Objective: To investigate the clinicopathological characteristics and diagnostic-therapeutic strategies of oncocytic mucoepidermoid carcinoma (OMEC) of the parotid gland, and to enhance awareness of this rare variant among clinicians and pathologists. Methods: The clinical data, imaging findings, histopathological features, immunophenotype, and molecular characteristics of two patients with parotid OMEC were retrospectively analyzed, and the relevant literature was reviewed. Results: Case 1 was a 50-year-old man who presented with a painless mass behind the right earlobe for more than 2 years. The patient underwent extended parotidectomy with preservation of the facial nerve. Histopathological examination revealed that the tumor was predominantly composed of oncocytic cells with a small proportion of mucous cells. Immunohistochemically, the tumor cells were partially positive for cytokeratin 5/6, cytokeratin 7, and P63. Special staining with alcian blue, periodic acid-Schiff, and phosphotungstic acid hematoxylin yielded positive results. The diagnosis of right parotid OMEC was established. No recurrence or metastasis was observed during a 1 year follow-up. Case 2 was a 61-year-old man with a 3-month history of a mass beneath the left ear. After partial parotidectomy at an outside institution, pathological consultation at the Stomatological Hospital of Jilin University demonstrated that the tumor consisted almost entirely of oncocytic cells, exhibited infiltrative growth, and lacked typical mucous, epidermoid, and intermediate cells. Fluorescence in situ hybridization confirmed positive mastermind-like transcriptional activator 2 (MAML2) gene rearrangement, establishing the diagnosis of left parotid OMEC. The patient subsequently underwent total parotidectomy with preservation of the facial nerve, and no recurrence was detected during a short-term 3 months follow-up. A review of the literature indicated that OMEC most commonly arises in the parotid gland and is generally a low-grade malignancy with favorable prognosis. When tumors are composed exclusively of oncocytic cells, exhibit minimal cytological atypia, and lack the classical cellular components of mucoepidermoid carcinoma, they are highly prone to misdiagnosis as oncocytoma, nodular oncocytic hyperplasia, or other benign oncocytic lesions. Accurate differential diagnosis relies on recognition of infiltrative growth patterns, supportive immunophenotypic markers (e.g., P63 positivity), and detection of characteristic MAML2 gene rearrangement. Complete surgical excision remains the treatment of choice. Conclusion OMEC dominated by oncocytic cells carries a high risk of clinical misdiagnosis. Integrating the assessment Conclusion OMEC dominated by oncocytic cells carries a high risk of clinical misdiagnosis. Integrating the assessment of infiltrative histopathological features with immunohistochemistry and molecular detection of MAML2 rearrangement is crucial for accurate diagnosis, appropriate assessment of tumor behavior, and optimal surgical decision making.

The endothelial glycocalyx（EG）is a villous polyglycoprotein complex that covers the apical membrane of endothelial cells，situated between the blood vessel wall and the bloodstream.Due to its unique physiological position，the EG plays a crucial role in vascular permeability，mechanical conduction，coagulation，inflammation，and other processes.EG injury can cause endothelial barrier dysfunction，increase vascular permeability，and promote inflammation and thrombosis.Recent studies have revealed that the involvement of EG in inflammatory responses may contribute significantly to the pathogenesis of certain rheumatic and immune diseases as well as multi-system inflammatory syndrome，Kawasaki disease，rheumatoid arthritis，systemic lupus erythematosus and antiphospholipid syndrome，etc.This review paper aims to provide an overview of the structure and function of EG while highlighting its research progress in diagnosing and treating rheumatic and immune diseases.

