Objective:To evaluate the relevant factors to optimize the learning curve and the impact of the basic skills of endoscopic technology on the learning curve of gasless transaxillary posterior endoscopic thyroidectomy.Methods:A retrospective analysis was performed to evaluate the clinical outcomes of 50 patients who underwent Glandular Ultrasound-Assisted (GUA) thyroid surgery by a surgeon with a background in endoscopic thyroid surgery via the thoracic-areolar approach, and 50 patients operated on by a surgeon without such experience at the Thyroid Surgery Department of Jilin University China-Japan Union Hospital from Apr. to Dec. 2023. The patients were divided into two groups: the Endoscopic Experience Group and the Non-Endoscopic Experience Group. The Cumulative Sum Control Chart (CUSUM) was applied to construct learning curves for both groups, dividing the technical exploration period from the mastery period. The analysis compared the surgical time, postoperative first-day drainage volume, number of central lymph nodes dissected rates, and postoperative complications between the two groups and across the two phases.Results:The analysis of the learning curve revealed that the inflection point of the Endoscopic Experience Group was 15, while of the Non-Endoscopic Experience Group was 18. The learning curve was divided into the technical exploration stage and the proficient mastery stage. The operative time of technical exploration stagde was significantly longer than of proficient mastery stage of both group (183.46±36.13min vs.144.40±26.14min, P<0.001; 186.89±48.91min vs.131.59±22.90min; P<0.001) . The operative time in the proficient mastery stage of the Endoscopic Experience Group was longer than that of the Non-Endoscopic Experience Group (144.40±26.15min vs. 131.59±22.90min, P<0.05) . The postoperative drainage volume in the Endoscopic Experience Group was lower than that in Non-Endoscopic Experience Group in both stages (65.40±32.48mL vs.93.22±30.67mL, 57.40±15.35mL vs.78.50±28.30mL, P<0.05) , and the postoperative drainage volume in the proficient mastery stage of the Non-Endoscopic Experience Group was significantly lower than in the technical exploration stage (93.22±30.67mL vs.78.50±28.30mL, P<0.05) .No significant differences in central lymph node dissection numbers or postoperative complications were observed between the groups at both stages. Conclusions:There is a specific learning curve in the early stage of gasless transaxillary posterior endoscopic thyroidectomy. After crossing the learning curve, the operation time is obviously shortened with the improvement of the operator's surgical technique.Having a basic understanding of endoscopic technology in the early stage can reduce the occurrence of postoperative drainage, but has a minimal impact on the learning curve.

The lumbar intervertebral disc exhibits a complex physiological structure with interactions between various segments, and its components are extremely complex. The material properties of different components in the lumbar intervertebral disc, especially the water content (undergoing dynamic change as influenced by age, degeneration, mechanical loading, and proteoglycan content) - critically determine its mechanical properties. When the lumbar intervertebral disc is under continuous pressure, water seeps out, and after the pressure is removed, water re-infiltrates. This dynamic fluid exchange process directly affects the mechanical properties of the lumbar intervertebral disc, while previous isotropic modeling methods have been unable to accurately reflect such solid-liquid phase behaviors. To explore the load-bearing mechanism of the lumbar intervertebral disc and establish a more realistic mechanical model of the lumbar intervertebral disc, this study developed a solid-liquid biphasic, fiber-reinforced finite element model. This model was used to simulate the four movements of the human lumbar spine in daily life, namely flexion, extension, axial rotation, and lateral bending. The fluid pressure, effective solid stress, and liquid pressure-bearing ratio of the annulus fibrosus and nucleus pulposus of different lumbar intervertebral discs were compared and analyzed under the movements. Under all the movements, the fluid pressure distribution was closer to the nucleus pulposus, while the effective solid stress distribution was more concentrated in the outer annulus fibrosus. In terms of fluid pressure, the maximum fluid pressure of the lumbar intervertebral disc during lateral bending was 1.95 MPa, significantly higher than the maximum fluid pressure under other movements. Meanwhile, the maximum effective solid stress of the lumbar intervertebral disc during flexion was 2.43 MPa, markedly higher than the maximum effective solid stress under other movements. Overall, the liquid pressure-bearing ratio under axial rotation was smaller than that under other movements. Based on the solid-liquid biphasic modeling method, this study more accurately revealed the dominant role of the liquid phase in the daily load-bearing process of the lumbar intervertebral disc and the solid-phase mechanical mechanism of the annulus fibrosus load-bearing, and more effectively predicted the solid-liquid phase co-load-bearing mechanism of the lumbar intervertebral disc in daily life.
