Objective  To analyze the clinicopathological features and surgical strategy of papillary thyroid carcinoma(PTC) with coexistent Hashimoto’s thyroiditis(HT).
Methods  The clinical data of 884 patients with papillary thyroid cancer who underwent the first thyroid surgery in the same diagnosis and treatment group of General Surgery Department of Jiangsu Province Hospital of Chinese Medicine from July 2016 to December 2020 were analyzed retrospectively.The clinicopathological features of PTC patients with coexistent HT and PTC patients without HT were compared,and the risk fastors of central lymph node metastasis in PTC patients coexistent HT were analyzed.
Results  PTC patients with coexistent HT accounted for 30.8% of the total PTC patients.Compared with the PTC patients without HT,PTC patients with coexistent HT had higher proportion of females,younger age,higher proportion of unclear lesion boundary,lower proportion of thyroid capsule invasion and central lymph node metastasis(P<0.05).Multivariate logistic regression analysis showed that younger age,larger tumor diameter and thyroid capsule invasion were associated with higher risk of central lymph node metastasis(OR:0.940,1.644,0.434,P:<0.001,0.027,0.012,respectively).Receiver operating characteristic(ROC) curve analysis showed that age of 39.5 years and maximum tumor diameter of 0.525 cm were cut-off points for central lymph node metastasis in PTC patients with coexistent HT.
Conclusion  PTC with coexistent HT is more common in young women,with unclear boundary,less invasion of thyroid capsule and lower incidence of central lymph node metastasis.Unilateral thyroidectomy and isthmus resection or total thyroidectomy are feasible.Central lymph node dissection can be individualized.For patients younger than 39.5 years old,the maximum diameter of tumor greater than 0.525 cm and thyroid capsule invasion,central lymph node dissection should be routinely performed.

Objective  To analysize pathological character and prognosis factors of Chinese and American MBC patients,and constructing a nomogram for forecasting 3-year,5-year and 8-year overall survival(OS).
Methods  The clinical data of 5 671 MBC patients diagnosed from 2007 to 2012 were extracted from SEER database,which was assigned to modeling set.A retrospective analysis was performed on 101 MBC cases from Xijing hospital in China from 2004 to 2012,which was assigned to validation set.The clinical baseline characteristics of patients in modeling set and validation set were compared,and the independent risk factors for the overall survival(OS) were screened by Cox equal proportional regression model.Based on the results of multiple regression analysis of the modeling set Cox model,the nomogram models for predicting the OS were constructed.the reliability of the predictions obtained from the models were evaluated by C-index,ROC curve and calibration curve.Finally,the clinical benefit and application value of the model were evaluated by clinical decision curve analysis(DCA).
Results  There were no significant difference in the baseline characteristic between the patients in modeling set and validation set except age,surgery,whether first primary tumor，T stage,chemotherapy and radiotherapy.The results of analysis showed that age,surgery,radiation,T stage and M stage were independent risk factors for OS in MBC patients.Based on the above variables,the nomogram models were constructed and evaluated.The C-index of model in modeling set was 0.87,The C-index of model in validation set was 0.71,and the C-index of model for internal validation was 0.81.Moreover,the ROC curve analysis showed that prediction model had a relatively high accuracy and the calibration curve analysis showed that model predicted OS had a good consistency with the actual observed values.Finally,the clinical decision curve analysis showed that model can bring clinical benefit.
Conclusion  A nomogram can accurately predict the prognosis of MBC patients in China and provide scientific basis for clinical diagnosis and treatment.

Objective  Compare the differences between perioperative related indicators of thoracoscopic segmentectomy and wedge resection in the treatment of early stage lung cancer.
Methods  From 2019 to 2020, 65 patients were diagnosed with early stage lung cancer,divided them into two groups,32 cases of thoracoscopic segmentectomy group and  33 cases of thoracoscopic wedge resection group,compare the difference in operation time,blood loss,postoperative drainage volume,postoperative chest tube drainage duration，postoperative hospital stay，pain degree in the 24th and 48th hour after surgery and early postoperative complication rate.
Results  The value of the segmentectomy group  is larger than the wedge resection group in terms of operation time,blood loss,postoperative  drainage volume,postoperative chest tube drainage duration,postoperative hospital stay,and the difference is statistically significant (P<0.05);there was no significant difference between the two groups of patients in the comparison of pain degree at 24 hours and 48 hours after operation and the comparison of the incidence of early postoperative complications(P>0.05).
Conclusion  Both thoracoscopic segmentectomy and thoracoscopic wedge resection are effective and safe in the treatment of early stage lung cancer,and the corresponding surgical method should be selected according to the actual situation.

