Background:Papillary thyroid carcinoma (PTC) is the most common type of primary endocrine malignancy. The tumor immune microenvironment (TIME) and genetic alterations play crucial roles in the progression of PTC. With the advance in research, there has been a heightened focus on re-evaluating molecular targeted therapies and identifying novel targets through molecular biology-based approaches. This study aimed to identify robust prognostic biomarkers and to construct a reliable risk model for patients with PTC by integrating multiomics data. Methods:RNA-sequencing (RNA-seq) data from six Gene Expression Omnibus (GEO) datasets and genome-wide association study (GWAS) data were integrated to identify differentially expressed genes (DEGs) and facilitate Mendelian randomization (MR) analysis for causal inference. The CIBERSORT algorithm was employed to evaluate immune cell infiltration. A prognostic risk model was constructed via least absolute shrinkage and selection operator (LASSO) Cox regression and validated in The Cancer Genome Atlas (TCGA) and GEO cohorts. Functional experiments, including Cell Counting Kit-8 (CCK-8), transwell, and wound-healing assays, were conducted to investigate the role of the key gene ALOX15B in PTC cells. Results:We identified seven PTC-associated genes (ALOX15B, TIAM1, TMC6, GPX3, RAP1GAP, JUN, and PAPSS2) through expression quantitative trait loci and MR analysis. A robust three-gene risk model (ALOX15B, RAP1GAP, and JUN) was established. Patients in the high-risk group exhibited significantly poorer progression-free survival (PFS), which was confirmed to be an independent prognostic factor by multivariate analysis [hazard ratio =1.355, 95% confidence interval (CI): 1.052-1.746; P=0.02]. The high-risk group was characterized by an immunosuppressive TIME-including decreased CD8+ T-cell and increased regulatory T-cell abundance-higher tumor mutational burden, and a higher frequency of BRAF mutations. Conversely, the low-risk group showed a higher prevalence of NRAS mutations. In addition, functional assays in vitro revealed that ALOX15B markedly enhanced the proliferative, migratory, and invasive capacities of PTC cells. Conclusions:A novel three-gene signature was developed and was demonstrated to be an independent prognostic indicator for patients with PTC. This model effectively reflects the intrinsic characteristics of the TIME and genomic instability and can inform risk stratification and therapeutic targeting. Due to its oncogenic activity, ALOX15B may represent a viable therapeutic target in PTC.

NTRK2 fusions are exceptionally rare but act as potent oncogenic drivers in diverse pediatric and adult cancers. Tumors harboring these fusions respond dramatically to TRK inhibitors (e.g., larotrectinib, entrectinib, and repotrectinib), which selectively target the constitutively active fusion protein. The identification of NTRK2 fusions has facilitated precision oncology approaches, significantly improving outcomes for patients with advanced cancers. Although specific NTRK2 fusion partners have been identified in thyroid cancer, NTRK2 fusions remain exceptionally rare and incompletely characterized in medullary thyroid carcinoma (MTC). In this case, three novel NTRK2 fusion transcript variants-GTF2I-NTRK2 (G9:N13), GTF2I-NTRK2 (G9:N14), and NTRK2-GTF2I (N12:G11)-co-occur in a 33-year-old woman with MTC. To our knowledge, all three fusion transcript variants are novel and previously unreported, and their co-occurrence in a single individual is particularly unusual. Targeted RNA sequencing results revealed three novel in-frame NTRK2 fusion transcript variants; two featured the same 5' partner sequences (exons 1-9) of the GTF2I gene fused to distinct NTRK2 3' sequences: one fusion contained the NTRK2 exons 13-19 sequences; the other contained the NTRK2 exons 14-19 sequences. The third in-frame fusion contained the 5' sequences (exons 1-12) of the NTRK2 gene fused to the 3' sequences (exons 11-35) of the GTF2I gene. The supporting reads for the fusion transcripts were systematically visualized using the Integrative Genomics Viewer (IGV) and validated by Sanger sequencing. Conclusively, this first report of three novel NTRK2 fusion transcript variants co-occurrence in an MTC patient expands the known spectrum of translocation partners in NTRK2 rearrangements. Prospective validation of their impact on TRK-targeted therapy efficacy and disease prognosis requires long-term follow-up.