Humans ; Finite Element Analysis ; Intervertebral Disc/physiology* ; Lumbar Vertebrae/physiology* ; Weight-Bearing/physiology* ; Biomechanical Phenomena ; Stress, Mechanical ; Computer Simulation ; Models, Biological

Objective:To evaluate the relevant factors to optimize the learning curve and the impact of the basic skills of endoscopic technology on the learning curve of gasless transaxillary posterior endoscopic thyroidectomy.Methods:A retrospective analysis was performed to evaluate the clinical outcomes of 50 patients who underwent Glandular Ultrasound-Assisted (GUA) thyroid surgery by a surgeon with a background in endoscopic thyroid surgery via the thoracic-areolar approach, and 50 patients operated on by a surgeon without such experience at the Thyroid Surgery Department of Jilin University China-Japan Union Hospital from Apr. to Dec. 2023. The patients were divided into two groups: the Endoscopic Experience Group and the Non-Endoscopic Experience Group. The Cumulative Sum Control Chart (CUSUM) was applied to construct learning curves for both groups, dividing the technical exploration period from the mastery period. The analysis compared the surgical time, postoperative first-day drainage volume, number of central lymph nodes dissected rates, and postoperative complications between the two groups and across the two phases.Results:The analysis of the learning curve revealed that the inflection point of the Endoscopic Experience Group was 15, while of the Non-Endoscopic Experience Group was 18. The learning curve was divided into the technical exploration stage and the proficient mastery stage. The operative time of technical exploration stagde was significantly longer than of proficient mastery stage of both group (183.46±36.13min vs.144.40±26.14min, P<0.001; 186.89±48.91min vs.131.59±22.90min; P<0.001) . The operative time in the proficient mastery stage of the Endoscopic Experience Group was longer than that of the Non-Endoscopic Experience Group (144.40±26.15min vs. 131.59±22.90min, P<0.05) . The postoperative drainage volume in the Endoscopic Experience Group was lower than that in Non-Endoscopic Experience Group in both stages (65.40±32.48mL vs.93.22±30.67mL, 57.40±15.35mL vs.78.50±28.30mL, P<0.05) , and the postoperative drainage volume in the proficient mastery stage of the Non-Endoscopic Experience Group was significantly lower than in the technical exploration stage (93.22±30.67mL vs.78.50±28.30mL, P<0.05) .No significant differences in central lymph node dissection numbers or postoperative complications were observed between the groups at both stages. Conclusions:There is a specific learning curve in the early stage of gasless transaxillary posterior endoscopic thyroidectomy. After crossing the learning curve, the operation time is obviously shortened with the improvement of the operator's surgical technique.Having a basic understanding of endoscopic technology in the early stage can reduce the occurrence of postoperative drainage, but has a minimal impact on the learning curve.

