive lumbar discectomy, resulting in clinically documented neurological improvement during the immediate postoperative period. Chronic cortisol excess may disrupt spinal biomechanics and accelerate spinal degeneration through presumed bone demineralisation, muscle atrophy, altered fat distribution, and direct degradation of disc tissue. This case highlights the importance of early endocrine evaluation in patients with atypical or rapidly progressive spinal degeneration. Recognition and management of hypercortisolaemia are essential for surgical planning, optimising outcomes, and preventing recurrent spinal compromise.

Remote-access thyroidectomy has been developed to improve cosmetic outcomes while preserving surgical safety. With the introduction of single-arm robotic surgical systems, single-port robotic areolar approaches (SPRA) have been reported. However, previously described SPRA techniques still required an additional auxiliary port. We aimed to evaluate the feasibility of robotic thyroidectomy and parathyroidectomy performed through a single areolar incision without additional ports, termed the single areolar robotic approach (SARA). We retrospectively reviewed 3 patients who underwent robotic endocrine surgery using SARA, including 2 thyroidectomies and one parathyroidectomy.All procedures were successfully completed with single incision, and postoperative vocal cord function was preserved in all patients. Two patients developed immediate postoperative hypoparathyroidism; one recovered during follow-up, while the other required ongoing observation. This case series suggests that SARA may be a feasible and safe strategy for true single-incision robotic thyroidectomy and parathyroidectomy in selected patients.

Purpose: Persistent hypercalcemia after parathyroidectomy (PTx) remains a significant concern in patients with tertiary hyperparathyroidism (THPT) following kidney transplant (KT). Complete resection of hyperfunctioning glands is challenging due to ectopic or intrathyroidal glands. This study evaluated whether intraoperative parathyroid hormone (ioPTH) monitoring during PTx in KT patients with THPT reduces the surgical failure rate. Methods: We retrospectively analyzed 111 patients with THPT who underwent PTx at a single tertiary center. Patients were divided into 2 groups: those without ioPTH monitoring (n=98) and those with ioPTH monitoring (n=13). Surgical procedures included less than subtotal, subtotal, or total PTx with autotransplantation. Surgical failure was defined as persistent hypercalcemia (serum calcium ≥10.3 mg/dL and intact parathyroid hormone [PTH] >65 pg/mL) on postoperative day 1 (POD1) or at ≥6 months postoperatively. Results: The ioPTH group demonstrated a significantly lower mean PTH level on POD1 (21±15.3 pg/mL vs. 39±39 pg/mL; P=0.006). Although not statistically significant, the ioPTH group showed a higher biochemical cure rate at 3 months (53.8% vs. 30.6%) and no cases of persistent hyperparathyroidism, compared to 15.3% in the non-ioPTH group.Despite adequate intraoperative PTH reduction, some patients in both groups exhibited isolated PTH elevation without hypercalcemia. Conclusion Although ioPTH monitoring did not significantly reduce the surgical failure rate in PTx for THPT, the use of ioPTH may meaningfully improve surgical completeness and reduce the risk of persistent or recurrent hyperparathyroidism, suggesting its substantial potential value as an intraoperative.

Purpose: Papillary thyroid microcarcinoma (PTMC) is generally associated with an excellent prognosis. Despite this, lymph node metastases (LNM) are not uncommon which may influence decision making and clinical management. This study evaluates the rates of LNM in PTMC at our centre and explores clinicopathological variables associated with the presence of LNM. Methods: One hundred twenty-one cases of PTMC that were managed at a single centre from 2013 to 2024 were retrospectively analysed. Data on clinicopathological variables, including age, gender, multifocality, tumour size, extra-thyroidal extension and lymph node status, were collected. Lymph node dissection outcomes were categorized by central and lateral lymph nodes. Results: One hundred twenty-one PTMC patients were included in this study. Lymph Node dissection was performed for 57 patients and of those, 21 (37%) had LNM. Central LNM were found in 17/57 (30%) patients undergoing central lymph node dissection (CLND) and lateral LNM were identified in 10/11 (91%) patients undergoing lateral lymph node dissection.Multifocality (77.27% vs. 48.57%, P<0.05) and microscopic extrathyroidal extension (40.91% vs. 2.86%, P<0.0005) were associated with LNM. Patients with PTMC had lower rates of gross extrathyroidal extension (0% vs. 9.16%, P<0.001) and positive surgical margins (18.18% vs. 27.89%, P<0.05) compared to patients with macrocarcinoma. Conclusion LNM are not uncommon in PTMC, despite its indolent nature. Multifocality and extrathyroidal extension were found to be associated with LNM in PTMC patients. These findings suggest that prophylactic CLND should be considered in PTMC when these risk factors are present. Further studies are needed to refine PTMC management strategies.