Systemic juvenile idiopathic arthritis is one of the common rheumatic and immune diseases in children. It has a sudden onset, obvious systemic symptoms, and lung involvement. However, systemic juvenile idiopathic arthritis with an early manifestation of pulmonary ground-glass opacities combined with macrophage activation syndrome is rare. The clinical data of a child with systemic juvenile idiopathic arthritis with pulmonary ground-glass shadow and macrophage activation syndrome who was admitted to Hubei Maternal and Child Health Care Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology in December 2021 were analyzed retrospectively in order to improve the understanding of rheumatic diseases and pulmonary lesions. The child was admitted to the hospital for 10 days due to rash and fever. Thoracic CT showed scattered ground glass like shadows in both lungs due to the prevention and control screening of COVID-19 pneumonia epidemic situation. After admission, the child was still repeatedly flaccid with high fever, accompanied by dysfunction of both lower limbs. The knee joint MRI found that there was synovitis in the knee joint, and various laboratory indicators suggested macrophage activation syndrome. After that, systemic juvenile idiopathic arthritis was diagnosed. After being treated with methylprednisolone, cyclosporine and topzumab, the clinical remission and the ground-glass shadow of the lung basically disappeared. Through the analysis of this case, it is suggested that clinicians should not ignore other diseases that cause ground glass shadow in the lung during the current epidemic of COVID-19.

Objective:To improve clinicians' understanding of Multisystem Inflammatory Syndrome in Children (MIS-C) and to reduce missed and misdiagnosis.Methods:The clinical data of a patient with Multisystem inflammatory syndrome in children admitted to Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology in January 2023 were analyzed retrospectively, together with literature review.Results:A 10-year-old male patient was admitted to hospital with a fever for 5 days. This patient had a history of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection 1 month prior to admission; after admission, he continued to have recurring high fevers, accompanied by abdominal pain and Kawasaki disease like manifestations, shock, multiple organ function impairment, and a significant increase in inflammatory indicators. Finally, the patient was diagnosed with MIS-C, treated with intravenous immunoglobulin, glucocorticoids and aspirin, and discharged with clinical improvement.Conclusion:MIS-C was a novel syndrome with Kawasaki-like manifestations.Currently, the overall prognosis for MIS-C is good, but its pathogenesis is unclear and the therapeutic consensus remains limited. More studies are needed to clarify the best diagnosis and treatment methods and true prognosis.

Objective:To examine the posterior sternocleidomastoid border approach which elevated whole sternocleidomastoid in gasless transaxillary endoscopic thyroidectomy.Methods:The clinical data of 46 patients with papillary thyroid carcinoma treated with gasless transaxillary endoscopic thyroidectomy from May 2019 to June 2020 at Department of Head and Neck Surgery, Sichuan Cancer Hospital was analyzed retrospectively. There were 9 males and 37 females, aged (38.6±12.0) years (range: 19 to 74 years). Fourteen and 32 cases performed posterior sternocleidomastoid border and sternocleidomastoid fascia approach, respectively. Comparative analysis were performed on clinical characters, surgical outcomes, postoperative complications, postoperative pain score, and quality-of-life of postoperative 1 month by t test, Wilcoxon rank sum test, Fisher exact test and χ 2 test,respectively. Resuts Complete exposure of central compartment was higher (11/14 vs. 34.4%(11/32),χ2=7.624, P=0.006), more lymph nodes was retrieved (4.2±2.9 vs. 2.0±2.5, t=2.663, P=0.011) in posterior sternocleidomastoid border approach. There were no significant differences between groups in postoperative complications such as recurrent laryngeal nerve palsy (1/14 vs. 3.1%(1/32), P=0.521) and transient hypoparathyroidism (0 vs. 6.2%(2/32), P=1) and pains and quality-of-life. Conclusion:Posterior sternocleidomastoid border approach of gasless transaxillary endoscopic thyroidectomy is safe and reliable and has the advantage of central compartment dissection without increasing trauma.

