Objective To develop and compare prediction models for hyperuricemia(HUA)in perim-enopausal and postmenopausal women using Lasso regression,random forest,and multivariate logistic regres-sion.Methods A multi-stage,stratified cluster sampling method was used to select 12 790 subjects from An-ning City,Yunnan Province.Prediction models for HUA were constructed using Lasso regression,random for-est,and multivariate logistic regression.The efficacy of the model was evaluated by accuracy,sensitivity,speci-ficity,F1 score,and area under the curve(AUC).Results LASSO regression analysis screened 19 variables for inclusion in the model,such as age,waist circumference,diastolic blood pressure,BMI,HDL-C,fasting blood glucose(FBG),etc.The accuracy rate was 0.701,the sensitivity was 0.703,the specificity was 0.680,and the F1 score was 0.806.The AUC(95%CI)was 0.770(0.748-0.792).The results of the random forest model show that variables such as creatinine,triglyceride-glucose index(TyG),TG,BMI,TC,Urea nitrogen(Urea),and ALT were relatively important,with an accuracy rate of 0.663,a sensitivity of 0.653,a specificity of 0.738,and an F1 score of 0.774.The AUC(95%CI)was 0.763(0.741-0.785).Multivariate logistic re-gression results showed that 11 variables including creatinine(Cr),TyG,BMI,Urea,and ALT were included in the model,with an accuracy rate of 0.705,a sensitivity of 0.707,a specificity of 0.686,an F1 score of 0.809,and an AUC(95%CI)of 0.771(0.749-0.793).Conclusion The overall performance of LASSO re-gression and multivariate logistic regression models is better.The random forest model has a strong variable screening ability and high specificity,and can be used as a supplement to provide more accurate predictions.

Objective:To discuss the long-term survival and risk factors of thyroid cancer in the real world in China.Methods:The clinical data of thyroid cancer patients who underwent initial surgery from Apr. 1998 to Dec. 2018 were retrospectively analyzed, including patients’sex, age, surgical records, pathology, hospitalization records and follow-up. According to the prognosis, the patients were divided into disease-free survival group and recurrence/metastasis/death group. Univariate analysis and multivariate regression analysis were conducted to analyze the risk factors affecting the prognosis of thyroid cancer. The clinical features and prognostic risk factors of thyroid cancer patients were investigated.Results:A total of 2038 cases were collected, and the longest follow-up time was more than 20 years. A total of 1876 cases were included in the study, 162 cases were lost, and the rate of follow-up was 7.9%. Among them, 1858 survived, the overall survival rate was 99.04%; 18 died, and the overall mortality rate was 0.96%. According to the prognosis of thyroid cancer, the patients were divided into 2 groups, including 1808 cases in the disease-free survival group and 68 cases in the relapsed-metastatic-death group. The study found that there were statistical differences between the two groups in terms of patients’age [ (45.40±11.016) vs (51.53±15.199, P=0.000) , the male ratio (32.854%, 48.529%, P=0.001) , whether tumor breaks through capsule (20.077%, 33.823%, P=0.006) , central lymph node metastasis (48.834%, 70.588%, P=0.001) and lateral lymph node metastasis (31.084%, 55.882%, P=0.000) , and there was no difference between the number of tumor lesions. Conclusion:Thyroid cancer has a good prognosis, but according to the characteristics of patients with thyroid cancer in my country, it should still be treated early in the clinic, and the standardization and thoroughness of surgery should be adhered to during the treatment.

