Thyroid surgery has experienced more than a century of development. From conventional anterior neck incision to various types of endoscopic surgery， minimally invasive and beauty are increasingly valued by doctors and patients. However， there is no unified conclusion on whether all thyroid surgeries performed under endoscopy are minimally invasive surgery， how to define surgical trauma， how to evaluate postoperative physical and psychological trauma， and how scars affect patients. This article reviews the above issues.
Objective To construct a model using radiomics to predict the mutation status of isocitrate dehydrogenase （IDH） in gliomas. Methods A retrospective analysis was conducted on preoperative magnetic resonance imaging （MRI） images of 336 glioma patients， and imaging features were extracted to construct an radiomics model. Receiver operating characteristic curve was used to evaluate the effectiveness of the model in predicting IDH mutation status. Results The radiomics features of each sequence were compressed and selected， of which 26 radiomics features were obtained from T1WI， 24 radiomics features were obtained from T2WI， 12 radiomics features were obtained from enhanced T1WI， and 27 radiomics features were obtained from the three sequences combined. In the single sequence model， the area under the curve （AUC） of T1WI was 0.780 （95%CI 0.724-0.836） in the training set and 0.763 （95%CI 0.650-0.876） in the test set. The AUC of T2WI was 0.790 （95%CI 0.736-0.845） in training group and 0.785 （95%CI 0.677-0.893） in test group. The AUC of enhanced T1WI was 0.815 （95%CI 0.762-0.867） in the training group and 0.810 （95%CI 0.702-0.918） in the test group. The radiomics model based on three sequences （T1WI， T2WI and enhanced T1WI） combined had the best prediction performance. The area under the curve of the training group was 0.877 （95%CI 0.837-0.917）， and the area under the curve of the test group was 0.862 （95%CI 0.773-0.952）. Conclusion The radiomics feature model based on conventional MRI can effectively predict the IDH genotype of gliomas， thereby further guiding clinical diagnosis and treatment， and evaluating patient prognosis.
Objective To investigate the effects of electroconvulsive therapy （ECT） on depressive behaviors and explore the mechanisms by which it regulates the composition and function of the gut microbiota via the microbiota-gut-brain axis. Methods A mouse model of depression was established using Chronic Unpredictable Mild Stress （CUMS）. The mice were divided into the control group， depression group and ECT group （n = 6 in each group）， and the depressive symptoms were assessed by behavioral experiments such as body weight change， open field test （OFT）， sucrose preference test， and forced swimming test （FST）. Meanwhile， histological and microcirculatory blood flow changes in the brain and intestines were assessed by HE staining， immunofluorescence （IF） and laser speckle contrast imaging （LSCI）. The levels of inflammatory factors such as TNF-α and IL-6 in intestinal tissues were detected by enzyme-linked immunosorbent assay （ELISA）， and changes in the diversity and abundance of gut microbiota in mice were analyzed by metagenomic sequencing. Results ECT significantly improved the behavioral performance of depressed mice， as reflected by weight gain， reduced immobility time in the FST and tail suspension test （TST） （all P < 0.05）. HE staining showed a significant reduction in intestinal inflammatory infiltration after ECT （P < 0.05）， and IF analysis demonstrated an increase in the expression of c-Fos in the hippocampal region （P < 0.05）. Inflammatory factor assay results showed that the TNF-α and IL-6 levels were significantly reduced in the ECT group （both P < 0.01）. In addition， the results of metagenomic sequencing showed that ECT significantly increased the diversity of gut microbiota， especially the abundance of Bacteroidota and Verrucomicrobiota was restored （both P < 0.05）. Conclusion ECT exerts antidepressant effects and improves sleep by regulating intestinal flora and improving gut-brain axis function.
