Mental Injury Research Articles

Symbolism as a Means of Creating Uncertainty in Salman Rushdi’s Novel «Midnight’s Children»

The article deals with a role of symbolismin creation of the poetics of uncertainty as an important phenomenon of modern literature. It is noted that in a theoretical sense, symbol is a type of artistic image that is effectively used by writers for the purpose of forming a multi-meaningful content. In the proposed paper, the material for studying the specified effect is Salman Rushdi's novel «Midnight's Children», recognized as very representative of the postmodern paradigm. The purpose of the studio is to identify the means and methods of creating symbolic imagery in the novel, to establish itsartistic and aesthetic functions in the general context of the author's genre and poetic-style searches.The direct factor in expansion of complex symbolic imagery in the novel is an unreliable narration of the protagonist Saleem Sinai. His perception and interpretation of the historical reality is complicated by the physical and mental injuries he suffered and actual mental illness. The recent history of India in the novel has a grotesque-symbolic dimension, which is consistent with the multi-genre status of the work, in which signs of neo-mythological, post-colonial, post-modernist discourse are intertwined. The novel's protagonist conducts his story in such a way that the descriptions of historical events lose their one-dimensionality, acquire a symbolic meaning, become instable in their ambiguity and tend towards uncertainty.

Case Laudamotion: The CJEU Rules that Severe Mental Injury Equals Bodily Injury Under the 1999 Montreal Convention

Breaking with international jurisprudence, the Court of Justice of the European Union ruled that pure psychological injuries could be compensated under the 1999 Montreal Convention in Laudamotion (C-111/21). Claimants would have to demonstrate, however, that the psychological injury seriously affects their state of health and needs medical treatment. Montreal Convention, Accident, Bodily Injury, Mental Injury, CJEU, Uniformity, Travaux preparatoires

Structural Equation Modeling of the Relationship between Spiritual Iintelligence and Corona Anxiety with the Mediation of Depression

Introduction: Today, identifying the factors related to depression as well as mental injuries caused by various biological, social, cultural, political crises, etc., is very important in order to perform better in various fields of prevention and dealing with these injuries and disorders. Purpose: Therefore, the present study was conducted with the aim of identifying the relationship between spiritual intelligence and anxiety caused by Corona as a traumatic global crisis with the mediation of depression. Method: The current research is a descriptive study using the correlation method, which was carried out in the form of statistical analysis of the structural equation model. The statistical population of this research is all university students or graduates living in Tehran, from this statistical population, by calculating the sample size of 420 people using the formula to determine the sample size based on Cohen's effect size and including 20 dropouts, a total of 440 people are sampled by sampling method. Available options were selected. The tools used in this research are: King's Spiritual Intelligence Questionnaire (2008), DASS-21 Questionnaire (1995), Corona Anxiety Questionnaire by Alipour et al. (2018). Findings: The findings of the present study showed that spiritual intelligence has a direct effect on depression and also an indirect effect on corona anxiety with the mediation of depression variable. Conclusion: According to the findings of the current research, it can be concluded that spiritual intelligence is one of the factors affecting depression and anxiety of Corona; Therefore, this concept can be used to prevent and deal with the mentioned disorders.

Association of Family Income With Morbidity and Mortality Among US Lower-Income Children and Adolescents

