Objective:To explore the reoperation cause and molecular classification of patients reoperated for papillary thyroid carcinoma (PTC).Methods:This is a retrospective case series study. Clinical data from 102 PTC patients who underwent reoperation at the Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center were collected between February 2019 and December 2024. The cohort comprised 26 males (25.5%) and 76 females (74.5%), with initial age of (33.1±12.2) years (range: 9 to 67 years). At initial surgery, 25.5% (26/102) exhibited extrathyroidal extension, 52.0% (53/102) had multifocal tumors, and 19.6% (20/102) had metastatic lymph nodes with extranodal extension. AJCC staging classified 95.1% (97/102) as stage Ⅰ, 2.9% (3/102) as stage Ⅱ, and 2.0% (2/102) as stage Ⅲ. Standardized primary tumor resection was performed in 81.4% (83/102), prophylactic central compartment lymph node dissection (LND) in 89.2% (91/102), and therapeutic lateral LND in 47.1% (48/102). Data on recurrence, genetic alterations, reoperation intervals, and clinical features of multiple recurrent PTC cases were analyzed.Results:Among 102 patients, 81.4% (83/102) presented with lateral neck metastases, 48.0% (49/102) with central compartment metastases, and 22.6% (23/102) with residual thyroid lobe recurrence at reoperation. Reoperation occurred within 6 months postoperatively in 18.6% (19/102) and after 6 months in 81.4% (83/102). Genetic detection revealed BRAF mutation in 63.7% (65/102), RET fusions in 19.6% (20/102), and TERT promoter mutations in 8.8% (9/102). During reoperation, 88.2% (90/102) underwent therapeutic lateral LND, and 39.2% (40/102) required residual gland resection. Twelve patients received multiple surgeries, including 4 cases with BRAF+TERT mutations, 4 with RET fusions, and 4 with BRAF mutation alone. Conclusions:The reasons for the reoperation of PTC mainly include recurrence and complementary surgery. Genetic alterations such as BRAF mutation and RET fusion are common in PTC patients requiring reoperation.

ObjectiveTo investigate the relationship between the composition of traditional Chinese medicine (TCM) and depression/anxiety/sleep disturbances (D/A/S) in patients with chronic pain.MethodsThis cross-sectional study was conducted at 13 tertiary hospitals across China, enrolling patients who experienced chronic pain between November 2023 and May 2024. The Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Pittsburgh Sleep Quality Index, and TCM constitution categories were used to assess the patients. The association between the TCM constitution and the D/A/S ratio was analyzed using multivariable logistic regression.ResultsA total of 1107 patients (63.2% women) were analyzed. Compared with those with a balanced constitution, patients who had qi-deficiency and yin-deficiency were at a higher risk of depression. Qi-deficiency and yin-deficiency were associated with anxiety. Sleep disturbances were common in patients with qi-deficiency constitution (odds ratio [OR]: 2.32, 95% confidence interval [CI]: 1.42–3.81), yang-deficiency constitution (OR: 1.94, 95% CI: 1.26–2.98), yin-deficiency constitution (OR: 2.03, 95% CI: 1.24–3.32), blood stasis constitution (OR: 2.07, 95% CI: 1.01–4.22), and qi-stagnation constitution (OR: 2.66, 95% CI: 1.35–5.25).ConclusionIn patients with chronic pain, specific TCM constitutions may be associated with D/A/S. Further longitudinal studies are needed to clarify the potential causal relationships between TCM constitution types and these conditions.