Nanogenerator (triboelectric nanogenerator and piezoelectric nanogenerator) has experienced a rapid development since it was proposed. This technique can covert various mechanical energies into electric energy, including human motion energy, wind energy, acoustic energy and ocean energy. The converted electricity can be used for health monitoring and physiological function regulation, such as pulse detection, bioelectrical stimulation and cardiac pacing. This review summarizes the structure, working mechanism, output performance of nanogenerator and its latest progress in circulatory system, nervous system, biological tissue, sleep and rescue system. Additionally, a further analysis was also made on the application challenge of nanogenerator in clinical treatment. In the future, nanogenerator is expected to be an auxiliary power source, or even to replace battery to power medical electronic device and realize the self-powered health monitoring and physiological function regulation of human body.
Electric Power Supplies ; Electricity ; Humans

Objective To detect the influence of the first operation standardized or not on reoperation for differentiated thyroid carcinoma.Methods Retrospective analysis was conducted of the clinical data of 217 reoperation case of differentiated thyroid carcinoma from May 2009 to March 2018 in the 960th Hospital of the PLA Joint Logistic Support Force,including 58 male cases and 159 female cases,with the average age of 46.65 years (range from 19 to 76).According to the first operation standardized or not,all patientswas divided into standardized group (n =114) and non-standard group (n =103).Between the two groups,the number of dissected and metastatic lymph nodes,tumor pathology,recurrence range of glandular and central lymph nodes,number of lymph nodes removed and transferred,operation and drainage time,tumor invaded surrounding tissues,invasion sites,and complications were conducted.Results The overall gland recurrence rate was 20.2％ of 217 cases (44/217),8.8％ (10/114) in the standardized group and 33％ (34/103)in the non-standard group.The central group had a total recurrence rate of 38.7％ (84/217),and the standardized group and non-standard group were 22.8％ (26/114) and 56.3 ％ (58/103),respectively.For patients,the total cervical lymph node recurrence rate was 74.7％ (162/217),and the standardized group and non-standard group were 87.7％ (100/114),and 60.3％ (62/103),respectively.All of the difference was statistically significant(P =0.000,P =0.000,P =0.000).The operation time and drainage time of the standardized surgery group were significantly shorter than the non-standard group[(2.52±0.80)h vs(3.14±0.83) h,P=0.000;(4.37±1.28)d vs (5.16±1.41)d,P=0.000].Conclusions For differentiated thyroid carcinoma,the nonstandard treatment significantly affected the tumor residual rate in gland and lymph node metastasis rate of reoperation,andstandardized surgical treatmentshould be advocated.

Objective To evaluate the clinical safety and effectiveness of da Vinci Si surgical system in total parathyroidectomy with autotransplantation of secondary hyperparathyroidism.Methods A retrospective analysis was conducted with da Vinci Si surgical system on 16 patients with secondary hyperparathyroidism who were given total parathyroidectomy with autotransplantation from Mar 2014 to June 2016.The changes of clinical symptoms,parathyroid hormone,calcium and phosphate blood levels were followed up from 6 months to 2 years.Results Surgery was successful in all 16 cases and 62 parathyroid glands were resected.There were no operation-related complications and no conversions to open or endoscopic surgery.Mean operation time was (136 ± 24) minutes.In all postoperative cases the musculoskeletal pain,skin itching were relieved or disappeared.PTH,calcium and phosphate blood levels decreased and no recurrence during follow-up period,The postoperative cosmetic result was satisfatory.Conclusions Da Vinci Si surgical system used in the parathyroid surgery is safe and effective,especially suitable for patients with cosmetic requirements.