Family income is known to be associated with children's health; the association may be particularly pronounced among lower-income children in the US, who tend to have more limited access to health resources than their higher-income peers. To investigate the association of family income with claims-based measures of morbidity and mortality among children and adolescents in lower-income families in the US enrolled in Medicaid or the Children's Health Insurance Program. This cross-sectional analysis included 795 000 participants aged 5 to 17 years enrolled in Medicaid (Medicaid Analytic eXtract claims, 2011-2012) living in families with income below 200% of the federal poverty threshold (American Community Survey, 2008-2013). Follow-up ended in December 2021. Family income relative to the federal poverty threshold. Record of International Classification of Diseases, Ninth Revision codes for an infection, mental health disorder, injury, asthma, anemia, or substance use disorder and death record within 10 years of observation (Social Security Administration death records through 2021). Among 795 000 individuals in the sample (all statistics weighted: mean [SD] income-to-poverty ratio, 90% [53%]; mean [SD] age, 10.6 [3.9] years; 56% aged 10 to 17 years), 33% had a diagnosed infection, 13% had a mental health disorder, 6% had an injury, 5% had asthma, 2% had anemia, 1% had a substance use disorder, and 0.6% died between 2011 and 2021, with the mean (SD) age at death of 19.8 (4.2) years. For those aged 5 to 9 years, higher family income was associated with lower adjusted prevalence of all outcomes, except mortality: children in families with an additional 100% income relative to the federal poverty threshold had 2.3 (95% CI, 1.8-2.9) percentage points fewer infections, 1.9 (95% CI, 1.5-2.2) percentage points fewer mental health diagnoses, 0.7 (95% CI, 0.5-0.8) percentage points fewer injuries, 0.3 (95% CI, 0.09-0.5) percentage points less asthma, 0.2 (95% CI, 0.08-0.3) percentage points less anemia, and 0.06 (95% CI, 0.03-0.09) percentage points fewer substance use disorder diagnoses. Except for injury and anemia, the associations were more pronounced among those aged 10 to 17 years than those 5 to 9 years (P for interaction <.05). For those aged 10 to 17 years, an additional 100% income relative to the federal poverty threshold was associated with a lower 10-year mortality rate by 0.18 (95% CI, 0.12-0.25) percentage points. Among children and adolescents in the US aged 5 to 17 years with family income under 200% of the federal poverty threshold who accessed health care through Medicaid or the Children's Health Insurance Program, higher family income was significantly associated with a lower prevalence of diagnosed infections, mental health disorders, injury, asthma, anemia, and substance use disorders and lower 10-year mortality. Further research is needed to understand whether these associations are causal.

An Investigation of the Effects of the Ukraine War on Children’s Mental Health

Since the start of the Ukraine war, children that have fallen victim to the war have become a part of the “lost generation”. Many of them lost family members, educational opportunities, and their childhoods. After losing the most important aspects of lives, they only encountered more impediments: physical, mental, and moral injuries. In order to mitigate the destructive impacts of this war, charities are donating food, water, clothes, and money – basic necessities that humans need to survive. Although the Ukraine war has received global attention and countless charities and non-profit organizations have provided such tangible services, there are other significant issues regarding children’s mental health that are going unseen. Mental illnesses and psychological disorders have been more prevalent in children as a result of the war. Mental issues are much more impairing and serious than physical injuries.Yet, most of the focus is on the physical health of the victims. In conclusion, more humanitarian organizations must consider interventions that would relieve psychological distress and help the children overcome their hurdles. &#x0D;

Gender Violence Suffered by the Daughter-In-Law in the Changing Chinese Family — A Case Study from the Perspective of Family Power Structure

With the development of society, the structure and function of the Chinese family have undergone great changes but gender violence still exists. Through in-depth interviews with two in-laws families, the article describes the gender violence suffered by three daughters-in-law (DILs) within two generations from the 1970s to the 2000s, discovering that despite the nuanced differences in the forms and frequencies of gender violence, three DILs were all at the inferior status in the stem family and were victims of family power inequality. It was revealed that the family power inequality gave rise to gender violence toward the DIL, inducing severe physical or mental injury to the DIL. However, family power inequality was rooted in the traditional gender ideology. The traditional gender ideology originated from the feudal society of China and still pervaded modern society. Consequently, the traditional gender ideology was the rooted cause of the occurrence of gender violence. The article concludes with a reminder of reflecting upon the impacts of the traditional gender ideology on our lives and promoting a new gender consciousness.