Objective:To explore the reoperation cause and molecular classification of patients reoperated for papillary thyroid carcinoma (PTC).Methods:This is a retrospective case series study. Clinical data from 102 PTC patients who underwent reoperation at the Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center were collected between February 2019 and December 2024. The cohort comprised 26 males (25.5%) and 76 females (74.5%), with initial age of (33.1±12.2) years (range: 9 to 67 years). At initial surgery, 25.5% (26/102) exhibited extrathyroidal extension, 52.0% (53/102) had multifocal tumors, and 19.6% (20/102) had metastatic lymph nodes with extranodal extension. AJCC staging classified 95.1% (97/102) as stage Ⅰ, 2.9% (3/102) as stage Ⅱ, and 2.0% (2/102) as stage Ⅲ. Standardized primary tumor resection was performed in 81.4% (83/102), prophylactic central compartment lymph node dissection (LND) in 89.2% (91/102), and therapeutic lateral LND in 47.1% (48/102). Data on recurrence, genetic alterations, reoperation intervals, and clinical features of multiple recurrent PTC cases were analyzed.Results:Among 102 patients, 81.4% (83/102) presented with lateral neck metastases, 48.0% (49/102) with central compartment metastases, and 22.6% (23/102) with residual thyroid lobe recurrence at reoperation. Reoperation occurred within 6 months postoperatively in 18.6% (19/102) and after 6 months in 81.4% (83/102). Genetic detection revealed BRAF mutation in 63.7% (65/102), RET fusions in 19.6% (20/102), and TERT promoter mutations in 8.8% (9/102). During reoperation, 88.2% (90/102) underwent therapeutic lateral LND, and 39.2% (40/102) required residual gland resection. Twelve patients received multiple surgeries, including 4 cases with BRAF+TERT mutations, 4 with RET fusions, and 4 with BRAF mutation alone. Conclusions:The reasons for the reoperation of PTC mainly include recurrence and complementary surgery. Genetic alterations such as BRAF mutation and RET fusion are common in PTC patients requiring reoperation.

Objective:To explore the application effect of ultrasound-guided pectoralis Ⅱ(PECS-Ⅱ)blocks anesthesia in benign tumor resection of breast.Methods:A total of 60 female patients who underwent benign tumor resection of breast were selected from Maternity and Child Care Center of Qinhuangdao from January 2021 to December 2021,and they were divided into the thoracic nerve block group(nerve block group)and local infiltration anesthesia group(local anesthesia group)according to the random number table method.The nerve block group used ultrasound-guided PECS-Ⅱ anesthesia,and the local anesthesia group used local infiltration anesthesia for tumor.The hemodynamic indicators,postoperative visual analogue score,first intervention time of postoperative analgesic drugs,and the use of sufentanil within 24 hours after surgery were compared and analyzed between the two groups of patients.Results:The average operation time of the nerve block group was(127.32±34.56)min,and the difference of that between the nerve block group and local anesthesia group(128.11±33.84)min was no statistically significant(P>0.05).The differences of the heart rate(HR)and mean arterial pressure(MAP)before anesthesia(T0)between two groups of patients were not statistically significant(P>0.05).The HR and MAP levels at the time of skin incision(T1),at the 0.5 h after the surgery was conducted(T2)and the time of completing surgery(T3)in nerve block group were significantly lower than those of the local anesthesia group,respectively.The differences were statistically significant(tHR=5.709,5.836,5.662,tMAP=3.501,3.223,3.128,P<0.05),respectively.Compared with the local anesthesia group,the pain level at the same time point in the nerve block group was significantly reduced,and the difference was statistically significant(t=4.501,6.575,8.197,8.262,P<0.05),respectively.The intervention time of analgesic medication at the first time of the nerve block group was significantly later than that of the local anesthesia group,and the consumption of sufentanil within 24 hours after surgery of the nerve block group was also significantly reduced,and the differences of them were statistically significant(t=13.741,9.482,P<0.05),respectively.Conclusion:Ultrasound-guided PECS-Ⅱ can effectively relieve postoperatively early pain in patients with benign tumors of breast,and delay the intervention time of postoperative analgesic medication,and reduce the intake amount of opioid drugs.