BackgroundPapillary thyroid carcinoma (PTC) has an excellent prognosis, and the transoral endoscopic thyroidectomy vestibular approach (TOETVA) is increasingly used in selected low-risk patients. However, creation of long working tunnels may predispose to tract-related tumor seeding, and deep tract recurrences have rarely been reported. Case presentationA 29-year-old woman underwent right hemithyroidectomy with central neck dissection via TOETVA in 2016 for a 3 cm encapsulated PTC with one metastatic central node. Serial ultrasounds over five years showed no disease before a three-year lapse in follow-up. In 2024, ultrasound detected a new 1.1 cm hypoechoic nodule anterior to the left sternohyoid; by late 2025, it had enlarged to about 2 cm and cytology confirmed PTC. Computed tomography demonstrated an enhancing mass in the deep left sternohyoid–sternocleidomastoid (SH–SCM) intermuscular compartment, noncontiguous with the thyroid bed and outside usual nodal chains. The lesion was excised en bloc via a supraclavicular approach, and histology again showed PTC without lymph node architecture. Review of the index TOETVA video revealed deviation of the vestibular tunnel into the SH–SCM space, where dissected central nodal tissue, including the metastatic node, had been temporarily placed. ConclusionsThis isolated PTC recurrence in the deep SH–SCM plane, detected about eight years after TOETVA, is highly suggestive of delayed tract-related implantation with a latency of at least five years, although causality cannot be proved. The case emphasizes strict adherence to recommended dissection planes, careful handling of lymph node specimens, and consideration of extended, access-tract-oriented ultrasound surveillance in young patients undergoing TOETVA.

Accurate preoperative diagnosis of thyroid nodules via fine-needle aspiration (FNA) biopsy remains challenging, particularly in cases with indeterminate cytology. This prospective, noninterventional, blinded, multicenter study establishes ThyroProt, a diagnostic classifier that integrates targeted mass-spectrometry-based quantification of a 3-protein signature with BRAFV600E mutation status, age, and gender. Developed and validated on 837 FNA samples, the classifier is evaluated in a prospective test set of 322 samples, achieving an area under the curve (AUC) of 0.94 with an overall accuracy of 90.7%. For the critical subgroup of Bethesda III/IV nodules, ThyroProt demonstrates an accuracy of 88.0%, with 82.4% sensitivity and 100% specificity. The classifier's robust performance is further evaluated in two independent multicenter cohorts, where it maintains an AUC of 0.87-0.91 and an accuracy of 84.3%-85.7%. This study supports the clinical utility of mass-spectrometry-based targeted proteomics for improving preoperative diagnosis of thyroid nodules, particularly those with indeterminate cytology.

OBJECTIVE:To systematically evaluate the efficacy and safety of video-assisted lateral neck dissection (VALND) in the treatment of lateral lymph node metastasis (LLNM) of papillary thyroid carcinoma (PTC). METHODS:A retrospective cohort study was performed on PTC patients with LLNM who underwent VALND in our center from June 2013 to December 2017. The safety of VALND was evaluated by the rate of postoperative complications, while its efficacy was evaluated by the number of lateral necks dissected (LND) and the rate of recurrence. RESULTS:A total of 191 patients with pathologically confirmed PTC and LLNM who underwent VALND were included in this study. The median follow-up time was 69.21 (95% CI: 65.83-72.58) months and the mean follow-up time was 64.36 months. There were 3 patients with accessory nerve injury, 1 with hypoglossal nerve injury, 1 with vagus nerve injury, 1 with phrenic nerve injury and 2 with lymphatic fistula. The number of LND during VALND in the left and right lateral neck compartment was 45.27 ± 13.92 and 43.33 ± 13.99, respectively. 2 patients developed pathologically confirmed recurrences that required reoperation, with recurrent lesions located in Level II and Level V, respectively. CONCLUSIONS:Our findings demonstrate that VALND has excellent safety and commendable efficacy in the treatment of LLNM of PTC. Compared with conventional open surgery, VALND performs better in reducing incision length and enhancing cosmetic satisfaction. VALND warrants global promotion in view of the benefits it can bring to PTC patients.

