Novel perspective in transplantation therapy of mesenchymal stem cells: targeting the ferroptosis pathway / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Ex vivo culture-amplified mesenchymal stem cells (MSCs) have been studied because of their capacity for healing tissue injury. MSC transplantation is a valid approach for promoting the repair of damaged tissues and replacement of lost cells or to safeguard surviving cells, but currently the efficiency of MSC transplantation is constrained by the extensive loss of MSCs during the short post-transplantation period. Hence, strategies to increase the efficacy of MSC treatment are urgently needed. Iron overload, reactive oxygen species deposition, and decreased antioxidant capacity suppress the proliferation and regeneration of MSCs, thereby hastening cell death. Notably, oxidative stress (OS) and deficient antioxidant defense induced by iron overload can result in ferroptosis. Ferroptosis may inhibit cell survival after MSC transplantation, thereby reducing clinical efficacy. In this review, we explore the role of ferroptosis in MSC performance. Given that little research has focused on ferroptosis in transplanted MSCs, further study is urgently needed to enhance the in vivo implantation, function, and duration of MSCs.

Clinical research progress of spinal epidural lipomatosis / 中国修复重建外科杂志

OBJECTIVE@#To review the clinical research progress of spinal epidural lipomatosis (SEL).@*METHODS@#The clinical studies on SEL at home and abroad in recent years were extensively reviewed, and the pathogenesis, clinical and imaging manifestations, and treatment status of SEL were summarized and analyzed.@*RESULTS@#SEL is a disease characterized by compression of the spinal cord and nerve roots due to abnormal accumulation of epidural adipose tissue in the spinal canal. Its prevalence and diagnosis rate are low and the pathogenesis is not fully understood. MRI is the most sensitive and specific diagnostic test for SEL. Surgical decompression and removal of excess adipose tissue are the only options for patients with acute SEL or those who have failed conservative management, and conservative management should be considered for other patients.@*CONCLUSION@#SEL is a rare disease and related research still needs to be improved. In the future, high-quality, multi-center and large-sample studies will be of great significance for evaluating the choice of treatment methods and effectiveness of SEL patients.

Analysis of chyle leakage after central lymph node dissection for thyroid carcinoma / 中华耳鼻咽喉头颈外科杂志

Objective@#To analyze the clinical characteristics, treatment and prognosis of chyle leakage after central lymph node dissection for thyroid cancer.@*Methods@#A retrospective analysis was made of 985 patients who underwent surgical for thyroid carcinoma plus central lymph node dissection from January 2017 to June 2018 in Renji Hospital Affiliated to Medical College of Shanghai Jiaotong University. Patients were divided into those without (group A, n=973) and with (group B, n=12) chyle leakage. Patients with chyle leakage who underwent left central lymph node dissection were divided into group B1 (n=5) and right central lymph node dissection into group B2 (n=7). Patients with chyle leakage were treated with fat-free diet and negative pressure drainage. SPSS 20.0 software was used to analyze the general condition, surgical pathology, postoperative drainage, hospitalization days, treatment and prognosis of patients in B1 and B2 groups.@*Results@#The incidence of chyle leakage after central lymph node dissection for thyroid cancer was 1.2% (12/985). There were no significant differences in age, sex, size of primary lesion, number of lymph node dissection in central area and number of lymph node metastasis in central area between group A and group B (all P>0.05). The drainage volume on the first day after operation [((51.7±26.7)) ml] and the average hospitalization days [(3.4±0.8) d] in group A were significantly lower than those in group B ([131.3±56.0)]ml, [10.4±2.6)]d). The differences were statistically significant (t value was -5.442, -11.238, respectively, both P<0.001). There were no significant differences in age, size of primary lesion, number of lymph node dissection, number of lymph node metastasis, drainage volume on the first day after operation and average hospitalization days between group B1 and group B2 (all P>0.05). All chyle leakages in group B stopped after conservative management without surgical intervention.@*Conclusion@#The occurrence of chyle leakage after central lymph node dissection is a rare complication. It can be cured by conservative treatment such as diet control, pressure bandaging and negative pressure drainage, and generally does not require secondary surgery.