Objective  To discuss the expression level of Transcobalamin I(TCN1) in colorectal cancer(CRC) and lung metastasis tumors and its clinical significance.
Methods  A total of 42 cases of CRC patients with lung metastasis were collected in the Fourth Hospital of Hebei Medical University form May,2009 to January,2019.The expression level of TCN1 in the tissues,including CRC tissues,adjacent normal colonrectal mucosa tissues,lung metastastatic tissues and normal lung tissues,was detected by immunohistochemistry(IHC),and the relationships between expression level of TCN1 and the clinical characteristics of CRC were analyzed.
Results  TCN1 was highly expressed in CRC and its lung metastasis tissues than in the adjacent colorectal mucosa and normal lung tissues(P<0.01).There was a similar expression levels between the expression level of TCN1  in CRC and its lung metastasis tissues and CRC and normal lung tissues(P=0.588).The expression level of TCN1 in CRC tissues by colonoscopy was consistent with that in surgically resected CRC tissues(P<0.01).TCN1 expression level in CRC tissue decreased after neoadjuvant chemotherapy.
Conclusion  TCN1 is highly expressed in CRC and CRC lung metastasis tissues,neoadjuvant chemotherapy can reduce the expression level of TCN1 in CRC tissues.TCN1 is expected to be a biomarker for predicting lung metastasis and chemosensitivity of CRC.

Objective  Malnutrition is a poor prognostic factor for many tumors.The current research mainly focuses on locally resectable or radical resectable gastric cancer.The purpose of this study was to investigate the effect of the nutritional risk index(NRI) on the prognosis of stage IV gastric cancer.
Methods  107 patients with civ gastric cancer diagnosed in Lishui Central Hospital from October 2011 to October 2015 were selected.By calculating the NRI,NRI < 97.5 was defined as malnutrition,and the correlation between age,gender,tumor location,metastasis location,body weight,body height index(BMI) and NRI,and the overall survival time of patients was analyzed.The NRI of patients after chemotherapy was reevaluated,and the relationship between the change of NRI and the overall survival time has been analyzed The correlation of survival time.
Result  Kaplan- Meier analysis showed that there was no significant correlation between age,gender,tumor location and treatment regimen and overall survival time(P>0.05).There was a significant correlation between tumor metastasis site and overall survival time(P<0.05).Cox regression analysis showed that BMI(P=0.017) and NRI(P=0.025) were independent factors of poor prognosis.In the chemotherapy subgroup analysis,the overall survival time of patients without malnutrition at the initial evaluation but with malnutrition during chemotherapy was significantly worse(17 months vs 13 months,χ2=4.366,P=0.037).However,there was no significant difference in the survival time of patients with malnutrition and still malnutrition at the initial assessment(9 months vs 10 months,χ2= 0.269,P=0.604).
Conclusion  NRI is an independent prognostic factor for patients with newly diagnosed stage IV gastric cancer,and in the chemotherapy subgroup,the overall survival of patients with malnutrition is significantly shorter than that of patients with good nutrition.NRI can be used as a nutritional assessment tool to help doctors to develop better treatment strategies.

Objective  To explore the feasibility,safety and efficacy of laparoscopy combined with medial umbilical fold repair for the treatment of giant inguinal hernia in children.
Methods  We retrospectively analyzed the clinical data from 97 cases of high ligation of simple hernia sac under laparoscopy and 79 cases laparoscopy combined with medial umbilical fold repair.Clinical data were compared between the two groups.
Results  The operation time of the combined group was(26.14±2.84),and the operation time of the simple group was(22.21±3.00) min.There was a statistical difference between the two groups(P<0.05).There was no significant difference in perioperative inflammatory indexes between the two groups.after early complications including wound infection,knot reaction,scrotal edema,effusions scrotal no significant difference(P>0.05),6 cases of recurrence in the simple group and no recurrence in the combined group.The recurrence rate of the two groups was There was a statistical difference(P<0.05).There was no significant difference in blood flow of spermatic cord(P<0.05) no significant difference in blood flow of spermatic cord(P>0.05),and no testicular atrophy occurred.
Conclusion  Inguinal hernia in children with laparoscopy combined with medial umbilical fold repair can reduce recurrence,without additional inflammatory reaction and other surgical stress incidence of postoperative complications.