RATIONALE:Bilateral thyroid ima artery (TIA) arising from the brachiocephalic trunk is an extremely rare anatomical variation, with no prior cases reported. Recognizing such vascular anomalies is crucial for optimizing surgical outcomes in thyroid and mediastinal procedures, as failure to identify these variations can lead to severe intraoperative complications. PATIENT CONCERNS:A 28-year-old female presented for surgical management of a thyroid nodule detected during a routine physical examination. The patient reported no significant medical history or prior neck surgeries. Preoperative ultrasonography revealed a high malignancy risk and evidence of cervical and mediastinal lymph node involvement. DIAGNOSES:Intraoperative findings unexpectedly identified two small arteries originating from the brachiocephalic trunk. These were later confirmed as bilateral TIAs through postoperative imaging and 3D reconstruction. INTERVENTIONS:The patient underwent total thyroidectomy, bilateral modified radical neck dissection, and mediastinal lymph node dissection. Appropriate measures were taken to preserve these vessels during the procedures. OUTCOMES:The patient recovered uneventfully, with no complications. Postoperative imaging validated the intraoperative findings, confirming the unique vascular variation. LESSONS:This case highlights the importance of detailed intraoperative assessment and advanced imaging techniques in surgical planning. Awareness of rare vascular anomalies, such as bilateral TIA, is vital for minimizing surgical risks and improving patient outcomes. This report provides valuable insights into vascular anatomy and clinical practice.

To evaluate the technical feasibility and surgical outcomes of modified gasless endoscopic total thyroidectomy via a unilateral subclavian approach for treating papillary thyroid carcinoma. A retrospective analysis of the clinical data of 117 patients with papillary thyroid carcinoma who underwent modified gasless endoscopic total thyroidectomy via a unilateral subclavian approach at the Department of Head and Neck Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, from March 2022 to June 2024 was conducted. All surgeries were successfully completed endoscopically without conversion to open surgery. The mean tumour size was 8.4±4.7 mm, and the mean operative time was 154.2±32.4 minutes. The mean number of harvested central compartment lymph nodes was 12.4±6.6, and the mean length of postoperative hospital stay was 3.2±1.1 days. Postoperative complications included temporary hypoparathyroidism (n=6, 5.1%), temporary hoarseness (n=3, 2.6%), and postoperative haemorrhage (n=2, 1.7%). All temporary complications resolved spontaneously within three months. No permanent recurrent laryngeal nerve（RLN）palsy, permanent hypoparathyroidism, or incision infection occurred. During the follow-up period, one patient developed lateral neck lymph node recurrence at 13 months postoperatively and subsequently underwent bilateral neck dissection. Modified gasless endoscopic total thyroidectomy via a unilateral subclavian approach demonstrated feasibility in carefully selected patients. This technique enables comprehensive central compartment lymph node dissection while preserving anterior cervical function, suggesting its potential clinical applicability.

