Objective:To explore the use of near-infrared autofluorescence probe (NIRAF-P) and its application in identifying parathyroid glands during surgery.Methods:A total of 68 patients undergoing thyroid surgery at Peking Union Medical College Hospital and Beijing Longfu Hospital between Dec. 2023 and Jun. 2024 were selected. During the operation, the near-infrared parathyroid gland detector was used to identify the parathyroid gland tissue to be tested, and histopathological examination was performed. The positive predictive value and accuracy of the near-infrared parathyroid gland detector were analyzed.Results:A total of 111 parathyroid glands were identified in 68 patients, and the positive predictive value and accuracy of the NIRAF-P were 95.5% and 94.6%, respectively.Conclusions:The NIRAF-P has high accuracy in identifying parathyroid glands. The standardized application of the NIRAF-P can help improve the efficiency of identifying parathyroid glands during surgery.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To explore whether deep learning could apply to recognize the recurrent laryngeal nerve in the video of unilateral axillary approach endoscopic thyroidectomy.Methods:Videos of endoscopic thyroidectomy via unilateral axillary approach in Peking Union Medical College Hospital from Jul. 1st, 2020 to May. 1st, 2021 were collected. Videos containing the recurrent laryngeal nerve were selected, and the outline of recurrent laryngeal nerve were marked by two senior thyroid surgeons and staffs. Data were divided into training set and test set in a ratio of 5:1, and classified into high, medium and low recognition group according to difficulty of recognizing the outline of the nerve. The neuron network was based on PSPNet combined with Resnet50. All data were analyzed by R (ver. 4.0.2) .Results:A total of 38 videos including 35,501 frames of pictures were included in this study. 29, 704 frames of 32 videos were in our training set and 5797 frames of 6 videos were in the test set. When the intersection over union (IOU) threshold is 0.1, the sensitivity and precision is 100.0%/92.1%, 95.8%/80.2% and 81.0%/80.6% in high, medium and low recognition group respectively. When the IOU threshold is 0.5, the sensitivity and precision is 92.6%/85.3%, 71.7%/60.5% and 38.1%/37.9% in high, medium and low recognition group respectively, indicating that neuron network could located the outline of recurrent laryngeal nerve in high and medium recognition group. False negatives were often due to small targets and unclear boundaries.Conclusion:Recurrent laryngeal nerve recognition based on deep learning is feasible and has potential application value in endoscopic thyroidectomy, which may help surgeons reduce the risk of accidental injury of recurrent laryngeal nerve and improve the safety of thyroidectomy.

Objective:To explore whether deep learning could apply to recognize the recurrent laryngeal nerve (RLN) in videos of endoscopic thyroidectomy (ETE) via breast approach.Methods:Videos of ETE via breast approach in Peking Union Medical College Hospital from Feb. 2020 to Aug. 2021 were collected. Videos containing RLN were selected, and the outline of RLN was marked by two thyroid surgeons. Then data were divided into a training set and a test set in a ratio of 5:1 and classified into the high and low difficulty group according to a senior thyroid surgeon’s opinion. Those pictures were input to D-LinkNet model. Precision, sensitivity and mean dice index was calculated.Results:A total of 46 videos including 153, 520 frames of pictures were included in this study. 131,039 frames of 39 videos were in the training set and 22,481 frames of 7 videos were in the test set. When the intersection over union threshold was 0.1, the sensitivity and precision was 92.9%/72.8% and 47.6%/54.9% in high and low recognition group, respectively. When the intersection over union threshold was 0.5, the sensitivity and precision turned to 85.8%/67.2% and 37.6%/43.5% in high and low difficulty group, respectively. Mean Dice index was 0.781 and 0.663 in high and low difficulty group, respectively.Conclusions:RLN recognition based on deep learning is feasible and has potential application value in ETE, which may help surgeons reduce the risk of accidental injury of RLN and improve the safety of thyroidectomy.