BACKGROUND: Limited data are available on the changes in the quality of care for ST elevation myocardial infarction (STEMI) during China's health system reform from 2009 to 2020. This study aimed to assess the changes in care processes and outcome for STEMI patients in Henan province of central China between 2011 and 2018. METHODS: We compared the data from the Henan STEMI survey conducted in 2011-2012 ( n = 1548, a cross-sectional study) and the Henan STEMI registry in 2016-2018 ( n = 4748, a multicenter, prospective observational study). Changes in care processes and in-hospital mortality were determined. Process of care measures included reperfusion therapies, aspirin, P2Y12 antagonists, β-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and statins. Therapy use was analyzed among patients who were considered ideal candidates for treatment. RESULTS: STEMI patients in 2016-2018 were younger (median age: 63.1 vs . 63.8 years) with a lower proportion of women (24.4% [1156/4748] vs . 28.2% [437/1548]) than in 2011-2012. The composite use rate for guideline-recommended treatments increased significantly from 2011 to 2018 (60.9% [5424/8901] vs . 82.7% [22,439/27,129], P <0.001). The proportion of patients treated by reperfusion within 12 h increased from 44.1% (546/1237) to 78.4% (2698/3440) ( P <0.001) with a prolonged median onset-to-first medical contact time (from 144 min to 210 min, P <0.001). The use of antiplatelet agents, statins, and β-blockers increased significantly. The risk of in-hospital mortality significantly decreased over time (6.1% [95/1548] vs . 4.2% [198/4748], odds ratio [OR]: 0.67, 95% confidence interval [CI]: 0.50-0.88, P = 0.005) after adjustment. CONCLUSIONS Gradual implementation of the guideline-recommended treatments in STEMI patients from 2011 to 2018 has been associated with decreased in-hospital mortality. However, gaps persist between clinical practice and guideline recommendation. Public awareness, reperfusion strategies, and construction of chest pain centers need to be further underscored in central China.
Humans ; Female ; Middle Aged ; ST Elevation Myocardial Infarction/drug therapy* ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use* ; Cross-Sectional Studies ; Aspirin/therapeutic use* ; Platelet Aggregation Inhibitors/therapeutic use* ; Adrenergic beta-Antagonists/therapeutic use* ; Hospital Mortality ; Registries ; Treatment Outcome ; Percutaneous Coronary Intervention

Objective:To investigate the effects of compound insulation measure in operation room on hypothermia of cesarean section of very low birth weight infant (VLBWI).Methods:A total of 96 VLBWI, who were born with cesarean section in the People`s Hospital of Guangxi Zhuang Autonomous Region from January 2018 to October 2020 and admitted to the neonatal intensive care unit were enrolled in the present study. They were assigned to observation group and control group according to the enrolled time, each group was 48 cases. The control group received routine protocol, the observation group implemented the compound insulation measures. The body temperature, heart rate, blood oxygen saturation (SpO 2), end tidal carbon dioxide partial pressure (P ETCO 2) were measured at birth, 10 min after birth and before entering the transfer incubator. The incidence of hypothermia, hypoglycemia and hypoxemia in premature infants were compared between the two groups. Results:At 10 min after birth and before entering the transfer incubator, the body temperature, SpO 2, P ETCO 2 were (36.58 ± 0.49) ℃, 0.95 ± 0.02, (37.17 ± 3.15) mmHg (1 mmHg =0.133 kPa) and (36.50 ± 0.55) ℃, 0.94 ± 0.02, (38.08 ± 3.85) mmHg in the observation group, which were significantly higher than those in the control group (36.27 ± 0.57) ℃, 0.93 ± 0.02, (35.85 ± 3.14) mmHg and (35.75 ± 0.48) ℃, 0.93 ± 0.01, (36.63 ± 3.17) mmHg, the differences were statistically significant ( t values were 2.03-7.13, all P<0.05). Before entering the transfer incubator, the heart rate was (140.25 ± 8.67) times/min in the observation group, which was significantly lower than that in the control group (145.89 ± 9.23) times/min, the difference was statistically significant ( t value was 3.09, P<0.05). The incidence of hypothermia, hypoglycemia and hypoxemia were 16.7%(8/48), 8.3%(4/48) and 12.5%(6/48) in the observation group, which were significantly lower than those in the control group 37.5%(18/48), 22.9%(11/48) and 29.2%(14/48), the differences were statistically significant ( χ2=5.28, 3.87, 4.04, all P<0.05). Conclusions:Evidence-based operation room compound insulation measure can effectively maintain the constant body temperature in VLBWI, reduce the incidence of hypothermia, hypoglycemia and hypoxemia.

