Since the 90s of the 20th century, thyroid endoscopic surgery has undergone the development from multi-port to single-site, from endoscopy to robot. In recent years, the emergence of da Vinci single-port robots and domestic single-port robots have further promoted the technological innovation of minimally invasive thyroid surgery. This article reviewed the development process of minimally invasive thyroid surgery from the development of endoscopic thyroid surgery, the breakthrough of single-site endoscopic surgery, and the realization of robotic thyroid surgery and single-port robotic thyroid surgery, and discussed the future of thyroid surgery in the era of artificial intelligence.

Objective To evaluate the relationship between anxiety levels and clinicopathological characteristics in patients with papillary thyroid carcinoma (PTC). Methods Among the patients who underwent surgical treatment in our center from July 2022 to September 2023, 304 patients completed the Hamilton anxiety rating scale (HAM-A) questionnaire. The clinical and pathological characteristics of these patients and their association with anxiety levels were investigated. Results Among the 304 patients, 271 were pathologically confirmed to have PTC. Of the 271 patients, 75 had higher levels of anxiety (according to HAM-A scoring system, a score ≥14 indicates clinically significant anxiety) and were assigned to the anxiety group. Univariate statistical analysis showed that the proportion of patients with elevated thyroid peroxidase antibody (TPOAb) in the anxiety group was higher than that in the non-anxiety group (34.7% vs. 16.8%, P=0.002 4). Moreover, the proportion of patients with multifocal tumors in the anxiety group was also higher than that in the non-anxiety group (33.3% vs. 16.7%, P=0.004 4). Multivariate Logistic regression confirmed that anxiety levels were associated with elevated TPOAb (P=0.005 6) and tumor multifocality (P=0.001 9). Conclusions Anxiety levels may be related to elevated TPOAb and tumor multifocality in PTC patients.

Objective To investigate the relationship between drug susceptibility of Salmonella bacteria and ion peak by mass spectrometry.Methods A total of 19 strains of Salmonella collected from the laboratory of Chengdu Center for Disease Control and Prevention from 2017 to 2020 were selected as the research objects.Serotyping and drug sensitivity tests were performed.The protein fingerprints of Salmonella were detected by matrix-assisted laser desorption ionization time-of-flight mass spectrometry.The relationship between drug sensitivity test and mass spectrometry in serotyping and drug resistance type identification was compared.Re-sults A total of 19 strains of Salmonella were generally resistant to β-lactam,and the antimicrobial resistance rate was above 50.00%except for cefepime,cefotetan and ertapenem.It was generally sensitive to non-β-lac-tam antibiotics,and the sensitivity rate was higher.The results of matrix assisted laser desorption ionization time-of-flight mass spectrometry showed that 3 128,3 158,5 144,6 094,64 84 m/z might be the specific pro-tein peaks of imipenem resistant Salmonella,5 772 m/z might be the specific protein peak of tobramycin re-sistant salmonella,3 046 m/z might be the specific protein peak of Salmonella resistant to levofloxacin,4 165 m/z might be the characteristic peak of Salmonella resistant to cefepime,10 957 m/z might be the common characteristic peak of Salmonella resistant to imipenem,cefazolin and ceftazidime,5 710 m/z might be the common characteristic peak of Salmonella resistant to tobramycin and cefotetan,4 165 m/z may be the com-mon characterstic peak of Salmonella resistant to imipenem and levofloxacin.Conclusion This study prelimi-narily explored the drug resistance spectrum of salmonella fingerprint results,which can provide reference for clinical drug use in time.