Objective To explore the influence factors of visual impairment and recovery in patients with central retinal vein occlusion （CRVO） complicated with macular edema （ME）. Methods One hundred patients who were initially diagnosed with CRVO-ME and phlegm and blood stasis syndrome based on traditional Chinese medicine in Eye Hospital， China Academy of Chinese Medical Sciences were involved. They were treated with Quji Tongluo Decoction combinied with intravitreal ranibizumab injections. At baseline and 90 days after treatment， optical coherence tomography angiography （OCTA） was used to measure the vascular density （VD） of optic disc （VD in the whole optic disc scanning area， VD inside disc and peripapillary VD optic disc）， the thickness of the retinal nerve fiber layer （RNFL）， the vertical cup / disc ratio （C/D）， the area of the optic disc， the volume of the optic cup， VD of the superficial capillary plexus （SCP） and the deep capillary plexus in the macula， and central macular thickness （CMT）. Results After treatment， best corrected visual acuity（BCVA （LogMAR））， RNFL thickness， VD in the whole optic disc scanning area， VD inside disc， peripapillary VD， DCP-VD and CMT had significant differences before and after treatment （all P < 0.05）. At baseline， BCVA （LogMAR） was significantly correlated with VD in the whole optic disc scanning area （rs = -0.294， P =0.003）， VD inside disc， optic disc （rs = -0.401， P < 0.001）， peripapillary VD （rs = -0.315， P = 0.001）， SCP-VD （rs = -0.291， P = 0.003）， DCP-VD （rs = -0.258， P = 0.009）， and CMT （rs = 0.334， P = 0.001）. Multivariate linear regression analysis showed that VD within the optic disc （B = -0.045， P < 0.001） and CMT （B = 0.001， P = 0.018） had a significant impact on visual acuity. After treatment， the changes of BCVA （LogMAR） were correlated with the changes of VD in the whole optic disc scanning area （rs =-0.226， P = 0.024）， VD within the optic disc （rs = -0.284， P = 0.004） and CMT （rs = 0.241， P = 0.016）. Multivariate linear regression analysis showed that the changes of VD within the optic disc （B = -0.028， P = 0.006） and CMT （B = 0.001， P = 0.023） had a significant impact on the improvement of visual acuity. Conclusion The blood flow perfusion of the main vessels in the optic disc is of significance for the occurrence and recovery of CRVO. VD within the optic disc could be used as a new biomarker evaluating visual impairment and prognosis.
Objective To compare the efficacy and safety of multifocal rigid gas permeable （MFRGP） lenses versus single-vision rigid gas permeable （SVRGP） lenses in controlling myopia progression in adolescents aged 8 to 14 with high myopia. Methods A total of 120 adolescent patients with high myopia， who visited the Guangdong Provincial People’s Hospital between 2021 and 2023， were enrolled. Based on their myopia correction method， the patients were divided into the MFRGP group （58 cases） and the SVRGP group （62 cases）. Follow-up was conducted for 1 year， during which we assessed their spherical equivalent （SE）， annual increase of axial length （AL）， visual acuity with lenses， residual SE， and the incidence of corneal adverse reactions. Results Both groups showed an increasing trend in SE and AL. In the MFRGP group， the SE change was （-0.40±0.31） D and and the AL growth was （0.25±0.13） mm， while in the SVRGP group， the SE change was （-0.62±0.37） D and the AL growth was （0.38±0.27） mm. The differences in the SE and AL increment changes between and within the two groups were statistically significant （all P < 0.05）. At 12 months， the MFRGP group had better corrected visual acuity than the SVRGP group [LogMAR： +0.02±0.06 vs. +0.10±0.09， P < 0.001]， and the residual SE was significantly lower than that in the SVRGP group [（-0.29±0.31）D vs.（-0.78±0.71）D，P = 0.002]. No severe complications occurred in either group， and although the MFRGP group had a slightly higher probability of adverse reactions compared with the SVRGP group， the difference was not statistically significant and could be alleviated with intervention. Conclusions MFRGP is superior to SVRGP in controlling the progression of high myopia in adolescents， and its safety is controllable. MFRGP shows better clinical efficacy in myopia prevention and control.
Objective To investigate the risk factors for the mortality of Intensive Care Unit （ICU） patients with Pseudomonas aeruginosa bloodstream infections， and to construct a predictive nomogram model to assist clinical decision-making. Methods Clinical data from 74 patients with Pseudomonas aeruginosa bloodstream infections in ICU of the First Affiliated Hospital of Sun Yat-sen University were gathered from January 2014 to December 2023. The patients were classified into the survival group（n = 52） and mortality group （n = 22） based on the prognosis. Univariate and multivariate Cox regression analyses were used to screen for independent prognostic factors， and a predictive nomogram model was constructed. The predictive performance and accuracy of the model were verified. Results Acute physiology and chronic health status scoreⅡ （APACHEⅡ） >20 and multiple organ dysfunction syndrome （MODS） were the independent risk factors for the mortality of ICU patients with Pseudomonas aeruginosa bloodstream infections （both P < 0.05）. The nomogram model was constructed based on these two independent risk factors， with a concordance index （C-index） of 0.759. The predictive efficiencies for survival probabilities at 7 days and 14 days were 0.776 and 0.844. Calibration curve and clinical decision curve showed that the model had good predictive efficiency. Conclusions A time-dynamic predictive nomogram model is constructed for the risk factors of the mortality of ICU patients with Pseudomonas aeruginosa bloodstream infections， which could effectively predict the risk of mortality of such patients. This model can assist clinicians to rapidly identify high-risk patients and optimize antibiotic use strategies.