Objective  To investigate the clinical efficacy of anterior cervical fusion and non-fusion surgery(Hybrid surgery，HS) in the treatment of cervical spondylosis with jumping responsibility segment.
Methods  From January 2015 to December 2018,6 cases with cervical spondylosis in jumping responsibility segment were treated with HS.Neck Disability Index(NDI) was used to evaluate daily activities of the patients and Neurological status was evaluated according to Japanese Orthopedic Association(JOA).The visual analog scale(VAS)was used to assess the neck pain intensity.All the changes of NDI,JOA and VAS scores of cervical spine before and during the last follow-up were evaluated,and the clinical effect was also evaluated according to Odom criteria.Finally,radiological analysis was conducted via lateral radiographs in flexion,extension and neutral position.The angular range of motion(ROM) of C2-C7,the ROM of non-fused segments,and cervical lordosis were measured by the Cobb method.
Results  No patient was performed unplanned reoperation during the following period,and the loosening of internal plant,formation of prosthetic joint and the fusion phenomenon in non-fusion segmental were not found in the last follow-up.JOA,VAS and NDI scores of cervical spine were improved compared with those before operation(P<0.05).Odom classification:excellent in 2 cases,good in 3 cases,fair in 1 case,the excellent and good rate was 83.3%.There was no difference between C2-C7 ROM and the ROM of non-fused segments before and after operation(P=0.06;P=0.07).C2-C7 cervical lordosis was detected to improve significantly as compared to the preoperative(P<0.05).
Conclusion  HS is safe and effective in the treatment of cervical spondylosis with jumping responsibility segment,and additional keepingROM of cervical spine in a certain extent.

Objective  To compare the clinical effect of superpath approach and Watson Jones approach in the treatment of traumatic femoral neck fracture.
Methods  120 cases of traumatic femoral neck fracture treated by total hip arthroplasty in our hospital were retrospectively selected.77 cases in the observation group were treated by total hip arthroplasty via superpath approach,and 43 cases in the control group were treated by total hip arthroplasty via Watson Jones approach.The curative effect,perioperative indexes,Harris score and incidence of complications of the two groups were compared.
Result  The postoperative hospitalization time of observation group was significantly lower than control group(P＜0.05).The Harris score of observation group was significantly higher than that of control group at 7 d,1 month and 12 months after operation(P＜0.05).The delayed wound healing rate in observation group was significantly lower than that in control group(P＜0.05).
Conclusion  Superpath approach in the treatment of traumatic femoral neck fracture has certain clinical advantages,such as less trauma,better postoperative hip function recovery,and low incidence of delayed healing.

Objective  To compare predictive accuracy of S.T.O.N.E.,Guy’s stone score(GSS) and CROES Nephrolithometry Nomogram(CNN) for stone free rate after Percutaneous Nephrolithotomy(PCNL). 
Methods  Our study retrospectively collected clinical data of 133 patients with nephrolithiasis who suffered PCNL,respectively analyzed and compared predictive accuracy of the S.T.O.N.E., GSS and CNN to determine which is the most predictive scoring system and the relation with clinical data ,including operating duration, postoperative length of stay,estimated blood loss,etc.
Result   There are 53 cases (39.85%) in the residual stone group of 133 patients after PCNL. With the increase scores of S.T.O.N.E.and GSS,the stone clearance rate decreased gradually,contrary to the CNN.The predictive stone free accuracy of the CNN is more precise than the S.T.O.N.E.and GSS. 
Conclusion   The predictive stone free accuracy of the CNN is more precise than the S.T.O.N.E.and GSS.