Objective To study the invasive histopathological features of papillary thyroid carcinoma(PTC)with tall cell variant(TCV).Methods A retrospective analysis of 19 170 cases of PTC in Ruijin Hospital,Shanghai Jiao Tong University School of Medicine from January 2018 to May 2023 was performed to analyze and the clinicopathological features between TCV-PTC group and classic PTC(cPTC)group.Results Pathological results showed 1 380 cases in TCV-PTC group and 15 578 cases in cPTC group.TCV-PTC had higher proportion and(or)mean value in patients'age,extraglandular invasion,nerve invasion,vascular invasion,maximum diameter of cancer focus,multifocality,lymph node metastasis and BRAF mutation,but the proportion of patients with coexistent Hashimoto's thyroiditis was lower than cPTC,and all results had significant difference(P<0.05).Conclusions Compared with the cPTC,TCV-PTC has stronger local invasive characteristics and lymph node metastasis rate,which provides the basis for the subsequent clinical treatment.

The medical records of patients of both sexes with sleep disorders treated with multimodal sleep therapy for which patient controlled sleep with dexmedetomidine was the main method, aged≥18 yr, with body mass index of 18-30 kg/m 2, from February 2019 to January 2021, were collected.Dexmedetomidine 60 ml/h (4 μg/ml) was intravenously infused until non-rapid eye movement (NREM) Ⅲ phase was reached or the consumption of dexmedetomidine reached 1 μg/kg.Whether dexmedetomidine induced restless legs syndrome (RLS) was judged according to the Chinese guidelines for the diagnosis and treatment of restless legs syndrome (2021 edition). When the titration was stopped and on the next day after emergence from anesthesia, clinical diagnosis was performed according to Chinese guidelines for the diagnosis and treatment of restless legs syndrome (2021 edition) to determine whether RLS was combined or not.Kappa consistency analysis was used to assess the consistency between dexmedetomidine titration and the Chinese guidelines for the diagnosis and treatment of restless legs syndrome (2021 Edition) in diagnosis of RLS.The sensitivity and specificity of diagnosis of RLS by dexmedetomidine titration were calculated.A total of 39 patients were included and 8 patients had RLS symptoms which were judged accroding to dexmedetomidine titration.The results of Kappa consistency test showed that there was a strong consistency between dexmedetomidine titration and Chinese guidelines for the diagnosis and treatment of restless legs syndrome (2021 edition) (Kappa value 1.0, P<0.01). The sensitivity and specificity of dexmedetomidine titration in judging RLS were 100%.In conclusion, dexmedetomidine titration can accurately judge RLS.

Objective To discuss the safety and effectiveness of transurethral resection of the prostate (TURP) on large-size (≥ 80 ml) benign prostatic hyperplasia (BPH).Methods Retrospective analysis of 958 BPH patients in Southwest Hospital during January 2010 to January 2013 was conducted.The patients were grouped into ≥80 ml prostate group (Group A) and ＜80 ml prostate group (Group B) according to the volume of prostate.Comparison was made between the 2 groups on the safety and effectiveness of TURP.Results There were 276 patients in Group A and 682 in Group B.No significant differences were shown in average age and preoperative American society of anesthesiology score of Group A and B.Compared with Group B,decrement in hemoglobin level and blood Na+ concentration of Group A was more significant (P＜0.01).There were more prostate tissues excised and duration of the operations was longer (P＜0.01).No significant difference was observed in peri-operative complications graded by the modified Clavien classification system,catheter durations and durations of hospital stay between the 2 groups (P＞0.05).At 6 months after the surgery,average maximum urinary flow rate (Qmax) increased from 5.9±2.9 ml/s to 17.1±8.2 ml/s for Group A and 6.1±3.0 ml/s to 17.5±6.4 ml/s for Group B,both groups showed significant increase in Qmax after surgery(P＜0.01).Six months after surgery,international prostate symptom score (IPSS) of Group A decreased from 23.7±6.1 to 5.9±4.9 while IPSS of Group B decreased from 23.1±5.5 to 6.2±4.4,both groups showed a significant decrease (P＜0.01).No significant difference was shown in IPSS,quality of life,Qmax,postvoid residual urine volume and occurrence rate of long-term complications after 6 months between the 2 groups (P＞0.05).Conclusion TURP is as safe and effective in treating large-size BPH as treating medium and small-size BPH.

