Clinically,the surgical treatment of varicose veins of the lower extremities(VVLE)is now developing towards the direction of precision,minimally-invasive and individuation.Thus,comprehensive preoperative examination and evaluation of the venous system,and scientific marking of the target veins are prerequisite for achieving these goals.This paper describes the latest research progress in VVLE,focusing on the pathophysiology,risk factors,etiology,evaluation method of venous system,preoperative evaluation of commonly-seen secondary etiology,selection of surgical method,and marking technique of targeted veins,etc.So as to promote the development of surgical treatment for VVLE in clinical practice.

Objective:To share our experience of single-port transoral Da Vinci robotic surgery for laryngeal and pharyngeal benign tumors.Methods:Three patients aged over 18 years and diagnosed respectively with epiglottic cyst, aryepiglottic fold cyst and thyroglossal duct cyst at tongue base were included who received operations in Hainan Hospital of Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine (Boao Research Hospital of Hainan) between August 1, 2023 and April 10, 2024. There were 1 male and 2 females, with an average age of 59 years old. The clinical diagnosis of these 3 patients was respectively epiglottic cyst, aryepiglottic fold cyst and thyroglossal duct cyst at tongue base. Intraoperative conversion rate, blood loss, operation time, hospital stay, pain score and swallowing function score were analyzed.Results:All three patients successfully underwent the operations with the single-port Da Vinci robotic system. The clean-contaminated resection rate of the tumors was 100%. The conversion rate was nil. The blood loss was 0-7 ml. The operation time was 5-30 minutes. There were no adverse events such as loosening of teeth and soft tissue abrasions of pharyngeal side wall. The rate of oral feeding within 24 hours after surgery was 100%. No postoperative coughing, bleeding, or dyspnea occurred. The average length of hospital stay was 3.7 days. The VAS score decreased 3 days after surgery compared to 1 day after surgery. The swallowing function recovered 1 month after surgery.Conclusion:The single-port transoral robotic surgery for laryngeal and pharyngeal benign lesions is safe and efficient, with fewer complications.

Objective:To investigate the efficacy of naloxone in improving health-related quality of life in patients with chronic arsenic exposure-related pruritus, and to explore the modification effect of gene polymorphisms associated with arsenic metabolism and endorphin receptors.Methods:A randomized, double-blind, placebo-controlled trial was conducted between January and March 2019 in Changde City, Hunan Province, China. Eligible patients with moderate to severe chronic pruritus under arsenic exposure were recruited, and randomly assigned to the naloxone group and the control group to receive sublingual naloxone and placebo (0.4 mg/d) respectively for 7 consecutive days. Outcomes were assessed before treatment and on day 7 after treatment, including the primary outcome (the dermatology life quality index [DLQI]) and secondary outcomes (depression symptoms, anxiety symptoms, and quality of sleep). Genotyping of the arsenic (+3 oxidation state) methyltransferase and 3 opioid receptor genes was performed using ligase detection reaction. Data analysis was performed using t test for normally distributed continuous variables, non-parametric tests for skewed continuous variables, and chi-square test for categorical data. Linear regression analysis was carried out to evaluate the effect of naloxone on outcome measures, while the interactive effect of demographic factors, genotypes and treatment methods on changes in DLQI were assessed by the generalized linear model. Results:A total of 126 patients with chronic arsenic exposure-related pruritus were enrolled, including 73 males and 53 females. They were randomly divided into the control group (64 cases) and the naloxone group (62 cases), with the ages being 60.0 ± 9.1 years and 58.4 ± 8.6 years, respectively. There were no significant differences between the two groups in terms of age, gender, income, education levels, or hair arsenic concentrations (all P > 0.05). After treatment, the decrease in DLQI scores was significantly higher in the naloxone group than in the control group (-8.79 ± 6.84 vs. -5.19 ± 8.10; P = 0.008). However, there were no significant changes in depression symptoms, anxiety symptoms, or quality of sleep between the naloxone group and control group (all P > 0.05). Linear regression analysis showed that naloxone significantly affected DLQI with a crude regression coefficient of -3.60 (95% CI: -6.25, -0.96; P = 0.008). Stratification analysis revealed that patients with the κ-opioid receptor gene rs1051660 (wild-type, CC) responded better to the treatment than those with the mutated genotype (CA), and there was a significant interaction between the rs1051660 genotype and therapeutic drugs in relation to DLQI changes ( P = 0.014) . Conclusion:Naloxone can effectively improve health-related quality of life in patients with chronic arsenic exposure-related pruritus, and its efficacy is modified by the gene polymorphism of the κ-opioid receptors.