Conventional open surgery (OP) is effective and simple for treating papillary thyroid cancer (PTC), but the excessive separation of band strap muscles causes discomfort in the anterior cervical region and a long scar, which may impair the patient’s life quality and beauty. Gasless endoscopic surgery via subclavicular approach (ESSA) may provide a better alternative. The prospective data of 90 PTC patients who underwent ESSA or OP (45:45) in hemithyroidectomy and central neck dissection (CND) in our center from March 2022 to August 2023 were analyzed. Safety indicator incidence of complications, efficiency indicator No. lymph nodes (LNs) of CND, postoperative recurrence of central neck LNs indicated by Ultrasound (US) at 6 months, postoperative functions of the anterior cervical region and cosmetic satisfaction were recorded as the primary endpoints. The ESSA group had no significant differences with the OP group in baseline data, complications, No. LNs (9.04 ± 4.58 vs. 9.87 ± 4.89, p = 0.413) and metastatic LNs (1.60 ± 2.79 vs.1.69 ± 2.50, p = 0.874) of CND. The two groups had no postoperative recurrence of central neck LNs indicated by ultrasound (US) at 6 months. The ESSA group exhibited better functionally sensitive and motional outcomes in the anterior cervical region compared to the OP group (P = 0.0217 and P = 0.008), and had higher cosmetic satisfaction than the OP group (P < 0.001). Compared with OP, ESSA is equally safe and effective, but more cosmetic and conducive to preserving functions of the anterior cervical region. ESSA can be considered an alternative approach to OP in hemithyroidectomy and CND.

Background:The external branch of the superior laryngeal nerve (EBSLN) is susceptible to iatrogenic injury during thyroidectomy, which may lead to voice impairment. While intraoperative neuromonitoring (IONM) has been established for recurrent laryngeal nerve (RLN) protection, its application for identifying and preserving the EBSLN in gasless unilateral subclavian approach endoscopic thyroid surgery remains technically challenging and poorly documented. This study aims to evaluate the feasibility and safety of IONM for EBSLN exploration in this specific approach. Methods:In this retrospective cohort study, we analyzed 48 patients with papillary thyroid carcinoma who underwent modified gasless unilateral subclavian endoscopic hemithyroidectomy with central compartment dissection between October 2023 and June 2024. Feasibility was assessed by EBSLN identification rate, dissection time, and total operative time. Safety was evaluated by incidence of EBSLN-related complications, other surgical complications, and conversion rates. Results:The cohort included 39 females and 9 males, with a mean age of 35.4±10.4 years (19-59 years). The EBSLN was successfully identified in 46 cases (95.8%). Mean operative time was 115.6±25.1 minutes (60-165 minutes), with mean EBSLN dissection time of 3.4±1.0 minutes (2-6 minutes). Mean tumor size was 7.0±2.7 mm (3-16 mm). The mean number of harvested central compartment lymph nodes was 9.1±4.4 (3-21). The mean length of postoperative hospital stay was 2.9±0.7 days (2-5 days). All procedures were completed endoscopically without conversion. No EBSLN injuries, permanent RLN palsies, hemorrhages, or infections occurred. Conclusions:IONM enables high-rate identification and safe preservation of the EBSLN in gasless subclavian endoscopic thyroid surgery. These findings support the integration of this technique into clinical practice to minimize EBSLN injury and improve functional outcomes in patients undergoing endoscopic thyroidectomy.

Papillary thyroid carcinoma (PTC) is one of the most common malignancies of the head and neck, with a rising incidence worldwide. Circular RNAs (circRNAs), a type of noncoding RNAs (ncRNAs) found abundantly in cells and tissues, have been demonstrated to be crucial regulators in cancer initiation and progression. However, the molecular functions of circRNAs in PTC remain largely unexplored. In this study, we identified circPFKP as a significantly dysregulated circRNA by mining clinical databases and demonstrated its important role in PTC progression. Even with its elevated expression, we found silencing of circPFKP markedly promoted the proliferation, migration, and invasion of PTC cells in vitro. Through bioinformatics analysis and dual-luciferase reporter assays, we confirmed that circPFKP acts as a sponge for miR-4516, thereby upregulating the expression of SPRY4. Enhanced SPRY4 inhibited tumor cell proliferation and migration while simultaneously reducing tumor cell sensitivity to pro-apoptotic factors in the tumor microenvironment, primarily by suppressing the p38 MAPK signaling pathway. Collectively, our study is the first to uncover the biological function of circPFKP in PTC and highlights its potential as a novel therapeutic target for PTC patients.

