1.Yifei Zhuji Formula Reverses Epithelial-mesenchymal Transition of Non-small Cell Lung Cancer by Regulating PI3K/Akt/mTOR Signaling Pathway
Jiarui LI ; Na ZHANG ; Xuefang LIU ; Qi WANG ; Di ZHAO ; Suxiang FENG ; Zijiang YANG
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(23):92-104
ObjectiveTo investigate the effects of Yifei Zhuji formula (YFZJF) on epithelial-mesenchymal transition (EMT) in non-small cell lung cancer (NSCLC) through regulation of phosphatidylinositol 3-kinase (PI3K)/protein kinase B (Akt)/mammalian target of rapamycin (mTOR) signaling pathway. MethodsThe Lewis lung carcinoma mouse model and human lung adenocarcinoma PC-9 cell model were used in this study. In the animal experiments, 60 C57BL/6 mice were randomized into a blank group and a Lewis lung carcinoma modeling group. The modeled mice were further randomized into model, low-, medium-, and high-dose (7.475, 14.95, 29.9 g·kg-1·d-1, respectively) YFZJF, and cisplatin groups, with 10 mice in each group. Mice in YFZJF groups were administrated with YFZJF at different doses by gavage, and those in the cisplatin group received intraperitoneal injection of cisplatin at 6 mg·kg-1. Mice in the blank group and model group were administrated with equal volumes of normal saline by gavage every day. All the groups were treated for 14 consecutive days, and samples were collected for analysis after completion of treatment. Changes in body mass, tumor volume, and tumor mass were measured. Hematoxylin-eosin (HE) staining was performed to observe pathological changes in the lung tissue. Immunohistochemistry, Real-time PCR, and Western blot were employed to determine the expression of proliferating cell nuclear antigen (Ki-67), PI3K/Akt/mTOR signaling pathway-related molecules, and EMT-related molecules in the tumor tissue. In the cell experiments, human lung adenocarcinoma PC-9 cells were allocated into control, YFZJF-containing serum, and cisplatin groups, which were treated with 20% blank rat serum, 20% YFZJF-containing rat serum, and 5.4 μmol·L-1 cisplatin for 48 h, respectively. The cell counting kit-8 (CCK-8) assay was adopted to detect cell proliferation and determine drug concentration. Cell scratch assay and Transwell assay were employed to evaluate cell migration and invasion. Immunofluorescence staining and Real-time PCR were used to analyze changes in expression of EMT markers. ResultsCompared with those in the model group, the tumor volume and tumor mass were reduced in the high-dose YFZJF group (P<0.01). Immunohistochemical results showed that compared with the model group, the medium- and high-dose YFZJF groups exhibited reduced Ki-67 expression in the tumor tissue (P<0.01). HE staining results showed that YFZJF alleviated the pathological injury of the lung tissue to different degrees. Real-time PCR results in the tumor tissue showed that compared with the model group, the high-dose YFZJF group displayed downregulated mRNA levels of protein kinase B1 (Akt1) and N-cadherin (P<0.05), phosphatidylinositol 3-kinase p85 regulatory subunit (p85) (P<0.01), mTOR (P<0.01), and Vimentin (P<0.01), and an upregulated mRNA level of E-cadherin (P<0.01). Western blot results showed that compared with the model group, the high-dose YFZJF group exhibited downregulated protein levels of phosphorylated (p)-PI3K/PI3K, p-Akt/Akt, p-mTOR/mTOR, Vimentin, and N-cadherin (P<0.01), and an upregulated protein level of E-cadherin (P<0.01) in the tumor tissue. The cell experiment results showed that compared with the blank serum group, YFZJF-containing serum inhibited the proliferation, migration, and invasion of PC-9 cells (P<0.05, P<0.01). Immunofluorescence results showed that compared with the control group, YFZJF-containing serum downregulated the protein levels of N-cadherin and Vimentin and upregulated the protein level of E-cadherin (P<0.01). Real-time PCR results showed that compared with the control group, YFZJF-containing serum upregulated the mRNA level of E-cadherin (P<0.05) and downregulated the mRNA levels of N-cadherin, Vimentin, P85, Akt1, and mTOR (P<0.05, P<0.01). ConclusionYFZJF can significantly inhibit the progression of non-small cell lung cancer and reduce the migration and invasion of tumor cells by inhibiting the abnormal activation of PI3K/Akt/mTOR signaling pathway and reversing EMT.