Objective:To investigate the efficacy of naloxone in improving health-related quality of life in patients with chronic arsenic exposure-related pruritus, and to explore the modification effect of gene polymorphisms associated with arsenic metabolism and endorphin receptors.Methods:A randomized, double-blind, placebo-controlled trial was conducted between January and March 2019 in Changde City, Hunan Province, China. Eligible patients with moderate to severe chronic pruritus under arsenic exposure were recruited, and randomly assigned to the naloxone group and the control group to receive sublingual naloxone and placebo (0.4 mg/d) respectively for 7 consecutive days. Outcomes were assessed before treatment and on day 7 after treatment, including the primary outcome (the dermatology life quality index [DLQI]) and secondary outcomes (depression symptoms, anxiety symptoms, and quality of sleep). Genotyping of the arsenic (+3 oxidation state) methyltransferase and 3 opioid receptor genes was performed using ligase detection reaction. Data analysis was performed using t test for normally distributed continuous variables, non-parametric tests for skewed continuous variables, and chi-square test for categorical data. Linear regression analysis was carried out to evaluate the effect of naloxone on outcome measures, while the interactive effect of demographic factors, genotypes and treatment methods on changes in DLQI were assessed by the generalized linear model. Results:A total of 126 patients with chronic arsenic exposure-related pruritus were enrolled, including 73 males and 53 females. They were randomly divided into the control group (64 cases) and the naloxone group (62 cases), with the ages being 60.0 ± 9.1 years and 58.4 ± 8.6 years, respectively. There were no significant differences between the two groups in terms of age, gender, income, education levels, or hair arsenic concentrations (all P > 0.05). After treatment, the decrease in DLQI scores was significantly higher in the naloxone group than in the control group (-8.79 ± 6.84 vs. -5.19 ± 8.10; P = 0.008). However, there were no significant changes in depression symptoms, anxiety symptoms, or quality of sleep between the naloxone group and control group (all P > 0.05). Linear regression analysis showed that naloxone significantly affected DLQI with a crude regression coefficient of -3.60 (95% CI: -6.25, -0.96; P = 0.008). Stratification analysis revealed that patients with the κ-opioid receptor gene rs1051660 (wild-type, CC) responded better to the treatment than those with the mutated genotype (CA), and there was a significant interaction between the rs1051660 genotype and therapeutic drugs in relation to DLQI changes ( P = 0.014) . Conclusion:Naloxone can effectively improve health-related quality of life in patients with chronic arsenic exposure-related pruritus, and its efficacy is modified by the gene polymorphism of the κ-opioid receptors.

Objective:To share our experience of single-port transoral Da Vinci robotic surgery for laryngeal and pharyngeal benign tumors.Methods:Three patients aged over 18 years and diagnosed respectively with epiglottic cyst, aryepiglottic fold cyst and thyroglossal duct cyst at tongue base were included who received operations in Hainan Hospital of Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine (Boao Research Hospital of Hainan) between August 1, 2023 and April 10, 2024. There were 1 male and 2 females, with an average age of 59 years old. The clinical diagnosis of these 3 patients was respectively epiglottic cyst, aryepiglottic fold cyst and thyroglossal duct cyst at tongue base. Intraoperative conversion rate, blood loss, operation time, hospital stay, pain score and swallowing function score were analyzed.Results:All three patients successfully underwent the operations with the single-port Da Vinci robotic system. The clean-contaminated resection rate of the tumors was 100%. The conversion rate was nil. The blood loss was 0-7 ml. The operation time was 5-30 minutes. There were no adverse events such as loosening of teeth and soft tissue abrasions of pharyngeal side wall. The rate of oral feeding within 24 hours after surgery was 100%. No postoperative coughing, bleeding, or dyspnea occurred. The average length of hospital stay was 3.7 days. The VAS score decreased 3 days after surgery compared to 1 day after surgery. The swallowing function recovered 1 month after surgery.Conclusion:The single-port transoral robotic surgery for laryngeal and pharyngeal benign lesions is safe and efficient, with fewer complications.

