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Thyroid cancer is the most common malignant tumor of the endocrine system, and its incidence is increasing year by year showing younger trend. The pathological types of thyroid cancer are papillary carcinoma, follicular carcinoma, medullary carcinoma and undifferentiated carcinoma. Medullary thyroid carcinoma (MTC) and papillary thyroid carcinoma (PTC) are the two common types of thyroid cancer. Since MTC and PTC have different biological origins, invasiveness and prognosis. Therefore, the occurrence of both medullary carcinoma and papillary carcinoma is very rare and rarely reported in China and abroad and the treatment is challenging. In this paper, we review the pathogenesis, ancillary tests, diagnosis and treatment of this disease, with the aim of providing reference for clinical treatment of patients with medullary thyroid carcinoma complicated by papillary carcinoma.
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In recent years, clinical applications of robotic thyroid surgery have been gradually promoted with the continuous improvement of the da Vinci robotic surgical system. Unlike traditional open surgery, robotic thyroid surgery mainly adopts remote access, which has many advantages, such as magnified high-definition 3D view and hand vibration stabilization. The rates and causes of postoperative complications differ due to different approaches, view angles, and operation sequences. This paper presents the literature on both transoral and bilateral areolar axillary approaches in robotic thyroid surgery, focusing on five common complications under both approaches, including laryngeal recurrent nerve injury and hypoparathyroidism, to provide theoretical support for the standardization of robotic thyroid surgery.
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Objective:To investigate the dose-effect relationship of alfentanil inhibiting cardiovascular responses to tracheal intubation when combined with midazolam and etomidate.Methods:American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ patients of either sex, aged 18-64 yr, with body mass index<32 kg/m 2, undergoing elective operation under general anesthesia with endotracheal intubation, were enrolled in this study.Midazolam 0.025 mg/kg was intravenously injected for adequate sedation, and 5 min later mean arterial pressure and heart rate were recorded for 3 consecutive times at an interval of 3 min, and the mean value was calculated and served as the baseline value.Etomidate 0.3 mg/kg was intravenously injected, and alfentanil and rocuronium 0.6 mg/kg were intravenously injected when bispectral index value < 60, and then 1.4 min later tracheal intubation was performed.The dose of alfentanil was determined by the Dixon′s up-and-down method.The initial dose of alfentanil was set at 20 μg/kg.The dose of alfentanil in the next patient was determined according to the development of cardiovascular responses to tracheal intubation, and the ratio between the two successive doses was 1.0∶1.1.The cardiovascular response was defined as as positive when the maximum value of mean arterial pressure or heart rate increased by ≥20% of the baseline value within 2 min after endotracheal intubation.Probit method was used to determine the ED 50, ED 95 and 95% confidence interval of alfentanil inhibiting cardiovascular responses to tracheal intubation. Results:When combined with midazolam and etomidate, the ED 50 (95% confidence interval) of alfentanil inhibiting cardiovascular responses to tracheal intubation was 21.343 (19.105-24.516) μg/kg, and the ED 95 (95% confidence interval) was 25.043 (22.983-48.983) μg/kg. Conclusions:When combined with midazolam and etomidate, the ED 50 and ED 95 of alfentanil inhibiting cardiovascular responses to tracheal intubation are 21.343 and 25.043 μg/kg, respectively.
