[Purpose]To analyze the trends of incidence and mortality of thyroid cancer in the cancer registration areas of Nanning City from 2016 to 2020.[Methods]The incidence and mor-tality data of thyroid cancer from 2016 to 2020 were collected from the Nanning cancer registries,and the the quality of data was assessed.The crude incidence/mortality rates,the age-standar-dized incidence/mortality rates by Chinese standard population(ASIRC,ASMRC)and world stan-dard population(ASIRW,ASMRW),the cumulative incidence/mortality rates(0～74 years old),and the age-specific incidence/mortality rates were calculated.The Joinpoint regression model was used to estimate the trends of incidence and mortality,expressed as average annual percentage change(AAPC).[Results]From 2016 to 2020,a total of 2 291 new cases of thyroid cancer were reported in Nanning cancer registries.The crude incidence rate was 7.70/105 with the ASIRC of 7.23/105 and ASIRW of 6.22/105,the cumulative incidence rate was 0.59％.The incidence was higher in female than that in male,and higher in urban areas than that in rural areas.The incidence rate of thyroid cancer began to rise sharply from the 20 years old and reached peak in the age group of 50～54 years old.The incidence rate in female remained at a high level in the age group of 30～59 years old,which was higher than that in male.A total of 121 deaths of thyroid cancer were re-ported with a crude mortality rate of 0.41/105,ASMRC of 0.32/105,ASMRW of 0.31/105 and cu-mulative mortality rate of 0.03％.The mortality rate was higher in female than that in male.The age-specific mortality rate for thyroid cancer showed a fluctuant upward trend after the 40 years old and peaked in the age group of 75～79 years old.The crude incidence rate and ASIRC showed an upward trend in whole population(AAPC=21.11％,t=3.25,P＜0.05;AAPC=22.02％,t=3.39,P＜0.05),in male(AAPC=19.45％,t=4.35,P＜0.05;AAPC=19.81％,t=5.74,P＜0.05)and urban areas(AAPC=30.62％,t=7.13,P＜0.05;AAPC=32.38％,t=7.25,P＜0.05).The crude mortality rate and ASMRC in urban areas(AAPC=43.06％,t=7.73,P＜0.05;AAPC=47.63％,t=8.60,P＜0.05)also showed an increasing trend.[Conclusion]The crude incidence rate and ASIRC of thyroid cancer in cancer registration areas of Nanning City showed an overall upward trend from 2016 to 2020,except in rural areas;while the rising trends of the crude mortality rate and ASMRC were only observed in urban areas.

Objective:To investigate the effect of ribonucleotide reductase regulatory subunit M2 (RRM2) on the malignant biological behavior and aerobic glycolysis of gastric cancer cells by regulating cyclin-dependent kinase (CDK) 1.Methods:Human gastric cancer MKN-45 cells were divided into si-NC group (transfected with blank fragment) , CoCl 2+si-NC group (hypoxia control transfected with blank fragment) , CoCl 2+si-RRM2 group (hypoxia with RRM2 silencing) , CoCl 2+si-RRM2+pcDNA3.1 NC group (hypoxia with RRM2 silencing and blank vector) and CoCl 2+si-RRM2+pcDNA3.1 CDK1 group (hypoxia with RRM2 silencing and CDK1 overexpression) . The mRNA relative expression levels of RRM2 and CDK1 were analyzed by real time fluorescent quantitative reverse transcription PCR. Co-immunoprecipitation (CoIP) was used to analyze the interaction between RRM2 and CDK1 protein. MTT assay was used to analyze the proliferation activity of cells. The cell migration distance was detected by cell scratch assay. Cell apoptosis was detected by flow cytometry. Adenosine triphosphate (ATP) and