Objective:Chronic urticaria presents a chronic process of recurrent attacks,and its first-line treatment is second-generation antihistamine with limited treatment options.The efficacy of antihistamine varies among individuals and cannot meet the needs of all patients.This study aims to explore the clinical efficacy and safety of Zhiyang Xiaozhen granules combined with antihistamine in the treatment of chronic urticaria patients. Methods:We retrospectively analyzed the clinical data of patients with chronic urticaria who visited the Xiangya Hospital of Central South University from April 2020 to March 2021.The patients who received conventional second-generation antihistamine treatment were selected as a control group,while the patients who received combined treatment with Zhiyang Xiaozhen granules on the basis of conventional second-generation antihistamine treatment were selected as an observation group.The differences in the Weekly Urticaria Activity Score(UAS7)and Dermatology Life Quality Index(DLQI)between the 2 groups before and 4 weeks after treatment were compared.The Symptom Score Reduce Index(SSRI)was used to evaluate and compare the efficacy of the 2 treatment regimens. Results:After 4 weeks of treatment,the UAS7 levels in both groups were significantly reduced(P=0.001 and P<0.001,respectively).The effective rates of the control group and the observation group were 61.11%and 59.38%,respectively when converting UAS7 to SSRI for efficacy evaluation,and there was no statistically significant difference in efficacy between the 2 groups(P>0.05);however,when converting DLQI to SSRI for efficacy evaluation,the effective rates of the control group and the observation group were 33.33%and 46.88%,respectively,and the difference in efficacy between the 2 groups was statistically significant(P<0.001).There were 3 patients with adverse drug reactions related to drowsiness in both groups. Conclusion:The combination of Zhiyang Xiaozhen granules and second-generation antihistamine can effectively improve disease activity in patients with chronic urticaria,and the improvement in quality of life is better than that with the second-generation antihistamine alone.

The cochlear auditory epithelium contains two types of sound receptors, inner hair cells (IHCs) and outer hair cells (OHCs). Mouse models for labelling juvenile and adult IHCs or OHCs exist; however, labelling for embryonic and perinatal IHCs or OHCs are lacking. Here, we generated a new knock-in Fgf8^P2A-3×GFP/+ (Fgf8^GFP/+) strain, in which the expression of a series of three GFP fragments is controlled by endogenous Fgf8 cis-regulatory elements. After confirming that GFP expression accurately reflects the expression of Fgf8, we successfully obtained both embryonic and neonatal IHCs with high purity, highlighting the power of Fgf8^GFP/+. Furthermore, our fate-mapping analysis revealed, unexpectedly, that IHCs are also derived from inner ear progenitors expressing Insm1, which is currently regarded as an OHC marker. Thus, besides serving as a highly favorable tool for sorting early IHCs, Fgf8^GFP/+ will facilitate the isolation of pure early OHCs by excluding IHCs from the entire hair cell pool.
Animals ; Mice ; Hair Cells, Auditory, Inner ; Cochlea/metabolism* ; Hair Cells, Auditory, Outer/metabolism* ; Disease Models, Animal ; Fibroblast Growth Factor 8/metabolism*

