The endoscopic thyroidectomy by gasless unilateral axillary approach (GUA) represents a significant advancement in the field of endoscopic thyroid surgery, offering notable aesthetic and clinical therapeutic benefits. This paper reviewed the current clinical application, core technological innovations, quality control systems, and future developmental directions of GUA. Research indicated that GUA achieved surgical outcomes comparable to traditional open surgery in the treatment of benign thyroid tumors and thyroid cancer, while substantially enhancing cosmetic results and patient satisfaction. By optimizing the surgical approach design, enhancing cavity construction equipment, and standardizing the operational process, GUA markedly reduced the incidence of postoperative complications, preserved the anterior cervical functional area, and improved patients' postoperative quality of life. Furthermore, multidisciplinary collaboration and thorough pre-operative evaluation were fundamental to surgical success, while intraoperative quality control measures and a comprehensive postoperative follow-up system ensured the safety and efficacy of the procedure. In the future, the integration of robotic technology and advancements in single-site devices are anticipated to enhance the role of GUA in endoscopic thyroid surgery, thereby offering patients more minimally invasive and aesthetically favorable treatment options.

Objective:To understand the status of bone health literacy in middle-aged and older female breast cancer patients undergoing chemotherapy and analyze its influencing factors using structural equation modeling.Methods:A convenience sampling method was used to select 250 middle-aged and older breast cancer patients undergoing chemotherapy in two tertiary hospitals in Xi'an from May to October 2024. Patients were surveyed using a general information questionnaire, the Bone Health Literacy Scale for Middle-Aged and Older Women, the Perceived Social Support Scale, and the General Self-Efficacy Scale. Pearson correlation analysis was used to examine the correlations among bone health literacy, perceived social support, and self-efficacy.Results:A total of 250 questionnaires were distributed, and 239 valid questionnaires were recovered, yielding an effective response rate of 95.6% (239/250). The mean score of the Bone Health Literacy Scale among the 239 patients was (39.71±8.16). Bone health literacy was positively correlated with perceived social support and self-efficacy ( P<0.01). Perceived social support directly affected bone health literacy and could also indirectly influence it through general self-efficacy, with an indirect effect value of 0.367, accounting for 45.2% of the total effect (0.367/0.812) . Conclusions:Healthcare professionals should implement effective interventions to enhance patients' perceived social support and strengthen their self-efficacy, thereby improving bone health literacy.

Objective:To compare the effectiveness of sacral nerve electric stimulation (SNES) and sacral nerve magnetic stimulation (SNMS) in treating patients with refractory neurogenic bladder (NB).Methods:Forty-six patients with NB after a spinal cord or cauda equina injury were randomly divided into an SNMS group and an SNES group, each of 23. In addition to basic bladder intervention, the SNMS group was treated with SNMS in the sacral 3 (S3) nerve root area once a day for 21 minutes, 5 days a week for 4 weeks. The SNES group received 24h uninterrupted SNES treatment for 4 consecutive weeks. The bladder pressure-volume assessment indexes, voiding diary indexes, and scores on the Chinese version of the Simplified Health Assessment Scale (SF-Qualiveen) were compared between the two groups before and after 4 weeks of treatment.Results:After the treatment, the safe bladder capacity, average daily number of micturitions, average daily single micturition volume, average daily single maximum micturition volume, average daily number of catheterizations, and average daily single maximum catheterization volume of both groups had improved significantly. After the treatment, the maximum intravesical pressure of the bladder (storage period), bladder compliance, average daily single catheterization volume, and SF-Qua-liveen scores of the SNES group had improved significantly. And that group′s average safe bladder capacity, bladder compliance, daily number of micturitions and average daily single catheterization volume were significantly better than the SNMS group′s averages. The SNES group′s average maximum intravesical bladder pressure and average SF-Qualiveen score were also significantly better.Conclusion:Both SNMS and SNES can improve urine storage and voiding for those with refractory NB in the short term, but SNES is clinically more effective and better improves patients′ life quality.