glucose kit were used to detect ATP production and glucose consumption. The protein expressions of ENO1, RRM2, HK2, PKM2, GLUT1 and p-CDK1/CDK1 were detected by Western blotting. Results:Real time fluorescent quantitative reverse transcription PCR results showed that the relative expression levels of CDK1 mRNA in si-NC group, CoCl 2+si-NC group and CoCl 2+si-RRM2 group were 1.01±0.15, 1.30±0.06 and 0.51±0.18, and the relative expression levels of RRM2 mRNA were 1.03±0.32, 1.59±0.28 and 0.44±0.17, respectively, and there were statistically significant differences ( F=25.52, P=0.001; F=14.47, P=0.005) . The mRNA expressions of RRM2 and CDK1 in CoCl 2+si-NC group were higher than those in si-NC group. Compared with the si-NC group and the CoCl 2+si-NC group, the mRNA expressions of RRM2 and CDK1 were lower in the CoCl 2+si-RRM2 group (all P<0.05) . CoIP results showed that there was interaction between RRM2 and CDK1. MTT assay, cell scratch assay and flow cytometry showed that the cell proliferation activity of si-NC group, CoCl 2+si-NC group, CoCl 2+si-RRM2 group, CoCl 2+si-RRM2+pcDNA3.1 NC group and CoCl 2+si-RRM2+pcDNA3.1 CDK1 group were 1.04±0.01, 1.18±0.04, 0.84±0.03, 0.81±0.03 and 0.93±0.05, respectively. The cell migration distances were (301.83±2.75) , (369.67±0.76) , (176.50±6.38) , (175.83±3.69) , (254.17±1.61) μm, respectively. The apoptosis rates were 8.05%±0.21%, 5.75%± 0.20%, 28.28%±0.04%, 30.18%±1.51% and 17.79%±0.22%, respectively, all with statistically significant differences ( F=73.82, P<0.001; F=1 600.01, P<0.001; F=787.15, P<0.001) . Compared with the si-NC group and CoCl 2+si-NC group, the proliferation and migration ability of cells in the CoCl 2+si-RRM2 group, CoCl 2+si-RRM2+pcDNA3.1 NC group and CoCl 2+si-RRM2+pcDNA3.1 CDK1 group were weaker, and the apoptosis rates were higher (all P<0.05) . Compared with the CoCl 2+si-RRM2+pcDNA3.1 NC group, the proliferation and migration ability of cells in the CoCl 2+si-RRM2+pcDNA3.1 CDK1 group were stronger, and the apoptosis rate was lower (all P<0.05) . The results of ATP and glucose detection showed that there were statistically significant differences in the amount of ATP production and glucose consumption among the above five groups ( F=12.53, P<0.001; F=19.21, P<0.001) . Compared with the si-NC group, the glucose consumption of cells was lower in the CoCl 2+si-RRM2+pcDNA3.1 CDK1 group ( P<0.05) . Compared with the CoCl 2+si-NC group, the ATP production and glucose consumption of cells in the CoCl 2+si-RRM2+pcDNA3.1 CDK1 group were lower (both P<0.05) . Compared with the CoCl 2+si-RRM2+pcDNA3.1 NC group, the ATP production and glucose consumption of the CoCl 2+si-RRM2+pcDNA3.1 CDK1 group were higher (both P<0.05) . Western blotting showed that there were statistically significant differences in the protein expressions of ENO1, RRM2, HK2, PKM2, GLUT1, and p-CDK1/CDK1 among the above five groups (all P<0.001) . Compared with the si-NC group and the CoCl 2+si-NC group, the protein expressions of ENO1, RRM2, HK2, PKM2, GLUT1 and p-CDK1/CDK1 in the CoCl 2+si-RRM2+pcDNA3.1 CDK1 group were lower (all P<0.05) . Compared with the CoCl 2+si-RRM2+pcDNA3.1 NC group, the protein expressions of ENO1, RRM2, PKM2, GLUT1 and p-CDK1/CDK1 in the CoCl 2+si-RRM2+pcDNA3.1 CDK1 group were higher (all P<0.05) . Conclusions:Silencing RRM2 can inhibit the malignant biological behavior of gastric cancer cells and the occurrence of aerobic glycolysis by regulating CDK1.