With the advent of the new era of minimally invasive and precise surgeries, patients are not only pursuing the thoroughness of tumor removal but also increasingly demanding a better quality of life and mental health in the future. Thyroid malignancies are gradually becoming more common among younger individuals. Compared to the "suicidal" scars on the neck, the development of minimally invasive surgeries is an inevitable trend in the surgical treatment of thyroid malignancies. The robotic thyroid surgery system overcomes the limitations of laparoscopic surgery and occupies a dominant position in the development of minimally invasive surgery. This article discusses the current application of robotic technology in thyroid cancer, including surgical indications, suitable patient populations, surgical approaches, intraoperative auxiliary methods, and the prevention and treatment of surgical complications.

Objective:To investigate the efficacy of preoperative ultrasound-guided injection of carbon nanoparticle suspension in cervical lymph node dissection for thyroid cancer reoperation.Methods:Ninety-four patients undergoing reoperation for thyroid cancer admitted by the same physician team of the Department of Thyroid and Breast Surgery of the Ninety-sixty Hospital of the People’s Liberation Army (PLA) from Jan. 2019 to Sep. 2024 were retrospectively analyzed. According to the different scope of the initial surgery, they were divided into the re-specification clearance group, the regional lymph node clearance group, and the metastatic lymph node dissection group, and the groups were subdivided into the carbon nanoparticle group and the control group according to whether they were injected with carbon nanoparticle before the surgery or not. The t-test, χ2-test, and non-parametric test were used to compare the age, gender, surgical method, duration of surgery, total number of lymph nodes detected, and positive lymph node detection rate between the nano-charcoal group and the control group in the three groups. Results:There was no statistically significant difference between the three groups in terms of age, gender, surgical methods, or the total number of lymph nodes detected (all P>0.05) , and the difference between the surgical time of the carbon nanoparticle group in the re-regulation clearance group and the control group was not statistically significant ( P>0.05) ; the surgical time of the carbon nanoparticle group was shorter than that of the control group in both the regional lymph node clearance and the metastatic lymph node dissection groups, and the difference was statistically significant (all P<0.05) ; the positive detection rate of lymph nodes in the carbon nanoparticle group was higher than that in the control group among the three groups, and the difference was statistically significant (all P<0.05) . Conclusion:In the operation of cervical lymph node dissection for papillary thyroid cancer, preoperative ultrasound-guided injection of carbon nanoparticle can accurately localize the lymph nodes, increase the positive detection rate of lymph nodes, reduce the difficulty of surgical operation, and shorten the operation time.

Objective:To evaluate the relevant factors to optimize the learning curve and the impact of the basic skills of endoscopic technology on the learning curve of gasless transaxillary posterior endoscopic thyroidectomy.Methods:A retrospective analysis was performed to evaluate the clinical outcomes of 50 patients who underwent Glandular Ultrasound-Assisted (GUA) thyroid surgery by a surgeon with a background in endoscopic thyroid surgery via the thoracic-areolar approach, and 50 patients operated on by a surgeon without such experience at the Thyroid Surgery Department of Jilin University China-Japan Union Hospital from Apr. to Dec. 2023. The patients were divided into two groups: the Endoscopic Experience Group and the Non-Endoscopic Experience Group. The Cumulative Sum Control Chart (CUSUM) was applied to construct learning curves for both groups, dividing the technical exploration period from the mastery period. The analysis compared the surgical time, postoperative first-day drainage volume, number of central lymph nodes dissected rates, and postoperative complications between the two groups and across the two phases.Results:The analysis of the learning curve revealed that the inflection point of the Endoscopic Experience Group was 15, while of the Non-Endoscopic Experience Group was 18. The learning curve was divided into the technical exploration stage and the proficient mastery stage. The operative time of technical exploration stagde was significantly longer than of proficient mastery stage of both group (183.46±36.13min vs.144.40±26.14min, P<0.001; 186.89±48.91min vs.131.59±22.90min; P<0.001) . The operative time in the proficient mastery stage of the Endoscopic Experience Group was longer than that of the Non-Endoscopic Experience Group (144.40±26.15min vs. 131.59±22.90min, P<0.05) . The postoperative drainage volume in the Endoscopic Experience Group was lower than that in Non-Endoscopic Experience Group in both stages (65.40±32.48mL vs.93.22±30.67mL, 57.40±15.35mL vs.78.50±28.30mL, P<0.05) , and the postoperative drainage volume in the proficient mastery stage of the Non-Endoscopic Experience Group was significantly lower than in the technical exploration stage (93.22±30.67mL vs.78.50±28.30mL, P<0.05) .No significant differences in central lymph node dissection numbers or postoperative complications were observed between the groups at both stages. Conclusions:There is a specific learning curve in the early stage of gasless transaxillary posterior endoscopic thyroidectomy. After crossing the learning curve, the operation time is obviously shortened with the improvement of the operator's surgical technique.Having a basic understanding of endoscopic technology in the early stage can reduce the occurrence of postoperative drainage, but has a minimal impact on the learning curve.