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Objective:To evaluate the dose-response relationship of alfentanil in combination with midazolam-etomidate inhibiting cardiovascular responses to laryngeal mask airway implantation in elderly patients.Methods:American Society of Anesthesiologists Physical Status Ⅰ or Ⅱ patients of either sex, aged 65-85 yr, with body mass index of 20-30 kg/m 2, undergoing elective operation under general anesthesia, were enrolled in this study.Midazolam 0.025 mg/kg was intravenously injected for adequate sedation, 5 min later mean arterial pressure and heart rate were recorded for 3 consecutive times at 3-min interval, the mean value was collected and considered as the baseline value.Etomidate 0.2 mg/kg was intravenously injected, and alfentanil and rocuronium 0.6 mg/kg were intravenously injected when bispectral index value < 60.A laryngeal mask airway was inserted at 1.4 min after intravenous injection of alfentanil, and mechanical ventilation was performed.The dose of alfentanil was determined by the Dixon′s up-and-down method.The initial dose of alfentanil was set at 6.83 μg/kg.The dose of alfentanil in the next patient was determined according to the development of cardiovascular response to laryngeal mask airway placement.If the cardiovascular response to laryngeal mask airway placement occurred, the dose was increased for the next patient, and if cardiovascular response to laryngeal mask airway placement did not occur, the dose was decreased, and the ratio between the two successive doses was 1.0∶1.1.The cardiovascular response to laryngeal mask airway placement was defined as increase in maximum mean arterial pressure or maximum heart rate by≥20% of baseline values within 2 min after laryngeal mask airway placement.The median effective dose (ED 50), 95% effective dose (ED 95) and 95% confidence interval (95% CI) of alfentanil inhibiting cardiovascular responses to laryngeal mask airway placement in elderly patients were calculated by the Probit method. Results:When combined with midazolam and etomidate, the ED 50 (95% CI) of alfentanil inhibiting the cardiovascular responses to laryngeal mask airway placement in elderly patients were 5.605 (5.036-6.082) μg/kg, and the ED 95 (95% CI) were 6.625 (6.125-9.763) μg/kg. Conclusions:When combined with midazolam and etomidate, the ED 50 and ED 95 of alfentanil inhibiting the cardiovascular responses to laryngeal mask airway placement are 5.605 and 6.625 μg/kg, respectively, in elderly patients.
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Objective:To investigate the clinical effectiveness of da Vinci robotics in thyroid surgery.Methods:304 cases of robotic thyroid surgery performed by the same experienced surgeon at the Department of Thyroid Surgery, China-Japan Union Hospital of Jilin University during the period from Apr. 3, 2020 to Nov. 5, 2021 were prospectively included, and the operation time, operation type, postoperative drainage, postoperative hospital stay, total number of lymph node dissection and number of positive lymph nodes, operation complications, and postoperative pain level of all patients were counted. The learning curve was plotted by applying the moving average method, divided into the initial stage and the mature stage, and the differences in surgical outcomes and surgical complications between the two stages were compared. SPSS 23.0 was applied for statistical analysis, and t-test and Mann-Whitney U test were used for comparison of measurement data, and χ2 test was used for comparison of count data. Result:All surgeries were completed successfully without conversion to open cases, including 29 males and 275 females, with a mean age of (33.8±8.9) years and a range of 27-41 years. The mean body mass index (BMI) was (22.9±3.6) kg/m 2 and a range of 20.5-25.4 kg/m 2. The median operative time was 140 min, the median postoperative drainage was 52.5 ml, and the median postoperative hospital stay was 3 days. The mean number of lymph nodes cleared was 4.4±3.5, and the mean number of positive lymph nodes was 0.9±1.7. The incidence of postoperative transient laryngeal nerve (RLN) injury was 3.3%, and the incidence of transient hypoparathyroidism was 0.7%. A significant decrease in operative time occurred after the 26th case and subsequently stabilized. Compared with the initial stage of the learning curve, the mature stage had a shorter operative time (146.0±36.5 vs 198.7±56.7 min, P<0.001) , a lower incidence of temporary RLN injury (2.5% vs 11.5%, P<0.05) , and a lower percentage of benign tumor surgery (12.2% vs 26.9%, P<0.05) . Conclusion:The application of robotic technology in thyroid surgery is safe and reliable, and its successful implementation should follow a corresponding learning curve, from easy to difficult, with different surgical approaches selected according to the patient’s condition, wishes, and the operator’s technical level.
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The incidence and mortality rates of cholangiocarcinoma (CCA) are increasing constantly, and it is of great importance to explore new therapeutic targets. Ferroptosis, a unique pattern of cell death caused by iron-dependent cellular oxidative injury, is closely associated with iron metabolism and oxidative stress imbalance in cancer and has become a research hotspot in the field of tumor. This article introduces the mechanism of ferroptosis and the research advances in ferroptosis involved in the development and progression of CCA, and it is pointed out that the regulatory mechanism of ferroptosis has an important clinical value in the malignant progression of CCA.