[Purpose]To analyze the trends of incidence and mortality of thyroid cancer in the cancer registration areas of Nanning City from 2016 to 2020.[Methods]The incidence and mor-tality data of thyroid cancer from 2016 to 2020 were collected from the Nanning cancer registries,and the the quality of data was assessed.The crude incidence/mortality rates,the age-standar-dized incidence/mortality rates by Chinese standard population(ASIRC,ASMRC)and world stan-dard population(ASIRW,ASMRW),the cumulative incidence/mortality rates(0～74 years old),and the age-specific incidence/mortality rates were calculated.The Joinpoint regression model was used to estimate the trends of incidence and mortality,expressed as average annual percentage change(AAPC).[Results]From 2016 to 2020,a total of 2 291 new cases of thyroid cancer were reported in Nanning cancer registries.The crude incidence rate was 7.70/105 with the ASIRC of 7.23/105 and ASIRW of 6.22/105,the cumulative incidence rate was 0.59％.The incidence was higher in female than that in male,and higher in urban areas than that in rural areas.The incidence rate of thyroid cancer began to rise sharply from the 20 years old and reached peak in the age group of 50～54 years old.The incidence rate in female remained at a high level in the age group of 30～59 years old,which was higher than that in male.A total of 121 deaths of thyroid cancer were re-ported with a crude mortality rate of 0.41/105,ASMRC of 0.32/105,ASMRW of 0.31/105 and cu-mulative mortality rate of 0.03％.The mortality rate was higher in female than that in male.The age-specific mortality rate for thyroid cancer showed a fluctuant upward trend after the 40 years old and peaked in the age group of 75～79 years old.The crude incidence rate and ASIRC showed an upward trend in whole population(AAPC=21.11％,t=3.25,P＜0.05;AAPC=22.02％,t=3.39,P＜0.05),in male(AAPC=19.45％,t=4.35,P＜0.05;AAPC=19.81％,t=5.74,P＜0.05)and urban areas(AAPC=30.62％,t=7.13,P＜0.05;AAPC=32.38％,t=7.25,P＜0.05).The crude mortality rate and ASMRC in urban areas(AAPC=43.06％,t=7.73,P＜0.05;AAPC=47.63％,t=8.60,P＜0.05)also showed an increasing trend.[Conclusion]The crude incidence rate and ASIRC of thyroid cancer in cancer registration areas of Nanning City showed an overall upward trend from 2016 to 2020,except in rural areas;while the rising trends of the crude mortality rate and ASMRC were only observed in urban areas.

Objective:To explore the application effect of microsurgical thinning optimized anterolateral thigh flap in the repair of limb tumor wounds.Methods:A retrospective analysis was conducted on the clinical data of patients with limb tumors at the Microsurgery and Reconstruction Department of Xuzhou Renci Hospital from January 2019 to January 2021. All patients underwent surgical resection of the lesions and were repaired with microsurgical thinning optimized anterolateral thigh flap. The outpatient follow-up was conducted after surgery. One year after surgery, limb function and appearance were evaluated using the Musculoskeletal Tumor Society (MSTS) bone tumor limb salvage surgery limb energy scale and efficacy satisfaction score. The total score is 30 points, and a higher score indicates better function. The limb appearance was evaluated using a satisfaction score scale, with a total score of 5-10 points being satisfactory, 0-4 points being average, and -5 to -1 points considered unsatisfactory. Descriptive methods were used for statistical analysis, and normally distributed measurement data were expressed as Mean±SD.Results:A total of 11 patients were included, comprising 7 males and 4 females, aged between 19 and 55 years, with an average age of 31.5 years. Among them, there were 3 cases of dermatofibrosarcoma protuberans, 4 cases of invasive fibroma, 1 case of mucinous fibrosarcoma, 2 cases of malignant fibrous histiocytoma, and 1 case of squamous cell carcinoma of the skin. The tumor lesion ranged from 5.5 cm × 8.0 cm to 9.0 cm × 19.0 cm, and the tumor resection