Standardised emergency management protocols for hand injury in microsurgery is critical, as it directly determines ultimate clinical outcomes. This consensus consolidates expert insights regarding diagnostic and treatment procedure for hand injury in microsurgery, emergency support protocols and key points of emergency workflow optimisation. It summarises the opinions of experts and puts forward standardised recommendations to guide clinical practice in microsurgical treatment process, so as to further improve the quality of treatment for hand injury in microsurgery and maximise the protection of limb function and quality of life of patients.

With continuous advancements in minimally invasive techniques and precision oncology, gastric cancer surgery is rapidly transitioning from traditional open approaches to minimally invasive and intelligent treatment paradigms. Robust clinical evidence, including trials such as CLASS-01 and KLASS-02, confirms the safety and long-term efficacy equivalence of minimally invasive surgery for locally advanced distal gastric cancer. The integration of robotic-assisted surgery with artificial intelligence in preoperative assessment, intraoperative navigation, and postoperative management drives the field toward greater precision and intelligence. Future developments in intelligent surgical operating systems that enables human-machine collaboration and automatic performance are expected to enhance treatment quality and patient outcomes. Concurrently, emphasis on technical standardization, ethical considerations, and legal frameworks is essential to ensure the safe and sustainable advancement of intelligent minimally invasive surgery.

Objective:To explore the surgical methods and treatment outcomes of nasal endoscopic surgery for nasal deformity secondary to unilateral cleft lip and palate, combined with nasal septal deviation, using nasal septal cartilage and bone.Methods:Eleven patients who underwent surgical treatment for unilateral cleft lip and palate secondary to nasal deformity in the Department of Otorhinolaryngology, Head and Neck Surgery, Linyi People′s Hospital, Shandong Second Medical University, from March 2021 to March 2023, were retrospectively analyzed. The cohort included 8 males and 3 females, aged (22.0±8.4) years (range: 17 to 35 years). Preoperatively, all of them underwent CT scanning and three-dimensional reconstruction of the nasal bones and sinuses to evaluate the size of the nasal septal cartilage and the design of the material to be taken, and to assess the degree of nasal deformity. During the operation, an open “V”-shaped incision was made through the nasal columella, and part of the septal bone and cartilage were removed under direct nasal endoscopic visualization. The septal cartilage and bony structures were used to correct the nasal deformity, and a nasal brace was used as an intraoperative support for the reconstruction of the nasal cartilage, which was then worn for 1 month after the operation to maintain a stable nasal shape. A visual analog scale (VAS) was used before and after surgery to assess the patient′s satisfaction with the nasal shape and the degree of nasal ventilation. Corresponding data on both sides of the external nose were measured, including nasal tip height, nostril height, nostril width, nasal base width, and nasal columella inclination, to assess the symmetry of the external nose objectively. SPSS 22.0 software was used for statistical analysis to evaluate the surgical results.Results:The surgical incisions of all 11 patients healed at stage Ⅰ. At 6-24 months of postoperative follow-up, nasal symmetry was restored, and the nostrils were equal in size. The difference in symmetry indexes before and after the surgery was statistically significant. The t value for nasal tip height, the nostril height, the nostril width, the nasal base width, and the nasal columellar inclination were 4.21, 2.26, 3.38, 3.65, and 2.36, respectively (all P<0.05). Postoperative incision scarring was not obvious, and patients were satisfied with the nasal appearance [VAS score (9.14±0.48) points vs (3.45±1.23) points, t=14.29, P<0.001], and nasal ventilation was significantly improved [VAS score (9.32±1.24) points vs (4.61±0.85) points, t=10.39, P<0.001]. Conclusion:Nasal endoscopic surgery using septal cartilage and bone to treat nasal deformity secondary to unilateral cleft lip and palate, combined with deviated septum, can simultaneously improve the patients′ nasal shape and nasal ventilation, yielding good clinical outcomes.