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Lung cancer has become the leading cause of death from malignant tumors worldwide. At the same time, statistics show that the incidence and mortality of lung cancer are increasing year by year. Because patients with lung cancer do not have typical symptoms in the early stage, this directly leads to the majority of patients who are already at advanced stage at the time of diagnosis, and the prognosis is not good. How to diagnose lung cancer early and accurately and find patients with potential risks and predict the prognosis is of great significance for the formulation of further treatment plans. In recent years, the field of artificial intelligence has been booming. As a branch of artificial intelligence, machine learning could learn efficiently from complex and large amounts of data. Besides, the learned model has good generalization ability. These characteristics can take greatly advance on the research about lung cancer
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Objective: To investigate the effectiveness of tibio-talo-calcaneal arthrodesis with full thread headless compression screws via combined minimal incisions. Methods: Between January 2012 and December 2016, 36 patients (36 feet) with ankle diseases underwent tibio-talo-calcaneal arthrodesis with parallel double thread headless compression screws via minimal anterior and lateral oblique incisions. There were 14 males and 22 females with an average age of 53.8 years (range, 18-76 years). There were 19 cases of left feet and 17 cases of right feet. There were 21 cases of talar necrosis, 7 cases of post-traumatic arthritis, 3 cases of rheumatoid arthritis, 2 cases of tuberculosis infection (inactive), 1 case of talar absence, 1 case of Charcot’s disease, and 1 case of pigmented villonodular synovitis of ankle and subtalar joints. Preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS) score were 53.7±2.5 and 5.9±0.2, respectively. The operation time was recorded and the wound healing and complications were observed. The bone healing was assessed by X-ray film and CT scanning. The function and pain of joint were evaluated by AOFAS and VAS scores. Results: The mean operation time was 49.8 minutes (range, 33-82 minutes). Incision infection occurred in 1 patient (2.8%) at 3 weeks after operation, and recovered after debridement. The other incisions healed by first intention without complications. Thirty-five patients were followed up with an average of 18.5 months (range, 12-29 months). Imaging examination showed fusion of the ankle and subtalar joints with an average fusion time of 10.9 weeks (range, 8-15 weeks). After 1 year, the AOFAS score (84.7±0.6) and VAS score (0.3±0.1) were significantly higher than preoperative scores ( t=12.596, P=0.000; t=30.393, P=0.000). Conclusion: It is an effective surgical method of tibio-talo-calcaneal arthrodesis with full thread headless compression screws via combined minimal incisions for end-stage ankle disease because of the less complications incidence and the higher postoperative fusion rate.
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Objective To investigate the long-term effects of modified Bristow-Latarjet operation for treatment of recurrent inferoanterior shoulder dislocation.Methods A retrospective case series study was done on 90 patients with recurrent inferoanterior shoulder dislocation treated by modified Bristow-Latarjct procedure from January 2001 to January 2016.There were 72 males and 18 females,with an average age of 36.8 years.There were 59 fight shouders and 31 left shoulders,with dislocation for 4-32 times (mean,13 times).Shoulder instability severity index score (ISIS) was 3-10 points (mean,6.4 points).The duration of disease was 6-26 months (mean,13 months).The operation methods were coracoid lateral incision with modification,rotator cuff interval approach,double hollow compression screw fixation,and bone congruent-arc technique in standing position.Clinical evaluation was done on postoperative recurrence of shoulder joint dislocation/subluxation,bone healing evaluated by X-ray and CT,Rowe score,simple shoulder function Test (SST) score,shoulder osteoarthritis score (Samilson-Prieto),bodv side shoulder external rotation angle and the subscapularis muscle strength.Results All patients were followed up for 1-15 years (mean,5.6 years).The rate of redislocation or subluxation during follow-up was zero.All transpositions of the coracoid got bone healing at postoperative 3-6 months.The Rowe score was increased significantly from (45.6 ± 9.4) points preoperatively to (92.6 ± 3.5) points postoperatively (P ＜0.01);SST score was increased significantly from (5.6 ± 1.2)points preoperatively to (9.6 ± 2.8) points postoperatively at final follow-up) (P ＜ 0.01).Samilson-Prieto score was mild in 2 patients (2％).The body side shoulder external rotation angles were (56.7 ± 13.9) ° preoperatively and (54.6 ±14.1) ° postoperatively (P ＞ 0.05).With regards to subscapularis strength,the lift-off and belly-press in injured side were (4.9 ± 0.9) kg and (4.4 ± 1.0) kg,respectively (P ＞ 0.05).Lift-off and belly-off in normal side were (5.1 ± 0.5) kg and (4.7 ± 1.1) kg,respectively (P ＞ 0.05).Conclusion The modified Bristow-Latarjet operation is a reproducible and effective technique that can restore shoulder stability,with advantages of sound bone healing,free shoulder external rotation,low incidence of shoulder joint osteoarthritis,remaining of myodynamia under scapula and hence has long-term effects and is worth of clinical applicaiton.
