Objective:To investigate the efficacy and prognosis of different surgical approaches in sporadic medullary thyroid carcinoma.Methods:A retrospective analysis was conducted on 101 patients with sporadic medullary thyroid carcinoma (MTC) who underwent surgical treatment at the Department of Thyroid Surgery, China-Japan Union Hospital of Jilin University, from Feb. 2009 to Nov. 2023. The patients included 36 males and 75 females, with a male-to-female ratio of 1:2.1. The median age of the patients was 47 years old, with an age range of 21 to 72 years old. The study divided participants into two groups based on their surgical methods: an observation group (78 cases) and a control group (23 cases). The observation group received surgical methods in accordance with expert consensus, while the control group did not. The study compared the efficacy and prognosis of the two groups.Results:Statistical differences were found between the two groups in terms of stage II and III in TNM staging, intraoperative frozen pathological findings, number of lymph node resections in the central group, number of lymph node metastases in the central group, number of lymph node resections in the lateral cervical region, postoperative follow-up time, and five-year postoperative serum procalcitonin (Ctn) levels ( P<0.05) .Both groups of patients obtained a significant decrease in Ctn after surgical treatment. In the observation group, Ctn was at the remission level in 57 cases (73.1%), at the stable level in 13 cases (16.7%), and at the progression level in 8 cases (10.2%), while in the control group, Ctn was at the remission level in 20 cases (86.9%), at the progression level in 3 cases (13.1%), and there were no patients at the stable level after the operation.One patient (1.3 per cent) in the observation group had a recurrence after surgery; Two patients (8.7 per cent) in the control group had a recurrence. Conclusions:Standardised and thorough surgery can maximise the clearance of metastatic lymph nodes, effectively reduce the recurrence rate, achieve better efficacy, and improve the long-term prognosis of patients without increasing the risk of surgery and postoperative complications.

In recent years, clinical applications of robotic thyroid surgery have been gradually promoted with the continuous improvement of the da Vinci robotic surgical system. Unlike traditional open surgery, robotic thyroid surgery mainly adopts remote access, which has many advantages, such as magnified high-definition 3D view and hand vibration stabilization. The rates and causes of postoperative complications differ due to different approaches, view angles, and operation sequences. This paper presents the literature on both transoral and bilateral areolar axillary approaches in robotic thyroid surgery, focusing on five common complications under both approaches, including laryngeal recurrent nerve injury and hypoparathyroidism, to provide theoretical support for the standardization of robotic thyroid surgery.

Thyroid cancer is the most common malignant tumor of the endocrine system, and its incidence is increasing year by year showing younger trend. The pathological types of thyroid cancer are papillary carcinoma, follicular carcinoma, medullary carcinoma and undifferentiated carcinoma. Medullary thyroid carcinoma (MTC) and papillary thyroid carcinoma (PTC) are the two common types of thyroid cancer. Since MTC and PTC have different biological origins, invasiveness and prognosis. Therefore, the occurrence of both medullary carcinoma and papillary carcinoma is very rare and rarely reported in China and abroad and the treatment is challenging. In this paper, we review the pathogenesis, ancillary tests, diagnosis and treatment of this disease, with the aim of providing reference for clinical treatment of patients with medullary thyroid carcinoma complicated by papillary carcinoma.