Gender Violence Suffered by the Daughter-In-Law in the Changing Chinese Family — A Case Study from the Perspective of Family Power Structure

With the development of society, the structure and function of the Chinese family have undergone great changes but gender violence still exists. Through in-depth interviews with two in-laws families, the article describes the gender violence suffered by three daughters-in-law (DILs) within two generations from the 1970s to the 2000s, discovering that despite the nuanced differences in the forms and frequencies of gender violence, three DILs were all at the inferior status in the stem family and were victims of family power inequality. It was revealed that the family power inequality gave rise to gender violence toward the DIL, inducing severe physical or mental injury to the DIL. However, family power inequality was rooted in the traditional gender ideology. The traditional gender ideology originated from the feudal society of China and still pervaded modern society. Consequently, the traditional gender ideology was the rooted cause of the occurrence of gender violence. The article concludes with a reminder of reflecting upon the impacts of the traditional gender ideology on our lives and promoting a new gender consciousness.

Numb Chin Syndrome in Sickle Cell Disease: A Systematic Review and Recommendations for Investigation and Management.

Numb chin syndrome (NCS) is a rare sensory neuropathy resulting from inferior alveolar or mental nerve injury. It manifests as hypoesthesia, paraesthesia, or, rarely, as pain in the chin and lower lip. Several case reports suggest that sickle cell disease (SCD) could be a cause of NCS. However, information about NCS is scarce in this population. Our objectives were to synthesize all the available literature relevant to NCS in SCD and to propose recommendations for diagnosis and management based on the best available evidence. A systematic review was performed on several databases to identify all relevant publications on NCS in adults and children with SCD. We identified 73 publications; fourteen reports met the inclusion/exclusion criteria. These described 33 unique patients. Most episodes of NCS occurred in the context of typical veno-occlusive crises that involved the mandibular area. Radiological signs of bone infarction were found on some imaging, but not all. Neuropathy management was mostly directed toward the underlying cause. Overall, these observations suggest that vaso-occlusion and bone infarction could be important pathophysiological mechanisms of NCS. However, depending on the individual context, we recommend a careful evaluation to rule out differential causes, including infections, local tumors, metastatic disease, and stroke.

Mental Health and Injury Outcomes in Liberia, 1990–2017: An Ecological Systems Analysis

Bronfenbrenner’s bioecological model of human development is widely used to explain health outcomes, but most research focuses on the more immediate microsystem influences. Over the last 30 years, Liberia has experienced two civil wars, government regime changes, and an Ebola outbreak. We considered associations between those macrosystem and chronosystem shifts in Liberia on four public health outcomes from 1990 to 2017: suicide, depression, sexual violence, and substance use disorders. We conducted separate analyses for women and men. The results indicated substantial changes in health that coincided with macrosystem and chronosystem changes in Liberia. Men’s suicide rates increased during wartime and decreased afterwards, especially during the stable Sirleaf presidency. Both men and women experienced decreasing depression rates during the First Civil War. Depression rates for both men and women flattened during the stable Sirleaf presidency and increased during the Ebola outbreak. The rate of sexual violence was high for both genders during wartime and economic turmoil but declined markedly, especially among women, during the Sirleaf presidency, when government policies were enacted to reduce sexual violence. Substance use disorders were highest during times of economic stability and growth. Men experienced higher rates of suicide and substance use and lower rates of depression and sexual violence compared to women at all times. Consistent with Bronfenbrenner’s model, the results indicate how macrosystem and chronosystem shifts coincided with changes in individual-level mental health and injury outcome trends. We recommend macrosystem-level changes to prevent violence and increase mental health services, both in Liberia and globally.

Abstract 297: Chronic Oral Anticoagulant Use By Emergency Medical Services Patients In The United States

