[Clinical application of parathyroid autofluorescence imaging in endoscopic thyroid surgery].

Objective:To investigate the application value of near-infrared autofluorescence imaging in identifying and protecting parathyroid glands in endoscopic thyroid surgery. Methods:From May 2022 to February 2023, 158 patients who underwent endoscopic thyroid surgery in the Department of Thyroid and Breast Vascular Surgery of Guilin People's Hospital were selected. The endoscopic fluorescence camera system was used to monitor the parathyroid glands under autofluorescence during endoscopic thyroid surgery. A total of 214 pieces were collected, among which the first 15 cases that could not be preserved in situ during the operation needed to be autotransplanted or the tissue clamped parts that could not be clearly identified as parathyroid glands were sent to fast-frozen pathology to determine whether they were parathyroid glands. Results:Among the first 15 patients who could not be preserved in situ during the operation or whose anatomy could not be clearly defined, 23 parathyroid glands were detected by autofluorescence imaging, 21 parathyroid glands were confirmed by pathology, and 2 were adipose tissue, with an accuracy rate of 91.30%; 158 patients underwent surgery Blood calcium decreased 2 hours after operation compared with preoperative blood calcium（P<0.05）, decreased blood calcium 5 days after operation compared with preoperative blood calcium（P<0.01）, and increased slightly 5 days after the operation compared to blood calcium 2 hours after the operation, but the difference was not statistically significant（P>0.05）; while comparing parathyroid hormone（PTH）, PTH at 2 hours after operation decreased significantly compared with PTH before operation（P<0.01）, and PTH at 5 days after operation compared with PTH before operation PTH also decreased（P<0.01）, but increased compared with PTH 2 hours after operation（P=0.001）. Conclusion:In laparoscopic thyroid surgery, the application of near-infrared autofluorescence imaging technology can help surgeons quickly identify and protect parathyroid glands, and reduce the incidence of permanent hypoparathyroidism. Combining autofluorescence imaging, visual anatomy recognition under magnification of laparoscope, and intraoperative frozen pathological examination "trinity" method can improve the success rate of parathyroid gland recognition.

Long-Term Prognostic Factors in Patients With Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: A 15-Year Multicenter Retrospective Study.

Background: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a multisystem autoimmune disease with small-vessel involvement. In AAV, microscopic polyangiitis (MPA) and granulomatosis with polyangiitis (GPA) are major clinicopathologic variants. In addition, myeloperoxidase (MPO) and proteinase 3 (PR3) are major target antigens. The objective of the study was to explore the predictive factors for long-term survival in AAV patients. Materials and Methods: A multicenter retrospective study was carried out on 407 patients between 2005 and 2020. Clinical parameters were obtained from laboratory tests including the ANCA types, antinuclear antibody (ANA), extractable nuclear antigen (ENA), anti-streptolysin O (ASO), glomerular filtration rate (GFR), and the laboratory examinations for the blood routine, liver function, renal function, and immunity, etc. The data for clinical parameters were collected from electronic medical records (EMRs), and the data for patient survival were acquired through regular follow-up. The association of clinical parameters with overall survival (OS) along with 3-year and 5-year survival rates was analyzed, and the nomogram as a predictive model was established according to the analysis results. Results: In the present study, 336 (82.6%) patients and 46 (11.3%) patients were diagnosed with MPA and GPA, respectively. The mean and median OS for all the patients were 2,285 and 2,290 days, respectively. The 1-year, 3-year, 5-year, and 10-year cumulative survival rates for all the patients were 84.2%, 76.3%, 57.2%, and 32.4%, respectively. Univariate and multivariate survival analyses indicated that the independent prognostic factors included age, pathological categories (MPA, GPA, and other types), serum ANCA types (negative or positive for MPO and/or PR3), ANA, ASO, GFR, lymphocyte, neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP), and these clinical parameters except for ASO were used to construct a nomogram. The nomogram for 3-year and 5-year survival rates had a C-index of 0.721 (95% CI 0.676-0.766). The calibration curves showed that the predicted values of the nomogram for 3-year and 5-year survival rates were generally consistent with practical observed values, and decision curve analysis (DCA) further demonstrated the practicability and accuracy of the predictive model. Conclusion: Laboratory tests at diagnosis have great significance in the prediction of long-term survival in AAV patients.