Objective:To investigate whether the levels of 15 micronutrients could influence the risk of HER2-positive and negative breast cancer using Mendelian randomization (MR) .Methods:In this study, multivariate Mendelian randomization analysis was used to obtain the data of 15 micronutrients (copper, calcium, carotene, folate, iron, magnesium, potassium, selenium, zinc, vitamin A, vitamin B12, vitamin B6, vitamin C, vitamin D and vitamin E) and HER2 (+/-) breast cancer in the Genome-Wide Association Study (GWAS) database. Analyses were performed using R software and the TwoSampleMR package. This study used the inverse variance weighting (IVW) method as the main method to analyze the causal relationship between micronutrients and HER2 (+/-) breast cancer, combined with MR-Egger regression, weighted median (WM) , Simple mode, and Weighted mode as complementary methods. Heterogeneity and horizontal pleiotropy of our results were detected by the Cochran Q test, MR-Egger regression test, MR-PRESSO composite test, and MR Egger intercept to enhance the reliability and stability of the results. Reverse MR analysis was performed as HER2 (+/-) breast cancer exposure factors. The micronutrients screened by the MR above analysis were used as outcome variables for effect and sensitivity analyses. Multivariate Mendelian randomization analysis was performed on the relevant trace elements screened by MR to avoid interference between variables. The independent effects of trace elements were analyzed to improve the reliability of our results.Results:The results of MR analysis showed that micronutrient vitamin B6 was negatively associated with the risk of developing HER2-negative breast cancer (IVM: OR=0.69,95% CI:0.45-0.96, P=0.029) . The results of the Cochran Q test, MR-Egger regression test, MR-PRESSO composite test, and MR Egger intercept test showed that there was no heterogeneity and horizontal pleiotropy among the instrumental variables. At the same time, the analysis of leave-one-out test confirmed that a single SNP had no significant effect on the overall results, which further enhanced the reliability and stability of the results. Conclusions:Among the 15 micronutrients, our results suggested that vitamin B6 may be a protective factor for HER-negative breast cancer. Our study provided a reference for the pathogenesis of HER-negative breast cancer and its early prevention and treatment.

