Objective To evaluate the clinical efficacy of acupuncture at Four Gates(bilateral LI4 and LR3)and other acupoints in treating postoperative pain after laparoscopic inguinal hernia repair and to explore its potential mechanism of action.Methods Sixty patients who underwent tension-free laparoscopic inguinal hernia repair at the Third Affiliated Hospital of Guangzhou University of Chinese Medicine between June 2024 and January 2025 and developed postoperative pain were enrolled.They were randomly divided into an observation group(n=30)and a control group(n=30)using a random number table.The control group received standard postoperative care,while the observation group received additional acupuncture at Four Gates and other acupoints(administered at 0 hour and 24 hours postoperatively).Clinical efficacy was assessed after 24 hours.Changes in the Numerical Rating Scale(NRS)for pain and the Bruggrmann Comfort Scale(BCS)were recorded.Serum levels of white blood cells(WBC),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),and cortisol(COR)were compared before and after treatment.Safety and adverse reactions were also evaluated.Results(1)After 4 hours and 24 hours of treatment,the NRS scores in the observation group were significantly improved(P＜0.05).Additionally,the observation group showed a significantly greater improvement in NRS scores than the control group during the same period,with statistically significant differences(P＜0.05).(2)After 4 hours and 24 hours of treatment,the BCS scores of both groups of patients were significantly improved(P＜0.05).The observation group showed a significantly greater improvement in BCS scores than the control group,with statistically significant differences(P＜0.05).(3)After treatment,the levels of WBC,CRP,and ESR in the observation group were significantly lower than those in the control group(P＜0.05).There was no statistically significant difference in COR levels between the two groups(P＞0.05).After treatment,the WBC levels in the observation group were slightly lower than before treatment,but the difference was not statistically significant(P＞0.05),while the WBC levels in the control group were significantly higher than before treatment(P＜0.05).(4)The overall response rate in the observation group was 96.70％(29/30),while that in the control group was 56.77％(17/30).The efficacy of the observation group was superior to that of the control group,with a statistically significant difference(P＜0.05).(5)No significant adverse reactions occurred in either the observation group or the control group.There was no statistically significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion Acupuncture at Four Gates and other acupoints significantly alleviates postoperative pain,enhances patient comfort,and demonstrates excellent clinical efficacy with high safety.The treatment modulates postoperative WBC,CRP,ESR,and COR levels,suggesting systemic anti-inflammatory and stress-regulatory effects.

Objective:To analyze the perioperative risks and prognosis in patients with differentiated thyroid cancer (DTC) complicated by Graves' disease (GD) .Methods:Clinical data of 880 DTC patients who underwent radical thyroidectomy at the Department of General Surgery, the First Medical Center of Chinese PLA General Hospital between Jan. 2016 and Dec. 2022 was retrospectively collected. The cohort included 119 DTC patients with GD (hyperthyroid group) and 761 DTC patients with normal thyroid function without GD (normal group) . Use propensity score matching (PSM) was used to obtain cohorts with balanced baseline characteristics between the hyperthyroid and normal groups. Perioperative risks and prognos were compared between the two groups.Results:For perioperative risk comparison, after 1∶2 matching, 116 patients were included in the hyperthyroid group and 232 patients in the normal group. The operation time was longer in the hyperthyroid group compared to normal group ([107.26±30.27]min vs. [96.45±32.51]min, P=0.003) . There were no statistical differences between the two groups in intraoperative blood loss, postoperative drainage volume or postoperative hospital stay ( P>0.05) . There were no statistical difference in the incidence of complications such as temporary or permanent hypoparathyroidism, temporary or permanent recurrent laryngeal nerve injury, and lymphatic leakage between the two groups. For prognostic comparison, after 1∶2 matching, 117 cases were included in the hyperthyroid group and 234 cases in the normal group. During follow-up period, 16 patients experienced DTC recurrence, including 5 cases in the hyperthyroid group and 11 cases in the normal group. There was no statistical difference in reccurence-free survival rates between the two groups (5-year RFS: 95.7% vs. 95.3%, P=0.907) . Multivariate Cox regression analysis revealed GD was not the risk factor for DTC recurrence. Conclusions:With standardized and adequate preoperative preparation, the perioperative risks of DTC patients complicated by GD were not increased compared to patients without GD. Additionally, GD does not increase the risk of postoperative tumor recurrence in DTC patients.