Objective:To describe the clinical and pathological features of patients with myofasciitis.Methods:The clinical manifestations and auxiliary examination (laboratory, electromyogram, imaging and muscle biopsy) results of 52 patients with myofasciitis diagnosed by pathology at Peking University First Hospital from August 2002 to December 2024 were collected and analyzed.Results:Among the 52 patients (33 males and 19 females), the age of disease onset was (34.4±16.4) years (6.0-73.0 years) and the disease duration was 17.7 (0.3, 120.0) months; the main symptoms included myalgia in the distal limbs (28 cases, 53.8%), diffuse cutaneous or muscle sclerosis (21 cases, 40.4%), muscle weakness (22 cases, 42.3%) and limited joint activity (23 cases, 44.2%); 12 patients (23.1%) were combined with other diseases. All patients had no history of vaccination. Laboratory examinations showed that 80.8% (21/26) of patients had elevated C-reactive protein, 80.0% (20/25) had elevated erythrocyte sedimentation rate, and 26.5% (9/34) had elevated creatine kinase. Among 19 patients undergoing electromyography, 6 cases showed myogenic changes, 4 cases showed neurogenic changes, 1 case showed both myogenic and neurogenic changes, and 8 cases showed no obvious abnormality. Myofascial edema was observed in all 15 patients who underwent muscle magnetic resonance imaging, with partial involvement of adjacent muscles in some cases. According to myopathological changes, the 52 patients were divided into macrophagic myofasciitis in 41 cases (78.8%), lymphocytic myofasciitis in 7 cases (13.5%), and eosinophilic fasciitis in 4 cases (7.7%). Among the 52 patients, fibroblast proliferation in the myofascia was present in 39 cases (75.0%), subfascial muscle fiber atrophy in 28 cases (53.8%), and scattered muscle fiber necrosis and regeneration in 15 cases (28.8%). Major histocompatibility complex class Ⅰexpression on muscle fibers was positive in 89.5% (34/38) of patients, and membrane attack complex deposition on muscle fibers and/or capillary walls was present in 39.5% (15/38) of patients. Among 25 patients with follow-up, all received low-dose oral glucocorticoids, and 7 additionally received methotrexate, intravenous immunoglobulin, or hydroxychloroquine. During follow-up, 22 patients showed clinical improvement, 1 patient remained stable, and 2 patients died.Conclusions:Non-vaccine-associated macrophagic myofasciitis is the most common pathological subtype of myofasciitis. A few patients are concomitant with other diseases. Muscle magnetic resonance imaging is helpful in the diagnosis of the disease. Most patients respond to immunosuppressive treatment.

Radiotherapy-induced late effects(RILE)or delayed reactions have significant impacts on patients'long-term quality of life.However,current understanding of their developmental mechanisms remains limited,with a lack of effective risk prediction models and preventive interventions.Radiobiological studies and radiation-induced senescence models have revealed that radiotherapy can alter the epigenetic characteristics in late-responding tissue cells,leading to derepression of retrotransposable elements(particularly endogenous retroviral elements),subsequent activation of cytoplasmic nucleic acid sensor systems(cGAS-STING,MDA5/RIG-I-MAVS)and type Ⅰ interferon-mediated immune-inflammatory responses.This review summarized relevant research findings,proposing that the autoimmune-like inflammatory response induced by the'radiotherapy-epigenetic alteration-retrotransposable element activation'cascade is an underinvestigated mechanistic basis in the development of RILE.Constructing risk prediction models for late effects based on epigenetic signatures,cell type,and radiation dose,along with developing strategies to epigenetically suppress retrotransposable element expression,holds promise for preventing or mitigating RILE.

Radiotherapy-induced late effects(RILE)or delayed reactions have significant impacts on patients'long-term quality of life.However,current understanding of their developmental mechanisms remains limited,with a lack of effective risk prediction models and preventive interventions.Radiobiological studies and radiation-induced senescence models have revealed that radiotherapy can alter the epigenetic characteristics in late-responding tissue cells,leading to derepression of retrotransposable elements(particularly endogenous retroviral elements),subsequent activation of cytoplasmic nucleic acid sensor systems(cGAS-STING,MDA5/RIG-I-MAVS)and type Ⅰ interferon-mediated immune-inflammatory responses.This review summarized relevant research findings,proposing that the autoimmune-like inflammatory response induced by the'radiotherapy-epigenetic alteration-retrotransposable element activation'cascade is an underinvestigated mechanistic basis in the development of RILE.Constructing risk prediction models for late effects based on epigenetic signatures,cell type,and radiation dose,along with developing strategies to epigenetically suppress retrotransposable element expression,holds promise for preventing or mitigating RILE.