Objective:To explore the value of quantitative parameters of diffusion weighted imaging (DWI) combined with dynamic enhanced magnetic resonance imaging (DCE-MRI) in predicting the efficacy of neoadjuvant chemotherapy for locally advanced breast cancer (LABC) .Methods:A total of 97 patients with LABC admitted to the hospital from Mar. 2020 to Mar. 2023 were studied and received neoadjuvant chemotherapy to evaluate the therapeutic effect, and DWI and DCE-MRI scans were performed before and after treatment. The difference of DWI and DCE-MRI quantitative parameters before treatment in patients with different therapeutic effects was compared, and the correlation between the difference of DWI and DCE-MRI quantitative parameters and therapeutic effect was analyzed. The predictive value of quantitative parameters of DWI and DCE-MRI before treatment was analyzed. The quantitative parameters of DWI and DCE-MRI in patients with different pathological reactions were compared before treatment, and the quantitative parameters of DWI and DCE-MRI were compared before and after treatment.Results:The apparent diffusion coefficient (ADC) of patients with effective chemotherapy before treatment was higher, but transport constant (Ktrans) , extracellular space volume percentage (Ve) and rate constant (Kep) were lower ( t=5.0, 3.27, 3.55, 3.89, P < 0.05) ; Spearman correlation analysis showed that ADC was positively correlated with chemotherapy efficacy before treatment (r=0.66; P < 0.05) , while Kep, Ve, Ktrans were negatively correlated with it (r=-0.58, -0.47, -0.60; P < 0.05) ; ROC curves showed that the area under the curve (AUC) values of ADC, Kep, Ve and Ktrans in predicting chemotherapy efficacy before treatment were 0.771, 0.797, 0.664 and 0.715, respectively, while the combined AUC value of each indicator was 0.832; Compared with patients with non-significant pathological response, ADC before treatment was higher in patients with significant pathological response, Kep, Ve and Ktrans were lower ( t=4.46, 3.32, 3.60, 3.95, P < 0.05) ; Compared with before treatment, ADC value increased after treatment, while Kep, Ve and Ktrans decreased ( t=8.77, 6.22, 9.34, 10.26, P < 0.05) . Conclusion:Quantitative parameters of DWI and DCE-MRI can reflect the changes in the condition of patients with locally advanced neoadjuvant chemotherapy, and the combination of the two can help to improve the predictive value of chemotherapy efficacy in patients.

Objective:To explore the diagnostic value of combining Ki67, molecular subtyping, and ultrasonographic parameters in predicting axillary lymph node metastasis in breast cancer.Methods:200 breast cancer patients who were admitted to Meizhou People’s Hospital from Jan. 2020 to Dec. 2022 were collected. Based on the presence or absence of axillary lymph node metastasis in breast cancer, the patients were divided into an axillary lymph node metastasis group and a non-axillary lymph node metastasis group. Age, clinical stage, tumor location, tumor size, degree of differentiation, boundary, blood flow, echo, calcification, morphology, vascular invasion, Ki67, molecular typing, resistance index (RI) , shear wave velocity were collected. Multivariate Logistic regression analysis was used to screen the risk factors for axillary lymph node metastasis of breast cancer, and receiver operating characteristic curve (ROC) was used to evaluate the clinical value of ki67, molecular typing combined with ultrasound parameters in the diagnosis of axillary lymph node metastasis of breast cancer.Results:There were no statistically significant differences in age, clinical stage, tumor location, tumor size, differentiation degree, boundary, blood flow, echo or calcification between the axillary lymph node metastasis group and the non-axillary lymph node metastasis group ( t=0.80, χ20.13, χ2=0.14, χ2=0.90, χ2=0.64, χ2=1.03, χ2=0.04, χ2=0.34, χ2=1.2, P>0.05) , while there were statistically significant differences in morphology, vascular invasion, Ki67, molecular classification, RI and shear wave velocity between the two groups ( χ2=12.01, χ2=8.75, χ2=11.36, χ2=11.43, t=6.34, t=7.25, P<0.05) . Multivariate Logistic regression analysis showed that vascular invasion, Ki67 high expression, triple negative breast cancer, RI and shear wave velocity were all risk factors for axillary lymph node metastasis ( OR=5.572,4.026,3.632,107.639,1.936, P<0.05) . ROC curve analysis results showed that the AUC of Ki67, molecular typing, RI and shear wave velocity in the diagnosis of axillary lymph node metastasis of breast cancer was 0.620, 0.594, 0.744 and 0.792, respectively, and the AUC of Ki67, molecular typing, RI and shear wave velocity in the diagnosis of axillary lymph node metastasis of breast cancer was 0.846. The AUC of the combination of Ki67, molecular typing, RI and shear wave velocity in the diagnosis of axillary lymph node metastasis of breast cancer was higher than that of Ki67, molecular typing, RI and shear wave velocity alone ( Z=5.55,7.10,3.44,2.45, P<0.05) . Conclusions:High Ki67 expression, triple-negative breast cancer, lymphovascular invasion,RI, and shear wave velocity are all risk factors for axillary lymph node metastasis in breast cancer. The combined use of Ki67, molecular subtype, RI, and shear wave velocity can improve the diagnostic accuracy for axillary lymph node metastasis in breast cancer.