Objective:To investigate the timing and features of fine-needle aspiration biopsy (FNAB) guided by ultrasound for Bethesda Ⅲ thyroid nodules and to further optimize the puncture scheme.Methods:A retrospective analysis was conducted on data from patients who underwent rFNAB for Bethesda Ⅲ thyroid nodules at the China-japan Union Hospital of Jilin University Thyroid Surgery Department from Dec. 2020 to Dec. 2022. The study included 71 cases (73 nodules), consisting of 57 females and 14 males, with an average age of (45.7±10.4) years. Patients were grouped based on rFNAB results: Bethesda Ⅱ as the benign group ( n=21), Bethesda Ⅴ/Ⅵ as the malignant group ( n=39), and the remaining cases categorized as the indeterminate group ( n=13). Data on rFNAB results, puncture interval time, postoperative pathology, ultrasound features, and FNAB characteristics were recorded. Descriptive statistics were used for categorical data, presented as percentages and numbers, while continuous data were presented as mean ± standard deviation ( ± s). The χ2 test or Fisher's exact test was applied for analysis. Results:In this study, rFNAB was performed on 73 Bethesda Ⅲ thyroid nodules. The results showed that 60 nodules (82.2%) received a definite diagnosis, while 13 nodules (17.8%) were indeterminate. There was a statistically significant difference in the calcification classification between the malignant group and the benign group as well as the indeterminate group ( P<0.05). Among the malignant group, 29 patients underwent surgical treatment, with only 2 cases (8.0%) showing intermediate recurrence risk when surgery was performed more than three months after the initial FNAB. Upon reevaluation of the 31 initial FNAB samples from the malignant group, 9 samples (29.0%) exhibited mild cytological atypia, and 22 samples (71.0%) had poor quality specimens, mainly comprising fibrous and calcified components. Conclusions:For nodules initially classified as Bethesda Ⅲ, if suspicious ultrasound features persist or emerge, especially if microcalcifications are present, rFNAB should be performed after a follow-up period exceeding three months. However, during the puncture, multiple points should be targeted at the non-calcified areas of the nodule to enhance the accuracy and reliability of rFNAB.

BACKGROUND:Avascular necrosis of the femoral head is a refractory orthopedic disease that seriously affects the normal life of patients.Hip preservation is recommended for young patients due to the limited prosthesis longevity and revision.Accurate prediction of the mechanical properties of the necrotic area in the early stage and then intervention is the key to hip preservation. OBJECTIVE:To establish a dynamic contact mechanics finite element model of necrotic femoral head based on human hip CT data and predict effects of both necrotic volume magnitude and its position on biomechanics of the necrotic region under walking movement. METHODS:CT data of a volunteer were collected and then geometry model of the hip was rebuilt.Finite element model of the necrotic femoral head was established using the Abaqus software.Nine different necrotic femoral models were constructed by combined both three different necrotic volume magnitudes(small,medium and big volume)and three different necrotic positions(coincided with,medium deviated with and kept away from the line of the force).The Von Mises of the necrotic region for all models were predicted under both 3 000 N static load and dynamical loads of one whole ISO walking gait cycle.The collapse risk for all models was evaluated based on collapse criterion. RESULTS AND CONCLUSION:(1)More approaching of the necrotic region to the line of force and bigger collapse volume made the maximum Von Mises increasing.This also enlarged the collapse risk of the necrotic region.(2)For different load types,walking movement increased the maximum Von Mises of the necrotic region than that of the value under static load under the same necrotic volume and location.(3)In conclusion,dynamic load would result in increasing of the maximum Von Mises of the necrotic region comparing to static load during exercise.Therefore,the risk of local collapse will increase due to greater Von Mises.However,the overall collapse risk is lower than that of static load due to the dynamic change of bearing area.This factor should be carefully considered by surgeons when they evaluate the mechanical performance of the necrotic femoral head.