The main purpose of the reported endoscopic thyroidectomy with the several incisions on the chest wall or other approaches was to meet the cosmetic demands of patients, but they had inherent technical disadvantages. To solve these problems, we developed a single-incision gasless trans-subclavian approach endoscopic thyroidectomy and evaluated its feasibility. We reviewed clinical data from 243 consecutive patients who underwent gasless trans-subclavian approach endoscopic thyroidectomy with a single incision at our centre from January 2021 to March 2022. Patients’ basic information, the extent of surgery, the duration of surgery, the number of lymph node dissection, postoperative hospital stay, complications, and follow-up outcomes were collected and analysed. No cases converted to open surgery. The mean time for lobectomy + central neck dissection was 84.9 ± 29.9 min and 95.0 ± 24.3 min for lobectomy. The mean number of lymph node dissection in the central compartment was 5.6 ± 3.9, with a mean number of metastatic lymph nodes of 0.8 ± 1.6. Temporary recurrent laryngeal nerve (RLN) injury occurred in eigth patients, and minor lymphatic fistula occurred in one patient. During at least 6 months of follow-up, one patient was found to have a recurrence of lateral neck lymph nodes by ultrasound 6 months after surgery. The single-incision gasless trans-subclavian approach endoscopic thyroidectomy is a feasible and truly minimally invasive procedure for selected patients, providing a scarless cervical appearance. Given the simplicity and ease of learning, this surgical technique is well-suited for widespread clinical application.

Papillary thyroid cancer (PTC) is an endocrine malignant tumor with a rapidly increasing incidence in recent years. Although the disease prognosis is good in general, there are still some patients with local invasion, distant metastasis and recurrence, which make treatment difficult. This study aimed to investigate the effect of a novel circRNA, circPCNXL2, on the progression of PTC and to explore its underlying mechanism in PTC. In this study, we found that the expression of circPCNXL2 was upregulated in PTC, which was positively correlated with the proliferation of PTC, and knockdown of circPCNXL2 enhanced the cell cycle arrest of PTC and promoted cell apoptosis. Further research revealed that circPCNXL2 can interact with ACC1, a key enzyme of cellular lipid metabolism, and then promote cell growth by affecting the de novo synthesis of fatty acids. Mechanistically, circPCNXL2 enhances the protein activity of ACC1 by reducing ACC1 phosphorylation of ser 79, thereby promoting the formation of fatty acids such as free fatty acids and triglycerides in cells to meet the energy metabolism needs of cells and promote cell growth. In a nude mouse subcutaneous tumorigenesis model, knockdown of circPCNXL2 inhibited the growth of PTC tumors while high levels of circPCNXL2 expression promoted tumor proliferation. This study revealed that circPCNXL2 regulates PTC lipid metabolism by enhancing the protein activity of ACC1 and identified a novel signaling pathway, the circPCNXL2-ACC1 axis, that can be targeted for the treatment of PTC.