2.Effect of different layers of masseter on the bony structure of facial lateral area
Yu-Qi ZHAO ; Jin-Rui JIANG ; Jin-Ran CHEN ; Ze-Chuan WANG ; Hou-En ZHOU ; Wen-Di XU ; Liu-Jun YONG
Acta Anatomica Sinica 2025;56(2):208-213
Objective To observe the morphology of the superficial,middle,and deep layers of the masseter muscle and related bony structures in the lateral facial region of adults through gross anatomy,and to probe into the effects of these muscle layers on the bony structures of the lateral facial region.Methods The bilateral masseter muscles of 12 adult cadavers were exposed,and the superficial,middle,and deep layers were separated and measured for muscle length,tendon length,and muscle belly length.After the masseter muscles were stripped,the total thickness was measured,and the mandible and zygomatic arch were exposed to measure the angle of the mandibular angle,thickness of the zygomatic arch,and width of the zygomatic arch.Observations were made of the masseter tuberosities,and statistical analysis was conducted on their interrelations.Results The zygomatic arch thickness was positively correlated with the length of superficial,middle and deep masseter muscles and the length of superficial and middle masseter belly(r superficial masseter length=0.624,r middle masseter length=0.787,r deep masseter length=0.423,r superficial masseter belly length=0.493,r middle masseter belly length=0.548).The width of the zygomatic arch was positively correlated with the lengths of the superficial and middle muscle layers and the middle muscle belly length(r superficial masseter length=0.527,r middle masseter length=0.521,r middle masseterbelly length=0.437).The angle of the mandibular angle was only negatively correlated with the middle muscle belly length(r=-0.422).The tuberosities of the superficial and middle masseter muscles were not affected by the corresponding muscle layers;However,the tuberosity of the deep masseter was negatively correlated with the length of the deep muscle and the length of the deep tendon(r deep masseter length=-0.543,r deep masseter tendon length=-0.443).Conclusion In the masseter muscle layers of Chinese individuals,the superficial and middle layers have the most significant impact on the bony structures structures of the lateral facial region.These findings are of guiding significance for the remodeling of structures in the lateral facial region.
3.Plasma exchange and intravenous immunoglobulin prolonged the survival of a porcine kidney xenograft in a sensitized, brain-dead human recipient.
Shuaijun MA ; Ruochen QI ; Shichao HAN ; Zhengxuan LI ; Xiaoyan ZHANG ; Guohui WANG ; Kepu LIU ; Tong XU ; Yang ZHANG ; Donghui HAN ; Jingliang ZHANG ; Di WEI ; Xiaozheng FAN ; Dengke PAN ; Yanyan JIA ; Jing LI ; Zhe WANG ; Xuan ZHANG ; Zhaoxu YANG ; Kaishan TAO ; Xiaojian YANG ; Kefeng DOU ; Weijun QIN
Chinese Medical Journal 2025;138(18):2293-2307
BACKGROUND:
The primary limitation to kidney transplantation is organ shortage. Recent progress in gene editing and immunosuppressive regimens has made xenotransplantation with porcine organs a possibility. However, evidence in pig-to-human xenotransplantation remains scarce, and antibody-mediated rejection (AMR) is a major obstacle to clinical applications of xenotransplantation.
METHODS:
We conducted a kidney xenotransplantation in a brain-dead human recipient using a porcine kidney with five gene edits (5GE) on March 25, 2024 at Xijing Hospital, China. Clinical-grade immunosuppressive regimens were employed, and the observation period lasted 22 days. We collected and analyzed the xenograft function, ultrasound findings, sequential protocol biopsies, and immune surveillance of the recipient during the observation.
RESULTS:
The combination of 5GE in the porcine kidney and clinical-grade immunosuppressive regimens prevented hyperacute rejection. The xenograft kidney underwent delayed graft function in the first week, but urine output increased later and the single xenograft kidney maintained electrolyte and pH homeostasis from postoperative day (POD) 12 to 19. We observed AMR at 24 h post-transplantation, due to the presence of pre-existing anti-porcine antibodies and cytotoxicity before transplantation; this AMR persisted throughout the observation period. Plasma exchange and intravenous immunoglobulin treatment mitigated the AMR. We observed activation of latent porcine cytomegalovirus toward the end of the study, which might have contributed to coagulation disorder in the recipient.