AIM:To investigate the protective ef-fect of sinomenine hydrochloride(SIN)on adjuvant arthritis(AA)rats by regulating the NLRP3/Gasder-min D/Caspase-1/Interleukin-1β pyroptosis path-way.METHODS:Sixty rats were randomly divided into 6 groups,10 rats in each group:Con group(normal rats),AA group(AA rat model),L-SIN group(AA rats were intragastrically administered with 100 mg/kg SIN),M-SIN group(AA rats were intra-gastrically administered with 200 mg/kg SIN),H-SIN group(AA rats were intragastrically administered with 400 mg/kg SIN),ACG group(positive drug group:AA rats were intragastrically administered with 150 mg/kg Wantong Jingu Tablets).Observe the degree of joint swelling and arthritis index.HE was used to observe the pathological changes of the right ankle joint tissue of rats.The levels of in-flammatory factors and oxidative stress-related in-dicators in synovial tissue were detected.Western Blot was used to detect the expression levels of NL-RP3/Gasdermin D/Caspase-1/Interleukin-1β pyrop-tosis pathway-related proteins.RESULTS:Com-pared with Con group,the degree of joint swelling,arthritis index,inflammatory factors and oxidative stress levels,NLRP3,GSDMD,Caspase-1 and IL-1β protein expression levels in AA group were signifi-cantly increased(P<0.05).Compared with AA group,the degree of joint swelling,arthritis index,inflammatory factors and oxidative stress levels,NL-RP3,GSDMD,Caspase-1 and IL-1β protein expres-sion levels were significantly decreased in SIN treat-ment group with the increase of treatment dose(P<0.05).Compared with AA group and L-SIN group,the degree of joint swelling,arthritis index,inflam-matory factors and oxidative stress levels,NLRP3,GSDMD,Caspase-1 and IL-1β protein expression levels in ACG group were significantly decreased(P<0.05).Compared with H-SIN group,the degree of joint swelling,arthritis index,inflammatory factors and oxidative stress levels,NLRP3,GSDMD,Cas-pase-1 and IL-1β protein expression levels in ACG group were significantly increased(P<0.05).CON-CLUSION:SIN can alleviate the inflammatory injury of AA rats and reduce the levels of inflammatory factors and oxidative stress,thus exerting a protec-tive effect on AA rats.The mechanism may be based on the NLRP3/Gasdermin D/Caspase-1/Inter-leukin-1β pyroptosis pathway.

Objective:To analyze the perioperative risks and prognosis in patients with differentiated thyroid cancer (DTC) complicated by Graves' disease (GD) .Methods:Clinical data of 880 DTC patients who underwent radical thyroidectomy at the Department of General Surgery, the First Medical Center of Chinese PLA General Hospital between Jan. 2016 and Dec. 2022 was retrospectively collected. The cohort included 119 DTC patients with GD (hyperthyroid group) and 761 DTC patients with normal thyroid function without GD (normal group) . Use propensity score matching (PSM) was used to obtain cohorts with balanced baseline characteristics between the hyperthyroid and normal groups. Perioperative risks and prognos were compared between the two groups.Results:For perioperative risk comparison, after 1∶2 matching, 116 patients were included in the hyperthyroid group and 232 patients in the normal group. The operation time was longer in the hyperthyroid group compared to normal group ([107.26±30.27]min vs. [96.45±32.51]min, P=0.003) . There were no statistical differences between the two groups in intraoperative blood loss, postoperative drainage volume or postoperative hospital stay ( P>0.05) . There were no statistical difference in the incidence of complications such as temporary or permanent hypoparathyroidism, temporary or permanent recurrent laryngeal nerve injury, and lymphatic leakage between the two groups. For prognostic comparison, after 1∶2 matching, 117 cases were included in the hyperthyroid group and 234 cases in the normal group. During follow-up period, 16 patients experienced DTC recurrence, including 5 cases in the hyperthyroid group and 11 cases in the normal group. There was no statistical difference in reccurence-free survival rates between the two groups (5-year RFS: 95.7% vs. 95.3%, P=0.907) . Multivariate Cox regression analysis revealed GD was not the risk factor for DTC recurrence. Conclusions:With standardized and adequate preoperative preparation, the perioperative risks of DTC patients complicated by GD were not increased compared to patients without GD. Additionally, GD does not increase the risk of postoperative tumor recurrence in DTC patients.