Parathyroid gland transplantation into the sternocleidomastoid muscle is effective, but it is not possible to confirm transplant survival with this method. In this study, we evaluated parathyroid autotransplantation into the brachioradialis muscle and its survival rate.OBJECTIVES:To evaluate autologous parathyroid gland left forearm brachioradial muscle transplantation and its survival rate.SUMMARY BACKGROUND DATA:The most commonly used transplantation site is the sternocleidomastoid muscle, but transplant survival cannot be confirmed using this method. Autologous parathyroid gland left forearm brachioradial muscle transplantation solves this problem, and we evaluate the transplant survival using this method.METHODS:We followed-up patients who underwent thyroidectomy and autologous parathyroid left forearm brachioradial muscle transplantation in our center from September 2013 to January 2018. The last follow-up date was January 2021; all enrolled patients underwent at least 3 years of follow-up. We calculated the transplant survival rate at several time points.RESULTS:We evaluated 238 transplanted cases, for which the long-term survival rate was 85.7% (204/238), and the short-term survival rate was 86.1% (205/238). Sixty-five cases had two parathyroid glands transplanted into the left forearm brachioradialis muscle. The long-term survival rate was 92.3% (60/65), and the short-term survival rate was 95.4% (62/65).CONCLUSIONS:Autologous parathyroid gland left brachioradialis transplantation is a reliable, measurable method with good survival rate, and we recommend this method for consideration for transplanting parathyroid glands in thyroidectomy.

Abstract Background Osteosarcoma is a malignant tumor that tends to occur in adolescents. In recent years, surgical treatment has reduced mortality rates in patients with osteosarcoma. However, many patients still die of osteosarcoma, and further studies are needed to elucidate the complicated pathogenesis of this disease. Methods The function of circCHD7 was detected by transwell, clone formation, Cell Counting Kit 8, and apoptosis assays after knockdown of circCHD7 in 143B and HOS cells. Bioinformatics analysis was used to identify binding between miR-608 and circCHD7, and the results were further validated using luciferase, pull-down, and RNA immunoprecipitation assays. Bioinformatics and quantitative real-time polymerase chain reaction were used to identify downstream target genes of miR-608. The expression and effects of circCHD7 inhibitor were evaluated in stable sh-circCHD7 143B cell lines and a subcutaneous tumor model. Results CircCHD7, regulated by eIF4A3, was found to promote tumor proliferation and migration. Knockdown of circCHD7 and overexpression of miR-608 enhanced apoptosis and inhibited migration ability in osteosarcoma cells. The inhibitory effects of circCDH7 knockdown in 143B and HOS cells could be rescued by miR-608 inhibitor. Bioinformatics and western blotting results showed that miR-608 could regulate the expression of downstream matrix metalloproteinase 2 (MMP2) and Frizzled-4 (FZD4) and further modulate the Wnt/β-catenin pathway, thereby exerting inhibitory effects on osteosarcoma. Conclusion In this study, we discovered a new circRNA, circCHD7, that was regulated by eIF4A3 and modulated tumor growth through the miR-608/FZD4/MMP2 pathway. These findings provide insights into the potential application of circRNAs in the treatment of osteosarcoma.