Objective: Oral anticoagulant (OAC) use raises risk of death in life-threatening conditions such as hemorrhagic stroke and trauma, including traumatic brain injury. Only limited data describe the characteristics of individuals who use OACs. We sought to describe the national characteristics of Emergency Medical Services (EMS) patients with a history of OAC use. Methods: We used the 2018-2020 ESO data set, a national EMS electronic health record system. We included adults (age≥18 years) receiving 911 prehospital emergency care. OAC use included warfarin, dabigatran, rivaroxaban and apixaban. We determined the incidence of EMS calls by OAC users as well as their variation by EMS agency. We compared EMS call, patient, and response characteristics between OAC and non-OAC users, including primary impressions and hospital diagnoses. Results: Among 2,100 EMS agencies, there were 16,244,550 adult 911 prehospital events, including 948,671 by OAC users (58 per 1,000 events). OAC call incidence varied by EMS agency; median 53 per 1,000 events (IQR 27 to 83). Compared with non-OAC users, OAC users were more likely to be &gt;70 years (64.6% vs. 30.3%, OR 4.19, 95% CI: 4.17 to 4.21), white race (77.4% vs. 65.8%, OR 2.62, 95 CI: 2.47 to 2.78) and non-Hispanic (84.4% vs. 78.0%, OR 2.66, 95% CI 2.63 to 2.69). Calls involving OAC users were more likely at nursing homes (17.9% vs. 9.1%, OR 2.16, 95% CI: 2.14 to 2.17) but less likely to involve trauma (17.8. vs. 21.6%, OR 0.787, 95% CI: 0.783 to 0.791) or cardiac arrest (1.2 vs. 1.4%; OR 0.89, 95% CI: 0.87 to 0.90). Among OAC users, the most common EMS primary clinical impressions were chest pain (7.4%), altered mental status (7.3%), injury (6.5%), abdominal pain (4.3%), and brain injury (2.8%). Among the 67,567 OAC prehospital encounters linked to hospital data, the most common primary discharge diagnoses were: ICD10 R00-R99 signs and symptoms (23.1%), I00-I99 circulatory diseases (19.9%), and J00-J99 respiratory diseases (10.1%). Conclusions: 1 in 17 adult prehospital encounters involve OAC users. While OAC use was common in high-risk populations, presentation with injury was less common. These results characterize the presentation of this high-risk population in EMS care.

Birth order and sickness absence: register-based evidence from Finland

Abstract Background In working ages, sickness absence is strongly related to persons’ health condition. We studied how birth order was associated with receipt of sickness absence, distinguishing mental disorders, musculoskeletal disorders and injuries. Methods A follow-up study based on the entire Finnish population was conducted for sibling groups born 1969-1982, in which each sibling was observed from age 35 years in the period 2004-2018. Focus was on within-family variation in first-time sickness allowance receipt. Stratified Cox regressions were estimated using Stata 16. Results Each increase in birth order was associated with a higher risk of sickness absence. For mental disorders, the hazard ratio as compared to first borns was 1.03 (95% CI: 0.98, 1.08) of second borns, 1.10 (95% CI: 0.99, 1.22) of third borns, and 1.52 (95% CI: 1.25, 1.85) of fourth or higher borns. Corresponding numbers for musculoskeletal disorders were 1.12 (95% CI: 1.07, 1.17), 1.19 (95% CI: 1.09, 1.30) and 1.15 (95% CI: 0.96, 1.38), and for injuries 1.06 (95% CI: 1.01, 1.12), 1.09 (95% CI: 1.21, 1.14) and 0.96 (95% CI: 0.77, 1.20), respectively. These associations were notably stronger for women than men, but modestly influenced by mother’s age at birth, educational level, occupation, income and family composition. Conclusions The study was the first to provide evidence about an interrelation between birth order and sickness absence, utilising diagnose information and family fixed effects methods. A clear birth order pattern was observed for these main causes, but not for a residual group that consisted of other miscellaneous causes. Higher birth order was found associated with a higher risk of sickness absence, and particularly so for mental disorders and muscoloskeletal disorders in women. The underlying mechanisms behind these associations constitute an avenue for future research. Key messages • Using sibling fixed effects, the study was the first to analyse if sickness absence by main cause is associated with birth order in working ages. • First-born siblings were the least likely to be sick because of mental or musculoskeletal disorders, and the associations were notably more accentuated for women than men.

Protect the Player, Protect the Game: Reflections from Ex-Professional Rugby Union Players on Law Changes, Protective Equipment, and Duty of Care in the Professional Game.