Objective:To investigate and analyze the surgical method and therapeutic effect of removing benign masses between the nasal radix and eyebrow via a V-shaped cosmetic incision approach through the columella with the assistance of nasal endoscopy.Methods:The data of patients who underwent surgical treatment from May 2020 to August 2023 at the Department of Otorhinolaryngology, Head and Neck Surgery, Linyi People’s Hospital were retrospectively analyzed, because of a mass involving the radix of the nose and the interbrow area. Preoperative CT examination of the nose was performed to clarify the nature, size, and level of the mass, and a V-shaped incision was made in the middle and lower third of the nasal columella, with subcutaneous tunnels along the dorsal median line of the nose, and the mass was excised with the aid of nasal endoscopy. Postoperative follow-up was performed for recurrence of swelling, diplopia, ocular dyskinesia, frontal-facial numbness, and recovery of the operative area; patients were evaluated by visual analogue scoring (VAS) to assess satisfaction with the appearance of the incorporeal scar (0~10 points, higher scores indicate higher satisfaction).Results:A total of 4 patients were included, with an average age of 18.5 years (15-21 years). All 4 patients had complete resection of the tumor through the columellar V-shaped incision approach, and the surgical incisions were all healed by primary intention. Postoperative pathology suggested epidermoid cysts in 1 case, lipoma in 1 case, sebaceous cysts in 1 case, and osteomas in 1 case. Postoperative follow-up ranged from 6 to 24 months, with an average follow-up of 12 months, with no recurrence of the mass, no depression at the radix of the nose and between the eyebrows, and no noticeable scar at the columella. The patients were satisfied with the appearance of the incision scar with a VAS score of 10 points.Conclusion:Nasal endoscopic transnasal columella approach to excision of benign tumors at the root of the nose and between the eyebrows has the advantages of small skin incision and hidden scarring, and has good treatment effect.

Objective To investigate the function of glymphatic system in patients with mild traumatic brain injury via diffusion tensor imaging analysis along the perivascular space(DTI-ALPS)index and its relationship with clinical features.Methods The clinical and imaging data from 163 patients with mild traumatic brain injury were retrospectively collected,including 31 cases with MRI-negative findings and 132 cases with MRI-positive findings.In addition,29 healthy individuals underwent physical examinations were included as a control group.The differences in DTI-ALPS index and clinical features between mild traumatic brain injury and control group,as well as among subgroups of traumatic brain injury were analyzed.Results The DTI-ALPS index in patients with mild traumatic brain injury were significantly higher than those in control group(P＜0.05).Subgroup analysis showed that DTI-ALPS index of traumatic brain injury patients with MRI-negative findings and MRI-positive findings were all significantly higher than those of control group(P=0.023 and 0.004,respectively).Compared to control group,DTI-ALPS index in mild traumatic brain injury patients gradually increased with the progression of injury,and the difference was statistically significant(P=0.008).Conclusion Patients with mild traumatic brain injury exhibit increased functional activity of glymphatic system,as indicated by increased DTI-ALPS index,which further increase with the progression of injury.

Objective:To explore the causal relationship between 1 400 blood metabolites and hyperthyroidism or hypothyroidism by using Mendelian randomization(MR) approach.Methods:This study employed a bi-directional Mendelian randomization analysis and sourced data of blood metabolites related to hyperthyroidism and hypothyroidism from the genome-wide association study(GWAS) database. R software and TwoSampleMR software package were used for analysis. The inverse variance weighting method(IVW) was used as the main method, and MR-Egger regression, weighted median method, simple mode and weighted mode were used as supplementary methods to analyze the causal relationship between blood metabolites and hyperthyroidism and hypothyroidism. The false-positive rate was corrected by false discovery rate(FDR, FDR<0.2) to control for false positives; Meta-analysis of different sample pools was performed for overall assessment. Results:The analysis found three blood metabolites significantly linked to hypothyroidism: pregnenediol disulfate(IVW: OR=1.068, 95% CI 1.032-1.106, P<0.001), 1-(1-enyl-palmitoyl)-2-linoleoyl-GPE(IVW: OR=0.891, 95% CI 0.840-0.944, P<0.001), and linoleic-arachidonic glycerin(IVW: OR =0.923, 95% CI 0.885-0.963, P<0.001). Glutamine was also noted(IVW: OR=0.998, 95% CI 0.997-0.999, P<0.001). Reverse MR showed no significant correlation between hyperthyroidism and the four metabolites(IVW: P>0.05). Validation from FinnGen Biospecimen Library and UKB Biospecimen Library confirmed these findings. Conclusions:Among 1 400 blood metabolites, pregnenediol disulfate showed a positive correlation with hypothyroidism. In contrast, 1-(1-enyl-palmitoyl)-2-linoleoyl-GPE and linoleic-arachidonic glycerin exhibited negative correlations with hypothyroidism, while glutamine showed a negative correlation with hyperthyroidism. This study offers insights into the pathogenesis, early screening, and treatment of hyperthyroidism and hypothyroidism.