Objective:To compare the effectiveness of sacral nerve electric stimulation (SNES) and sacral nerve magnetic stimulation (SNMS) in treating patients with refractory neurogenic bladder (NB).Methods:Forty-six patients with NB after a spinal cord or cauda equina injury were randomly divided into an SNMS group and an SNES group, each of 23. In addition to basic bladder intervention, the SNMS group was treated with SNMS in the sacral 3 (S3) nerve root area once a day for 21 minutes, 5 days a week for 4 weeks. The SNES group received 24h uninterrupted SNES treatment for 4 consecutive weeks. The bladder pressure-volume assessment indexes, voiding diary indexes, and scores on the Chinese version of the Simplified Health Assessment Scale (SF-Qualiveen) were compared between the two groups before and after 4 weeks of treatment.Results:After the treatment, the safe bladder capacity, average daily number of micturitions, average daily single micturition volume, average daily single maximum micturition volume, average daily number of catheterizations, and average daily single maximum catheterization volume of both groups had improved significantly. After the treatment, the maximum intravesical pressure of the bladder (storage period), bladder compliance, average daily single catheterization volume, and SF-Qua-liveen scores of the SNES group had improved significantly. And that group′s average safe bladder capacity, bladder compliance, daily number of micturitions and average daily single catheterization volume were significantly better than the SNMS group′s averages. The SNES group′s average maximum intravesical bladder pressure and average SF-Qualiveen score were also significantly better.Conclusion:Both SNMS and SNES can improve urine storage and voiding for those with refractory NB in the short term, but SNES is clinically more effective and better improves patients′ life quality.

Objective:To describe the clinical and pathological features of patients with myofasciitis.Methods:The clinical manifestations and auxiliary examination (laboratory, electromyogram, imaging and muscle biopsy) results of 52 patients with myofasciitis diagnosed by pathology at Peking University First Hospital from August 2002 to December 2024 were collected and analyzed.Results:Among the 52 patients (33 males and 19 females), the age of disease onset was (34.4±16.4) years (6.0-73.0 years) and the disease duration was 17.7 (0.3, 120.0) months; the main symptoms included myalgia in the distal limbs (28 cases, 53.8%), diffuse cutaneous or muscle sclerosis (21 cases, 40.4%), muscle weakness (22 cases, 42.3%) and limited joint activity (23 cases, 44.2%); 12 patients (23.1%) were combined with other diseases. All patients had no history of vaccination. Laboratory examinations showed that 80.8% (21/26) of patients had elevated C-reactive protein, 80.0% (20/25) had elevated erythrocyte sedimentation rate, and 26.5% (9/34) had elevated creatine kinase. Among 19 patients undergoing electromyography, 6 cases showed myogenic changes, 4 cases showed neurogenic changes, 1 case showed both myogenic and neurogenic changes, and 8 cases showed no obvious abnormality. Myofascial edema was observed in all 15 patients who underwent muscle magnetic resonance imaging, with partial involvement of adjacent muscles in some cases. According to myopathological changes, the 52 patients were divided into macrophagic myofasciitis in 41 cases (78.8%), lymphocytic myofasciitis in 7 cases (13.5%), and eosinophilic fasciitis in 4 cases (7.7%). Among the 52 patients, fibroblast proliferation in the myofascia was present in 39 cases (75.0%), subfascial muscle fiber atrophy in 28 cases (53.8%), and scattered muscle fiber necrosis and regeneration in 15 cases (28.8%). Major histocompatibility complex class Ⅰexpression on muscle fibers was positive in 89.5% (34/38) of patients, and membrane attack complex deposition on muscle fibers and/or capillary walls was present in 39.5% (15/38) of patients. Among 25 patients with follow-up, all received low-dose oral glucocorticoids, and 7 additionally received methotrexate, intravenous immunoglobulin, or hydroxychloroquine. During follow-up, 22 patients showed clinical improvement, 1 patient remained stable, and 2 patients died.Conclusions:Non-vaccine-associated macrophagic myofasciitis is the most common pathological subtype of myofasciitis. A few patients are concomitant with other diseases. Muscle magnetic resonance imaging is helpful in the diagnosis of the disease. Most patients respond to immunosuppressive treatment.