Objective To evaluate the impact of contrast-enhanced ultrasound （CEUS） on the diagnostic performance of ovarian-adnexal reporting and data system （O-RADS） 4-5 adnexal lesions. Methods A total of 224 patients with ovarian-adnexal lesions admitted to 10 hospitals between April 2021 and August 2023 were retrospectively enrolled. Sonographic characteristics and contrast-enhanced features were analyzed. The diagnostic performance of O-RADS， CEUS， and CEUS combined with O-RADS for O-RADS 4-5 lesions was evaluated using histopathology as the gold standard. Results A total of 232 lesions from 224 patients were included in this study， comprising 132 benign and 100 malignant lesions. O-RADS feature analysis revealed that lesion type， blood flow score， and presence of ascites were all significantly associated with malignancy in univariate analysis （all P < 0.001）. The CEUS manifestations of benign and malignant masses were distinct. The contrast-enhanced ultrasound features （enhancement morphology， time to initial enhancement， enhancement level， and washout pattern） and relative contrast parameters （arrival time，time to peak， peak intensity and area under the curve） showed statistically significant differences between the benign and malignant mass groups （all P < 0.001）. The AUC （95%CI） for differentiating benign from malignant adnexal masses in O-RADS categories 4-5 using O-RADS， CEUS， and the combination of CEUS and O-RADS was 0.716 （0.654， 0.773）， 0.793 （0.735， 0.843）， and 0.858 （0.806， 0.900）， respectively. The diagnostic accuracy of CEUS combined with O-RADS for O-RADS 4-5 lesions was significantly higher compared to either method alone （both P < 0.001）. Conclusion The combination of CEUS and O-RADS can improve diagnostic accuracy for O-RADS 4-5 lesions， providing additional valuable information to guide clinical management strategies in patients with such lesions.
Objective To investigate the relationship between sleep quality and nighttime sleep duration and sarcopenia in middle-aged and elderly men （≥ 45 years old）. Methods A cross-sectional study was conducted on 345 hospitalized patients inUrumqi. The Pittsburgh Sleep Quality Index was used to assess sleep quality， and L3 skeletal muscle index was used to diagnose sarcopenia. Univariate Logistic regression was used to analyze the relationship between sleep factors and sarcopenia， and multivariate Logistic regression models were used to explore the relationship between sleep quality and nighttime sleep duration and sarcopenia in middle-aged and elderly men. Results The prevalence of sarcopenia in the included patients was 35.1%. The prevalence of sarcopenia was different among those with different sleep quality and nighttime sleep duration （P < 0.05）. The prevalence of sarcopenia in patients with poor sleep quality and nighttime sleep duration ≤ 6 h was higher than that in the non-sarcopenia group （P < 0.05）. MultivariateLogistic regression analysis showed that， without adjusting for arguments， the prevalence of sarcopenia in men aged 45~<74 years with poor sleep quality was 1.992 times that of those with good sleep quality， and the prevalence of sarcopenia in men aged 45~<74 years with nighttime sleep duration ≤ 6 h was 2.770 times that of those with nighttime sleep duration > 6 h. After adjusting for body mass index， nutrition risk screening 2002， alcohol consumption， smoking， Generalized Anxiety Disorder-7， Patient Health Questionnaire-9， and C-reactive protein levels， the prevalence of sarcopenia in men aged 45~<74 years with poor sleep quality was 4.152 times that of those with good sleep quality， and the prevalence of sarcopenia in men aged 45~<74 years with nighttime sleep duration ≤ 6 h was 3.703times that of those with nighttime sleep duration > 6 h. However， in men aged ≥74 years， there was no statistically significant relationship between sleep quality and nighttime sleep duration and sarcopenia （P > 0.05）. Conclusion In men aged 45~<74 years， poor sleep quality and nighttime sleep duration ≤ 6 h increase the risk of sarcopenia.