Objective To evaluate the clinical safety and effectiveness of total parathyroidectomy with autotransplantation on the chronic renal failure (CRF) patients who are suffering from severe secondary hyperparathyroidism (SHPT).Methods A retrospective analysis was performed on 149 patients with secondary hyperparathyroidism who were given total parathyroidectomy with autotransplantation from Apr.2010 to Oct.2015.The changes of clinical symptoms,parathyroid hormone,calcium and phosphate blood levels were followed up during 6 months to 6 years.Results 598 parathyroid glands were obtained form 149 patients who underwent surgical resection.Musculoskeletal pain and skin itching relieved or disappeared in 145 cases the 2nd day after operation,while these symptoms gradually relieved one week after operation for 4 cases.Serum intact parathyroid hormone (iPTH)was 89.67±180.61,serum phosphate 1.74±0.52,and serum calcium 2.07±0.32 the 1st day after operation,and they all decreased compared with those before operation(P＜0.001).Serum calcium,phosphorus and iPTH levels were similar at 6,36 and 60 months after operation (P＞0.05).Two patients had pathological fracture after operation.No persistent bone pain or skin itching was found during the follow-up period.Two patients had secondary hyperparathyroidism.Six patients had recurrence,among whom five underwent surgery again,and one patient had clinical follow-up.One patient died of pulmonary infection at 13 months after operation.Conclusion Total parathyroidectomy with autotransplantation were applied to ineffective medical treatment for advanced secondary hyperparathyroidism in patients with chronic renal failure.

Objective To explore the diagnostic value in fine needle aspiration cytology combined with thyroghobulin measurement of suspected malignant cervical enlarged lymph node in differentiated thyroid carcinoma.Methods The study included 82 patients with differentiated thyroid carcinoma who were found suspected metastatic lymph nodes in neck during follow-up and accepted reoperation from January 2015 to May 2017.Ultrasound-guided fine-needle aspiration was done in 130 suspected malignant lymph nodes,at the same time,thyroghobulin in fine needle aspiration cytology washout fliud was measured with electrochemiluminescence,fine needle aspiration cytology combined with thymglobulin measurement in fine-needle aspiration biopsy.All suspicious malignant lymph nodes were precise positioning preoperative by injection of mnocarbon suspension under guidence of ultrasound.The analyze was performed according to the final pathological diagnosis after operation.The sensitivity,specificity and accuracy of fine needle aspiration cytology,thymglobulin measurement in fine-needle aspiration biopsy,fine needle aspiration cytology and thyroglobulin measurement in fine-needle aspiration biopsy were calculated by Fomage's statistical method and x2 test was used for comparison among groups.Results Eighty-two patients with 130 lymph nodes with definitemarkers and pathological diagnosis,with a pathological examination of 119 and negative 11 cases.The sensitivity of fine needle aspiration cytology,thyroglobulin measurement in fine-needle aspiration biopsy,fine needle aspiration cytology and thyroglobulin measurement in fine-needle aspiration biopsy was 88.2％,94.1％ and 95.8％,with specificity of 54.5％,72.7％ and 81.8％,with accuracy of 85.4％,92.3％ and 94.6％.Conclusion The sensitivity,specificity and accuracy of fine needle aspiration cytology combined thyroglobulin measurement in fine-needle aspiration biopsy were higher than that of fine needle aspiration cytology or thyroglobulin measurement in fine-needle aspiration biopsy alone,which can be used as a method of qualitative diagnosis during differentiated thyroid cancer postoperative follow-up.

Objective To evaluate the safety and feasibility of INTRABEAM in breast conserving surgery for early stage breast cancer.Methods Clinical data of 43 cases of early breast cancer undergoing INTRA-BEAM intraopetative radiotherapy from Jan.2013 to Dec.2014 were retrospectively analyzed.All cases underwent breast conserving surgery combined with 20 Gy INTRABEAM intraoperative radiotherapy.The postoperative incision,incidence of local complications and acute radiation injury were recorded after surgery.Breast recovery,the cosmetic effects,early overall survival,recurrence-free survival,and non-metastatic survival were followed up.Results All cases were given breast conserving surgery associated with INTRABEAM intraoperative radiotherapy (20 Gy),with median radiotherapy time of 31 mins ranging from 25 to 39 mins.Five cases underwent postoperative whole breast irradiation.Major early complications included incision infection (1 case),postoperative effusion (5 cases),radiation area skin pain (4 cases).The short-term follow-up survey showed that the satisfaction rate was 93.0％.The overall survival rate,recurrence free survival rate and metastasis free survival rate was 100％ respec tively.Conclusion Breast conseving surgery combined with INTRABEAM intraoperative radiotherapy for early breast cancer patients is safe and feasible.