Objective Investigate the clinical efficacy and application value of gasless trans-subclavian approach endoscopic surgery(GTAES)for the treatment of primary hyperparathyroidism(PHPT).Methods 55 PHPT patients who underwent unilateral parathyroid adenoma resection from January 2023 to October 2024 were absorbed.Based on surgical approaches,31 patients were divided into the traditional low-collar arc incision open surgery group(open group)and 24 patients were divided into gasless trans-subclavian approach endoscopic surgery group(endoscopic group).The perioperative data,anterior neck function recovery,and incision healing were compared between two groups.Results There were no significant differences in operation time,intraoperative blood loss,postoperative drainage volume and postoperative hospital stay between the two groups(P＞0.05).The preoperative blood calcium levels of the endoscopic group and the open group were(2.68±0.10)mmol/L and(2.63±0.16)mmol/L,respectively.The blood calcium levels on the first day after surgery were(2.39±0.12)mmol/L and(2.36±0.16)mmol/L,respectively.Preoperative parathyroid hormone(PTH)was 27.55(110.05,155.75)pg/ml in endoscopic group and 137.00(107.00,210.30)pg/ml in open group,respectively.PTH on the first day after surgery was 18.98(12.64,23.53)pg/ml and 13.85(7.36,23.23)pg/ml,respectively.Blood calcium and PTH in each group 1 day after surgery decreased compared with that before surgery,and the difference was statistically significant(P＜0.05).There were no postoperative complications such as hoarseness,bleeding and incision infection in both groups.Postoperative hand and foot numbness:5 cases(20.8％)in endoscopic group and 8 patients(25.8％)in the open group,there was no significant difference between the two groups(P=0.667).There was no significant difference in the score of neck pain 3 days after surgery between the two groups(P＞0.05).The score of swallowing tension[(1.92±1.06)points compared with(2.77±1.38)points,P=0.015]and the score of anterior neck discomfort[(1.63±0.88)points compared with(2.35±1.33)points,P=0.018]in the endoscopic group one month after surgery were better than those in the open group.There was no significant difference in the score of neck scar scale between the two groups 3 months after surgery(P＞0.05).VAS score of incision satisfaction was(9.08±0.88)in endoscopic group and(8.19±1.30)in open group,and the endoscopic group was better than the open group,the difference was statistically significant(P=0.004).Conclusion For PHPT patients caused by unilateral parathyroid adenoma confirmed through preoperative localization examination,GTAES is a safe and effective surgical approach,which offers unique advantages in intraoperative lesion identification,cosmetic outcomes of the incision,and preservation of anterior neck function,providing a new surgical option for PHPT patients.