CONCLUSIONS
5GE and clinical-grade immunosuppressive regimens were sufficient to prevent hyperacute rejection during pig-to-human kidney xenotransplantation. Pre-existing anti-porcine antibodies predisposed the xenograft to AMR. Plasma exchange and intravenous immunoglobulin were safe and effective in the treatment of AMR after kidney xenotransplantation.
Transplantation, Heterologous/methods*
;
Kidney Transplantation/methods*
;
Heterografts/pathology*
;
Immunoglobulins, Intravenous/administration & dosage*
;
Graft Survival/immunology*
;
Humans
;
Animals
;
Sus scrofa
;
Graft Rejection/prevention & control*
;
Kidney/pathology*
;
Gene Editing
;
Species Specificity
;
Immunosuppression Therapy/methods*
;
Plasma Exchange
;
Brain Death
;
Biopsy
;
Male
;
Aged
4.Development goals and strategies of ecological agriculture of Chinese materia medica.
Chuan-Zhi KANG ; Si-Qi LIU ; Bang-Xing HAN ; Tao ZHOU ; Xiao WANG ; Da-Hui LIU ; Ye YANG ; Lan-Ping GUO
China Journal of Chinese Materia Medica 2025;50(1):42-47
This paper aims to contribute to guaranteeing the stable development and enhancing the understanding of ecological agriculture of Chinese materia medica so that the national strategy and industrial demand can be better served. It first introduces current traditional Chinese medicine(TCM)policy and industrial development status from five aspects, including policy guarantee, theoretical support, technological innovation, standardization system, and brand influence. Then, the paper analyzes the development dilemma of TCM agriculture in production and quality increase and ecological environment protection. It also proposes the development goals of ecological agriculture of Chinese materia medica that meet the current industrial development demand, which are reducing chemical fertilizers, pesticides, and carbon emissions, improving quality, increasing efficiency, and protecting ecological environment. In addition, the new development goals are interpreted through case studies. Finally, this paper proposes four development strategies for ecological agriculture of Chinese materia medica: conducting research on the pattern and spatial and temporal variations of nationwide TCM production areas; studying the internal and external ecological memories of medicinal plant growth from the perspectives of genetic variations and environmental adaptation variations and elucidating their contributions to the formation of quality; carrying out selection and breeding of stress-resistant varieties for ecological agriculture of Chinese materia medica, the optimization of key technologies for soil improvement and restoration and green prevention and control against diseases and pests, and the improvement of quality; carrying out research on the quality assurance and value realization of ecological products made from TCM. This research can provide guidance for policy formulation, theoretical development of the discipline, and the enhancement of industrial technology for ecological agriculture of Chinese materia medica.
Agriculture/methods*
;
China
;
Drugs, Chinese Herbal
;
Plants, Medicinal/chemistry*
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Ecosystem
;
Materia Medica
;
Medicine, Chinese Traditional
5.Scientific characterization of medicinal amber: evidence from geological and archaeological studies.
Qi LIU ; Qing-Hui LI ; Di-Ying HUANG ; Yan LI ; Pan XIAO ; Ji-Qing BAI ; Hua-Sheng PENG ; Lu-Qi HUANG
China Journal of Chinese Materia Medica 2025;50(11):2905-2914
Amber and subfossil resins are subjects of interdisciplinary research across multiple fields. However, due to their diverse origins and complex compositions, different disciplines vary in their definitions and functional interpretations. In traditional Chinese medicine(TCM), amber has been utilized as a medicinal material since ancient time, with extensive historical documentation. However, its classification, provenance, and nomenclature remain ambiguous, and authentic medicinal amber artifacts are exceedingly rare. This study employed Fourier-transform infrared spectroscopy(FTIR) to characterize amber and subfossil resins from various geological sources and commercially "medicinal amber". Additionally, historical literature and market surveys were analyzed to explore their provenance, composition, and functional attributes. The results indicate that amber and subfossil resins from different sources and with different compositions exhibit distinct fingerprint characteristics in the FTIR spectral range of 1 800-700 cm~(-1). "Medicinal amber" available in the market primarily consists of subfossil or modern resins, significantly differing in composition and structure from geological amber. This study highlights the importance of interdisciplinary research on amber identification and resource management. It is essential to establish a systematic database of amber and subfossil resin characteristics and integrate modern analytical techniques to enhance research on their composition, pharmacological mechanisms, and potential therapeutic effects, thereby promoting the standardized utilization of amber resources and advancing the modernization of TCM.
