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.

Objective:The aim of this study is to analyse the clinical characteristics of Special clinical types of lung cancer nodules with "small tumors and big metastases" .Methods:From Jan. 2019 to Nov. 2024, patients with stage T1 solid lung cancer who were pathologically confirmed in the First Affiliated Hospital of Chongqing Medical University were prospectively collected and divided into lung cancer nodule with metastasis group (study group) and stage Ia lung cancer group (control group). The differences in clinical, imaging, pathological and molecular features between the two groups were compared, and the differences in the distribution of metastases in the study group and in patients with or without bone metastasis were analyzed.Results:A total of 827 patients with an average age of 62.65±11.01 years were included, including 425 in the study group and 402 in the control group. The proportion of males, number of smokers, nodule size and EGFR mutation rate in the study group were significantly higher than those in the control group (all P<0.05). Stage IV patients accounted for 63.76% in the study group, among which bone metastasis patients accounted for the highest proportion (51.66%), and alkaline phosphatase, calcium and phosphorus were significantly increased. Conclusions:Patients with smoking, male and solid lung cancer nodules are more likely to have "small tumor and large metastasis", and bone metastasis is the most common distant metastatic site. The increase of alkaline phosphatase, calcium and phosphorus is helpful for early identification of bone metastases.

Objective:To explore the value of material separation technique based on energy spectrum CT in predicting the recurrence of osteoporotic vertebral fractures after operation, in order to provide reference for the evaluation of postoperative recurrence of fractures.Methods:A total of 80 cases with percutaneous vertebroplasty (PVP) treated in the First People’s Hospital of Shangqiu, Henan Province from Jan. 2020 to Dec. 2021 were selected for pre-operative CT material separation examination and postoperative follow-up for at least 2 years. The patients were divided into recurrence group and no recurrence group according to the recurrence of fracture. The clinical data and the results of material separation technique by energy spectrum CT were compared. The relevant factors for fracture recurrence was assessed by Logistic regression analysis, and ROC curve was used to evaluate the predictive value of material separation technique based on energy spectrum CT in the recurrence of fracture.Results:After a follow-up of at least 2 years, 26 of the 80 patients had a recurrence of the fracture. The age, calcium water and hydroxyapatite (HAP) -water values in recurrent group were higher than those in no recurrent group, and the proportion of bone cement leakage was higher ( t/ Fisher=2.57, 5.40, 3.96, - P = 0.012 < 0.001, < 0.001, 0.033) . Logistic regression analysis showed that calcium-water ( OR=2.321, 95%CI: 1.464-3.679) and HAP-water ( OR=1.784, 95%CI: 1.246-2.554) values were the factors for postoperative fracture recurrence in osteoporotic fractures ( P<0.001) . ROC curve showed that AUC, sensitivity and specificity of combined calcium-water and HAP-water values in predicting postoperative fracture recurrence were 0.868, 88.46% and 79.63%, respectively ( P<0.001) . Conclusions:The material separation technique based on energy spectrum CT in predicting the recurrence of osteoporotic vertebral fractures after operation has high clinical application value, and provides a new idea for the clinical evaluation of postoperative recurrence of fractures.

Iodine is an indispensable trace element in the human body and its intake level is closely related to thyroid function. Iodine deficiency or iodine excess will lead to iodine-related diseases. The implementation of the universal salt iodization policy of China has achieved remarkable results, yet it is still facing the problems of iodine deficiency and iodine excess at present. Since iodine in the human body is mainly metabolized by the kidneys and excreted in urine, urinary iodine test has become an effective way to reflect the recent iodine nutrition status of the body. This article will discuss the current iodine nutrition status of the population in China, the hazards of iodine deficiency and iodine excess, as well as the clinical application of urinary iodine test.