Objective:To summarize the experience and the clinical data of patients with primary hyperparathyroidism undergoing endoscopic parathyroidectomy.Methods:A total of 24 patients who underwent endoscopic parathyroidectomy for primary hyperparathyroidism in Peking Union Medical College Hospital during Feb. 2021 to May. 2022 were concluded in this study (20 cases of parathyroidectomy via axillary approach and 4 cases of parathyroidectomy via thoracic and breast approach) . The operation time, postoperative drainage, length of stay, level of parathyroid hormone and serum calcium of those patients were collected. Postoperative complications and recurrence of hyperparathyroidism were also observed.Results:The postoperative levels of serum parathyroid hormone and serum calcium were significantly reduced (over 50%) compared with preoperative level ( P<0.05) . The average operation time was (96±22) min (64-157 min) . The mean postoperative drainage volume was (47±16) ml on day 1, (46±11) ml on day 2, and (30±9) ml on day 3, respectively. The average length of postoperative hospital stay was (2.8±1.1) days (2-6 days) . In one case of parathyroidectomy via axillary approach, the operation was converted to open surgery because of the low position of lesion. Other cases completed endoscopic surgery and obtained satisfactory cosmetic results. There were no postoperative complications such as bleeding, permanent hoarseness, coughing while drinking water, or surgical site infection. The mean follow-up time was (7.4±4.2) months (1-16 months) . There was no obvious discomfort and no recurrence during follow-up. Conclusion:Endoscopic parathyroidectomy is safe and effective in the treatment of primary hyperparathyroidism, which can be used as a surgical option for patients with cosmetic requirements.

Objective:To investigate the application value of machine learning algorithms for gauze detection in laparoscopic pancreatic surgery.Methods:The retrospective and descriptive study was conducted. The 80 intact laparoscopic pancreatic surgery videos from Peking Union Medical College Hospital of Chinese Academy of Medical Sciences with timing of July 2017 to July 2020 were collected. The training set was used to train the neural network, and the test set was used to test the ability of neural network for gauze detection under different difficulties. Under the supervision of two superior doctors, videos that containing gauze were selected and classified according to recognition difficulty into three difficulty level including easy, normal and hard difficulty, and further divided based on random number method into training set with 61 videos and test set with 19 videos in a ratio of 3:1 roughly. The minimum enclosing rectangle of the gauze were marked frame by frame. All images were input to the neural network model for training after normalization and preprocessing. For every image, the output of neural network is the predicted minimum enclosing rectangle of gauze. The intersection over union >0.5 was identified as positive result. Observation indicators: (1) video annotation and classification; (2) test outcomes of neural network for test set.Count data were represented as absolute numbers or percentages.Results:(1) Video annotation and classification: a total of 26 893 frames of images form 80 videos were annotated, with 61 videos including 22 564 frames of images as the training set and 19 videos including 4 329 frames of images as the test set. Of the training set, 19 videos including 5 791 frames of images were classifed as easy difficulty, 38 videos including 15 771 frames of images were classifed as normal difficulty, 4 videos including 1 002 frames of images were classifed as hard difficulty, respectively. Of the test set, 4 videos including 1 684 frames of images were classifed as easy difficulty, 6 videos including 1 016 frames of images were classifed as normal difficulty, 9 videos including 1 629 frames of images were classifed as hard difficulty, respectively. (2) Test outcomes of neural network for test set: the overall sensitivity and accuracy of gauze detection by neural network in the test set were 78.471%(3 397/4 329) and 69.811%(3 397/4 866), respectively. The sensitivity and accuracy of gauze detection by neural network were 94.478%(1 591/1 684) and 83.168%(1 591/1 913) in easy difficulty test set. The sensitivity and accuracy of gauze detection by neural network were 80.413%(817/1 016) and 70.859%(817/1 153) in normal difficulty test set, 60.712%(989/1 629) and 54.944%(989/1 800)in hard difficulty test set. The frame rate reached more than or equally to 15 fps. The overall false negative rate and false positive rate of gauze detection by neural network in the test set were 21.529%(932/4 329) and 30.189%(1 469/4 866), respectively. The false negative was mainly due to the existence of blurred images, too small gauze exposure or blood immersion of gauze. The false positive was caused by the reflection of connective tissue or body fluids.Conclusion:The machine learning algorithms for gauze detection in laparoscopic pancreatic surgery is feasible, which could help medical staff identify gauze.

Objectives To research clinical effects of severe brain injury patients treated by acupuncture and herb combine mild hypothermia,discuss the new approach of severe brain injury patients treatment combine Chinese traditional and Western medicine.Methods Investigated 68 severe traumatic brain injured patients,randomly divided into three groups,acupuncture and herb combine mild hypothermia group (n =22),mild hypothermia group (n =24) and normal temperature routine treatment group (n =22).Dynamic intracranial pressure,brain damage index (cytoskeletal protein),immunologic function (IL-6,β2 microglobulin),combine rate of complications (including irritable ulcer,lung infection,epilepsy,sugar metabolism disorder,and so on),and long-term GOS score were analyzed.SPSS12.0 software was used for statistical processing,and the standard deviation of the measurement data were expressed as the standard deviation.The counting data were expressed as apercentage,and the chi-square test was used for the comparison between group.Results There were significant differences between three groups of intracranial pressure,immunologic function,complication occurring rate (P ＜0.05),but there had no significant difference between acupuncture and herb combine mild hypothermia group and mild hypothermia group of brain damage index and GOS,and there have significant difference between these two groups and normal temperature routine treatment group.Conclusions Acupuncture and herb combined mild hypothermia might be better in reducing intracranial pressure,the incidence of complication,and improving immune function of severe brain injury,than mild hypothermia group and normal temperature routine treatment group.

