ObjectiveTo explore the learning curve of endoscopic thyroidectomy using the gasless unilateral axillary approach for papillary thyroid microcarcinoma.MethodsWe retrospectively analyzed the clinical data of 51 patients diagnosed with papillary thyroid microcarcinoma who underwent an endoscopic thyroidectomy using a gasless unilateral axillary approach by the same surgeon from November 2019 to September 2020 in the Department of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University. The cumulative sum (CUSUM) analysis was used to determine the learning curve of the technology, and the CUSUM learning curve was modeled by the best fit. The operative time, intraoperative blood loss, number of lymph nodes dissected, incidence of complications and postoperative hospital stay in different phases of the learning curve were compared.ResultsThe CUSUM fitting curve reached the top at the 18th case. As a cut-off point, the learning curve was divided into two stages: the learning improvement period and the proficiency period. The operative time of patients in the proficiency stage was significantly shorter than that in the learning improvement stage (P<0.05), and there were no statistically significant differences in other data of patients in the two stages (P>0.05).ConclusionThe CUSUM analysis method is used to accurately analyze the learning curve of endoscopic thyroidectomy using the gasless unilateral axillary approach for papillary thyroid microcarcinoma, indicating that the cumulative number of operations required to master this technique is 18 cases.
ObjectiveTo detect the expression of Ki-67 in papillary thyroid carcinoma (PTC) and investigate its clinical significance. MethodsA retrospective analysis was conducted on PTC patients treated at West China Hospital of Sichuan University from August 2024 to February 2025. The relation between the Ki-67 expression in the postoperative pathological tissues and clinicopathologic features was analyzed. Additionally, the concordance of Ki-67 expression between the preoperative fine-needle aspiration samples and postoperative pathological tissues was evaluated by Bland-Altman analysis. The significance level was set at α=0.05. ResultsA total of 290 PTC patients met the inclusion and exclusion criteria were enrolled. Patients with classical PTC, M1 classification, TNM stage Ⅳ, and those achieving thyroid stimulating hormone (TSH) suppression targets at one month postoperatively had higher Ki-67 expression than those with follicular variant PTC, M0 classification, TNM stages Ⅰ–Ⅲ, or inadequate TSH suppression (all P＜0.05). No significant differences were observed in other subgroups (P>0.05). Furthermore, Bland-Altman analysis of 27 paired samples showed a mean bias of 1.269% between preoperative and postoperative measurements. Elevated variability occurred in high Ki-67 cases, with 11.1% (3/27) exceeding ±6% limits of agreement. ConclusionsThe study demonstrates that Ki-67 expression correlates with malignant attributes including tumor aggression and advanced disease. It may serve as a prognostic biomarker for assessing malignant potential in PTC.
ObjectiveTo investigate clinical characteristics and influencing factors of lower respiratory tract infection of Acinetobacter baumannii (AB-LRTI) in respiratory intensive care unit (RICU).MethodsClinical data were collected from 204 RICU patients who were isolated Acinetobacter baumannii (AB). The bacteriological specimens were derived from sputum, bronchoscopic endotracheal aspiration, bronchoalveolar lavage fluid, pleural effusion and blood. The definition of bacterial colonization was based on the responsible criteria from Centers for Disease Control and Prevention/National Medical Safety Network (CDC/NHSN). The patients were divided into three groups as follows, AB colonization group (only AB was isolated, n=40); simple AB-LRTI group (only AB was isolated and defined as infection, n=63), AB with another bacteria LRTI group (AB and another pathogen were isolated simultaneously, n=101). The epidemiology, clinical characteristics and influencing factors of each group were analyzed and compared. ResultsCompared with the AB colonization group, the AB with another bacteria LRTI group had higher proportion of patients with immunosuppression, specimens from sputum and bronchoalveolar lavage fluid, more than 4 invasive procedures, 90-day mortality, white blood cell count >10×109/L (or <4×109/L), neutrophil percent >75% (or <40%), lymphocyte count <1.1×109/L, platelet count <100×109/L, albumin <30 g/L, high sensitivity C-reactive protein >10 mg/L, and neutrophil-to-lymphocyte ratio (NLR). The frequency of bronchoscopy and days of infusing carbapenem within 90 days before isolating AB, the Acute Physiology and Chronic Health Evaluation Ⅱ score, the proportion of patients with invasive mechanical ventilation and the duration of invasive mechanical ventilation in the AB with another pathogen LRTI group were higher than those in the AB colonization group (all P<0.05). Days of infusing carbapenem and β-lactams/β-lactamase inhibitors within 90 days before isolating AB, proportion of septic shock, NLR and 90-day mortality of the patients from the AB with another pathogen LRTI group were more than those in the simple AB-LRTI group (all P<0.05). After regression analysis, more than 4 invasive procedures, or immunosuppression, or with more days of infusing carbapenem within 90 days before isolating AB were all the independent risk factors for AB-LRTI.ConclusionsThere are significant differences in epidemiology, clinical symptoms and laboratory indicators between simple AB-LRTI, AB with another pathogen LRTI and AB colonization in RICU patients. For RICU patients, who suffered more than 4 invasive procedures, immunosuppression, or with more days of infusing carbapenem within 90 days before isolating AB, are more susceptible to AB-LRTI.