Amber/history*
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Archaeology
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Spectroscopy, Fourier Transform Infrared
;
Medicine, Chinese Traditional
6.Mechanism of metformin inhibiting malignant progression of hepatocellular carcinoma by promoting degradation of aldo-keto reductase AKR1C3
Lei QI ; Jingyi HUA ; Qiuju FENG ; Di PAN ; Lingxiang LIU ; Li ZHAO
Journal of China Pharmaceutical University 2025;56(5):572-582
This study aimed to elucidate the mechanism of action of metformin (MET) in inhibiting the malignant progression of hepatocellular carcinoma (HCC) by regulating the degradation of aldo-keto reductase family 1 member C3 (AKR1C3). The correlation between the sensitivity of different hepatocellular carcinoma cell lines to MET and their basal expression levels of AKR1C3 was firstly evaluated. MET was found to significantly reduce the level and accelerate the degradation rate of AKR1C3 protein by Western blot. The interaction between MET and AKR1C3 protein was confirmed by cellular thermal shift assay (CETSA). Proteasome inhibitor MG132 and the lysosomal inhibitor chloroquine (CQ) were used to screen the degradation pathway, and confirm, in combination with the HBSS starvation-induced autophagy model, that MET mediated the degradation of AKR1C3 through the autophagy lysosome pathway. Ubiquitylation assay showed that MET specifically enhanced the K63-linked polyubiquitylation modification of AKR1C3. Sequestosome 1 (SQSTM1/p62) knockdown, immunoprecipitation, and immunofluorescence co-localization analyses confirmed that the autophagy receptor p62 plays a key role in mediating MET-induced degradation of AKR1C3. The adenosine 5'-monophosphate (AMP)-activated protein kinase (AMPK) inhibitor compound C was used to demonstrate that the regulatory effect of MET on AKR1C3 is independent of the classical AMPK signaling pathway. The experimental results showed that metformin promoted the ubiquitination modification of AKR1C3 by targeting AKR1C3, enhanced the binding of AKR1C3 to autophagy receptor p62, then degraded the AKR1C3 protein through selective autophagy-like pathway, and ultimately inhibited the malignant phenotypes of hepatocellular carcinoma cells, which is a regulatory mechanism free of the classical AMPK activation pathway of metformin.
7.Effect mechanism of LncRNA MALAT1 on doxorubicin resistance in osteosarcoma cells
Fudong LIANG ; Shufang DI ; Wei LUO ; Jianghua QI ; Libing LIU
China Pharmacy 2025;36(6):698-703
OBJECTIVE To investigate the relationship of long non-coding RNA (LncRNA) metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) and doxorubicin (DOX) resistance in osteosarcoma (OS) cells. METHODS MG-63 and MG-63/DOX cells were treated with different concentrations of DOX (0, 0.01, 0.05, 0.1, 1 μmol/L), and survival rates and half maximal inhibitory concentration were determined using CCK-8 assay. The expressions of LncRNA MALAT1 in MG-63 and MG-63/ DOX cells were detected by real-time quantitative fluorescence PCR. MG-63/DOX cells were divided into Control group, knocking down LncRNA MALAT1 negative control (sh-NC) group, sh-MALAT1 group, sh-MALAT1+anti-NC group, and sh-MALAT1+ anti-miR-154-5p group. The expressions of LncRNA MALAT1, miR-154-5p and cyclin D1 (CCND1) mRNA in MG-63/DOX cells of each group were detected. The effects of knocking down LncRNA MALAT1 on the proliferation, migration, invasion, and apoptosis of MG-63/DOX cells were detected by CCK-8 assay, scratch test, Transwell experiment and flow cytometry, respectively. The expression of proliferating cell nuclear protein (PCNA) and CCND1 protein in MG-63/DOX cells was detected by Western blot assay. Interactions between LncRNA MALAT1 and miR-154-5p, miR-154-5p and CCND1 were detected by dual luciferase reporter gene experiment. RESULTS Compared with 0 μmol/L DOX, 0.01, 0.05, 0.1 and 1 μmol/L DOX could reduce the survival rates of MG-63 and MG-63/DOX cells (except for 0.01 μmol/L DOX) (P<0.05), IC50 were 0.07 and 0.13 μmol/L, respectively. The survival rate, cell migration number and invasion number of MG-63/DOX cells, scratch closure rate, mRNA expressions of LncRNA MALAT1, mRNA and protein expressions of CCND1, and PCNA protein expression in sh-MALAT1 group were significantly lower than sh-NC group and Control group; the apoptosis rate and miR-154-5p expression were significantly higher than sh-NC group and Control group (P<0.05). sh-MALAT1+anti-miR-154-5p group was able to reverse the aforementioned biological effects in sh-MALAT1 group (P<0.05). In MG-63/DOX cells transfected with both MALAT1-wild type (WT) and CCND1-WT, the luciferase activity in the miR-154-5p mimic group was significantly lower than mimic negative control group (P< 0.05). CONCLUSIONS Knocking down LncRNA MALAT1 can inhibit the DOX resistance of OS cells, and its mechanism may be targeting the miR-154-5p/CCND1 axis.