Objective:To investigate the clinical effectiveness of da Vinci robotics in thyroid surgery.Methods:304 cases of robotic thyroid surgery performed by the same experienced surgeon at the Department of Thyroid Surgery, China-Japan Union Hospital of Jilin University during the period from Apr. 3, 2020 to Nov. 5, 2021 were prospectively included, and the operation time, operation type, postoperative drainage, postoperative hospital stay, total number of lymph node dissection and number of positive lymph nodes, operation complications, and postoperative pain level of all patients were counted. The learning curve was plotted by applying the moving average method, divided into the initial stage and the mature stage, and the differences in surgical outcomes and surgical complications between the two stages were compared. SPSS 23.0 was applied for statistical analysis, and t-test and Mann-Whitney U test were used for comparison of measurement data, and χ2 test was used for comparison of count data. Result:All surgeries were completed successfully without conversion to open cases, including 29 males and 275 females, with a mean age of (33.8±8.9) years and a range of 27-41 years. The mean body mass index (BMI) was (22.9±3.6) kg/m 2 and a range of 20.5-25.4 kg/m 2. The median operative time was 140 min, the median postoperative drainage was 52.5 ml, and the median postoperative hospital stay was 3 days. The mean number of lymph nodes cleared was 4.4±3.5, and the mean number of positive lymph nodes was 0.9±1.7. The incidence of postoperative transient laryngeal nerve (RLN) injury was 3.3%, and the incidence of transient hypoparathyroidism was 0.7%. A significant decrease in operative time occurred after the 26th case and subsequently stabilized. Compared with the initial stage of the learning curve, the mature stage had a shorter operative time (146.0±36.5 vs 198.7±56.7 min, P<0.001) , a lower incidence of temporary RLN injury (2.5% vs 11.5%, P<0.05) , and a lower percentage of benign tumor surgery (12.2% vs 26.9%, P<0.05) . Conclusion:The application of robotic technology in thyroid surgery is safe and reliable, and its successful implementation should follow a corresponding learning curve, from easy to difficult, with different surgical approaches selected according to the patient’s condition, wishes, and the operator’s technical level.

Objective:To explore the clinical efficacy of posterior short-segment internal fixation for the treatment of brucella spondylitis (BS).Methods:The medical records of 34 patients with BS admitted from January 2014 to June 2019 were retrospectively analyzed. There were 22 males and 12 females; the age was 52.3±10.6 years (range 35-72 years). On the basis of standardized use of antibacterial drugs, the lumbar spine posterior short-segment internal fixation was used. Twenty-nine cases underwent simple internal fixation, and posterolateral bone graft fusion, while 5 cases underwent primary debridement, autologous bone grafting and interbody fusion. Monitor erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and test tube agglutination test (SAT) were used to assess inflammation control. Imaging examinations of patients before operation, 1 month after operation, 3 months after operation, 6 months after operation, 1 year after operation to the last follow-up were analyzed to evaluate the condition of intervertebral fusion. The clinical efficacy evaluation was based on the pain visual analog scale (VAS), Japanese Orthopaedic Association (JOA) score, modified MacNab grading, and American Spinal Injury Association (ASIA) grading, as well as surgery-related complications.Results:The operation time of 34 patients was 104.64±16.72 min (range 65-145 min), the average hospital stay was 16.49±7.41 days (range 7-38 d), and the average postoperative follow-up time was 20.2 months (range 12-34 months). At the last follow-up, the ESR and CRP fell to the normal range, and the SAT was negative. At 3 months postoperatively, 11 cases (32.35%) reached Bridwell fusion criteria of grade II, 23 cases (67.65%) of grade III; 3 cases (8.82%) of grade I fusion at 6 months after surgery, 31 cases reached grade II fusion (91.18%); all reached grade I fusion at the last follow-up. After the operation, the symptoms of the waist or lower extremities were significantly relieved. The VAS score was 6.3±1.4 before the operation, 4.1±1.2 at 1 month after the operation, 2.7±1.4 at 3 months after the operation, 1.6±1.0 at 6 months after the operation, and 1.2±0.8 at the last follow-up. The JOA score before surgery was 13.8±2.4, 1 month after surgery 17.6±2.6, 3 months after surgery 21.7±3.1, 6 months after operation 4.9±2.7, and at the last follow-up 25.7±1.8. Compared with the preoperative time nodes of the above indicators, the differences were statistically significant. At the last follow-up, of the 12 patients (2 cases of grade C, 10 cases of grade D) with preoperative neurological dysfunction, 2 cases recovered from grade C to grade D, and 10 cases recovered from grade D to E; the excellent and good rate of modified MacNab grading reached 97.06% (33/34). No extradural hematoma, nerve damage, cerebrospinal fluid leakage and other surgical complications occurred. Only 1 case had wound infection complication, and the prognosis was good after active treatment. There were no recurrences during the follow-up period.Conclusion:On the basis of standardized antimicrobial treatment, posterior lumbar short-segment internal fixation is a safe and effective method for the treatment of BS, and good clinical effects can be obtained.