Objective:To explore the threshold and efficacy of thyroglobulin assessment in the needle washout after fine needle aspiration (FNA-Tg) in the preoperative diagnosis of cervical lymph metastasis of thyroid papillary carcinoma (PTC).Methods:A retrospective analysis was performed on the FNA-Tg results of a total of 541 lymph nodes in 410 patients who underwent thyroid node surgery at the Department of Head Neck Surgery, Sir Run Run Shaw Hospital of Zhejiang University College of Medicine from July 2016 to January 2018. Taking the postoperative lymph node pathological results as the "gold standard", the ROC curve was plotted to obtain the optimal diagnostic threshold of FNA-Tg for cervical lymph node metastasis and evaluate its diagnostic efficacy. According to the level of serum thyroglobulin (sTg), the lymph nodes were divided into either a low sTg group (sTg ≤10 ng/ml) or a high sTg group (sTg >10 ng/ml), the ROC curve was plotted to analyze the diagnostic threshold of FNA-Tg in the two groups. The diagnostic threshold and efficacy of FNA-Tg/sTg ratio and FNA-Tg-sTg difference were then analyzed.Results:The ROC curve of FNA-Tg for diagnosis of lymph node metastasis was plotted, and the optimal diagnostic threshold of FNA-Tg was determined to be 0.835 ng/ml. Using this threshold as the cut-off point, the sensitivity and specificity were 88.5% and 97.5%, respectively, and the area under the ROC curve (AUC) was 0.944 (95%CI: 0.914~0.974). The level of FNA-Tg was correlated with the level of sTg (r=0.350, P＜0.001). Then, the lymph nodes were divided into either a low sTg group (n = 296) or a high sTg group (n = 245) according to the level of sTg, and the optimal diagnostic threshold for the two groups was determined to be 0.825 ng/ml (AUC = 0.909, 95%CI: 0.838~0.981) and 0.875 ng/ml (AUC = 0.951, 95%CI: 0.918~0.984), respectively. The optimal diagnostic cut-off of FNA-Tg/sTg ratio was determined to be 0.145; using this cut-off, the AUC of FNA-Tg/sTg ratio was 0.922 (95%CI: 0.889~0.955), and the sensitivity, specificity, positive predictive value, and negative predictive value were 82.7%, 95.5%, 85.3%, and 94.3%, respectively. The optimal diagnostic cut-off of FNA-Tg-sTg difference was determined to be >0; using this cut-off, the AUC of FNA-Tg-sTg difference was 0.841 (95%CI: 0.802~0.879), and the sensitivity, specificity, positive predictive value, and negative predictive value were 74.8%, 93.3%, 79.4%, and 91.5%, respectively.Conclusion:FNA-Tg can be used for the preoperative diagnosis of cervical lymph node metastasis in patients with papillary thyroid carcinoma. When 0.835 ng/ml is used as the cut-off value of FNA-Tg, the diagnostic performance is better. To avoid the possible impact of sTg level, FNA-Tg/sTg ratio and FNA-Tg-sTg difference could be used in combination.

Objective:To study the safety and feasibility of gasless transoral endoscopic thyroidectomy though vestibular approach using self-retaining retractor for papillary thyroid carcinoma.Methods:The clinical data of 39 papillary thyroid carcinoma patients undergoing gasless transoral endoscopic thyroidectomy were collected at Department of Head and Neck Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from Nov 2020 to Jun 2021.Results:All cases successfully underwent laparoscopic surgery without conversion to open surgery. The mean duration of operation was (142±35) min, and the postoperative mean hospital stay was (4.1±0.8) days. The mean maximum diameter of the tumor was (8.5±4.5) mm, and the mean number of lymph node harvest of by central compartment dissection was 7.7±5.9. Postoperative complications were transient hypoparathyroidism in 2 cases but recovered in 1 month. Scalp hydrop in 1 patient,fading subsequently. Transient sensory change around the lower lip in 3 cases, which recovered in 6 months. No patient suffered from recurrent laryngeal nerve palsy or hematoma, no permanent hypoparathyroidism occurred, nor of the postoperative bleeding .Conclusion:The gasless transoral endoscopic thyroidectomy viaoral vestibular approach is a feasible approach in selected papillary thyroid carcinoma patients.

Background:The development of transoral endoscopic vestibular approach thyroidectomy (TOETVA) has been limited by inherent defects, such as mental nerve injury and carbon dioxide (CO2)-related complications. Herein, we proposed a new technique without CO2 called gasless submental-transoral combined approach endoscopic thyroidectomy (STET) to solve the problems in TOETVA.Methods:We reviewed 75 patients who successfully underwent gasless STET using novel instruments at our institution from November 2020 to November 2021. A main incision of approximately 2 cm was made in the natural submental crease line and then combined with two vestibule incisions to complete the procedure. Demographic data, surgical technique and perioperative outcomes were retrospectively recorded.Results:Thirteen male and sixty-two female patients with a mean age of 34.0 ± 8.1 years were enrolled in this study. Sixty-eight patients had papillary thyroid carcinomas and seven had benign nodules. We successfully performed all gasless STET without conversion to open surgery. The average postoperative hospital stay was 4.2 ± 1.8 days. One transient recurrent laryngeal nerve injury and two transient hypoparathyroidisms were observed. Three patients complained of slight lower lip numbness on the first postoperative day. One case of lymphatic fistula, subcutaneous effusion, and incision swelling occurred each, all of which were conservatively cured. One patient developed a recurrence six months after surgery.Conclusions:Gasless STET using our own designed suspension system is technically safe and feasible with reasonable operative and oncologic results.