8.The impact of different surgical methods on the surgical outcomes and short-term prognosis of pig-to-pig kidney transplantation
Xiaoyan ZHANG ; Di WEI ; Guohui WANG ; Shichao HAN ; Ruochen QI ; Kepu LIU ; Xiaoyan FAN ; Xiaojian YANG ; Shuaijun MA ; Weijun QIN
Organ Transplantation 2025;16(4):538-544
Objective To investigate the impact of two different surgical methods, orthotopic kidney transplantation and abdominal heterotopic kidney transplantation, on the surgical outcomes of pig-to-pig kidney transplantation and the short-term survival of recipient pigs after surgery. Methods Twenty-four Bama miniature pigs were divided into two groups, with 12 pigs in each group, and underwent orthotopic kidney transplantation and abdominal heterotopic kidney transplantation, respectively. The perioperative indicators of the recipient pigs, renal blood perfusion, the overall incidence rate of complications and survival rate were compared between the two surgical methods. Results The total surgical time, renal artery anastomosis time, renal vein anastomosis time, cold ischemia time and total ischemia time were all shorter in the abdominal heterotopic kidney transplantation group than in the orthotopic kidney transplantation group, with statistically significant differences (all P<0.05). The number of satisfactory renal perfusion cases was higher in the abdominal heterotopic kidney transplantation group than in the orthotopic kidney transplantation group (83% vs. 75%), but the difference was not statistically significant (P>0.05). The total incidence of postoperative complications was 33% in the heterotopic kidney transplantation group, with a survival rate of 92%, and the cause of death was rupture of the vascular anastomosis. The total incidence of postoperative complications was 50% in the orthotopic kidney transplantation group, with a survival rate of 83%, and the causes of death were renal vein thrombosis and renal artery thrombosis. There were no statistically significant differences in the total incidence of postoperative complications and survival rates between the two groups (all P>0.05). Conclusions Compared with orthotopic kidney transplantation, abdominal heterotopic kidney transplantation showes better surgical outcomes in pig-to-pig kidney transplantation and is more beneficial for the short-term survival of recipient pigs after surgery. This provides experience for improving the stability of pig-to-non-human primate kidney xenotransplantation models in the future.
9.Peak growth hormone and insulin-like growth factor 1 levels in girls with isolated premature thelarche and their predictive value for central precocious puberty.
Jie CHEN ; Kun-Di WANG ; Rong HUANG ; Shu-Fang LIU ; Qi YANG ; Li YANG
Chinese Journal of Contemporary Pediatrics 2025;27(11):1360-1366
OBJECTIVES:
To compare serum insulin-like growth factor 1 (IGF-1) and peak growth hormone (GH) levels between girls with isolated premature thelarche (IPT) and central precocious puberty (CPP), to construct a prediction model for progression from IPT to CPP, and to assess its diagnostic value.