Fruit cracking is a common physiological disease. Many fruits such as tomato, sweet cherry, apple, jujube, pomegranate, and litchi are liable to crack, causing considerable economic loss and agricultural resources waste. The mechanisms of fruit cracking are comprehensive. Some correlations have been observed between susceptibility of fruit cracking and some fruit traits (genetic, fruit size, fruit shape, fruit growth rate, water content, fruit skin characteristics, related gene expression, etc). Also, environmental condition (temperature, light, rainfall, etc) and orchard management (irrigation, sun-shade, mineral, growth regulator, etc) can influence fruit cracking. Here, progress in studies on fruit cracking is reviewed to provide a reference for prevention and control of fruit cracking.
Fruit ; Litchi ; Lycopersicon esculentum

The environmental gas concentration affects the storage period and quality of fruits and vegetables. High concentration CO₂ treating for a long time will cause damage to fruits, However, the specific molecular mechanism is unclear. To analyze the mechanism of CO₂ injury in apple, high-throughput sequencing technology of Illumina Hiseq 4000 and non-targeted metabolism technology were used to analyze the transcriptome sequencing and metabolomics analysis of browning flesh tissue of damage fruit and normal pulp tissue of the control group. A total of 6 332 differentially expressed genes were obtained, including 4 187 up-regulated genes and 2 145 down regulated genes. Functional analysis of the differentially expressed genes confirmed that the occurrence of CO₂ injury in apple was related to redox process, lipid metabolism, hormone signal transduction process and energy metabolism process. Twenty candidate browning genes were successfully screened, among which grxcr1 (md14g1137800) and gpx (md06g1081300) participated in the reactive oxygen species scavenging process, and pld1_ 2 (md15g1125000) and plcd (md07g1221900) participated in phospholipid acid synthesis and affected membrane metabolism. mdh1 (md05g1238800) participated in TCA cycle and affected energy metabolism. A total of 77 differential metabolites were obtained by metabolomic analysis, mainly organic acids, lipids, sugars and polyketones, including 35 metabolites related to browning. The metabolism of flavonoids was involved in the browning process of apple. Compared with the control tissue, the content of flavonoids such as catechin and quercetin decreased significantly in the damaged apple tissue, the antioxidant capacity of cells decreased, the redox state was unbalanced, and the cell structure was destroyed, resulting in browning. The results of this study further enrich the theoretical basis of CO₂ damage, and provide reference for the practical application of high concentration CO₂ preservation technology.
Carbon Dioxide ; Fruit ; Gene Expression Regulation, Plant ; Malus/genetics* ; Metabolome ; Transcriptome

Objective:To explore the effect and mechanism of low-dose chidamide on the treatment of primary immune thrombocytopenia (ITP) .Methods:Passive ITP animal model and active ITP animal model were established by C57BL/6J mice. Different doses of chidamide (0, 0.01, 0.1, 0.5, and 5 mg/kg) were orally administrated twice a week for 120 hours in passive ITP mice. Secondly, low-dose chidamine (0.1 mg/kg) was given intragastrically administrated twice a week in active ITP mice. The platelet counts in the peripheral blood before and after treatment were detected. Four weeks later, mice were executed to prepare splenocyte suspension; natural regulatory T cells (CD4 +CD25 +Foxp3 + nTreg cells) in splenocyte suspension were detected by flow cytometry. Serum IL-6 was measured by ELISA. Peripheral blood mononuclear cells from ITP patients were co-cultured with low-dose chidamide in vitro. After incubation for 72 hours, CD4 +CD25 +Foxp3 + Treg cells of mononuclear cells was detected. CD4 +CD25 + Treg cells and CD4 +CD25 - effector T cells were separated by immunomagnetic beads. The Treg cells and effector T cells were co cultured in a ratio of 1∶4, and treated with low-dose chidamide. The proliferation of effector T cells was detected. Results:Chidamide with low dose (0.1 mg/kg) significantly improved platelet counts in passive ITP mouse model, as well as in the ITP active mouse model and reduced the mortality related to bleeding. Low-dose chidamide significantly increased the number and proportion of nTreg cells in mouse splenocytes, and decreased serum IL-6 level in active ITP mice. In ITP patients, low-dose chidamide also significantly expanded Treg cells in the PBMC culture system. Besides, the proliferation of effector T cells was suppressed.Conclusion:Low-dose chidamide enhances the proliferation of CD4 +CD25 +Foxp3 + regulatory T cells to mediate immunosuppressive function. Serum IL-6 is inhibited for further immune tolerance. In vivo animal study suggestes that low-dose chidamide has a novel therapeutic effect on ITP.