Objective  To explore the curative effect of different surgical methods and analysis of curative effect-related factors in patients with inferior calyx stones with different infundibulum angles of the renal pelvis.
Methods  A retrospective analysis of the case data of 198 patients with inferior calyx stones admitted to the Department of Urology in our hospital from June 2019 to June 2020 was divided into two groups according to the IPA angle.Group A IPA>30°,Group B IPA≤30 ° group,divided into 4 subgroups according to the operation method of each group,A1 group(70 cases) was treated with microchannel percutaneous nephrolithotomy(MPCNL),and A2 group(62 cases) was treated with ureteroscopy holmium laser Lithotripsy(FURS) was used for treatment.Group B1(23 cases) was treated with FURS,and group B2(43 cases) was treated with FURS combined with MPCNL.The curative effect and complications of each group were compared,and the factors affecting the curative effect of lower calyx stones were analyzed.
Results  There was no statistically significant difference in operation time,postoperative hospital stay,stone removal rate,and complication rate between group A1 and group A2(P>0.05);group B1 and group B2 had no significant difference in operation time,postoperative hospital stay,There was no statistically significant difference in the incidence of complications(P>0.05),but the stone clearance rate in group B2 was higher than that in group B1,and the difference was statistically significant(P<0.05).Among the 198 patients,167 had complete stone removal(the removal group),and 31 cases had incomplete stone removal(uncleared group).The body mass index(BMI) <25 kg/m2 of the cleared group was higher than that of the uncleared group,the angle of the renal pelvic funnel(IPA) was higher in the cleared group,and the length of the renal pelvic funnel(IL) and stone diameter were lower than those of the uncleared group.The differences were statistically significant(P<0.05).Multivariate logistic regression showed that high BMI,small IPA,long IL,and large calculus diameter were independent risk factors that led to poor postoperative efficacy of inferior calyx stones(P<0.05).
Conclusion  In the renal calculus with IPA>30°,MPCNL and FURS have little difference in stone removal effect,but with IPA≤30°,the FURS calculus removal effect is limited,and the combined application with MPCNL can obtain better treatment effect;Moreover,high BMI,small IPA,long IL,and large calculus diameter are independent risk factors that lead to poor postoperative efficacy of inferior calyx stones.

Objective  To investigate the clinical effect of using free ultra-thin anterolateral thigh perforator flap to repair the soft tissue defect of hand and foot.
Methods  From January 2017 to January 2019,33 cases of hand and foot soft tissue defects were repaired by free ultra-thin anterolateral femoral perforator flap.Flap perforators identified by ultrasonic doppler blood vessel,and as the center,according to the shape and size of defect in the wound,free ultrathin femoral anterolateral perforators flap design,taking the flap on the broad fascia,retain most broadly fascia,free flap to wear with vascular pedicle,keeping a small number of broad fascia 2cm×3cm.The skin flap was thinned,and the subcutaneous fat was cut off successively from the periphery to near the penetrating point of the vessel cutaneous branch.The subcutaneous fat around the skin flap could be cut off completely,and only the dermis was retained.The tissue 2-3cm around the penetrating point was not trimmed to prevent the damage of the perforator vessel.The blood supply of the flap was observed and free transplantation was performed to repair the wounds of hand and foot.
Results  None of the 33 patients had vascular crisis after surgery,and all the flaps survived.Among them,3 patients had epidermal necrosis of about 1.5cm×2.0cm at the distal flap on the 6th day after surgery,which healed after dressing change.All 33 patients were followed up for 6-24 months,with an average of 14 months.After the operation,the skin flap was soft in texture,with good elasticity and no bloatness,and the skin color was close to normal skin.The sensory function recovered well,and the two-point discrimination sensation was 4.0-6.0mm.The function and appearance of hands and feet recovered well.According to the trial standard score of upper limb partial function evaluation by Hand surgery Society of Chinese Medical Association,the average score was 91,among which 24 cases were excellent,8 cases were good,and 1 case was fair.The excellent and good rate was 96.9%(32/33).
Conclusion  The ultra-thin free anterolateral thigh perforator flap can be used to repair the defect of hand and foot soft tissue.The flap has a high survival rate,good shape and satisfactory curative effect.No need for reconstructive surgery.