The transoral endoscopic thyroidectomy vestibular approach (TOETVA) is receiving increased attention, frequently due to growing requirements for cosmetic incisions. Here, we report our initial experience and discuss the safety and efficacy of the innovative surgical working space suspension system for gasless TOETVA. We retrospectively analyzed 75 consecutive patients for whom gasless TOETVA with our novel working space suspension system was used. This suspension system included self-developed retractors, a sterile bandage, and an anesthesia stand. We also improved some main surgical instruments in gasless TOETVA. The study included 75 patients who successfully underwent thyroidectomy and central neck dissection via gasless TOETVA. The mean operating time was 143.27 ± 34.60 min. The mean number of retrieved lymph nodes was 8.00 ± 5.39. Conversion to open surgery did not occur, nor did patients exhibit serious postoperative complications. Postoperative complications included 4 cases of transient recurrent laryngeal nerve (RLN) palsy, 9 of transient hypoparathyroidism, and 3 of transient mental nerve injury. One patient with subcutaneous fluid after surgery recovered after aspiration. Another patient with submental minor perforation recovered well after suturing. There was no evidence of specific complications related to self-designed retractors. The innovative working space suspension system for gasless TOETVA provided enough and stable working space and optimized the clarity of the surgical field without CO2-related complications.

Papillary thyroid cancer (PTC) is a common endocrine tumor with a rapidly increasing incidence in recent years. Although the majority of PTCs are relatively indolent and have a good prognosis, a certain proportion is highly aggressive with lymphatic metastasis, iodine resistance, and easy recurrence. Circular RNAs (circRNAs) are a class of noncoding RNAs that are linked to a variety of tumor processes in several cancers, including PTC. In the current study, circRNA high-throughput sequencing was performed to identify alterations in circRNA expression levels in PTC tissues. circTIAM1 was then selected because of its increased expression in PTC and association with apoptosis, proliferation, and migration of PTC cells in vitro and in vivo. Mechanistically, circTIAM1 acted as a sponge of microRNA-646 and functioned in PTC by targeting miR-646 and heterogeneous ribonucleoprotein A1. Fluorescence in situ hybridization and dual-luciferase reporter assays further confirmed these connections. Overall, our results reveal an important oncogenic role of circTIAM1 in PTC and may represent a potentially therapeutic target against PTC progression.

目的 探讨改良无充气经锁骨下入路腔镜甲状腺手术治疗甲状腺乳头状癌的可行性和安全性.方法 回顾性分析2021年1～7月在浙江大学医学院附属邵逸夫医院头颈外科接受改良无充气经锁骨下入路腔镜甲状腺手术的70例甲状腺乳头状癌病人的临床资料.记录手术时间、中央区完全显露率、住院时间、清扫淋巴结数目及术后并发症.采用门诊随访方式,随访截止时间为2022年1月.结果 所有病例均顺利在腔镜下完成手术,无中转开放手术.甲状腺乳头状癌最大直径为6(2～30)mm,中央区淋巴结获取数目为4(0～19)枚.中央区完全显露率为92.8％(65/70).手术时间为95(65～145)min,术后住院时间为4(2～5)d.暂时性喉返神经损伤1例,皮下积液1例,局部红肿2例,均经保守治疗痊愈.无术后出血发生.随访过程中无肿瘤残留或复发.结论 改良无充气经锁骨下入路腔镜甲状腺手术治疗甲状腺乳头状癌安全可行,中央区淋巴结清扫彻底,切口隐蔽性好,有临床运用价值.