Factors for lymph node metastasis and survival rate in papillary thyroid microcarcinoma: from a large cohort of 3 607 cases series / 中华耳鼻咽喉头颈外科杂志

Objective@#To investigate high-risk factors for lymph node metastasis (LNM) and 10-year survival rate in patients with papillary thyroid microcarcinoma (PTMC).@*Methods@#We retrospectively analyzed the clinical data of 3 607 patients with PTMC received surgery in our hospital from January 2005 to December 2015. Univariate and multivariate analyses were performed to identify the factors associated with metastasis and 10-year survival rate of the patients was calculated.@*Results@#The patients accepted an average follow-up of 68 months, with follow-up from 18 to 138 months. Total LNM rate in the 3 607 patients with PTMC was 17.13%. Central lymph node metastasis rate was 16.86%, which was related to gender (males 21.89% vs females 15.26%, P<0.01), age (<45 years old 24.44% vs ≥45 years old 11.96%, P<0.01), tumor diameter (P<0.01) and multifocality (P<0.01). Lateral lymph node metastasis rate was 1.05%, which was related to age (<45 vs ≥45, P<0.01) and tumor diameter (P<0.01). The 10-year-survival rate was 93.0% and 10-year recurrence-free survival rate was 87.5%.@*Conclusion@#PTMC may metastasize to cervical lymph node, especially in males, with age younger than 45, multifocal tumors and maximal tumor diameter larger than 0.7 cm. There was no significant correlation between these clinical features associated with LNM and the 10-year survival rate.

Study and advance of Ki67 expression in medullary thyroid carcinoma / 中华内分泌外科杂志

Medullary thyroid carcinoma is a kind of neuroendocrine tumor that originates from calcitoninproducing parafollicular C-cells of the thyroid.Its incidence,diagnosis and treatment are unique.Ki67 is a nuclear antigen related to cell proliferation.It plays an important role in tumor occurrence and development,and it has important clinical significance in a variety of malignancies.Ki67 proliferation index has become classification index in neuroendocrine tumors of the gastrointestinal tract.In this paper,we review the study of medullary thyroid carcinoma and the expression of Ki67 in medullary thyroid carcinoma.

Progress of metabonomics in papillary thyroid cancer / 中华内分泌外科杂志

Metabolomics, the newest “omics”science after genomics, thranscriptomics and proteomics, is the study of simultaneous identification and quantification of products of the biochemical reaction within an or-ganism. It has been used in the study of papillary thyroid cancer. This review presents an introduction to the con-cept and research techniques of metabolomics and the progress of application in papillary thyroid cancer.

Therapeutic evaluation of surgical procedure in treatment of secondary hyperparathyroidism / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze the short-term and long-term outcomes of the three operation methods in treatment of secondary hyperparathyroidism.</p><p><b>METHODS</b>Clinical data of 88 patients who underwent parathyroidectomy for secondary hyperparathyroidism from October 2004 to October 2014 were reviewed retrospectively. Patients were divided into three subgroups, including subtotal parathyroidectomy (group I), total parathyroidectomy with autotransplantation (group II) and intraoperative ⁹⁹Tc(m)-MIBI radioguided total parathyroidectomy with autotransplantation (group III). Their serum calcium, phosphorus, serum iPTH results in the pre-operation, short-term (≤ 6 months) and long term (> 6 months) of post-operation were collected and compared. The improvements of clinical symptoms together with the postoperative recurrence rate and the complication data were observed and analyzed.</p><p><b>RESULTS</b>The symptoms of all patients were improved after the operation.The short-term postoperative serum calcium, serum iPTH and recurrence rate of Group I and group II were all not statistically significant. The short-term postoperative serum calcium, iPTH and recurrence rate of group III were significantly lower than those of group I and group II (P < 0.05). Postoperative serum phosphorus values of the three groups had no statistical difference. The operation time of group III was significantly shorter than that of group II ((77 ± 13) vs (108 ± 17) min, P < 0.05). The positive rates were more accurate in group III than in group II (98.5% vs 88.7%, P < 0.05). For the long term follow-up, the postoperative serum calcium, phosphorus, serum iPTH and recurrence rate of group I and group II were not statistically different. The postoperative recurrence rate of group III was lower than that of group I and group II (3.6% vs 31.6% and 21.4% respectively, P < 0.05).</p><p><b>CONCLUSIONS</b>Total parathyroidectomy with autotransplantation has a good efficacy to treat secondary hyperparathyroidism. The intraoperative ⁹⁹Tc(m)-MIBI radioguided total parathyroidectomy with autotransplantation can find the ectopic and supernumerary glands to improve the success rate of operation. And it also can permit omission of frozen section to reduce the operative time.In the postoperative follow-up, the recurrence rate is low, so it is a safe and effective treatment.</p>