range during surgery was from 6.5 cm × 9.0 cm to 10.0 cm × 20.0 cm. The size of the skin flap ranged from 7.5 cm × 11.0 cm to 10.0 cm × 22.5 cm. The average thickness of the flap before thinning was 2.2 cm (1.6-3.5 cm), and the average thickness after thinning was 1.2 cm (0.9-1.7 cm). One case of superficial necrosis occurred at the edge of the flap measuring 1.5 cm × 2.0 cm after surgery, and the wound healed after dressing changes. One case of arterial crisis occurred 48 hours after surgery, and thrombus formation was detected at the distal end of the anastomosis during exploration. After reanastomosis, blood flow was restored. The remaining flaps survived well, and the incisions healed in one stage. The average postoperative follow-up period was 14.5 months (12-18 months) with no tumor recurrence. The MSTS score for limb function was (25.2±2.1) points, and the satisfaction score for limb appearance efficacy was (7.4±1.6) points, with a satisfaction rate of 10 out of 11.Conclusion:The application of microsurgical thinning optimized anterolateral thigh flap in the plastic surgery of limb tumors can restore satisfactory limb function and appearance, making it an ideal surgical method.

Objective:To explore the application effect of microsurgical thinning optimized anterolateral thigh flap in the repair of limb tumor wounds.Methods:A retrospective analysis was conducted on the clinical data of patients with limb tumors at the Microsurgery and Reconstruction Department of Xuzhou Renci Hospital from January 2019 to January 2021. All patients underwent surgical resection of the lesions and were repaired with microsurgical thinning optimized anterolateral thigh flap. The outpatient follow-up was conducted after surgery. One year after surgery, limb function and appearance were evaluated using the Musculoskeletal Tumor Society (MSTS) bone tumor limb salvage surgery limb energy scale and efficacy satisfaction score. The total score is 30 points, and a higher score indicates better function. The limb appearance was evaluated using a satisfaction score scale, with a total score of 5-10 points being satisfactory, 0-4 points being average, and -5 to -1 points considered unsatisfactory. Descriptive methods were used for statistical analysis, and normally distributed measurement data were expressed as Mean±SD.Results:A total of 11 patients were included, comprising 7 males and 4 females, aged between 19 and 55 years, with an average age of 31.5 years. Among them, there were 3 cases of dermatofibrosarcoma protuberans, 4 cases of invasive fibroma, 1 case of mucinous fibrosarcoma, 2 cases of malignant fibrous histiocytoma, and 1 case of squamous cell carcinoma of the skin. The tumor lesion ranged from 5.5 cm × 8.0 cm to 9.0 cm × 19.0 cm, and the tumor resection range during surgery was from 6.5 cm × 9.0 cm to 10.0 cm × 20.0 cm. The size of the skin flap ranged from 7.5 cm × 11.0 cm to 10.0 cm × 22.5 cm. The average thickness of the flap before thinning was 2.2 cm (1.6-3.5 cm), and the average thickness after thinning was 1.2 cm (0.9-1.7 cm). One case of superficial necrosis occurred at the edge of the flap measuring 1.5 cm × 2.0 cm after surgery, and the wound healed after dressing changes. One case of arterial crisis occurred 48 hours after surgery, and thrombus formation was detected at the distal end of the anastomosis during exploration. After reanastomosis, blood flow was restored. The remaining flaps survived well, and the incisions healed in one stage. The average postoperative follow-up period was 14.5 months (12-18 months) with no tumor recurrence. The MSTS score for limb function was (25.2±2.1) points, and the satisfaction score for limb appearance efficacy was (7.4±1.6) points, with a satisfaction rate of 10 out of 11.Conclusion:The application of microsurgical thinning optimized anterolateral thigh flap in the plastic surgery of limb tumors can restore satisfactory limb function and appearance, making it an ideal surgical method.