The emphasis of this study was to interview ex-professional male rugby union players (n = 23, mean age 35.5 ± 4.7 years) and discuss concussion management during their careers. In this study, two major themes were identified: (1) the duty of care to professional rugby union players by medical personnel, coaching staff, and owners of professional clubs and (2) the use of protective equipment and law changes to enhance player safety. In total, twenty-three ex-professional rugby union players were interviewed, and the majority (61%) had represented their countries at international test-level rugby. These interviews highlighted the belief that medical teams should be objective, independent entities within a professional rugby club. Furthermore, medical teams should not be in a position of being pressurised by head coaches, members of the coaching team, or club owners regarding return-to-play (RTP) protocols specific to concussion. The interviewees believed that they were pressured by coaches or members of the coaching team to play with concussion or concussive symptoms and other physical injuries. The results indicated that they had manipulated concussion testing themselves or with assistance to pass standard concussion testing protocols. The interviewees indicated that club owners have a duty of care to players even in retirement due to the high incidence of physical and mental injuries endured as a professional rugby player. Most participants indicated that a reduction in match playing time and reducing the amount of time engaged in contact training (workload volume) may assist in reducing concussion incidence. The participants suggested that changes to the current laws of the game or the use of protective equipment did not mitigate against concussion risk in the game of rugby union. The main limitation to the study is that participants had retired in the past ten years, and conditions for players may have changed. This study has highlighted that additional efforts are required by professional clubs to ensure the highest duty of care is delivered to current players and recently retired players.

Attention-Deficit Hyperactivity Disorder and Comorbid Mental Health Conditions Associated with Increased Risk of Injury.

Background To describe the influence of attention-deficit hyperactivity disorder (ADHD) and comorbid mental health conditions on the risk of selected injuries. Methods A retrospective cohort study design was employed using medical claim data from the Deseret Mutual Benefit Administrators (DMBA). Mental health conditions, injury, medication, and demographic data were extracted from claim files for ages 4-64, years 2016-2020. Results Approximately 51.8% of individuals with ADHD had one or more comorbid mental health conditions (anxiety [37.0%], depression [29.9%], autism spectrum disorder (ASD) [3.6%], bipolar disorder [4.7%], obsessive compulsive disorder (OCD) [2.4%], schizophrenia [0.9%], and manic disorder [0.2%]). The rate of injury was 1.33 (95% CI 1.27–1.39) for ADHD only versus no ADHD and 1.62 (95% CI 1.56–1.68) for ADHD and comorbid mental health conditions versus no ADHD, after adjusting for age, sex, salary, and year. Cases with ADHD but no comorbid mental health conditions versus no ADHD were at increased risk of each of 12 types of injury. The increased risk was noticeably more pronounced for ADHD cases with one or more comorbid mental health conditions versus no ADHD. The greatest increased risk of injury was among ADHD cases with comorbid schizophrenia, followed by bipolar disorder and OCD. Comorbid autism disorder does not increase the risk of injury, but lowers it. Finally, the number of comorbid mental health conditions among ADHD cases was positively associated with increased injury rates (6% for one, 30% for two, 65% for three, and 129% for four). Conclusions ADHD is positively associated with an increased risk of injury. Comorbid mental health conditions further increase the risk of injury among those with ADHD.

Feasibility of transoral robotic selective neck dissection with or without a postauricular incision for papillary thyroid carcinoma: A pilot study.

BackgroundThe study aimed to evaluate the feasibility of transoral robotic selective neck dissection (SND) with or without a postauricular incision for papillary thyroid carcinoma (PTC).MethodsWe studied 14 patients with PTC who underwent robotic SND via the transoral or combined transoral and postauricular approaches.ResultsThe transoral approach was performed on 10 patients for dissection of levels III and IV. An additional postauricular incision was made on 4 patients for dissection of level II in addition to levels III, IV, and V. The operation was completed successfully in 13 patients, except 1 patient with the procedure conversion due to uncontrolled bleeding from the internal jugular vein. The mean numbers of removed lymph nodes in the lateral compartment were 23.1 ± 9.4 and 38.3 ± 8.5 in the transoral and combined groups. Transient recurrent laryngeal nerve palsy occurred in 1 patient, transient hypoparathyroidism in 3 patients, and chyle leakage in 1 patient. There were no hematomas, mental nerve injuries, surgical space infections, or CO2 embolisms.ConclusionTransoral robotic SND is feasible with or without a postauricular incision.