Objective  To explore the clinical value of radiofrequency-induced thermotherapy(RFITT) ablation for varicose veins of the lower limbs.
Methods  78 patients(78 limbs) with primary varicose veins admitted to our department from September 2018 to August 2019 were divided into study group(43 cases) and control group(35 cases).The study group used RFITT ablation plus foam sclerosing agent injection and point ablation,and the control group used traditional high ligationplus foam sclerosing agent injection and point ablation.Operative time,bleeding volume,postoperative hospital stay,postoperative complications,varices recurrence rate,saphenous vein closure rate,venous clinical severity score(VCSS),chronic venous insufficiency questionnaire score(CIVIQ).
Results  The operation time,blood loss and length of hospital stay of the study group were(48.6±10.1)min,(20.1±3.2)ml,(1.6±1.0)d respectively，compared with the control group(63.1±17.8) min,(65.4±9.8)ml,(5.2±1.7) d,the difference was statistically significant(P<0.05).The incidence of postoperative complications in the study group was 4.7%,which was significantly higher than 22.9% in the control group(P<0.05).The VCSS score of the study group before treatment was(4.3±0.2),after treatment(1.4±0.9),compared with the control group(4.6±0.1),(1.6±0.4),There was no significant difference(P>0.05).The CIVIQ score of the study group after treatment was(91.2± 10.8) was higher than(83.5 ±10.1),the difference was statistically significant(P<0.05).Six months follow-up showed that there was no recurrence of varicose veins in both groups,and the closure rate of great saphenous vein was 100%.
Conclusion  RFITT ablation is safe and feasible for the treatment of varicose veins in the lower limbs.The operative time is short,the bleeding volume is small,the postoperative hospital stay is short,and the postoperative complications are small.The recent results are satisfactory.

Objective  To investigate the predictive value of preoperative inflammation in patients with lower extremity arteriosclerosis obliterans and restenosis after stent implantation.
Methods  A total of 86 patients who were admitted to our department from August 2018 to February 2019 who were planned to undergo stent implantation for lower extremity arteriosclerosis obliterans were selected as the research objects.Inflammatory status indicators of the patients were collected upon admission and followed up for 1 year.According to Whether stenosis occurs after stent implantation is divided into stenosis group and non-stenosis group;Logistic regression equation is used to analyze the correlation between preoperative inflammation and restenosis after stent implantation in patients with lower extremity arteriosclerosis obliterans,and draw receiver operating curve,Analyze its predictive value.
Results  A total of 6 patients were lost to follow-up after 1 year of follow-up,and 80 patients were finally included.According to whether stenosis occurred after stent implantation,they were divided into stenosis group(n=32 cases) and non-stenosis group(n=48 cases);Logistic multivariate showed that NLR(OR=18.412),PLR(OR=1.205),and low-density lipoprotein(OR=16.968) were risk factors for restenosis after stent implantation in arteriosclerosis obliteran patients;ROC curve analysis showed that NLR and PLR were The predictive AUC of restenosis after stent implantation in arteriosclerosis obliteran patients is higher than that of low-density lipoprotein.
Conclusion  NLR,PLR,and low-density lipoprotein are the risk factors for restenosis after stent implantation in arteriosclerosis obliteran patients.Monitoring the levels of NLR,PLR,and low-density lipoprotein in arteriosclerosis obliteran patients before stent implantation is important for preventing arteriosclerosis obliteran patients after stent implantation.

Objective  To explore the causes and countermeasures of chylous fistula after neck lymphatic malformation occurred in children patients.
Methods  In this case,at first we  use of local compression and continuous negative pressure drainage treatment,supplemented by fasting,parenteral nutrition and somatostatin and other symptomatic support therapy.
Results  Conservative treatment fails and then be cured by surgery.
Conclusion  Children’s neck lymphatic malformation postoperative chylous fistula and chylothorax most can be cured by conservative treatment.daily lead traffic is larger,more than 7 days after conservative treatment should be should taken operation ligation of thoracic duct treatment actively.

Circular RNAs(circRNAs) are a novel class of regulatory RNAs.They are covalently closed RNA molecules produced by precursor mRNA through back-splicing.CircRNAs are highly abundant in eukaryotes,and many of them are evolutionary conserved.Although generally expressed in low abundance when compared to their linear counterparts,they are often expressed in a tissue- and cell- specific expression patterns.Their biogenesis is regulated by specific cis-acting elements and trans-acting factors.Recent work shows that circRNAs exert important biological functions in tumorigenesis of colorectal cancer(CRC),including acting as microRNAs or protein “sponges”,and even by being translated themselves.Due to a covalent closed loop structure and resistance to RNase degradation,circRNAs are expected to become novel biomarkers for CRC.