Objective:To investigate the clinical effect of perforator flap of distal cutaneous perforator of medial plantar artery in recon struction of destructive defect in the base plane of proximal phalange of great toe.Methods:Twenty-six patients were treated in the Department of Foot and Ankle Surgery of Xuzhou Renci Hospital from September 2017 to December 2021. The patients were 24 males and 2 females, aged 26 to 60 years old. There were 12 defects in left foot and 14 in right foot. All the defects were the residual wounds at the first metatarsophalangeal joint with the defect at 2.0 cm × 3.0 cm - 4.0 cm × 5.0 cm in size. The flaps pedicled with distal cutaneous perforator of the medial plantar artery were used to repair the defects, with a size at 3.2 cm× 4.2 cm in average. Skin grafts were employed to repair the donor sites. Postoperative patient management including lifting the affected limbs and keeping warm, anti-infection, detumescence, anti-coagulation and pain relief.Results:All patients were entered in postoperative follow-up at outpatient clinic for 1-3 years. Twenty-two flaps survived after surgery, except 4 that had dark purple edge indicating venous congestion. Blood supply of the flap was regained after the tension of the flap was relieved by interval suture removal. Appearance of flaps was good, without obvious swelling nor pigmentation, good in elasticity, in hard texture and with good wear resistance. Patients showed no limp of the affected limbs, and without restriction in wearing shoes or walking. The function of feet was evaluated according to the American Orthopedic Foot and Ankle Societ (AOFAS) I50, with 24 patients in excellent and 2 in good.Conclusion:The anatomy of the flap pedicled with distal cutaneous perforator of the medial plantar artery is relatively constant. It provides a blood supply and does not affect the trunk of major artery. The flap has a thick skin cuticle hence it is wear-resistant. This flap provides a choice to the repair of a defect at proximal segment of great toe.

Objective:To explore the effect of preliminary application of a surgical microscope with a measuring system in measurement of the outer diameter of blood vessels in the super-microsurgical model of chicken wing.Methods:From November 2022 to January 2023, 12 chicken wing models were established by having the main blood vessels of chicken wings dissected and separated. Outer diameter of blood vessels were measured by the surgical microscope with an installed measuring system and a digital vernier calliper. Results of the 2 measuring methods and measuring time were compared. SPSS 26.0 was used for statistical analysis of the data. The comparison between the 2 measuring methods with continuity data consistent with the homogeneity of normal distribution variance was performed by paired t test, and expressed by Mean ± SD. The difference between the 2 measuring methods was statistically significant ( P<0.05). Results:Results measured by the microscope with a measuring system and a digital vernier calliper were 1.29 mm± 0.08 mm and 1.28 mm± 0.07 mm for chicken wing brachial artery, 1.11 mm± 0.11 mm and 1.09 mm ± 0.11 mm for radial artery, 0.98 mm± 0.09 mm and 0.99 mm± 0.12 mm for ulnar artery, 0.63 mm ± 0.06 mm and 0.64 mm± 0.07 mm for dorsal metacarpal artery, and 0.39 mm± 0.06 mm and 0.40 mm± 0.09 mm for palmar artery, respectively. No significant difference was found between the 2 measuring methods ( P>0.05). The time of measurement for the 2 measuring methods was 5.90 s± 1.12 s and 8.86 s± 1.74 s, respectively. The time for the microscope with a measuring system was less, with statistically significant difference ( P<0.05). Conclusion:It is accurate, convenient and intuitive to use a surgical microscope installed with a measuring system to measure the outer diameter of tinny vessels. It is worth to popularise and apply the surgical microscope equipped with a measuring system in super-microsurgery.

The nasal tip defect has a significant influence on one’s facial appearance, and reconstruction of this defect is challenging. In February 2021, a 44-year-old man with a soft tissue defect of the nasal tip after biting was diagnosed and treated in Xuzhou Renci Hospital. The nasal tip was reconstructed with a free preauricular flap based on the superficial temporal artery, which was anastomosed with the terminal branches of the facial artery by super microsurgical technique. After the operation, the skin flap survived with infection prevention, anticoagulation, and antispasmodic treatment. After three months of follow-up, the incision scar was un-noticeable, and the patient was satisfied with the appearance of the reconstructed nasal tip.