Mental Health and Substance Use in NCAA Athletes in the Context of the COVID-19 Pandemic and Lockdown.

Background Although the coronavirus disease 2019 (COVID-19) pandemic had pervasive effects on the lives of individuals, its influence on the mental health ofcollegiate athletes remains unknown. This study aimed to assess changes in mental health and substance use in National Collegiate Athlete Association (NCAA) Division I athletes in Southern California during the COVID-19 pandemic. Methodology An online survey was created using the Qualtrics software (Qualtrics, Provo, Utah). NCAA Division I athletes in Southern California completed preseason surveys querying indices of mental health, substance use, and injury in the year before the COVID-19 pandemic (March 2019 to March 2020) and during the pandemic (March 2020 to March 2021). The athletes filled out the survey from June 2021 to September 2021. Participants were asked how likely they were to agree with the following statements: I have felt physically prepared for athletic competitions, I have been satisfied with my mental health, and I have had adequate sleep. Participants were also asked to compare their substance use between the two time periods. Sociodemographic information regarding participants' age, gender, sports team, as well as year in sport and school was also collected. Group comparison analyses were performed using Fisher's exact test. Correlations between mental health measures and other variables were examined using Spearman's correlation coefficients. Results A total of 189 athletes completed the survey (out of the 259 surveys that were started). Females were significantly less likely to feel satisfied with mental health (p < 0.01) and physically prepared for sport (p < 0.01). Across all respondents, satisfaction with mental health was positively correlated with adequate sleep (p < 0.01) and physical preparedness for sport (p < 0.01) and negatively correlated with injury (p < 0.05). There was no significant correlation between mental health status and history of COVID-19 infection (p = 0.84). The vast majority of athletes reported no significant change in substance use pre- to post-pandemic, with no differences according to sex. Conclusions The COVID-19 pandemic had a differential impact on the mental health of female versus male NCAA athletes. Mental health was correlated with sleep, physical preparedness, and being injury-free but not with a history of COVID-19 infection. Despite reports indicating increased substance use in the general population, athletes in this group reported no change in licit and illicit substance use.

A Reliable Framework for Secure Communication and Health Assessment of Soldiers in the Battlefield

Wars against the enemy are mandatory for the integrity of a nation. With the passage of time, the nature of war is being changed, to some extent from a conventional war to the network-centric warfare. The rate of soldiers death has increased in modern combat operations. The lack of secure connectivity and the health (mental and physical) of soldiers are among a few major reasons for the increased mortality. Mental health or stress level produces permanent changes in the physiological systems of a soldier and long-term diseases such as asthma, diabetes, and hypertension are activated with chronic stress. Although modern communication technologies may provide huge support in the efficient conduction of combat’s activities but it is at the cost of huge power consumption. The proposed research presents a computationally efficient and low-power framework that not only ensures secure communication but also provides a robust command and control system to monitor the mental stress, injury, and death of soldiers. In the suggested framework, the Advanced Encryption Standard (AES) is used for communication that is highly suitable for power constraint devices. A wearable sensor system is suggested that can be embedded in a soldier’s uniform to assist in the recording of real-time stress, injury, and death of soldiers. The system contains a heart-rate monitor to record variations in heartbeats, an EDA sensor for skin conductance, and a respiration sensor for respiration variations along with a holster unit for storage and transmission of biomedical signals. Furthermore, it also provides a mechanism to prevent misuse of soldiers’ communication equipment by the enemy thus ensuring more security. The experimental analysis shows that the proposed mental stress computation module achieved 83.33% accuracy. Moreover, a score-based comparison is performed with the existing techniques and it is found that the proposed mechanism outperformed its counterparts with 37.5% improvements in the features-based analysis. The flexibility, security, efficiency, and reliability of the framework make it appropriate for modern warfare scenarios.