Objective:To compare the characteristics of background mucosa, lesion features, and the efficiency of endoscopic submucosal dissection(ESD)between elderly and non-elderly patients with early gastric cancer(EGC).Methods:This study retrospectively collected data on patients with EGC who underwent ESD treatment at Beijing Hospital from April 2020 to December 2022.The clinical characteristics, background mucosa, lesion features, ESD outcomes, and pathological results of the patients were analyzed to compare the differences between elderly and non-elderly patients.Results:A total of 100 patients with EGC were selected, comprising 57 patients in the elderly group and 43 patients in the non-elderly group, with a total of 111 lesions identified(64 lesions in the elderly group and 47 lesions in the non-elderly group).The proportion of patients with a history of chronic atrophic gastritis was significantly higher in the elderly group(89.5%、51/57)compared to the non-elderly group(74.4%、32/43), with a statistically significant difference( P=0.047).Additionally, the difference in the extent of atrophy between elderly patients with EGC and their non-elderly counterparts was statistically significant( P=0.022).Among these patients, the proportion of those classified as Kimura-Takemoto C0 to C1 in the elderly group(15.6%、10/64)was lower than that in the non-elderly group(40.4%、19/47).In contrast, the proportion of patients classified as C2 to C3 in the elderly group(65.6%、42/64)was higher than that in the non-elderly group(51.1%、24/47), and the proportion of those classified as O1 to O3 in elderly patients(12.5%、8/64)was also higher than in the non-elderly group(4.3%、2/47).Furthermore, the difference in the extent of intestinal metaplasia between elderly and non-elderly patients with early gastric cancer was statistically significant( P=0.007).The overall proportion of total intestinal metaplasia in elderly patients(85.9%、55/64)was significantly higher than that in non-elderly patients(61.7%、29/47).Notably, the proportion of patients exhibiting extensive intestinal metaplasia(intestinal metaplasia present in both the gastric antrum and gastric body)was greater in the elderly group(43.8%、28/64)compared to the non-elderly group(23.4%、11/47).The Kyoto gastric cancer risk endoscopic score for elderly patients with EGC was(2.43±1.28)points, significantly higher than that of the non-elderly group(1.72±1.41)points, with a statistically significant difference observed( t=2.778, P=0.006).No statistically significant differences were observed in the proportions of total resection rates, R0 resections, curative resections, or postoperative complications following ESD when comparing elderly patients with EGC to their non-elderly counterparts. Conclusions:The proportion of extensive atrophy and intestinal metaplasia was higher in the background mucosa of elderly patients with EGC, and correspondingly, the Kyoto endoscopic gastric cancer risk score was elevated.Therefore, endoscopic examinations for elderly patients with chronic atrophic gastritis should be conducted with greater care and comprehensiveness.

Auditory neuropathy spectrum disorder (ANSD) represents a variety of sensorineural deafness conditions characterized by abnormal inner hair cells and/or auditory nerve function, but with the preservation of outer hair cell function. ANSD represents up to 15% of individuals with hearing impairments. Through mutation screening, bioinformatic analysis and expression studies, we have previously identified several apoptosis-inducing factor (AIF) mitochondria-associated 1 (AIFM1) variants in ANSD families and in some other sporadic cases. Here, to elucidate the pathogenic mechanisms underlying each AIFM1 variant, we generated AIF-null cells using the clustered regularly interspersed short palindromic repeats (CRISPR)/CRISPR-associated protein 9 (Cas9) system and constructed AIF-wild type (WT) and AIF-mutant (mut) (p.‍T260A, p.‍R422W, and p.‍R451Q) stable transfection cell lines. We then analyzed AIF structure, coenzyme-binding affinity, apoptosis, and other aspects. Results revealed that these variants resulted in impaired dimerization, compromising AIF function. The reduction reaction of AIF variants had proceeded slower than that of AIF-WT. The average levels of AIF dimerization in AIF variant cells were only 34.5%‍‒‍49.7% of that of AIF-WT cells, resulting in caspase-independent apoptosis. The average percentage of apoptotic cells in the variants was 12.3%‍‒‍17.9%, which was significantly higher than that (6.9%‍‒‍7.4%) in controls. However, nicotinamide adenine dinucleotide (NADH) treatment promoted the reduction of apoptosis by rescuing AIF dimerization in AIF variant cells. Our findings show that the impairment of AIF dimerization by AIFM1 variants causes apoptosis contributing to ANSD, and introduce NADH as a potential drug for ANSD treatment. Our results help elucidate the mechanisms of ANSD and may lead to the provision of novel therapies.
