ObjectiveTo understand the research status, advantages and disadvantages, indications and contraindications, as well as the current challenges and countermeasures, controversies, and future development of gasless trans-subclavian approach endoscopic thyroidectomy (GTAET). MethodThe relevant domestic and international literature on GTAET was reviewed. ResultsIn terms of oncological outcomes (such as the number of central lymph nodes dissected), GTAET is comparable to traditional open surgery. It demonstrates markedly higher postoperative cosmetic satisfaction and significantly lower incidences of anterior neck paresthesia and swallowing traction discomfort. Compared to other endoscopic approaches (such as the transaxillary approach), GTAET offers advantages including a shorter surgical path, less trauma during cavity creation, a better visual field for central lymph node dissection, and a shorter operative time. It also avoids CO2 insufflation-related risks such as subcutaneous emphysema and hypercapnia. The main limitations of this technique are its generally longer operative time compared to open surgery and the potential for increased postoperative drainage. Furthermore, it faces several technical challenges and application difficulties in clinical practice, including the optimization of specialized instruments, standardization of surgical procedures, and management of lateral neck lymph node dissection. ConclusionsGTAET is a safe and feasible minimally invasive surgical approach for thyroid disease. While ensuring thorough tumor eradication, it combines the advantages of a well-concealed incision, excellent preservation of anterior neck function, and the safety and convenience of gasless technique. It also has a relatively manageable learning curve, making it an excellent surgical option for patients with thyroid tumors who prioritize cosmetic outcomes and quality of life.
ObjectiveConstructing a prediction model for seizures after stroke, and exploring the risk factors that lead to seizures after stroke. MethodsA retrospective analysis was conducted on 1 741 patients with stroke admitted to People's Hospital of Zhongjiang from July 2020 to September 2022 who met the inclusion and exclusion criteria. These patients were followed up for one year after the occurrence of stroke to observe whether they experienced seizures. Patient data such as gender, age, diagnosis, National Institute of Health Stroke Scale (NIHSS) score, Activity of daily living (ADL) score, laboratory tests, and imaging examination data were recorded. Taking the occurrence of seizures as the outcome, an analysis was conducted on the above data. The Least absolute shrinkage and selection operator (LASSO) regression analysis was used to screen predictive variables, and multivariate Logistic regression analysis was performed. Subsequently, the data were randomly divided into a training set and a validation set in a 7:3 ratio. Construct prediction model, calculate the C-index, draw nomogram, calibration plot, receiver operating characteristic (ROC) curve, and decision curve analysis (DCA) to evaluate the model's performance and clinical application value. ResultsThrough LASSO regression, nine non-zero coefficient predictive variables were identified: NIHSS score, homocysteine (Hcy), aspartate aminotransferase (AST), platelet count, hyperuricemia, hyponatremia, frontal lobe lesions, temporal lobe lesions, and pons lesions. Multivariate logistic regression analysis revealed that NIHSS score, Hcy, hyperuricemia, hyponatremia, and pons lesions were positively correlated with seizures after stroke, while AST and platelet count were negatively correlated with seizures after stroke. A nomogram for predicting seizures after stroke was established. The C-index of the training set and validation set were 0.854 [95%CI (0.841, 0.947)] and 0.838 [95%CI (0.800, 0.988)], respectively. The areas under the ROC curves were 0.842 [95%CI (0.777, 0.899)] and 0.829 [95%CI (0.694, 0.936)] respectively. Conclusion These nine variables can be used to predict seizures after stroke, and they provide new insights into its risk factors.