Objective To enhance the standardization of surgical operations,shorten the learning curve,and reduce surgical complications by summarizing common errors and proposing solutions for beginners during pre-study of cavity construction in non-inflatable axillary approach laparoscopic thyroid surgery.Methods A retrospective analysis was made on 210 patients who underwent noninflatable axillary approach luminal thyroid surgery at the Department of Head and Neck Surgery,Zhejiang Provincial People's Hospital,between January 2022 and June 2023.Among them,150 patients were luminalized by the practitioners in the practice group,while 60 patients were luminalized by the practitioners in the skilled group.The occurrence of nine common errors during cavity construction,such as supraclavicular nerve injury and scapulohumeral muscle injury,was assessed and compared between the two groups.Results There was no statistically significant difference in age,gender,tumor diameter,tumor location or pathology type between the two groups(P＞0.05).The staff in the practice group had a significant difference in supraclavicular cutaneous nerve injury(19.33％vs.3.33％),scapulohumeral muscle injury or disarticulation(16.00％vs.0),anterior cervical band of free excess(24.00％vs.3.33％),pectoralis major muscle and supraclavicular fascia injury(16.00％vs.5.00％),external jugular vein and genuine branch injury(8.00％vs.0),excessive freeing of the sternoclavicular joint(7.33％vs.0),and incorrect entry of the sternocleidomastoid muscle gap(8.67％vs.0)were significantly higher in incidence than the employees in the skilled group(P＜0.05).There was no statistically significant difference between employees in the practice group and those in the skilled group in terms of injury to the internal jugular vein and its geniculate branches(4.00％vs.0),and incorrect entry of the anterior cervical strap muscles into the hierarchy(2.00％vs.0)(P＞0.05).Conclusion The incidence of damage to the surrounding tissue was significantly higher in the novice group than in the expert group during endoscopic thyroid surgery for space construction.A solid anatomical foundation and proficient endoscopic surgical technique serve as fundamental prerequisites for achieving a successful space system construction.By summarizing common challenges and providing corresponding solutions encountered during endoscopic thyroid surgery,this study further enhances and refines the learning system for total endoscopic thyroid procedures.

Soft tissue defects resulting from head and neck tumor resection seriously impact the physical appearance and psychological well-being of patients. The complex curvature of the human head and neck poses a formidable challenge for maxillofacial surgeons to achieve precise aesthetic and functional restoration after surgery. To this end, a normal head and neck volunteer was selected as the subject of investigation. Employing Gaussian curvature analysis, combined with mechanical constraints and principal curvature analysis methods of soft tissue clinical treatment, a precise developable/non-developable area partition map of the head and neck surface was obtained, and a non-developable surface was constructed. Subsequently, a digital design method was proposed for the repair of head and neck soft tissue defects, and an in vitro simulated surgery experiment was conducted. Clinical verification was performed on a patient with tonsil tumor, and the results demonstrated that digital technology-designed flaps improved the accuracy and aesthetic outcome of head and neck soft tissue defect repair surgery. This study validates the feasibility of digital precision repair technology for soft tissue defects after head and neck tumor resection, which effectively assists surgeons in achieving precise flap transplantation reconstruction and improves patients' postoperative satisfaction.
Humans ; Plastic Surgery Procedures ; Surgical Flaps/surgery* ; Head and Neck Neoplasms/surgery* ; Head/surgery* ; Neck/surgery*

Objective: To improve the N biomarker in the amyloid/taueurodegeneration system by radiomics and study its value for predicting cognitive progression in individuals with mild cognitive impairment (MCI). Materials and Methods: A group of 147 healthy controls (HCs) (72 male; mean age ± standard deviation, 73.7 ± 6.3 years), 197 patients with MCI (114 male; 72.2 ± 7.1 years), and 128 patients with Alzheimer’s disease (AD) (74 male; 73.7 ± 8.4 years) were included. Optimal A, T, and N biomarkers for discriminating HC and AD were selected using receiver operating characteristic (ROC) curve analysis. A radiomics model containing comprehensive information of the whole cerebral cortex and deep nuclei was established to create a new N biomarker. Cerebrospinal fluid (CSF) biomarkers were evaluated to determine the optimal A or T biomarkers. All MCI patients were followed up until AD conversion or for at least 60 months. The predictive value of A, T, and the radiomics-based N biomarker for cognitive progression of MCI to AD were analyzed using Kaplan-Meier estimates and the log-rank test. Results: The radiomics-based N biomarker showed an ROC curve area of 0.998 for discriminating between AD and HC. CSF Aβ42 and p-tau proteins were identified as the optimal A and T biomarkers, respectively. For MCI patients on the Alzheimer’s continuum, isolated A+ was an indicator of cognitive stability, while abnormalities of T and N, separately or simultaneously, indicated a high risk of progression. For MCI patients with suspected non-Alzheimer’s disease pathophysiology, isolated T+ indicated cognitive stability, while the appearance of the radiomics-based N+ indicated a high risk of progression to AD. Conclusion We proposed a new radiomics-based improved N biomarker that could help identify patients with MCI who are at a higher risk for cognitive progression. In addition, we clarified the value of a single A/T/N biomarker for predicting the cognitive progression of MCI.