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Objective To explore the changes of plasma level of adrenomedullin(ADM)in congenital heart disease patients with heart failure,analyze the relationship between ADM and the severity of heart failure, assess the value of plasma ADM in the diagnosis of CHF and evaluate the cardiac function in pediatric patients with congenital heart disease. Methods 46 patients with CHD were enrolled according to the modified Ross Score. They were divided into three groups:mild CHF group(n = 16)and moderate CHF group(n = 18)and severe CHF group(n = 12). 25 matched normal children were enrolled as controls. Plasma ADM was measured with radioimmunoassay(RIA)and the contents of NT-proBNP were determined among all the patients. LVEF and E/A in all of them were also detected. The relationship between plasma ADM level and modified Ross Score and echocardiographic cardiac functional indexes was analyzed. Results Plasma ADM was positively correlated with modified Ross Score(r = 0.65,P < 0.01). Plasma ADM concentration in the severe CHF group was significantly higher than that of mild and moderate CHF group(P < 0.01),and plasma ADM concentration in the mild CHF group was higher than that in the control group(P<0.05).Plasma ADM was negatively correlated with LVEF and E/A(r =-1.05,P < 0.01). Conclusion Plasma ADM level could be used to assess cardiac function and diag-nose CHF with CHD.
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OBJECTIVE:To establish a method for the simultaneous determination of chlorogenic acid,vitexin glucoside,vi-texin rhamnoside,vitexin,rutin and hyperoside in Crataegus pinnatifida. METHODS:With reference peak of vitexin glucoside, HPLC was conducted to calculate the relative correction factor(RCF)of chlorogenic acid,vitexin glucoside,vitexin rhamnoside, vitexin,rutin and hyperoside,then the contents of above-mentioned 5 components in C. pinnatifida were calculated. The column was Agilent ZORBAX SB C18 with mobile phase of 0.1% formic acid-acetonitrile-tetrahydrofuran (gradient elution) at a flow rate of 1.0 ml/min,the detection wavelength was 350 nm,column temperature was 30 ℃,and the injection volume was 10 μl. RE-SULTS:The linear range was 12.50-400.0 μg for chlorogenic acid(r=0.999 8),25.00-800.0 μg for vitexin glucoside(r=0.999 9), 31.25-1 000.0 μg for vitexin rhamnoside(r=0.999 9),6.470-260.0 μg for vitexin(r=0.999 9),2.50-80.0 μg for rutin(r=0.999 8) and 9.375-300.0 μg for hyperoside(r=0.999 9);RSDs of precision,stability and reproducibility tests were lower than 2.0%;re-coveries were 99.2%-103.9%(RSD=1.6%,n=6),97.9%-100.8%(RSD=1.2%,n=6),99.2%-100.8%(RSD=0.5%,n=6), 97.3%-101.3%(RSD=1.5%,n=6),98.0%-103.0%(RSD=1.9%,n=6)and 95.5%-101.5%(RSD=2.2%,n=6). RCFs of vitex-in glucoside with chlorogenic acid,vitexin rhamnoside,vitexin,rutin and hyperoside were 1.119,1.009,0.706,1.063 and 0.830, respectively. CONCLUSIONS:The method is simple with good precision,stability and reproducibility,and it can be sued for the simultaneous determination of 6 components in C. pinnatifida.