METHODS:
Girls diagnosed with IPT (n=111) between January 2022 and August 2023 at the China-Japan Friendship Hospital and the Xinjiang Production and Construction Corps Hospital were retrospectively included. According to follow-up outcomes, participants were categorized into a CPP group (35 cases) and an IPT group (36 cases). A clinical prediction model for progression to CPP was constructed by multivariable logistic regression, and the contributions of IGF-1 and peak GH were evaluated. Restricted cubic spline analysis was used to assess the dose-response relationships of IGF-1 and peak GH with CPP. Decision curve analysis was applied to evaluate clinical utility.
RESULTS:
IGF-1 and peak GH were higher in the CPP group than in the IPT group (P<0.05). Compared with model 1 (without IGF-1 and peak GH), model 2 (with IGF-1 and peak GH) showed significantly higher area under the curve, integrated discrimination improvement, and net reclassification improvement (all P<0.05). Model 2 (χ 2=6.054, P=0.889) also demonstrated better goodness-of-fit than model 1 (χ 2=7.717, P=0.634). Nonlinear dose-response relationships were observed for peak GH and IGF-1 with CPP (P for overall trend <0.05; P for nonlinearity <0.05). Decision curve analysis indicated that combined prediction using IGF-1 and peak GH provided greater net benefit than either biomarker alone.
CONCLUSIONS
Peak GH and IGF-1 are closely associated with progression from IPT to CPP in girls. A clinical prediction model incorporating peak GH and IGF-1 can improve prediction of progression to CPP and yield higher net benefit.
Humans
;
Female
;
Puberty, Precocious/etiology*
;
Insulin-Like Growth Factor I/analysis*
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Child
;
Retrospective Studies
;
Human Growth Hormone/blood*
;
Predictive Value of Tests
;
Child, Preschool
;
Logistic Models
10.Clinical application of inflatable unilateral axillary approach robot assisted bilateral thyroid lobe lesion resection.
Di WU ; Zheng ZHAO ; Qi FANG ; Fei CAO ; Ruobin LIN ; Jun CHEN ; Xuekui LIU
Journal of Clinical Otorhinolaryngology Head and Neck Surgery 2025;39(11):1022-1027
Objective:To evaluate the feasibility, safety, and short-term efficacy of robot-assisted unilateral axillary approach for partial or total thyroidectomy without inflation. Methods:A retrospective analysis was performed on the clinical data of 98 patients who underwent gasless unilateral axillary approach robot-assisted resection of bilateral thyroid lesions at Sun Yat-sen University Cancer Center between October 2022 and October 2024. Perioperative indicators were recorded and compared among patients undergoing different surgical approaches(total thyroidectomy vs. bilateral partial thyroidectomy) and with different body mass index(BMI) values, including operative time, intraoperative blood loss, number of lymph nodes dissected, incidence of postoperative hoarseness, incidence of postoperative hypocalcemia, and other postoperative complications. Results:A total of 98 patients were included, of whom 78.57% were female, with a median age of 39 years(interquartile range[IQR]: 35-49) and a median BMI of 24.08 kg/m²(IQR: 21.43-25.98). The median intraoperative blood loss was 32.14 mL(IQR: 20.00-50.00), the median operative time was 130.0 minutes(IQR: 104.80-150.30), and the median hospital stay was 2.01 days(IQR: 1.00-2.00). The most common postoperative complication was transient hypocalcemia, with an incidence of 16.32%. There were no cases of permanent recurrent laryngeal nerve palsy or conversion to open surgery. Compared with the non-total thyroidectomy group, the total thyroidectomy group had a significantly longer operative time(135.10±33.28 min vs 120.30±30.53 min, P=0.033). Subgroup analysis based on BMI showed no statistically significant differences in operative time, hospital stay, drainage volume, or incidence of hypocalcemia between patients with BMI≥25 kg/m² and those with BMI<25 kg/m². Conclusion:The gasless unilateral axillary approach for robot-assisted partial or total thyroidectomy demonstrates favorable safety, cosmetic outcomes, and feasibility. Appropriate selection of surgical techniques and meticulous protection of critical structures during the procedure can further reduce the risk of complications and optimize therapeutic outcomes.
Humans
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Thyroidectomy/methods*
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Retrospective Studies
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Female
;
Robotic Surgical Procedures/methods*
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Male
;
Adult
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Middle Aged
;
Axilla/surgery*
;
Operative Time
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Postoperative Complications
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Thyroid Neoplasms/surgery*
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Thyroid Gland/surgery*
;
Lymph Node Excision

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