Objective To investigate the changes and significance of platelet parameters and leucocyte in the children suffered from mycoplasma pneumoniae pneumonia (MPP).Methods The platelet parameters (PLT),the platelet volume(MPV),the platelet distribution width (PDW),and the white blood cell count(WBC) were detected by automatic blood cell analyzer respectively in 300 children with MPP before and after the treatment by macrolides antibiotics for a week as well as in 40 normal children.The comparison was made among them.Results There were 156 cases that suffered from thrombocytosis (PLT ＞ 300 × 109/L) in MPP group,the incidence rate was 52.0％(156/300).While there was 1 case with thrombocytopenia,the incidence rate was 0.3％ (1/300).The WBC,MPV and PDW in MPP group before and after one-week treatment were higher than the control group.And the PLT was higher than the initial stage of hospitalization and the control group.The differences had statistical significance.Conclusion The incidence rate of thrombocytosis was high in the children suffered from MPP.The dynamic observation of platelet parameters and WBC in children with MPP could be used as the elementary basis of judging MP infection.

Objective To investigate the changes of the anion gap(AG)in the premature suffered from hyperbilirubinemia,to provide the basis for treatment.Methods The serum electrolyte,the renal function and the liver function in 94 premature babies suffered from hyperbilirubinemia were tested,and then calculated the value of AG,while the arterial blood gas analyses were done in 36 cases.Results 44 cases had high AG(46.81％),44 cases had normal AG(46.81％)and 6 cases had low AG(6.38％).The increase of AG was directly proportional to the concentration of Na+in blood,while was inversely proportion to the concentration of HCO3-.There was no close relationship between the AG and BUN,Scr in the serum.Conclusion The incidence rate of metabolic acidosis poisoning was high in premature suffered from hyperbilirubinemia with high AG,so the routine test of blood electrolyte,renal function and arterial blood gas should be done.Calculate the value of AG to guide the treatment,and to avoid correcting the acid by the alkali blindly.

Objective To analyse the change of the blood serum electrolyte in asphyxial neonates.Methods To test the concentration of blood serum K~+、Na~+、Cl~-、Ca~(2+) in enzyme linked immunosorbhent assay.In 343 cases,there were 297 cases of slight asphyxial neonates and 46 eases of serious neonates.In control group,there were 41 cases.Results The concentration of blood serum K~+、C~l-、Ca~(2+) in asphyxial neonates were significamly less than control group(all P<0.01) and the concentration after birth 24h～48h were significantly less than within 24h(all P<0.01).The incidence of hyponatremia,hypochloremia and hypocalcemia after birth 24h～48h were significantly hisher than within 24h(all P<0.01),There were no significant differences in the concentration of blood serum K~+、Na~+、Cl~-、Ca~(2+) between the slight asphyxial group and the serious asphyxial group(P>0.05).Conclusions The concentration of blood serum K~+、Na~+、Cl~-、Ca~(2+) in asphyxial neonates gradually reduced after birth 48h and tbe incidence of electrolyte disturbance gradually increased.The change of blood electrolyte should be dynamically routinely monitored.

60 g in 15 cases).The operation time ranged from 35 to 85 minutes(mean,45),and the blood loss was 50-100 ml(mean,60 ml).No case needed blood transfusion.No rupture of the prostatic capsule,venous sinuses,or perforation of the bladder-prostate junction occurred in this series.The patients were followed up for 4 to 6 months,during which the Qmax increased to 16.4-23.2 ml/s(mean,19.8 ml/s),RU decreased to 0-15 ml(mean,5 ml),and IPSS score improved to 0-6.8(mean,4.2).No patient developed urinary incontinence.Conclusions Transurethral retrograde dissection of the prostate is effective for the treatment of BPH with a low morbidity rate of urinary incontinence.The procedure is simple and results in low blood loss.