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Objective Toinvestigatethechangesofcognitiveimpairmentandcerebralhemodynamics inpatientswithacutelacunarcerebralinfarctionwithin2weeksafteronset.Methods Nineteenpatients with lacunar cerebral infarction (a patient group)were consecutive enrolled in the study. Twenty-three sex-and age-matched inpatients without ischemic cerebrovascular disease or healthy volunteers of outpatient department over the same period were used as a control group. The cerebral hemodynamic features were evaluated with transcranial Doppler (TCD)breath-holding test and single photon emission computed tomography (SPECT)resting + adenosine stress imaging. Simultaneously,the neuropsychological tests were performed,the Montreal cognitive assessment (MoCA)was performed including executive capacity, structural capacity,memory (including auditory memory,visual memory,and logic memory ),information processing speed,and visual-spatial ability. Results (1 )There were no significant differences in the years of education,hypertension,diabetes,hyperlipidemia,coronary heart disease,and smoking between the 2 groups (all P>0. 05). Compared with the control group,there were significant differences in the MoCA score,visual memory,executive function,structural capacity,and information processing speed of the patient group (all P<0. 05). (2)19 patients completed the SPECT resting + load test (12 in the control group and 7 in the patient group). There were significant differences in the uptake ratio (UR)in the right basal ganglia (8. 91[-2. 48 - 5. 87]and -6. 21 [-10. 39 - 5. 42 respectively])and left frontal lobe UR (11. 62 [2. 93-16. 87]and 1. 04 [-10. 17- 3. 82]respectively)between the patient group and the control group (P<0. 05). (3)26 patients completed the breath-holding test + head-up tilt table test (n=13 in each group]. The vascular motor reactivities were 13 ± 5 on the left and 21 ± 7 on the right, and the breath-holding indexes were 0. 66 ± 0. 26 on the left and 1. 0 ± 0. 4 on the right in the patient group;the vascular motor reactivities were 24 ± 11 on the left and 30 ± 9 on the right,and the breath-holding indexes were 1. 21 ± 0. 57 on the left and 1. 5 ± 0. 4 on the right in the control group. There were significant differencesbetweenthe2groups(P<0.05).Conclusion Attheearlystageoflacunarinfarction,the patients have presented varying degrees of cognitive impairment and the changes of cerebral hemodynamics.
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Objective To explore the situation of HIV infection among currently married MSM and the features of related sexual behavior on both males and females in Gansu province.Methods By "Place the recruitment" methodology,297 currently married MSM were recruited in Lanzhou and Tianshui cities of Gansu province.Participants filled in a questionnaire and underwent HIV antibody testing.SPSS 17.0 software was used to analyze the result and differences between positive HIV MSM and negative HIV MSM.Possible factors that influencing the HIV infection among currently married MSM were analyzed.Results Among those currently married MSM,the HIV positive rate was 4.7％.94.6％ participants admitted having had anal sex with male partners in the past 6 months while 30.9％ participants had more than 2 male sex partners in the past week,with the rate of condoms use as 45.9％.69.0％ of the participants had sex with females in the past 6 months,with the rate of condoms use as 24.9％.59.0％ of the participants did not use condoms when having sexual relations with parmers.Among HIV positive married MSM,the rate of AIDS awareness was 64.3％ and 7.1％ of them ever having had HIV testing last year and 92.9％ of them had anal sex with males.In the recent 6 months,14.3％ had ever used condom each time when having anal sex with males.35.7％ of the cases ever having had sex with females,with the rate of condom use as 60.0％.Conclusion HIV prevalence,low AIDS awareness,low HIV rate of testing and high rate of unprotected sex behavior with either sex partners were found among currently married MSM in Gansu province.Results of this study called for behavioral intervention and HIV testing measures should be taken immediately.
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Objective To investigate the effectiveness of femoral troehanter reconstruction and artificial femoral head replacement in treatment of unstable intertrochanterie fractures in the elderly pa- tients. Methods Femoral trochanter reconstruction and artificial femoral head replacement was done on 106 patients with unstable intertrochanterie fractures. There were 45 males and 61 females, at age range of 80-105 years (average 88 years). Most of patients slipt in the room and got fractured. According to the Evans classification, there were 31 patients with type ⅢA fractures, 45 with type ⅢB and 30 with type IV. We used 4 kinds of methods to reconstruct the fracturad imertrochanters : (1) shape of" ∞ " ten- sion band fixation after intertrochanterie fracture reduction;(2) wire loop fixation of the lesser troehanter around proximal femur;(3)defect within the femoral ealear was filled with bone cement and remodeled; (4) for patients with relative intact base of femoral neck, the intertrochanterie fracture was transformed in- to femoral neck fracture and the femoral ealear was fixed with femoral prosthesis stem. Results All the operations continued successfully, with duration of the operation for 45-70 minutes (average 55 minutes). No artificial femoral head dislocation occurred during hospitalization. Of all, 79 patients were followed up for 6-48 months (average 16 months). No Late loosening, dislocation or infections occurred, with total excellence rate of 87.3%. Conclusions For elderly patient with unstable intertrochanterie fractures, reconstruction of femoral intertrochant and artificial femoral head replacement can restore the proximal femoral anatomy, maintain stability of the hip joint and help early functional exeereise, as can reduce ease fatality rate and improve the quality of life.