Thyroglossal duct carcinoma combined with systemic lupus erythematosus: one case report / 临床耳鼻咽喉头颈外科杂志

Thyroglossal duct carcinoma is a malignant tumor which occurs in the thyroglossal duct cyst. The incidence of thyroglossal duct carcinoma has been reported as approximately 1%. Up to now, just about 250 cases of thyroglossal duct carcinoma have been reported in the literature,most of which are single case reports and small case series. In most cases, the diagnosis of the thyroglossal duct carcinoma is not made until the histologic examination after surgery operation. The preoperative examination such as CT or fine needle aspiration cytology can help the preoperative diagnosis. But the surgical treatment for the thyroglossal duct carcinoma is still controversial. Now we report a case of a thyroglossal duct carcinoma combined with systemic lupus erythematosus. The patient herself found an anterior neck mass in the median submental region one year ago. The preoperative CT examination suggested thyroglossal duct cyst with pouch canceration(papillary carcinoma). Then she underwent a Sistrunk procedure and level I neck dissection, and the histopathological diagnosis was thyroglossal duct carcinoma. The patient was treated with levothyroxine therapy at suppressive dose after the surgery. Now the patient is at regular follow-up with no relapse occur.

Diagnosis and treatment of thyroid microcarcinoma / 临床耳鼻咽喉头颈外科杂志

Papillary thyroid microcarcinoma (PTMC) is defined as a papillary thyroid carcinoma measuring less than 10 mm in diameter. With the development of ultrasonic technology and the popularization of physical examination, the incidence of PTMC increased dramatically. Routine preoperative diagnostic methods include clinical examination, thyroid ultrasound and fine needle aspiration biopsy. But its treatment methods are still controversal. In this paper, we review literatures in recent years and discuss the clinical common problems of PTMC.

Expression and clinical significance of Ki67 and calcitonin in medullary thyroid carcinoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the expression and clinical significance of Ki67 and calcitonin in medullary thyroid carcinoma(MTC).@*METHOD@#The expression level of Ki67 and calcitonin was studied in 44 cases of medullary thyroid carcinoma tissue and 20 cases of adjacent nontumor tissue by SP immunohistochemistry.@*RESULT@#The positive expression of Ki67 and calcitonin in medullary thyroid carcinoma tissue were 86.36% (38/44) and 100.00% (44/44) respectively. There was a significant difference between carcinoma and normal thyroid tissue (P<0.01). The overexpression of Ki67 and calcitonin in medullary thyroid carcinoma had no relationship with gender and age of patients,but had relationship with size of tumor,clinical staging and lymph node metastasis (P<0.05). Meanwhile, Ki67 and calcitonon had no significant correlation with each other.@*CONCLUSION@#The overexpression of Ki67 and calcitonin may play important role in occurrence, development and metastasis of medullary thyroid carcinoma. It may be used as an important judgement for the biological behavior of medullary thyroid carcinoma.

