Background and Aims:The incidence of papillary thyroid carcinoma (PTC) has shown a significant upward trend. Given its favorable prognosis,there is a growing trend toward de-escalating its treatment to improve patients' quality of life. Pathologists have renamed the encapsulated follicular variant of PTC with indolent biological behavior as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP),providing a theoretical basis for treatment de-escalation. However,challenges persist in the clinical pathological diagnosis of NIFTP,and it is still predominantly managed as classical PTC in most cases. This study was performed to explore the clinicopathologic diagnostic characteristics,surgical challenges,and prospects for de-escalation treatment of NIFTP.Methods:The clinical data of 33 patients with thyroid disease who were admitted to Xuanwu Hospital Capital Medical University from November 2017 to December 2022 and confirmed as NIFTP by final paraffin pathology were retrospectively analyzed. Results:Among the 33 NIFTP patients,there were 11 males and 22 females,with an average age of 50 years. Tumor sizes ranged from 0.6 to 7.5 cm. There were 31 cases of solitary NIFTP tumor and 2 cases of multifocal tumors (each involving 2 sites). Eleven patients had coexisting PTC (one lesion in each case),with 4 lesions located on the same side as the NIFTP and 7 on the opposite side. All patients underwent surgical treatment,including 27 cases of conventional open surgery and 6 cases of endoscopic surgery. Suspicious or potentially malignant lesions were treated according to PTC surgical principles (lobectomy of the affected side plus central compartment lymph node dissection on the same side). Preoperative ultrasonography revealed that the nodules were predominantly hypoechoic,relatively regular in shape,well-defined,often accompanied by calcifications,and had a longitudinal-to-transverse diameter ratio of<1. TI-RADS classifications were as follows:5 cases as grade 3,9 cases as grade 4a,and 11 cases as grade 4b or higher. Among 29 patients who underwent preoperative fine-needle aspiration,1 case was diagnosed as atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS),12 as follicular neoplasm/suspicious for follicular neoplasm (FN/SFN),12 as suspicious for malignancy (SUS),and 4 as PTC. BRAFV600E mutation testing was performed postoperatively in 25 cases,and 7 mutations were detected,all in cases with concomitant PTC.Conclusion:The introduction of the NIFTP concept provides a foundation for de-escalation or individualized treatment of certain less aggressive thyroid tumors. However,the preoperative and intraoperative diagnosis of NIFTP remains challenging in clinical practice. More precise preoperative diagnostic criteria and methods are needed to enable surgeons to adjust treatment decisions accordingly.

Background and Aims:The incidence of papillary thyroid carcinoma (PTC) has shown a significant upward trend. Given its favorable prognosis,there is a growing trend toward de-escalating its treatment to improve patients' quality of life. Pathologists have renamed the encapsulated follicular variant of PTC with indolent biological behavior as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP),providing a theoretical basis for treatment de-escalation. However,challenges persist in the clinical pathological diagnosis of NIFTP,and it is still predominantly managed as classical PTC in most cases. This study was performed to explore the clinicopathologic diagnostic characteristics,surgical challenges,and prospects for de-escalation treatment of NIFTP.Methods:The clinical data of 33 patients with thyroid disease who were admitted to Xuanwu Hospital Capital Medical University from November 2017 to December 2022 and confirmed as NIFTP by final paraffin pathology were retrospectively analyzed. Results:Among the 33 NIFTP patients,there were 11 males and 22 females,with an average age of 50 years. Tumor sizes ranged from 0.6 to 7.5 cm. There were 31 cases of solitary NIFTP tumor and 2 cases of multifocal tumors (each involving 2 sites). Eleven patients had coexisting PTC (one lesion in each case),with 4 lesions located on the same side as the NIFTP and 7 on the opposite side. All patients underwent surgical treatment,including 27 cases of conventional open surgery and 6 cases of endoscopic surgery. Suspicious or potentially malignant lesions were treated according to PTC surgical principles (lobectomy of the affected side plus central compartment lymph node dissection on the same side). Preoperative ultrasonography revealed that the nodules were predominantly hypoechoic,relatively regular in shape,well-defined,often accompanied by calcifications,and had a longitudinal-to-transverse diameter ratio of<1. TI-RADS classifications were as follows:5 cases as grade 3,9 cases as grade 4a,and 11 cases as grade 4b or higher. Among 29 patients who underwent preoperative fine-needle aspiration,1 case was diagnosed as atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS),12 as follicular neoplasm/suspicious for follicular neoplasm (FN/SFN),12 as suspicious for malignancy (SUS),and 4 as PTC. BRAFV600E mutation testing was performed postoperatively in 25 cases,and 7 mutations were detected,all in cases with concomitant PTC.Conclusion:The introduction of the NIFTP concept provides a foundation for de-escalation or individualized treatment of certain less aggressive thyroid tumors. However,the preoperative and intraoperative diagnosis of NIFTP remains challenging in clinical practice. More precise preoperative diagnostic criteria and methods are needed to enable surgeons to adjust treatment decisions accordingly.