Objective To investigate whether transcutaneous electrical acupoint stimulation(TEAS)can improve the muscle strength,endurance and work efficiency of calf muscles in healthy young men,aiming to explore a new method for preventing and combating microgravity-induced muscle atrophy in space environments.Methods 40 healthy young men aged 18-35 years were randomly divided into a Control group(Pseudo Transcutaneous Electrical Acupoint Stimulation)and a Experimental group(Transcutaneous Electrical Acupoint Stimulation)in a 1∶1 ratio,with 20 participants in each group.In the Control group,the indicator light of the stimulator was covered,and the device was turned on,but the electrodes did not contact the skin,The device automatically turned offafter 3 seconds.In the Experimental group,the TEAS device was connected to the current and TEAS intervention was performed.The electrical stimulation waveform was a sperse-dense wave with a frequency of 4/20 Hz,and the intensity was determined by patient tolerance.The acupoints selected for electrical stimulation in both groups were bilateral Zusanli(ST36)、Liangqiu(ST34),Taixi(KI3),and Fuliu(KI7).Zusanli and Liangqiu were paired,and Taixi and Fuliu were paired.The intervention frequency was 30 min/time,1 time/day,6 days/week,for 2 weeks.The relative peak torque at 60°/s,relative peak torque at 180°/s,and average power at 180°/s of the bilateral calf muscles were measured using an isokinetic dynamometer at 0th,7th,and 14d day of the experiment.Results After 1 week of TEAS,compared with Control group,there were no significant changes in the relative peak torque at 60°/s,relative peak torque at 180°/s and average power at 180°/s of the bilateral anterior calf muscles in the Experimental group(all P>0.05);however,compared with Control group,the relative peak torque at 60°/s and the relative peak torque at 180°/s of the bilateral posterior calf muscles in the Experimental group were significantly increased(all P<0.05).After 2 weeks TEAS;compared with the Control group,there were no significant changes in the relative peak torque at 60°/s,relative peak torque at 180°/s and average power at 180°/s of the bilateral anterior calf muscles in the Experimental group(all P>0.05);however,the relative peak torque at 60°/s,relative peak torque at 180°/s,and average power at 180°/s of the bilateral posterior calf muscles were significantly increased in the Experimental group(all P<0.05).Conclusion TEAS of Zusanli,Liangqiu,Fuliu and Taixi acupoints on the lower limbs for 2 weeks can effectively improve the maximum muscle strength,endurance and work efficiency of the posterior calf muscles in healthy young men.

Objective:To understand the status of bone health literacy in middle-aged and older female breast cancer patients undergoing chemotherapy and analyze its influencing factors using structural equation modeling.Methods:A convenience sampling method was used to select 250 middle-aged and older breast cancer patients undergoing chemotherapy in two tertiary hospitals in Xi'an from May to October 2024. Patients were surveyed using a general information questionnaire, the Bone Health Literacy Scale for Middle-Aged and Older Women, the Perceived Social Support Scale, and the General Self-Efficacy Scale. Pearson correlation analysis was used to examine the correlations among bone health literacy, perceived social support, and self-efficacy.Results:A total of 250 questionnaires were distributed, and 239 valid questionnaires were recovered, yielding an effective response rate of 95.6% (239/250). The mean score of the Bone Health Literacy Scale among the 239 patients was (39.71±8.16). Bone health literacy was positively correlated with perceived social support and self-efficacy ( P<0.01). Perceived social support directly affected bone health literacy and could also indirectly influence it through general self-efficacy, with an indirect effect value of 0.367, accounting for 45.2% of the total effect (0.367/0.812) . Conclusions:Healthcare professionals should implement effective interventions to enhance patients' perceived social support and strengthen their self-efficacy, thereby improving bone health literacy.