Influence of different thyroidectomy on perioperative blood calcium concentration / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#lo discuss the inmtluence of different thyroidectomy on perioperative blood calcium concentration.@*METHOD@#Total number of patients was 240. These patients of thyroid tumors were recruited. Clinical and follow-up datum were retrospective analyzed.@*RESULT@#Patients were divided into four groups by different operative methods. Group one was patients taken one-side thyroidectomy, group two taken one-side lymph node dissection plus, group three taken two-sides thyroidectomy,and group four taken one or two sides lymph node dissection plus. Group two was easier to become hypocalcemia and their calcium concentration decreased more remarkably, compared with group one. Patients taken two-sides thyroidectomy had the familiar outcome.@*CONCLUSION@#Patients taken lymph node dissection were easier to become hypocalcemia, compared with patients only taken thyroidectomy.

Diagnosis and treatment of primary ectopic thyroid carcinoma: report of 3 cases and literature review / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#Discuss the clinical features of primary ectopic thyroid carcinoma.@*METHOD@#The clinical data of three cases diagnosed of primary ectopic thyroid carcinoma in our department since 1990 were analyzed ret respectively and related literature was reviewed.@*RESULT@#All three patients were young females that had cervical lumps before surgery. The pathology results confirmed the diagnosis of ectopic thyroid papillary carcinoma. All cases had followed up till now and no relapse signs occurred.@*CONCLUSION@#Ectopic thyroid tissue is resulting from developmental defects at early stages of thyroid gland embryogenesis. They can cancerization, the treatment of ectopic thyroid carcinoma is also controversial. Here,we report 3 cases of primary ectopic thyroid papillary carcinoma, all of which were removed by surgery, take thyroxin orally after surgery and have a great prognosis.

The meaning of free sin flap in resection of papilloma of external auditory canal / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the indication of fixing defective epithelium with free skin flap after surgery treatment of papilloma of external auditory canal.@*METHOD@#One hundred and twenty patients suffered papilloma of external auditory canal and treated in our department was selected. The patients was divided into the surgery without skin grafting group and the surgery with skin grafting group according to their own options, surgery with skin grafting group was divided to group (pedicle/perimeter 0.05), indicating that it's not necessary to graft skin. In group B, the difference of two subunits had no statistical significance in tumor recurrence (P > 0.05), after skin-grafting, the epithelial change time reduced significantly (P < 0.05), there were 6 cases emerged stricture of external auditory canal and 8 cases emerged cleaning dysfunction of external auditory canal, had statistical significance between two subunits (P < 0.05).@*CONCLUSION@#Surgery with skin grafting should be choose when the tumor pedicle inhabits 1/3-2/3 of external auditory canal, it might improve the treatment effect significantly and reduce the complication.

Adjustment of levothyroxine during pregnancy in women undergoing thyroid carcinoma surgery / 中华内分泌外科杂志

Objective Hypothyroidism during pregnancy has been associated with impaired cognitive development and increased fetal mortality.In this retrospective study we attempt to identify the timing and adjustment of levothyroxine during pregnancy.Methods 20 women planning pregnancy after thyroidectomy because of thyroid cancer were observed before and throughout their pregnancies.Their thyroid function was measured before conception,and approximately every 4 weeks during pregnancy.The dose of levothyroxine was increased to maintain the thyrotropin concentration at preconception values throughout pregnancy.Results 21 pregnancies occurred in the 20 women and resulted in 20 full-term births.One woman had abortion.Their basal dose was all 100 μg.The dose increased by 12.5 μg a time to target the thyrotropin concentrations (0.1-0.25 mU/ml).The mean levothyroxine requirement increased 50 percent during the first half of pregnancy and plateaued by the 16th week.This increased dose was required until delivery.All the newborns and their mothers were healthy according to the follow-up.Conclusions We propose that women after thyroid cancer surgery should increase levothyroxine dose as soon as pregnancy is confirmed.Thereafter,serum thyrotropin level should be monitored and the levothyroxine dose adjusted accordingly.The adjustment dose is set at 12.5 μg and the maternal thyrotropin concentration is between 0.10 and 0.25 mU/ml,which guarantees healthy growth of fetus while suppresses thyroid tumor growth simultaneously.