Objective:To investigate the clinical value of dynamic AI ultrasonic intelligent assisted diagnosis system for preoperative evaluation of thyroid nodules with diameter ≤1.0 cm.Methods:From Apr. 1, 2023, to Dec. 30, 2023, 742 thyroid nodules with diameter ≤1.0 cm were removed from 532 patients with thyroid nodule disease who received surgical treatment in the Department of Thyroid (hernia) of the First Medical Center of the Chinese People’s Liberation Army General Hospital. Among them, 423 were d≤0.5 cm. 319 cases (235 males and 507 females) with 0.5

Objective:To compare the benefits and prognostic risks of unilateral lobectomy (with or without isthmusectomy) or total (or near-total) thyroidectomy for primary foci of unilateral papillary thyroid cancer (PTC) patients with ipsilateral lateral cervical lymph node metastasis (LLNM) , so as to find out the optimal surgery for these patients.Methods:A total of 505 unilateral PTC patients with ipsilateral LLNM who underwent initial surgical treatment at the Thyroid Surgery Department of Zhejiang Cancer Hospital from Feb. 2012 to Jan. 2020 were retrospectively reviewed. The patients were divided into unilateral lobectomy group ( n=314) and total thyroidectomy group ( n=191) according to the extent of resection of primary foci. Then 177 pairs of cases were screened out after eliminating the potential confounding bias between the two groups by using propensity score matching (PSM) , analyzing the differences in clinical outcomes such as recurrence-free survival (RFS) , overall survival (OS) , hospitalization costs, and postoperative complications between the two groups. Results:After PSM, the postoperative complication rate was 37.3% ( n=66) in the total thyroidectomy group and 3.4% ( n=6) in the unilateral lobectomy group. The complication was mainly characterized by temporary hypoparathyroidism (HP) . Although the difference in length of hospitalization between the two groups was not statistically significant ( P=0.792) , patients in the unilateral lobectomy group used less surgical time ( P<0.001) , had lower hospitalization and surgical costs ( P<0.0001) , and took a relatively smaller dose of levothyroxine (L-T4) one month after the operation ( P<0.0001) , as compared with the total thyroidectomy group. Univariate analysis showed that the number of LLNM total lymph node metastasis (LNM) rate, LLNM rate, and T stage were significant risk factors for relapse. Multi-factor regression analysis indicated that T-staging was a risk factor for recurrence. After a median follow-up of 60 (3-138) months, 19 patients (10.7%) in the unilateral lobectomy group and 11 patients (6.2%) in the total thyroidectomy group recurred, with no statistical difference between the two groups ( P=0.133) . The OS curve displayed no significant difference between the unilateral lobectomy and total thyroidectomy groups ( P=0.740) . Conclusion:For unilateral PTC patients with ipsilateral LLNM without other high-risk features, unilateral lobectomy could be a better option.

Objective:To investigate the expression of transcription factor Zinc finger and BTB domain-containing 4 (ZBTB4) in papillary thyroid carcinoma and its relationship with the clinicopathological features of the tumor.Methods:Immunohistochemistry (IHC) was used to assess ZBTB4 protein of cancerous tissues and paired-normal tissues extracted from surgical samples of 60 patients with papillary thyroid carcinoma (30 classical and 30 with Hashimoto’s thyroiditis) . Fresh tissue samples were collected from above patients, and the expression of ZBTB4 gene mRNA and ZBTB4 protein in cancerous tissues was detected by qRT-PCR and Western blot methods. SPSS statistical software was used to analyze the relationship between the expression level of this gene in tumor tissues, clinicopathological features and tumor prognosis.Results:Immunohistochemical results showed that the expression of ZBTB4 protein in papillary thyroid carcinoma tissues was significantly higher than that in normal thyroid tissues (25.0% vs. 3.3%, P=0.001) . The results of qRT-PCR showed that the expression of ZBTB4 gene mRNA in tumor tissues was significantly higher than that in normal thyroid tissues ( P<0.001) . There was no significant difference in the expression level of ZBTB4 between patients with classical papillary carcinoma and those with Hashimoto’s thyroiditis. Multivariate analysis showed that the patients with higher expression of ZBTB4 had relatively smaller tumor diameter ( t=2.31, P=0.025) and less lateral cervical lymph node metastasis ( t=4.13, P=0.042) . Conclusions:Patients with higher ZBTB4 expression level have better outcome, as reflected in smaller tumor diameter and lower rates of lateral cervical lymph node metastasis. The molecular mechanism of ZBTB4 gene in papillary thyroid carcinoma needs further study.