Humans ; Apoptosis Inducing Factor/metabolism* ; NAD/metabolism* ; Dimerization ; Apoptosis

Objective:To investigate the feasibility and advantages of unilateral primary hyperparathyroidism (PHPT) treated by transthyretal interosseous muscle approach surgery.Methods:Clinical data of 7 patients with unilateral PHPT treated by interstitial sternocleidomastoid muscle approach from Jan. 2021 to Feb. 2022 in the thyroid surgery of China-Japan Union Hospital of Jilin University were retrospectively analyzed, including preoperative blood calcium concentration, operation time, incision length, intraoperative parathyroid hormone (PTH) , blood calcium concentration and PTH value in the first month after surgery, abnormal sensation of the skin in the anterior cervical area, etc. The feasibility and advantages of interstitial sternocleidomastoid muscle approach surgery for unilateral PHPT were analyzed.Results:All 7 patients with unilateral PHPT were operated successfully. The PTH was 17.2-63.3 pg/ml on recheck 1 month after surgery, which were all within the normal range. The time from skin opening to resection of the diseased parathyroid gland was 20-35 min, and the length of the surgical incision was 3-4 cm. all patients were given intravenous and oral calcium therapy after surgery, and the blood calcium and PTH levels were within the normal range at 3-12 months of follow-up; the incision recovered well, and there was no significant sensory and functional abnormalities in the anterior neck area.Conclusion:The treatment of unilateral PHPT through the sternocleidomastoid interosseous approach can ensure the safety and efficacy of the operation while better protecting the sensory and motor functions of the anterior cervical region and improving the aesthetics of the surgical incision.

Objective:To investigate the effects of 40 Hz and 70 Hz frequency flash stimulation on the ability of learning memory and autonomous exploratory in young rats.Methods:Twenty-seven SPF grade male SD rats aged 19-21 days were divided into control group (Ctr group), 40 Hz group and 70 Hz group with 9 in each group according to the random number table.The rats in Ctr group were not given flash stimulation, while rats in the 40 Hz and 70 Hz group were received 40 Hz, 70 Hz flash stimulation (1.5 h/d for 39 days), respectively.The Morris water maze experiment was used to assess the learning and memory ability of rats, and the open field experiment was used to evaluate the ability of autonomous exploratory of rats.Nissl staining was used to assess the morphology of Nissl bodies in the hippocampus CA1 region of the rats.The local field potentials (LFPs) collected from the primary visual cortex (V1 area) region by electrophysiological experiments was used to verify the synchronization of flash evoked neural oscillations.SPSS 23.0 software was used for statistical analysis.The repeated measures ANOVA and one-way ANOVA were used to analyze normal distribution measurement data, and LSD and Tamhane tests were used for further pairwise comparison.The Kruskal-Wallis test was used for non-normal distribution measurement data.Results:(1) The flash stimulation of 40 Hz and 70 Hz both can effectively caused synchronization of neural oscillations in the primary visual cortex of healthy young rats.(2) The results of repeated measures ANOVA analysis showed that there was no interaction effect of grouping and time in the escape latency of young rats in the Morris water maze positioning navigation phase( F=1.326, P>0.05 ). The escape latency had time main effect ( F=40.025, P<0.05), but no grouping main effect ( F=2.039, P>0.05). With the increase of learning days, the escape latency of young rats in each group decreased significantly.There was no interaction effect of grouping and time in the total distance of young rats ( F=2.029, P>0.079). It had time main effect ( F=32.052, P<0.05), but not grouping main effect ( F=2.390, P>0.05) on total distance.With the increase of learning days, the total distance of young rats in each group significantly shortened.On the 6th day of the Morris water maze experiment, there was no statistically significant difference among groups in terms of time in the target quadrant and the number of crossing platforms ( F=2.511, 0.802, both P>0.05). The results of the open field experiment showed that the total distance traveled in the center of young rats in each group was statistically significant ( H=8.935, P<0.05), the total distance traveled in the center in the 70 Hz group (3.80 (2.25, 6.93) m)was significantly longer than that in the 40 Hz group (0.80 (0.72, 1.46) m), P<0.05). The percentage of time spent in the center was statistically significant in the three groups ( H=11.050, P<0.05). Young rats in the 70 Hz group spent significantly higher percentage of time in the center(3.20(2.43, 8.30)) than those in the 40 Hz group (0.95 (0.37, 1.06 ), P<0.05 ). (3) Nissl staining results showed that Nissl bodies in the hippocampal CA1 area of young rats in Ctr, 40 Hz and 70 Hz group were all arranged neatly and tightly, no edema was found in the surrounding stroma, and no obvious inflammatory cell infiltration was found. Conclusion:70 Hz frequency flash stimulation may promote the ability of learning memory and autonomous exploratory of young rats.