Objective To report the spontaneous remission and induced remission of phospholipase A2 receptor (PLA2R)-associated idiopathic membranous nephropathy (IMN) in adults,as well as to explore the potential prognostic factors.Methods A total of 120 patients with IMN in Huashan Hospital during 2012 and 2017 were enrolled and their clinical data were collected.Results PLA2R-associated IMN patients accounted for 89.2％ of the IMN patients.Spontaneous remission occurred in 35.5％ of PLA2R-associated IMN patients.The patients with higher serum albumin and lower level of PLA2R antibody were more likely to achieve spontaneous remission (both P ＜ 0.05).Multivariate logistic regression analysis showed that male was an independent risk factor for spontaneous remission in PLA2R-associated IMN patients (OR=0.060,95％CI 0.007-0.493,P=0.009),while higher serum albumin at baseline (OR=1.480,95％ CI 1.144-1.932,P=0.004) and the improvement of serum albumin after 3 months' non-immunosuppressive treatment (OR=2.040,95％CI 1.322-3.151,P=0.001) were independent protective factors for spontaneous remission.About 42.1％ PLA2R-associated IMN patients had received immunosuppressive therapy,with induced remission rate being 70.7％.High serum albumin before treatment was an independent protective factor for induced remission (OR=1.268,95％ CI 1.014-1.585,P=0.038).Conclusions PLA2R-associated IMN accounts for most of the IMN patients,with a spontaneous remission rate of 35.5％,during the follow-up period,which is even higher in patients with higher baseline serum albumin and lower PLA2R antibody titer.Induced remission rate is 70.7％ in patients in need of immunosuppresants.The serum albumin level may be helpful in predicting spontaneous remission and response to immunosuppressive therapy.

Objective: To investigate the effect of icariin (ICA) on the bisphenol A (BPA)-enhanced proliferation function of thyroid carcinoma cell B-CPAP and underlying mechanism. Methods: The proliferation of Gastric B-CPAP cell line was evaluated by cell counting kit-8 (CCK-8). Apoptosis and ROS expression in B-CPAP cells were detected by flow cytometry. The expression of superoxide dismutase (SOD) and malondialdehyde (MDA) in B-CPAP cells were measured by individual assay kits. The expressions of Bcl-2 and γ-HA2X were detected by Western blot. SPSS 18.0 software was used to analyze the data. Results: B-CPAP cell activity was promoted by treatment with 3×10^-7mol/L BPA for 48 h, with significant difference in absorbance between BPA and control groups (1.089±0.053 vs 0.935±0.010, P<0.05). The cell activities of BPA+ ICA₂₅, BPA+ ICA₅₀, BPA+ ICA₁₀₀ and BPA+ ICA₂₀₀ groups was 0.780±0.036, 1.007±0.050, 0.958±0.033 and 0.625±0.064, respectively (all P<0.01). The proliferation of B-CPAP cells treated with BPA for 72 hours showed a similar trend to 48 hours. There was no significant difference between all treatment groups in 24 hours. The apoptosis rate was (19.272±0.186)% in BPA-treated cells, and was (22.412±0.238)% in control cells (P<0.05). The apoptosis rates of BPA+ ICA₅₀ and BPA+ ICA₂₀₀ groups were (23.688±0.412)% and (30.270±0.696)%, respectively (P<0.01). The intracellular accumulation of ROS in BPA, BPA+ ICA₅₀, and BPA+ ICA₂₀₀ groups were 806±21, 1 772±37, 2 041±16, respectively (P<0.01). The expressions of anti-apoptotic protein Bcl-2 in control, BPA, BPA+ ICA₅₀, BPA+ ICA₂₀₀ groups were 7 120±151, 9 801±286, 5 902±171 and 4 203±216, respectively (P<0.01). Conclusion BPA can promote the proliferation of thyroid carcinoma B-CPAP cells and decrease the apoptosis of cells, and this effect can be inhibited by ICA. The possible mechanism is to induce high expression of intracellular ROS and inhibit the expression of antioxidase system, leading to cell oxidative damage, thereby inducing apoptosis.

The academic origin of homogeny of spleen and pancreas is explained from the aspect of Chinese medicine.The authors think spleen faihng to spread essence is the basic pathogenesis to diabetes mellitus.Spleen function of spreading essence is impaired.Thus essence of water and grain could not be spread in the whole body but amass sugar-turbidity,which manifests high blood sugar.Differentiating diabetes mellitus from the viewpoint of spleen,invigorating spleen and benefiting Qi could help spleen to ascend clear.Invigorating spleen-yin and clearing endogenous heat are used.The liver and kidney should be considered.The methods of dissipating phlegm and activating blood circulation could be combined.The treating idea of treating spleen is treating pancreas should be used in preventing and treating diabetes mellitus.