A childhood nasopharyngeal carcinoma with huge mass in skull base / 临床耳鼻咽喉头颈外科杂志

UNLABELLED@#The patient chiefly complained about headache and facial pain with recurrent epistaxis during the past two months. The pain started from the teeth and intermittent pinching headache especially on the left side. She also had mild epistaxis which healed itself. Later on the epistaxis became severe which couldn't be easily cured. Her nasopharyngoscopy examination showed a mass in nasopharynx while cranial CT scan indicated a huge mass in nasopharynx with erosion of skull base. Enhanced CT scan showed significant thickness in nasopharynx, upwards which became a huge mass breaking through skull base especially on the left side. Adjacent parapharyngeal space and paranasal sinuses and skull base were widely involved with the enlargement of neck lymph nodes. The chronic mastoiditis, ethmoiditis and maxillary sinusitis were also found.@*DIAGNOSIS@#nasopharyngeal nonkeratinizing squamous cell carcinoma (T4N2M0 stage IV).

Expression and clinical significance of Muc1, p63 protein in diffuse sclerosing variant of papillary thyroid carcinoma and conventional papillary thyroid carcinoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the expression and clinical significance of Muc1, p63 protein in diffuse sclerosing variant of papillary thyroid carcinoma and conventional papillary thyroid carcinoma.@*METHOD@#Immunohistochemistry (SP) was used to detect the expressions of Muc1, p63 protein in 30 samples of DSVPTC (experiment group) and 30 samples of CPTC (control group). Patients in two groups were matched in age, gender, tumor side, tumor size and date of diagnosis.@*RESULT@#(1) The positive rate of Muc1 in DSVPTC and CPTC was 76.67% (23/30) and 53.33% (16/30) respectively, immunohistochemical staining expressed as brown or tan particles in the membrane or the cytoplasm,with a significant difference between the two groups (P < 0.05). The positive rate of p63 in DSVPTC and CPTC was 80% (24/30) and 43.33% (13/30) respectively, immunohistochemical staining expressed as a brown or tan particles in the muclei,with a significant difference between the two groups (P < 0.05). (2) Cervical lymph node metastasis rate in DSVPTC and CPTC was 50% (15/30) and 20% (6/30) respectively, with a significant difference between the two groups (P < 0.05). (3) In All cases,the positive rate of Muc1 in cervical lymph node metastasis group (21 cases) and without metastasis group (39 cases) was 85.71% (18/21) and 53.85% (21/39) respectively,with a significant difference between the two groups (P < 0.05); the positive rate of p63 was 95.24% (20/21) and 43.59% (17/39) respectively,with a significant difference between the two groups (P < 0.01). (4) Spearman rank correlation analysis showed that expression of Muc1 and p63 were positively correlated in both groups(r = 0.530,0. 386, P < 0.05).@*CONCLUSION@#(1) There are high expression of Muc1 and p63 protein in DSVPTC, and relatively low expression in CPTC, DSVPTC have a higher rate of cervical lymph node metastasis at the time of being diagnosed, compared to the CPTC. These results show that DSVPTC is a more biologically aggressive variant of the PTC. (2) Abnormal expression of Muc1 and p63 may be important to promote the progression and metastasis of PTC, thus they can be used as predictors of malignant behavior in PTC. (3) Muc1 and p63 may be synergistically promote proliferation and invasion metastasis of the PTC malignant cell.