OBJECTIVETo evaluate surgical outcomes and the feasibility of robotic thyroidectomy and central neck dissection (CND).

METHODSThe clinical data of 40 patients of papillary thyroid microcarcinoma underwent total thyroidectomy (or lobectomy and isthmusectomy) and CND using the Da Vinci system through axillo-bilateral-breast approach in Jinan Military General Hospital of People's Liberation Army from February to December 2014 were analyzed retrospectively (robotic group). Other forty patients of papillary thyroid microcarcinoma underwent total thyroidectomy (or lobectomy and isthmusectomy) and CND by open approach were selected as the control (open group). Cosmetic satisfaction was assessed after a month postoperation by the numerical score system. t-test and χ(2) test were used to compare the clinical characters, total operative time, intraoperative estimated blood loss, postoperative hospital stay, number of lymph nodes removed, visual analogue scale for pain, postoperative complications, and cosmetic effect between the 2 groups.

RESULTSAll 80 patients were diagnosed of papillary thyroid microcarcinoma. The total thyroidectomy (or lobectomy/isthmusectomy) with CND of 40 patients were successfully performed by da Vinci Si surgical system. The numbers of total thyroidectomy of robotic group and the open group were 36 and 37, respectively. The numbers of metastatic lymph nodes of robotic group and open group were 14 and 15, respectively. The operation time of the robotic group was (130±12) minutes, which was longer than that of open group (98±11) minutes (t=12.432, P<0.05). The study showed statistical significant difference between the two groups regarding the visual analog scale pain assessment (1.9±0.9 vs.3.9±1.1, t=8.900, P<0.05). There were no statistical significant difference of intraoperative estimated blood loss, postoperative hospital stay, number of lymph nodes removed, and the complication rate between the 2 groups.Postoperative cosmetic result was more satisfying on the robotic group (9.1±0.5) than open group (4.8±1.5) (t=17.200, P<0.05).

CONCLUSIONSThe robotic total thyroidectomy (or lobectomy and isthmusectomy) and CND has similar surgery safety and feasibility as open procedures. The robotic thyroidectomy is a good alternative surgical modality for patients with papillary thyroid microcarcinoma who wish to avoid neck scars.

Axilla ; Breast ; Carcinoma, Papillary ; surgery ; Humans ; Length of Stay ; Lymph Nodes ; Neck Dissection ; Operative Time ; Postoperative Complications ; Postoperative Period ; Retrospective Studies ; Robotic Surgical Procedures ; Thyroid Neoplasms ; surgery ; Thyroidectomy ; methods

Objective To evaluate the safety of the da Vinci Si surgical system in thyroid surgery and to accumulate operation experience .Methods The da Vinci Si surgical system consists of a surgeon's console, a patient-side robotic cart, and high-definition 3D vision system.The robot arm tips were introduced via a single axillary incision or small chest wall ports and attached to the arms of the robot .The surgeon , sitting at the con-sole, manipulated the EndoWrist instruments and endoscope view that transfer the surgeon 's movements to the arm tips.The so called EndoWrist'technology offers seven degrees of movements ( up, down, left, right, twist, et al) , thus exceeding the capacity of a surgeon's hand in open surgery .The da Vinci Si surgical system was used to perform thyroidectomy in two small pigs .The animals were intubated and kept anesthetized with halothane .Re-sults Four surgical procedures were done using the da Vinci Si system from beginning to the end , including 2 thyroidectomies and 2 thymectomies .No conversions to open or laparoscopic procedure was used .The procedure length was 61 minutes and 50 minutes, respectively.Conclusions Robotic thyroidectomy can be performed safe-ly by the experienced surgeons after short-term da Vinci Si surgical system training .The learning curve for robotic thyroidectomy is shorter .