Background and purpose:Icariin (ICA) is the important active flavonoids extracted from Berberidaceaeepimedium. It has been shown to be effective in suppressing cancers including lung cancer and gastric cancer. Thus, it is expected to be developed for cancer treatment. However, there were few studies on icariin as a promising anticancer drug for the treatment of thyroid cancer. The mechanisms underlying anticancer effects of ICA in thyroid cancer are rarely reported. This study was to explore the proliferation and apoptosis, intracellular ROS and antioxidant enzyme systems of the thyroid carcinoma cell line B-CPAP treated with different concentrations of ICA. It aimed to explore the mechanism underlying anticancer effects of ICA, and to determine whether it is concentration- or time-dependent manner.Methods:The proliferation of B-CPAP cell line treated with different concentrations of ICA was detected by cell counting kit-8 (CCK-8). The cell apoptosis and intracellular ROS were observed by flow cytometry. The expression of intracellular superoxide dismutase and intracellular malondialdehyde were measured by SOD detection kit and MDA assay kit, respectively. Bcl-2 and γ-HA2X were detected by Western blot.Results:ICA reduced B-CPAP cell activity, increased the rate of apoptosis in a dose- and time-dependent manner after 48 h (P<0.01). The ROS of ICA 50 mg/L and 200 mg/L groups were (2.12±0.14)-fold and (2.41±0.12)-fold of the control group, respectively. ICA promoted accumulation of malondialdehyde, and reduced antioxidant enzyme SOD activity. The SOD activity was decreased by (9.35±1.45)% (ICA 50 mg/L group) and (21.5±1.52)% (ICA 200 mg/L group) compared with the control group, respectively. The anti-apoptotic protein Bcl-2 in ICA 200 mg/L group was decreased by (13.64±1.71)%compared with the control group.Conclusion:Icariin inhibited activity of thyroid cancer B-CPAP cells in a dose- and time-dependent manner. It plays an important role in promoting intracellular ROS expression, inhibiting superoxide dismutase expression and decreasing Bcl-2, which leads to irreversible damage to the cell, thereby inducing apoptosis.

Objective To study the influence of different contrast injection skills in interstitial magnetic resonance lymphography( IMRL) of breast cancer, and standardize the IMRL contrast injection process. Methods A total of 36 patients with invasive breast cancer were ran-domly divided into four groups. The imaging time of different contrast agent dose and local massage time on sentinel lymph node ( SLN) were analyzed. According to the results, the best contrast injection methods technology program was choosed. Results For the same massage time, different contrast agent doses showed no significant difference in the SLN imaging time (P>0. 05);For same contrast agent dose, dif-ferent massage time showed significant statistically different SLN imaging time(P<0. 05). Conclusion In clinical work, IMRL with a con-trast agent injection dose of 0. 5 mL/person, local massage 1 min after injection can successfully achieve the lymphatic system image of breast cancer.

An improved manufacturing process for rivastigmine(1)was developed by performing the condensation reaction of m-hydroxyacetophenone(4)with N-ethyl-N-methyl carbamoyl chloride, then Corey-Bakshi-Shibata(CBS)chiral reduction to(R)-3-(1-hydroxyethyl)phenyl ethyl(methyl)carbamate(2)and then mesylation with methanesulfonyl chloride and nucleophilic substitution with dimethylamine, respectively. To be successful, a crucial reductive process in the conversion of ketone(3)to chiralalcohol(2)had to be correctly understood and optimized via orthogonal experiment. The whole improved process was convenient for operation and purification, with completion of the synthesis of rivastigmine and an overall yield of 88%.

Objective To fabricate the bio-implant supported by regenerated periodontal tissue utilizing periodontal ligament cells(PDLC)-bone marrow stromal cells(BMSC) sheet and natural root.Methods Premolars of 2 beagle dogs were extracted to prepare the implanted area.Autologous tooth roots were carved into cylinders.PDLC and BMSC separated from beagle dogs were cultured into cell sheets in medium.Tooth roots were wrapped by one type of cell sheets or both to fabricate bio-implant and divided into four groups,tooth roots were wrapped by PDLC sheets and BMSC sheets successively (2 samples each dog),tooth roots were wrapped by PDLC sheets alone (2 samples each dog),tooth roots were wrapped by BMSC sheet alone (2 samples each dog),tooth roots without cell sheet (1 sample each dog).The implants were implanted into the mandibles.The mandibles were dissected 12 weeks later,sliced and stained by HE and Masson dyes for histological examination.Results In the PDLC cell sheet/root implants,histological examination revealed that new periodontal-like tissue including cementum,periodontium and alveolar bone was regenerated.In the BMSC implants,tooth ankylosis was observed.Conclusions PDLC sheet and natural root can be used to fabricate bio-implant.PDLC sheet could promote periodontal regeneration.