Objective Investigate the clinical efficacy and application value of gasless trans-subclavian approach endoscopic surgery(GTAES)for the treatment of primary hyperparathyroidism(PHPT).Methods 55 PHPT patients who underwent unilateral parathyroid adenoma resection from January 2023 to October 2024 were absorbed.Based on surgical approaches,31 patients were divided into the traditional low-collar arc incision open surgery group(open group)and 24 patients were divided into gasless trans-subclavian approach endoscopic surgery group(endoscopic group).The perioperative data,anterior neck function recovery,and incision healing were compared between two groups.Results There were no significant differences in operation time,intraoperative blood loss,postoperative drainage volume and postoperative hospital stay between the two groups(P＞0.05).The preoperative blood calcium levels of the endoscopic group and the open group were(2.68±0.10)mmol/L and(2.63±0.16)mmol/L,respectively.The blood calcium levels on the first day after surgery were(2.39±0.12)mmol/L and(2.36±0.16)mmol/L,respectively.Preoperative parathyroid hormone(PTH)was 27.55(110.05,155.75)pg/ml in endoscopic group and 137.00(107.00,210.30)pg/ml in open group,respectively.PTH on the first day after surgery was 18.98(12.64,23.53)pg/ml and 13.85(7.36,23.23)pg/ml,respectively.Blood calcium and PTH in each group 1 day after surgery decreased compared with that before surgery,and the difference was statistically significant(P＜0.05).There were no postoperative complications such as hoarseness,bleeding and incision infection in both groups.Postoperative hand and foot numbness:5 cases(20.8％)in endoscopic group and 8 patients(25.8％)in the open group,there was no significant difference between the two groups(P=0.667).There was no significant difference in the score of neck pain 3 days after surgery between the two groups(P＞0.05).The score of swallowing tension[(1.92±1.06)points compared with(2.77±1.38)points,P=0.015]and the score of anterior neck discomfort[(1.63±0.88)points compared with(2.35±1.33)points,P=0.018]in the endoscopic group one month after surgery were better than those in the open group.There was no significant difference in the score of neck scar scale between the two groups 3 months after surgery(P＞0.05).VAS score of incision satisfaction was(9.08±0.88)in endoscopic group and(8.19±1.30)in open group,and the endoscopic group was better than the open group,the difference was statistically significant(P=0.004).Conclusion For PHPT patients caused by unilateral parathyroid adenoma confirmed through preoperative localization examination,GTAES is a safe and effective surgical approach,which offers unique advantages in intraoperative lesion identification,cosmetic outcomes of the incision,and preservation of anterior neck function,providing a new surgical option for PHPT patients.

AIM:To investigate the protective ef-fect of sinomenine hydrochloride(SIN)on adjuvant arthritis(AA)rats by regulating the NLRP3/Gasder-min D/Caspase-1/Interleukin-1β pyroptosis path-way.METHODS:Sixty rats were randomly divided into 6 groups,10 rats in each group:Con group(normal rats),AA group(AA rat model),L-SIN group(AA rats were intragastrically administered with 100 mg/kg SIN),M-SIN group(AA rats were intra-gastrically administered with 200 mg/kg SIN),H-SIN group(AA rats were intragastrically administered with 400 mg/kg SIN),ACG group(positive drug group:AA rats were intragastrically administered with 150 mg/kg Wantong Jingu Tablets).Observe the degree of joint swelling and arthritis index.HE was used to observe the pathological changes of the right ankle joint tissue of rats.The levels of in-flammatory factors and oxidative stress-related in-dicators in synovial tissue were detected.Western Blot was used to detect the expression levels of NL-RP3/Gasdermin D/Caspase-1/Interleukin-1β pyrop-tosis pathway-related proteins.RESULTS:Com-pared with Con group,the degree of joint swelling,arthritis index,inflammatory factors and oxidative stress levels,NLRP3,GSDMD,Caspase-1 and IL-1β protein expression levels in AA group were signifi-cantly increased(P<0.05).Compared with AA group,the degree of joint swelling,arthritis index,inflammatory factors and oxidative stress levels,NL-RP3,GSDMD,Caspase-1 and IL-1β protein expres-sion levels were significantly decreased in SIN treat-ment group with the increase of treatment dose(P<0.05).Compared with AA group and L-SIN group,the degree of joint swelling,arthritis index,inflam-matory factors and oxidative stress levels,NLRP3,GSDMD,Caspase-1 and IL-1β protein expression levels in ACG group were significantly decreased(P<0.05).Compared with H-SIN group,the degree of joint swelling,arthritis index,inflammatory factors and oxidative stress levels,NLRP3,GSDMD,Cas-pase-1 and IL-1β protein expression levels in ACG group were significantly increased(P<0.05).CON-CLUSION:SIN can alleviate the inflammatory injury of AA rats and reduce the levels of inflammatory factors and oxidative stress,thus exerting a protec-tive effect on AA rats.The mechanism may be based on the NLRP3/Gasdermin D/Caspase-1/Inter-leukin-1β pyroptosis pathway.