Objective:To investigate the effect of prison police's job burnout on their life satisfaction and the role of psychological detachment between them.Methods:Questionnaire survey was conducted among 253 prison policemen in Henan Province with the Maslach Burnout Inventory-General Survey (MBI-GS,including emotional exhaustion,cynicism,and reduced personal accomplishment),Satisfaction with Life Scale (SWLS) and Psychological Detachment Questionnaire (PDQ).Results:The MBI-GS total scores and the scores of its three dimensions were negatively correlated with SWLS scores (r ＝-0.41,-0.38,-0.36,-0.21,Ps ＜0.001),PDQ scores were negatively correlated with MBI-GS total scores and emotional exhaustion scores (r ＝-0.21,-0.31,Ps ＜ 0.001),but positively correlated with SWLS scores (r ＝ 0.22,P ＜ 0.001).Psychological detachment played a moderating role between job burnout and life satisfaction (β ＝ 0.58,P ＜ 0.001).Conclusion:It suggests that prison police's job burnout may reduce their life satisfaction,and psychological detachment can moderate the influence of job burnout on life satisfaction.

Objective: To discuss the diagnosis, preoperative imaging and surgical technique of patients who underwent reoperation for persistent hyperparathyroidism. Methods: A prospective database about primary hyperparathyroidism in Department of General Surgery, Peking Union Medical College Hospital was searched for the patients who underwent reoperation for persistent hyperparathyroidism from January 2009 to December 2016. The information about the initial operation, preoperative imaging study and result of reoperations were collected and reviewed. A total of 58 patients underwent reoperation for hyperparathyroidism. Eleven of these patients were referred to this institute for reoperation after missing single parathyroid lesion in the initial parathyroidectomy. Nine patients were female, and the mean patient age at reoperation was 54.9 years. Results: For this group, the accuracy of ultrasound neck scan and sestamibi scintigraphy was 10/11 in identifying diseased parathyroid gland before reoperation. Combined with enhanced CT and SPECT, all parathyroid lesions were localized before reoperations. With general anesthesia or cervical plexus block, all diseased parathyroid glands were removed in the reoperations. No signs of hyperparathyroidism appeared during follow-up. Conclusions The initial surgery for primary hyperparathyroidism should be performed in experienced center to avoid reoperations. Combining preoperative localization and cervical exploration will help to increase the success rate of reoperation.

Objective To report a family with lipoid proteinosis (LP) from Shandong province and to analyze mutations in the extracellular matrix protein 1 (ECM1) gene in this family.Methods Eight members in a threegeneration family with LP were clinically investigated,and two patients were identified to suffer from LP,including the proband (Ⅲ 1) and her mother (Ⅱ 2).Both of the patients presented with papules on the palpebral margin,short and thick lingual frenum,and hoarseness.Indirect laryngoscopy showed infiltrating and thickening of the vocal cord.Pathological examination of lesions on the palpebral margin and laryngeal mucosa revealed deposits of hyaline-like material in the dermis,which was strongly positive for periodic acid-Schiff (PAS) staining and resistant to diastase digestion.The pathological diagnosis was LP.Blood samples were collected from all the family members and 100 ethnically matched,unrelated and unaffected Chinese human controls followed by DNA extraction.PCR and sequencing were performed to detect the ECM1 gene,and nested PCR followed by agarose gel electrophoresis to analyze mutations in the coding region of the ECM1 gene.Results Both of the two patients were compound heterozygotes.Three missense mutations,incluing p.P169T,p.A44T and p.R392W,were found in the ECM1 gene of the affected mother,with p.P169T in one allele and p.A44T as well as p.R392W in the other.The girl patient inheried the missence mutation p.P169T from her mother and a synonymous mutation c.879G ＞ A from her father (Ⅱ 1).Nested PCR showed that the c.978G ＞ A mutation generated a splice-acceptor site AG,which leaded to a splicing defect.Conclusion A novel synonymous splice-acceptor site mutation c.879G ＞ A in the ECM1 gene is identified in the family with LP.