Objective:To investigate the application value of early and late interventional embolization in intracranial aneurysms.Methods:Eighty-two patients with intracranial aneurysm who received treatment in Wenzhou People's Hospital from October 2015 to February 2020 were included in this study. These patients were divided into early (≤ 3 days) and late (> 3 days) groups, with 41 patients in each group, according to time from disease onset to surgery. The early group was subjected to early interventional embolization, and the late group was treated with late interventional embolization. The effects of embolization and National Institutes of Health Stroke Scale score pre- and post-treatment, as well as modified Barthel index, Mini-Mental State Exam score, matrix metalloproteinase-9 level, and soluble intercellular adhesion molecule-1 level post-treatment and prognosis were compared between the two groups.Results:The embolization effects in the early group were statistically superior to those in the late group ( P = 0.046). After treatment, National Institutes of Health Stroke Scale score in the early group was significantly lower than that in the late group [(4.02 ± 1.64) points vs. (6.81 ± 2.02) points, t = 6.86, P < 0.01]. Mini-Mental State Exam score and modified Barthel index in the early group were (28.09 ± 1.35) points and (81.12 ± 9.67) points, respectively, which were significantly higher than (26.01 ± 1.19) points and (73.02 ± 8.19) points in the late group ( t = 7.40, 4.09, both P < 0.001). After treatment, matrix metalloproteinase-9 and soluble intercellular adhesion molecule-1 levels in the early group were (420.33 ± 29.40) μg/L and (403.70 ± 23.28) ug/L, respectively, which were significantly lower than (491.30 ± 31.19) μg/mL and (496.37 ± 30.46) μg/L in the late group ( t = 10.60, 15.47, both P < 0.001). Prognosis in the early group was superior to that in the late group ( P = 0.049). Conclusion:Early interventional embolization has better efficacy than late interventional embolization in the treatment of intracranial aneurysm. The former can effectively improve neurological function and mental state, enhance living ability, and improve prognosis, which may be related to the regulation of matrix metalloproteinase-9 and soluble intercellular adhesion molecule-1 levels.

Objective:To analyze potential roles of mechanical stress in the formation of plantar melanoma.Methods:A retrospective analysis was conducted on 129 cases of plantar melanoma in Xiangya Hospital, Central South University between 2014 and 2021, and the distribution and clinical characteristics of plantar melanoma were analyzed. The goodness-of-fit test was used to compare the distribution of plantar melanoma between weight-bearing areas (the toes, forefoot, lateral midfoot, heel) and non-weight-bearing areas of the foot (the arch) , while t test, Fisher′s exact test and Wilcoxon rank sum test were used to analyze differences in clinicopathological characteristics of plantar melanoma between weight-bearing areas and non-weight-bearing areas of the foot. Results:Among the 129 patients with plantar melanoma, 66 (51.2%) were males and 63 (48.8%) were females, and their age at onset was 60.6 ± 13.1 years. Plantar melanoma mostly occurred on the heel (65 lesions, 1.31 lesions per square centimeter) , followed by the forefoot (31 lesions, 0.41 lesions per square centimeter) , the bottom of the toes (15 lesions, 0.43 lesions per square centimeter) , lateral midfoot (11 lesions, 0.38 lesions per square centimeter) and the arch of foot (7 lesions, 0.16 lesions per square centimeter) . The goodness-of-fit test showed that melanoma was more prone to occur in the weight-bearing areas than in the non-weight-bearing areas ( χ2 = 66.59, P < 0.001) ; compared with the arch of foot, a higher incidence density was observed in the heel and forefoot ( χ2 = 38.29, 5.23, P < 0.001, = 0.022, respectively) . There were no significant differences in the gender ratio, age and occupation of patients, prevalence rates of left/right foot involvement, Breslow thickness, ulceration status, Clark grades, lymph node metastasis rate, and stages between melanomas in the weight-bearing areas and those in non-weight-bearing areas (all P > 0.05) . Conclusion:Plantar melanoma was more prone to occur in the weight-bearing areas than in the non-weight-bearing areas, suggesting that mechanical stress may be related to the occurrence and development of melanoma.