Objective The aim of current study is to determine the effect and mechanism of thymic stromal lymphopoietin on apoptosis of mouse nucleus pulposus cells by investigating the apoptotic activity and variation of intracellular phosphorylated protein kinase B (p-Akt),X-linkedinhibitor of apoptosis protein (XIAP),cysteinyl aspartate specific proteinase-3 (caspase-3),with the treatment of thymic stromal lymphopoietin.Methods Mouse lumbar nucleus pulposus cells were cultured and identified under a fluorescence microscope.Second or third passage cells maintained in monolayers were used for the following experiments.The groups were divided randomly into normal group,TNF-α treated group,TSLP treated group,TSLP+LY94002 treated group and TSLP+Embelin treated group.As a control,normal group was treated with PBS.TNF-α treated group was treated with 500 ng/ml TNF-αt as a positive control.TSLP treated group was treated with 10 ng/ml rhTSLP.TSLP+LY94002 treated group and TSLP+ Embelin treated group were treated with 10 ng/ml TSLP with the pretreatment of different pathway inhibitors for 30 ain in different corresponding experiments,for which 10 μ mol LY294002 or 50 LY294002 responding experimentsreatment of different pathway inhibitors formouse nucleus pulposus cells was detected by FACS.The expression levels of the intracellular p-Akt,XIAP,caspase-3 were investigated by Western blot analysis.Results As the culture cell type Ⅱ collagen staining was positive observed by fluorescence microscopy,we confirmed that the cuhured cells were nucleus pulposus cells.In comparison with negative control,the levels of p-Akt,XIAP in TSLP treated group were elevated (t=9.510,P=0.001;t=8.851,P=0.001).Thecaspase-3 activity were slightly enhanced and the rate of cells apoptosis was no significance.Compared with TSLP treated group,downregulated level of pAkt and XIAPand upregulatedcaspase-3 activity in TSLP+LY294002 treated group were observed (t=8.798,P=0.001;t=7.032,P=0.002;t=5.908,P=0.004).Upregulated caspase-3 activity were also observed in TSLP+ Embelin treated group (t=7.990,P=0.001).Furthermore,significant increased apoptotic cell rate was observed in TSLP+LY294002 or TSLP+Embelin treated groups (t=21.268,P=0.001;t=21.279,P=0.001).Conclusion TSLP may have a potential anti-apoptotic effect on mouse NP cells via upregulating XIAP in PI3K/Akt signaling pathway to restrain the activation of caspase-3.

Objective To evaluate the efficacy and safety of DA-EPOCH-R protocol for patients with B-cell non-hodgkin lymphoma (NHL). Methods 43 patients with B-cell NHL received DA-EPOCH-R protocol, and their efficacy and adverse reactions were analyzed. Results 43 patients received a total of 203 cycles of chemotherapy and the median chemotherapy cycle was 6 (2ˉ8 cycles). 32 patients (74.4%) achieved complete remission (CR) after 2ˉ4 cycles of chemotherapy. A further analysis found that age ≤60 years and>60 years, stageⅠ/Ⅱand stageⅢ/Ⅳ, germinal center B-cell (GCB), non-GCB, double expression lymphoma (DEL) and non-DEL patients had no significant differences (P> 0.05). With a median follow-up of 40 months (9ˉ62 mouths), the overall survival (OS) rate of 1-year and 3-year was 97.6 % and 92.8 % respectively. The major toxicity of DA-EPOCH-R protocol was hematologic toxicity. Other toxicities were mild, and no treatment-related deaths occurred. At the end of follow-up, no secondary tumors were found. Conclusions DA-EPOCH-R protocol is an effective and safe protocol for patients with NHL. The result shows that the curative effect of patients in stageⅢandⅣis similar to the patients in stageⅠandⅡ.