Objective To investigate the function of glymphatic system in patients with mild traumatic brain injury via diffusion tensor imaging analysis along the perivascular space(DTI-ALPS)index and its relationship with clinical features.Methods The clinical and imaging data from 163 patients with mild traumatic brain injury were retrospectively collected,including 31 cases with MRI-negative findings and 132 cases with MRI-positive findings.In addition,29 healthy individuals underwent physical examinations were included as a control group.The differences in DTI-ALPS index and clinical features between mild traumatic brain injury and control group,as well as among subgroups of traumatic brain injury were analyzed.Results The DTI-ALPS index in patients with mild traumatic brain injury were significantly higher than those in control group(P＜0.05).Subgroup analysis showed that DTI-ALPS index of traumatic brain injury patients with MRI-negative findings and MRI-positive findings were all significantly higher than those of control group(P=0.023 and 0.004,respectively).Compared to control group,DTI-ALPS index in mild traumatic brain injury patients gradually increased with the progression of injury,and the difference was statistically significant(P=0.008).Conclusion Patients with mild traumatic brain injury exhibit increased functional activity of glymphatic system,as indicated by increased DTI-ALPS index,which further increase with the progression of injury.

Objective:To explore the causal relationship between 1 400 blood metabolites and hyperthyroidism or hypothyroidism by using Mendelian randomization(MR) approach.Methods:This study employed a bi-directional Mendelian randomization analysis and sourced data of blood metabolites related to hyperthyroidism and hypothyroidism from the genome-wide association study(GWAS) database. R software and TwoSampleMR software package were used for analysis. The inverse variance weighting method(IVW) was used as the main method, and MR-Egger regression, weighted median method, simple mode and weighted mode were used as supplementary methods to analyze the causal relationship between blood metabolites and hyperthyroidism and hypothyroidism. The false-positive rate was corrected by false discovery rate(FDR, FDR<0.2) to control for false positives; Meta-analysis of different sample pools was performed for overall assessment. Results:The analysis found three blood metabolites significantly linked to hypothyroidism: pregnenediol disulfate(IVW: OR=1.068, 95% CI 1.032-1.106, P<0.001), 1-(1-enyl-palmitoyl)-2-linoleoyl-GPE(IVW: OR=0.891, 95% CI 0.840-0.944, P<0.001), and linoleic-arachidonic glycerin(IVW: OR =0.923, 95% CI 0.885-0.963, P<0.001). Glutamine was also noted(IVW: OR=0.998, 95% CI 0.997-0.999, P<0.001). Reverse MR showed no significant correlation between hyperthyroidism and the four metabolites(IVW: P>0.05). Validation from FinnGen Biospecimen Library and UKB Biospecimen Library confirmed these findings. Conclusions:Among 1 400 blood metabolites, pregnenediol disulfate showed a positive correlation with hypothyroidism. In contrast, 1-(1-enyl-palmitoyl)-2-linoleoyl-GPE and linoleic-arachidonic glycerin exhibited negative correlations with hypothyroidism, while glutamine showed a negative correlation with hyperthyroidism. This study offers insights into the pathogenesis, early screening, and treatment of hyperthyroidism and hypothyroidism.

Standardised emergency management protocols for hand injury in microsurgery is critical, as it directly determines ultimate clinical outcomes. This consensus consolidates expert insights regarding diagnostic and treatment procedure for hand injury in microsurgery, emergency support protocols and key points of emergency workflow optimisation. It summarises the opinions of experts and puts forward standardised recommendations to guide clinical practice in microsurgical treatment process, so as to further improve the quality of treatment for hand injury in microsurgery and maximise the protection of limb function and quality of life of patients.

With continuous advancements in minimally invasive techniques and precision oncology, gastric cancer surgery is rapidly transitioning from traditional open approaches to minimally invasive and intelligent treatment paradigms. Robust clinical evidence, including trials such as CLASS-01 and KLASS-02, confirms the safety and long-term efficacy equivalence of minimally invasive surgery for locally advanced distal gastric cancer. The integration of robotic-assisted surgery with artificial intelligence in preoperative assessment, intraoperative navigation, and postoperative management drives the field toward greater precision and intelligence. Future developments in intelligent surgical operating systems that enables human-machine collaboration and automatic performance are expected to enhance treatment quality and patient outcomes. Concurrently, emphasis on technical standardization, ethical considerations, and legal frameworks is essential to ensure the safe and sustainable advancement of intelligent minimally invasive surgery.