Objective:To investigate the effect of minimally invasive treatment of mild to moderate hallux valgus using frequency conversion waterflood ultrasound extracapsular osteotomy.Methods:The data of patients with mild to moderate hallux valgus who were treated with frequency conversion waterflood ultrasound extracapsular osteotomy at Department of Foot and Ankle Surgery, Xuzhou Renci Hospital from August 2017 to August 2020 were retrospectively analyzed. During the operation, the metatarsal bone was truncated outside the capsule of the medial joint of the first metatarsal head with frequency conversion waterflood ultrasound osteotomy to correct the hallux valgus deformity. The changes of hallux valgus angle (HVA), the first and second intermetatarsal angle (IMA), the distal articular surface angle of the first metatarsal bone (DMAA) and the range of motion(ROM) of the first metatarsophalangeal joint were compared before operation and at the last follow-up. The American Foot and Ankle Society (AOFAS) forefoot scoring system was used to evaluate the clinical effect. Measurement data with normal distribution were expressed as Mean±SD and analyzed by t-test. Results:A total of 32 patients (53 feet) were enrolled, including 6 males and 26 females; 28 left feet and 25 right feet; age (34.5±7.8) years old. All patients were followed up for (13.0±5.9) months. All osteotomy sites healed without metastatic metatarsalgia, infection and deformity recurrence. At the last follow-up, HVA, IMA, and DMAA were all improved compared with those before surgery [(11.25±1.59) ° vs. (33.45±4.45) °; (6.83±0.95) ° vs. (14.96±2.10) °; (6.26±1.92) ° vs. (23.64±4.72) °; all P<0.01], AOFAS forefoot score was significantly higher than that before operation (90.96±2.92 vs. 59.22±5.63, P<0.01). There was no significant difference in the ROM of the first metatarsophalangeal joint before and after operation ( P>0.05). Conclusions:The application of frequency conversion waterflood ultrasonic bone cutter combined with extracapsular osteotomy for minimally invasive treatment of mild to moderate hallux valgus has the advantages of small damage, inconspicuous scars, and reliable correction. It can be popularized in clinical practice.

Objective:To investigate the efficacy of TiRobot navigation combined with ankle arthroscopy in the reduction and internal fixation of Hawkins type Ⅱ talus neck fracture.Methods:From January 2019 to September 2020, a total of 13 patients with Hawkins type Ⅱ talus neck fracture were admitted to Department of Foot and Ankle Surgery, Xuzhou Renci Hospital. They were 8 males and 5 females, with a mean age of 35.8 years (from 22 to 61 years). All fractures were reduced and fixated using TiRobot navigation combined with ankle arthroscopy. Time for fracture reduction assisted by intraoperative arthroscopy, time for internal fixation assisted by TiRobotic navigation, fracture union time and complications were recorded. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was used at the last follow-up to evaluate the functional outcomes.Results:All the operations were finished within 2 hour. The primary screw placement succeeded in all. The time for fracture reduction assisted by intraoperative arthroscopy averaged 52.8 min (from 43 to 66 min) and the time for internal fixation assisted by TiRobotic navigation 43.6 min (from 33 to 55 min). All the patients were followed up for an average 13.3 months(from 12 to 15 monhs). They obtained bony union within 3 months. One patient developed traumatic subtalar arthritis with mild pain and was treated conservatively. None of the patients had complications like incision infection or talus necrosis. The average AOFAS ankle-hindfoot score was 91.0 points (from 83 to 94 points) at the last follow-up.Conclusion:In the reduction and internal fixation of Hawkins type Ⅱ talus neck fracture, TiRobot navigation combined with ankle arthroscopy shows advantages of minimal invasion, accurate reduction and screw placement, and limited complications, leading to fine short-term functional outcomes.