Objective:To investigate the risk factors and clinical significance of lymph nodes metastasis between sternocleidomastoid and sternohyoid muscle lymph node (LNSS) metastasis in thyroid cancer patients, so as to guide the reasonable dissection of LNSS region and lateral cervical lymph node in patients with papillary thyroid carcinoma (PTC) .Methods:We selected 111 PTC patients with lateral cervical lymph node metastasis who underwent radical thyroidectomy and lateral cervical lymph node dissection from Nov. 2018 to Dec. 2021 in China-Japan Union Hospital of jilin university. All patients were treated with low collar arc incision. Radical thyroidectomy and lateral cervical lymph node dissection were performed according to the guidelines, and lymph nodes in each district were grouped for pathological examination. According to whether LNSS metastasis occurred, they were divided into two groups: LNSS positive group (LNSS metastasis occurred) and LNSS negative group (LNSS metastasis did not happen). We collected the basic information of all 111 PTC patients with lateral lymph node metastasis (LLNM), preoperative color Doppler ultrasound examination and paraffin-embedded pathology and other related clinical case data. Then we described the clinicopathological features of cervical lymph node metastasis. Independent sample t test and Mann-Whitney U test were used for continuous variables, and Fisher exact test was used for data analysis for classified variables. Correlation analysis adopted binary logistics regression model, and analyzed the regularity and risk factors of LNSS metastasis. Results:In this study, the detection rate of LNSS was 64.9% (72/111), the overall LNSS metastasis rate was 7.2% (8/111), and the number of lymph node metastasis was 0-5. Univariate analysis showed that the location of LNSS metastasis was related with the cancer focus ( P<0.001), the preoperative serum thyroglobulin (Tg) level ( P=0.002), the number of lymph node metastasis in lateral cervical level Ⅳ ( P=0.001), the longest diameter of the cancer focus ( P=0.003) and the longest diameter of metastatic lymph nodes ( P=0.001) However, age, sex, whether there is lymph node metastasis in the central region (central lymph node metastasis ,CLNM), and whether there is multifocal cancer were not related to LNSS metastasis ( P≥0.05). Further multivariate analysis and work curve analysis of subjects showed that the tumor located in the lower pole ( P=0.014) and the number of lymph node metastasis in level Ⅳ more than 3 ( P=0.027) were independent risk factors for LNSS metastasis. It was found that the risk of LNSS metastasis increased when the cancer focus was located at the lower pole relative to the upper pole or middle part of the cancer focus ( OR=74.508, 95% CI: 2.373-2339.544). The number of lymph node metastasis in level Ⅳ had a positive effect on LNSS metastasis. The more lymph node metastasis in level Ⅳ, the higher the risk of LNSS metastasis ( OR=1.556; 95% CI=1.051-2.303) . Conclusions:In PTC patients with LLNM, the LNSS metastasis rate was 7.2%, and the advantages of LNSS cleaning outweigh the disadvantages. When the cancer focus is located at the lower pole and the number of lymph node metastasis in region Ⅳ is more than 3, it is necessary to pay attention to the dissection of this group of lymph nodes.