The rights of disabled children in Iraq

Disability is generally defined as a physical, mental, or psychological injury that causes harm to the child’s physical or mental development, or both, and may affect his psychological state and the development of his education and training. Thus, the individual or the child becomes a person with special needs and is less than his peers of the same age in physical functions perception, or both. Handicapped children are usually classified into the following groups: Physically handicapped children disability physical Mentally retarded intellectual disabilitysocially handicapped children disability Social. Disability occurs for several reasons or factors, the most important of which are congenital factors , communicable diseases , non - communicable physical diseases , functional psychological and mental disorders , accidents , malnutrition , addiction to alcohol and drugs , and During pregnancy problems occur . Since the disability, of its various types, drains a huge effort, incurred by the state and the family, so it depends Methods and programs protection From disability on me How aware are we?

Novel suspension system for gasless transoral vestibular thyroidectomy.

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 ± 34.60min. 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.

The modified vermilion border-marionette line approach: A management for buccal cancer with wider indications and higher satisfaction.

The purpose of this study is to explore the effects of modified vermilion border-marionette line (MVBML) approach on postoperative facial scar, nerves injury, and prognosis of patients with buccal squamous cell carcinoma (BSCC). This is a single-center, prospective cohort study that enrolled 80 patients with BSCC from June 2015 to December 2020. According to the different surgical approaches, the patients were divided into two groups: the lower lip median (LLM) approach group and the MVBML approach group. The results showed that the appearance (p=0.003), scar consciousness (p < 0.001) and satisfaction with appearance (p=0.001) of patients in the MVBML group were significantly better than those in the LLM group, and the difference was more obvious in elderly group. Statistical analysis of postoperative nerves injury showed that the MVBML group had a lower risk of facial and mental nerves injury than the LLM group, and there was a significant statistical difference in mental nerve injury between the two groups (p < 0.001). Through Kaplan-Meier survival analysis, we found no significant difference in disease-specific survival (p=0.47) or disease-free survival (p=0.70) between the LLM approach group and the MVBML approach group. The MVBML surgical approach is worthy of advancement for the surgical treatment of BSCC.

Clinical application of transoral and submental thyroidectomy (TOaST): a series of 54 human cases

ObjectiveA new endoscopic thyroidectomy approach—transoral and submental endoscopic thyroidectomy (TOaST)—was applied in clinical practice and considered an improved approach for endoscopic thyroid surgery via the oral approach. This paper discusses the feasibility and effectiveness of this surgical method.MethodsA retrospective analysis was performed on the clinical data of 54 patients who had undergone TOaST in the thyroid disease center of the First Affiliated Hospital of Nanchang University between December 2020 and December 2021. The surgical data and techniques, complications, and cosmetic outcomes of these patients were studied.ResultsAmong the total 54 patients, 23 underwent unilateral subtotal thyroidectomy, 3 patients underwent bilateral subtotal thyroidectomy, 27 with unilateral thyroid cancer underwent affected thyroid + isthmus + central lymph node resection, and only 1 patient underwent total thyroidectomy. The mean operative time was 88.06 ± 12.03 min (range: 65–135 min), the mean intraoperative blood loss was 8.61 ± 4.60 ml (range: 5–20 ml), the mean postoperative drainage volume was 49.96 ± 9.88 ml (range: 30–60 ml), the mean drainage time was 36.61 ± 2.65 h (range: 32–50 h), and the mean length of hospital stay was 46.63 ± 3.28 h (range 45–70 h). One patient experienced transient recurrent laryngeal nerve injury, and another patient experienced transient parathyroid dysfunction; there was no superior laryngeal nerve injury and other complications, such as postoperative subcutaneous hematoma, hypercapnia, mental nerve injury, tracheoesophageal injury, infection, or lymphatic leakage.ConclusionTOaST cannot only achieve a good therapeutic effect but also avoid mental nerve injury, reduce the discomfort of the patient’s jaw, obtain a good cosmetic effect, and facilitate the operation of the operator. It is an endoscopic thyroidectomy technique with a certain clinical value.