Objective:To examine the posterior sternocleidomastoid border approach which elevated whole sternocleidomastoid in gasless transaxillary endoscopic thyroidectomy.Methods:The clinical data of 46 patients with papillary thyroid carcinoma treated with gasless transaxillary endoscopic thyroidectomy from May 2019 to June 2020 at Department of Head and Neck Surgery, Sichuan Cancer Hospital was analyzed retrospectively. There were 9 males and 37 females, aged (38.6±12.0) years (range: 19 to 74 years). Fourteen and 32 cases performed posterior sternocleidomastoid border and sternocleidomastoid fascia approach, respectively. Comparative analysis were performed on clinical characters, surgical outcomes, postoperative complications, postoperative pain score, and quality-of-life of postoperative 1 month by t test, Wilcoxon rank sum test, Fisher exact test and χ 2 test,respectively. Resuts Complete exposure of central compartment was higher (11/14 vs. 34.4%(11/32),χ2=7.624, P=0.006), more lymph nodes was retrieved (4.2±2.9 vs. 2.0±2.5, t=2.663, P=0.011) in posterior sternocleidomastoid border approach. There were no significant differences between groups in postoperative complications such as recurrent laryngeal nerve palsy (1/14 vs. 3.1%(1/32), P=0.521) and transient hypoparathyroidism (0 vs. 6.2%(2/32), P=1) and pains and quality-of-life. Conclusion:Posterior sternocleidomastoid border approach of gasless transaxillary endoscopic thyroidectomy is safe and reliable and has the advantage of central compartment dissection without increasing trauma.

Objective To explore the effect and compare the relapse rates of 1-desamino-8-D-Arginine Vasopressin(DDAVP) different withdrawal ways after initial 3 months in primary monosymptomatic nocturnal enuresis(PMNE) patients,in order to provide some evidences and references to use DDAVP to cure PMNE preferably.Methods Two hundred and fifty-six cases PMNE patients who were treated in Hubei Maternal and Child Health Hospital from November 2014 to June 2016 were selected and randomly divided into group A (DDAVP immediate withdrawal group,65 cases),group B(DDAVP day reduction group,58 cases) and group C (DDAVP step reduction group,60 cases).All patients were given DDAVP tables for 3 months.After 3 months for DDAVP,patients who were effective (full respond and partial respond) to DDAVP continued to undergo a withdrawal stage,those in group A underwent immediate cessation,those in group B continued to receive the effective dose every other day for 2 months and those in group C were step by step tapered by 0.05-0.10 mg every 2-4 weeks until completely stopped,the period was not more than 3 months.All patients had a follow-up visit for 3 months after cessation of DDAVP.Results A total of 183 patients completed the study finally,there were 65 patients in group A,58 patients in group B and 60 patients in group C.Initial 3 months the effective rates of group A,B and C were respectively 89.23％ (58/65),89.66％ (52/58) and 86.67％ (52/60),there were not statistically significant difference(x2 =0.309,P =0.857).There were 58 patients in group A,52 patients in group B and 52 patients in group C continued to undergo the withdrawal stage.One month after cessation of DDAVP,the effective rates of group B (88.46％,46/52) and group C (92.31％,48/52) were significantly higher than group A(67.24％,39/58) (x2 =7.030,P=0.008;x2 =10.417,P=0.001),while the relapse rates of group B(19.23％,10/52) and group C(17.31％,9/52) were significantly less than group A(36.21％,21/58) (x2=3.904,P=0.048;x2=4.937,P =0.026).Three months after cessation of DDAVP,the effective rates of group C (78.85％,41/52) were significantly higher than group A (50.00％,29/58) and group B (57.69％,30/52) (x2 =9.859,P=0.002;x2 =5.371,P=0.020),and the relapse rates of group C(32.69％,17/52) were significantly less than group A (55.17％,32/58) and group B (51.92％,27/52) (x2 =5.609,P =0.018;x2 =3.939,P =0.047),while the effective rates and relapse rates were not statistically significant difference between group A and group B(x2 =0.652,P =0.419;x2 =0.116,P =0.733).Severe adverse events related to DDAVP were not observed in any patients.Conclusion Gradual withdrawal after initial 3 months of DDAVP may improve the effect and reduce the relapse rates,the short-term and long-term curative effects of step-by-step withdrawal treatment are both well,while long-term curative effects of every other day withdrawal treatment is not obviously well.