Objective To investigate the clinical characteristics and peritoneal function changes in chronic kidney disease （CKD） patients undergoing long-term peritoneal dialysis （PD）， and to evaluate the diagnostic utility of normalized protein catabolic rate （nPCR） in assessing dialysis adequacy in this population. Methods CKD patients receiving continuous ambulatory peritoneal dialysis （CAPD） at Dongguan Tungwah Hospital from 2009 to 2022 were selected， and divided into long-term and short-term dialysis groups. The long-term dialysis group was further categorized into high and low peritoneal equilibration test （PET） subgroups according to the average D/Pcr from PET. Intergroup differences were compared. The trend of solute transport was analyzed using the Friedman’s test， while Spearman’s correlation and receiver operating characteristic （ROC） curve analysis were employed to assess the correlation between nPCR and dialysis adequacy， and the diagnostic performance of nPCR， respectively. Results Among long-term dialysis patients， those in the high PET subgroup exhibited lower levels of serum albumin and nPCR， but higher creatinine clearance index （Ccr） （all P < 0.05）. The D/Pcr showed a downward trend followed by an upward trend over the first five years of dialysis （all P < 0.05）. nPCR was positively correlated with Ccr （rs=0.305， P < 0.05） and urea clearance index （Kt/V， rs=0.288，P < 0.05）， and negatively correlated with D/Pcr （rs=-0.417， P < 0.001）. The area under the ROC curve for nPCR in diagnosing dialysis adequacy was 0.68 （P < 0.05）. Conclusion In CKD patients with long-term peritoneal dialysis， peritoneal function tends to decline initially and then improve. nPCR can serve as a nutritional indicator for evaluating dialysis adequacy.
Diabetes mellitus has become a chronic metabolic disease that seriously threatens global public health. Its severe complications markedly increase mortality and disability， and insulin resistance is the core pathological mechanism. Thus， new therapeutic targets are needed. In recent years， activation of brown adipose tissue （BAT） and browning of white adipose tissue （WAT）， owing to their distinct thermogenic function and metabolic regulatory roles， have become focal areas in the research of diabetes treatment. Accordingly， this review systematically summarizes research advances concerning BAT activation and WAT browning in diabetes mellitus and the regulation of glucose metabolism， with emphasis on the mechanisms by which BAT activation and WAT browning improve insulin sensitivity， maintain glucose homeostasis， and enhance energy metabolism， aiming to provide more precise and effective clinical interventions for patients with diabetes mellitus.
Fat mass and obesity-associated protein （FTO）， the first identified obesity-susceptibility gene， exerts complex roles in tumors via its RNA demethylase function. Through modulation of N6-methyladenosine （m6A） modification levels on mRNA， FTO influences the stability of oncogenes and related signaling pathways， thereby promoting metabolic reprogramming， proliferation， invasion， and chemoresistance in tumor cells. In obesity-related tumors， FTO expression exhibits tissue-specific patterns： it is highly expressed in endometrial， colorectal， pancreatic and breast cancers， where it facilitates tumor progression by activating an immunosuppressive microenvironment and glycolysis. Conversely， FTO expression is downregulated in thyroid cancer， inhibiting malignancy through the regulation of ferroptosis. Additionally， FTO exerts dual oncogenic or tumor-suppressive roles in ovarian and liver cancers， depending on molecular contexts and subtypes. FTO expression correlates closely with tumor staging， metastasis， and prognosis， underscoring its potential as a novel prognostic biomarker. Small-molecule inhibitors targeting FTO have demonstrated promising antitumor effects in preclinical models， presenting a new therapeutic strategy for precision intervention in obesity-associated cancers. This review summarizes the molecular mechanisms and translational prospects of FTO in obesity-related tumors， providing theoretical support for precision medical strategies.
Inflammatory bowel disease （IBD） including Crohn’s disease and ulcerative colitiscan. It affects the perianal region and the rectum， often presenting as anal fistulas， perianal abscesses， and fecal incontinence， etc. Among these manifestations， fecal incontinence is frequently neglected in clinical practice， whereas it will cause significant impact on the quality of life and mental health of IBD patients. In this article， research progress in the current status of fecal incontinence in IBD， adverse effects， associated risk factors， assessment and management of anal function was reviewed， aiming to enhance awareness among healthcare professionals regarding the importance of fecal incontinence in the IBD population and to provide valuable insights for effective management of this condition in affected patients.