Objective:To explore the efficacy and safety of domestic RECO flow restoration device in acute intracranial large-vessel occlusion (LVO).Methods:This study was a multicenter, prospective, randomized, open, controlled trial; 136 patients with acute intracranial LVO at 7 Chinese stroke centers from February 2014 to August 2016 were randomly assigned into an experimental group (thrombectomy by RECO device, n=67) and a control group (thrombectomy by Solitaire device, n=69). The efficacy and safety of patients from the two groups were compared and analyzed. The primary efficacy end point was set as achievement of good recanalization (modified thrombolysis in cerebral infarction [mTICI] grading≥2); the secondary efficacy end points included good prognosis (modified Rankin scale scores≤2 90 d after thrombectomy), time from puncture to achieving good recanalization/time from puncture to final angiogram on condition that good recanalization was not gained, or mortality within 90 d of thrombectomy. The safety end points included any device-related serious adverse events, symptomatic intracerebral hemorrhage or serious adverse events within 24 of thrombectomy. Results:There was no statistically significant difference between the experimental group and the control group in successful rate of good recanalization (91.0% vs. 86.9%), good prognosis rate (62.7% vs. 46.4%), time from puncture to achieving good recanalization/time from puncture to final angiogram on condition that good recanalization was not gained([85.4±47.0] min vs. [89.9±53.3] min), and mortality within 90 d of thrombectomy (13.4% vs. 23.2%, P>0.05). There were no device-related serious adverse events in all patients. No significant differences were found in the incidences of symptomatic intracranial hemorrhage (1.5% vs. 7.4%) or serious adverse events (death [1.5% vs. 1.4%] and brain hernia [4.5% vs. 0.0%]) between the two groups ( P>0.05). Conclusion:The domestic RECO flow restoration device is an effective and safe mechanical thrombectomy stent retriver for acute intracranial LVO.

Aim To investigate the protective effects of MLT(melatonin) on acute ischemia-reperfusion induced myocardium damage in rats in vivo. Methods 36 anesthetized rats were separated randomly into 3 groups: ① Control group (n=12), without LAD (left anterior descending coronary artery) ligation and MLT; ② I/R(ischemia reperfusion) group(n=12), LAD was ligated for 10 min and reperfused for 15 min without MLT; ③ I/R+MLT group(n=12): MLT(10 mg?kg~(-1)) was in jected via peritonium 10 minutes before LAD ligation and reperfusion. ECG and haemodynamics were continuously monitored and recorded throughout the whole process, MDA(malondialdehyde, lipid peroxidation product, an index of myocardium damage) and SOD( superoxide dismutase ) activity were tested in the injuried myocardium. The hearts tissue of each group was also examinated by electron microscopy.Result The levels of MDA were significantly higher while the SOD activities were lower in I/R group compared with I/R+MLT and control group(P0.05). The haemodynamics indices of contractile and diastolic functions were also better in I/R+MLT group than inI/R group(P

AIM: The aim of this study was to investigate the possibility of establishing a chronic atrial fibrillation model with long-term rapid atrial stimulation ( 1 000 bpm), which was performed in rabbits in vivo. METHODS: 20 rabbits were randomly divided into 2 groups: 1) control group (n=10): pacemaker was implanted but no pacing; 2) experimental group (n=10): a left intercostal thoracotomy was performed and the pericardium was opened to expose the heart and a steel-wire pacing electrode was fixed on the epicardium of the left atria in 10 rabbits. Then the rapid pulse generator was implanted subcutaneously in the left abdominal region and rapid atrial pacing ( 1 000 beats/min) was initiated and continued for 30 days. Electrocardiogram (ECG) was monitored and recorded on day 1, 3, 5, 7, 14, 21 and 30. The atrial effective refractory period (AERP) was measured before pacing and at the time of fibrillation. RESULTS: On day 14, atrial fibrillation was developed in 8 rabbits (80%) and sustained at least till to day 30 (P