Objective:To evaluate the cost effectiveness of primary prophylaxis (PP) with pegylated recombinant human granulocyte colony stimulating factor (PEG-rhG-CSF), PP with recombinant human granulocyte colony stimulating factor (rhG-CSF) and no prophylaxis in women with early-stage breast cancer in China.Methods:Two phase Markov models were constructed for a hypothetical cohort of patients aged 45 with stage Ⅱ breast cancer. The first phase modelled costs and outcomes of 4 cycles docetaxel combined with cyclophosphamide [TC×4, febrile neutropenia (FN) risk>20%] chemotherapy, which assumptions based on literature reviews, including FN rates [base-case (deterministic sensitivity analysis range), 0.29 (0.24-0.35)] and related events [FN case-fatality, 3.4 (2.7-4.1)]. Second phase modelled the long term survival which was link with the relative dose intensity (RDI) [mortality hazard ratio ( HR) of RDI < 85% vs ≥85%, 1.45 (1.00-2.32)]. Clinical effectiveness, therapeutic costs, and economic utilities were estimated from peer-reviewed publications and expert opinions in case of unavailability of published evidences. Results:Compared to rhG-CSF PP and no prophylaxis, the cost of PEG-rhG-CSF PP increased to 5 208.19 RMB and 5 222.73 RMB, respectively. The quality-adjusted life-years (QALYs) enhanced to 0.066 and 0.297, respectively. Accordingly, the incremental cost effectiveness ratios (ICERs) are 79 146.3 RMB and 17 558.77 RMB per QALY, which were both below the willingness to pay (WTP) threshold of three times GDP per capita (18, 000 RMB) recommended by the WHO. Sensitivity analysis suggested that the more clinically effective the primary prophylaxis with PEG-rhG-CSF is, the more cost-effective primary prophylaxis with PEG-rhG-CSF will be. And the lower the mortality HR of RDI<85% vs ≥85% is, the more cost-effective primary prophylaxis with PEG-rhG-CSF will be. Conclusion:Although the cost of PP PEG-rhG-CSF is higher, considering the additional benefits, the administrating of PP PEG-rhG-CSF is likely to be a cost-effective alternative to PP rhG-CSF and no prophylaxis in patients with early stage breast cancer whose FN risks are more than 20% in China.