Objective To explore the diagnosis of clinically suspicious von Willebrand disease(vWD)in a family and its pathogene-sis.Methods The pedigree information and the biological specimen were collected from the clinically suspected VWD patient and her family members(4 persons in total)in Peking University First Hospital.The levels of platelet count(PLT),activated partial thrombo-plastin time(APTT),vWF antigen(vWF:Ag),vWF activity(vWF:Ac)and FⅧ activity(FⅧ:C)were detected,and vWF risto-cetin cofactor(vWF:RCo)assay,ristocetin-induced platelet aggregation assay(RIPA)and vWF collagen binding(vWF:CB)assay were performed for phenotype diagnosis.The peripheral blood genomic DNAs were extracted from the proband and her family members to perform whole-exome sequencing for identifying the mutation of vWF gene,The mutation site was analyzed by using bioinformation tools to explore the pathogenesis of the proband.Results The APTT of proband(m 1)was slightly prolonged and her vWF:Ag,vWF:Ac,vWF:RCo and vWF:CB were significantly decreased.There was no obvious aggregation in RIPA assay(1.0 mg/mL and 1.25 mg/mL).In her father(Ⅱ3),APTT,FⅧ:C,vWF:Ag,vWF:Ac and vWF:CB were normal,but vWF:RCo was slightly decreased.In her mother(Ⅱ4),APTT,FⅧ:C,vWF:Ag,vWF:RCo and vWF:CB were all normal,but vWF:Ac significantly decreased.In her brother(Ⅲ2),APTT and FⅧ:C were normal,but vWF:Ag,vWF:Ac,vWF:RCo and vWF:CB were reduced to varying degrees.In all the family members(father,mother and brpther),no apparent aggregation in RIPA(1.0 mg/mL)was shown.Genetic analysis showed that the proband(Ⅲ1)carried a compound heterozygous mutation of vWF gene c.7288-9T＞G and c.1117C＞T,her father(Ⅱ3)carried vWF gene c.7288-9T＞G heterozygous mutation,and vWF gene c.1117C＞T heterozygous mutation was presented in both mother(Ⅱ4)and brother(Ⅲ2).Conclusion According to the results of laboratory tests,the proband was diagnosed as type 2A vWD.The hetero-zygous mutation in vWF gene c.1117C＞T and c.7288-9T＞G may be the molecular mechanism leading to type 2A vWD in the proband.

Objective To investigate the potential of a two-component model combining T2 and diffusion weighted imaging(T2-DWI)in the diagnosis of prostate cancer.Methods Thirty-two prostate cancer patients and twenty prostatic hyperplasia patients underwent combined T2-DWI,with TE values set at 50 ms and 70 ms and b values at 50 s/mm2 and 800 s/mm2,respectively.This provided four measurements for each voxel.The signal fractions were calculated from the slow component(SFslow)extracted from the two-component model of T2-DWI,which was fitted with two free parameters.The results were compared with the traditional single exponential apparent diffusion coefficient(ADC)model.Results A significant difference was observed between SFslow(0.77±0.14 vs 0.35±0.10)and ADC[(0.91±0.24)μm2/ms vs(1.98±0.32)μm2/ms]in region of interest(ROI)between peripheral zone tumors and normal prostate tissue(P＜0.001).No significant difference was found between SFslow(0.75±0.13 vs 0.68±0.11)and ADC[(0.88±0.18)μm2/ms vs(0.97±0.13)μm2/ms]in ROI between non-peripheral zone tumors and prostatic hyperplasia.The area under the curve(AUC)of the receiver operating characteristic(ROC)for distinguishing tumors from prostate voxels was 0.962 for two-component SFslow and 0.940 for single exponential ADC models.The Spearman correlation coefficients between tumor SFslow and ADC with Gleason scores were 0.631 and-0.558,respectively.Conclusion SF estimation based on T2-DWI two-component model can effectively differentiate tumors from normal prostate tissue,showing potential in diagnosing prostate cancer.