Detection of Runx2 mRNA expression using relatively real-time RT-PCR in papillary thyroid carcinoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To relatively detect the Runx2 mRNA expression in papillary thyroid carcinoma (PTC) and thyroid adenoma, then to investigate the role of Runx2 in the development and progression in PTC and the relationship with the micro calcification in PTC.@*METHOD@#The expression of Runx2 mRNA in 14 samples of PTC and 14 samples of thyroid adenoma was examined by relatively real-time RT-PCR.@*RESULT@#The deltaCT value of the carcinoma group and adenoma group was 2.395 +/- 0.302 and 5.028 +/- 1.179 respectively (P0.05), and the adenoma group as well. The carcinoma group was divided into two groups by the size of carcinoma ( or = 1 cm). The deltaCT value was 2.629 +/- 0.300 and 2.212 +/- 0.124 respectively (P0.05).@*CONCLUSION@#The expression of Runx2 mRNA was high in PTC, and was related to the size of carcinoma which was higher in bigger size carcinoma. The role of Runx2 may contribute to the formation of the micro-calcification and the development and progression in PTC and other malignant tumors, such as breast cancer, prostatic carcinoma and osteosarcoma.

The analysis of the calcification in differentiating malignant thyroid neoplasm and the molecular mechanisms for the formation of the calcification / 临床耳鼻咽喉头颈外科杂志

The purpose of this review is to investigate the value of the calcification in differentiating malignant thyroid neoplasm and the molecular mechanisms for the formation of the calcification. Many published reports have proved the presence of calcifications in thyroid neoplasm and calcified nodules in these studies are more frequently malignant than noncalcified nodules. Through viewing the related references, we found that psammoma bodies (PBs), Runx2, osteocalcin, osteopontin, CD44v6 play an important role in the molecular mechanisms in the formation of the calcification in PTC. But further study is required for elucidating the mode of action.

Establishment of a human laryngeal carcinoma Hep-2/5-Fu cell line and the screening of differentially expressed genes / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To establish a Hep-2/5-Fu of human drug-resistant laryngeal carcinoma cell line, and to screen the possible drug resistance-associated genes.@*METHOD@#Hep-2/5-Fu of a human drug resistant laryngeal carcinoma cell line was induced by continuously exposing human laryngeal carcinoma cells to gradually increasing concentrations of 5-Fu. The growth law was observed and the growth curve was protracted. The drug resistance of Hep-2/5-Fu was measured by MTT assay and the drug resistant index RI was calculated. Genes expressed differentially between Hep-2/5-Fu and its parent cell line Hep-2 were screened using a gene chip, and several selected drug resistance associated genes were confirmed by reverse transcription-polymerase chain reaction (RT-PCR).@*RESULT@#Compared with its parental cells, the drug resistance cell line had slower growth rate and larger size. The Hep-2/5-Fu cell line showed cross drug resistance to 5-Fu, cisplatin and vincristine. There were 1210 differentially expressed genes possibly associated with drug resistance by the gene chip screening method. The possible drug resistance-related genes included Cyclin D, IGF-BP3, CASP9, and CDK4/6. The expression of Cyclin D in the Hep-2/5-Fu cell line was 6.5997 times of that in the parent cell line. RT-PCR results were consistent with the gene chip results.@*CONCLUSION@#The altered biological properties of Hep-2/5-Fu may be related to its drug resistance phenotype. Several genes, such as Cyclin D, are possibly involved in the mechanism of drug resistance in this cell line.

The significance of calcification in the thyroid papillary carcinoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the significance of calcification in the thyroid papillary carcinoma.@*METHOD@#Retrospectively analyze 88 cases of thyroid papillary carcinoma.@*RESULT@#There was no association between calcification with age,TSH and TNM. But calcification was related to the size of tumor (P < 0.05). In addition, the level of TSH has no relationship with the size of tumor.@*CONCLUSION@#Calcification especially microcalcification may have significant relationship with thyroid papillary carcinoma and be directly related to the size of tumor. The larger size of tumor implies the higher possibility of calcification.