Objective:To evaluate the cost effectiveness of primary prophylaxis (PP) with pegylated recombinant human granulocyte colony stimulating factor (PEG-rhG-CSF), PP with recombinant human granulocyte colony stimulating factor (rhG-CSF) and no prophylaxis in women with early-stage breast cancer in China.Methods:Two phase Markov models were constructed for a hypothetical cohort of patients aged 45 with stage Ⅱ breast cancer. The first phase modelled costs and outcomes of 4 cycles docetaxel combined with cyclophosphamide [TC×4, febrile neutropenia (FN) risk>20%] chemotherapy, which assumptions based on literature reviews, including FN rates [base-case (deterministic sensitivity analysis range), 0.29 (0.24-0.35)] and related events [FN case-fatality, 3.4 (2.7-4.1)]. Second phase modelled the long term survival which was link with the relative dose intensity (RDI) [mortality hazard ratio ( HR) of RDI < 85% vs ≥85%, 1.45 (1.00-2.32)]. Clinical effectiveness, therapeutic costs, and economic utilities were estimated from peer-reviewed publications and expert opinions in case of unavailability of published evidences. Results:Compared to rhG-CSF PP and no prophylaxis, the cost of PEG-rhG-CSF PP increased to 5 208.19 RMB and 5 222.73 RMB, respectively. The quality-adjusted life-years (QALYs) enhanced to 0.066 and 0.297, respectively. Accordingly, the incremental cost effectiveness ratios (ICERs) are 79 146.3 RMB and 17 558.77 RMB per QALY, which were both below the willingness to pay (WTP) threshold of three times GDP per capita (18, 000 RMB) recommended by the WHO. Sensitivity analysis suggested that the more clinically effective the primary prophylaxis with PEG-rhG-CSF is, the more cost-effective primary prophylaxis with PEG-rhG-CSF will be. And the lower the mortality HR of RDI<85% vs ≥85% is, the more cost-effective primary prophylaxis with PEG-rhG-CSF will be. Conclusion:Although the cost of PP PEG-rhG-CSF is higher, considering the additional benefits, the administrating of PP PEG-rhG-CSF is likely to be a cost-effective alternative to PP rhG-CSF and no prophylaxis in patients with early stage breast cancer whose FN risks are more than 20% in China.

OBJECTIVETo analyze the core acupoints and compatibility of electroacupuncture (EA) for simple obesity based on complex network technique, and to explore the usage of EA waveform.

METHODSThe clinical research literature regarding EA for simple obesity published from January of 1980 to June of 2016 were searched in PubMed, CNKI, , VIP, CBM and TCM online database to establish a prescription database of EA for simple obesity. The Matlab2014a software was used to perform the center analysis and cluster analysis, and the analysis of core points and compatibility were conducted. Gephi 9.1 software was used to demonstrate the complex network diagram to further analyze the usage of EA waveform.

RESULTSTotally 238 prescriptions were obtained. The selection of acupoints at -meridians were equally important with acupoints at -meridians. The meridians with highest core degree were stomach meridian, conception vessel and spleen meridian. The acupoints with highest core degree were Sanyinjiao (SP 6), Tianshu (ST 25) and Zusanli (ST 36). The cluster analysis indicated three acupoint clusters, including the key-acupoint cluster, syndrome-acupoint cluster, and -point cluster; it was revealed Tianshu (ST 25) and Zhongwan (CV 12) had the highest intensity of compatibility. The sparse-dense wave was mostly used in EA for simple obesity, followed by continuous wave, indicating both sparse-dense wave and continuous wave had high clinical application value.

CONCLUSIONThe acupoints of EA for simple obesity are mainly in stomach meridian, conception vessel and spleen meridian; sparse-dense wave is mostly used, followed by continuous wave.

Objective To investigate the positive rates and susceptibility of Ureaplasma urealyticum(Uu) and Mycoplasma hominis(Mh) in urogenital mycoplasma infection under three years.Methods Culture,identification and susceptibility test were performed on 4 414 specimens collected from suspected patients with mycoplasma infection by using Antu mycoplasma kits.Results In the 4 414 patients,2 295 cases with mycoplasma infection were detected and the positive rate was 51.99％.The infection rates of Uu and Mh respectively were 40.69％ and 2.08％,and the both infection rate was 9.22％.Antibiotic sensitive rates of josamycin(JOX),doxycycline(DOX),clarithromycin(CLA),gatifloxacin(GAT) and erythromycin(ERY) were 96.03％,95.51 ％,78.69 ％％,77.21 ％ and 72.55 ％.Drug resistant rates of roxithromycin(RXT),thiamphenicol (THI),clindamycin (CLI) and clarithromycin(CLA) were 16.90％,22.27％,41.96％ and 17.60％.Conclusion Uu is the predominant mycoplasma in urogenital tract infection in the study.DOX,JOS,GAT and ERY can be chosen as the fist line drugs for the treatment of urogenital tract infection.RXT,THI,CLI and CLA with high drug resistant rates are not recommended to be used.