Clinicopathological analysis of superior mediastinal lymph node metastases in medullary thyroid carcinoma / 中华肿瘤杂志

Objective: To investigate the clinicopathological characteristics of superior mediastinal lymph node metastases (sMLNM) in medullary thyroid carcinoma (MTC). Methods: This retrospective analysis enrolled the patients who were treated for sMLNM of MTC in our hospital from May 2012 to January 2021. All patients were suspected of sMLNM due to preoperative imaging. According to the pathological results, the patients were divided into two groups named sMLNM group and the negative superior-mediastinal-lymph-node group. We collected and analyzed the clinical features, pathological features, pre- and post-operative calcitonin (Ctn), and carcinoembryonic antigen (CEA) levels of the two groups. Logistic regression analysis was used to analyze risk factors, and receiver operation characteristic (ROC) curves were drawn to determine the optimal cut-off values of preoperative Ctn and preoperative CEA for predicting sMLNM. Results: Among the 94 patients, 69 cases were in the sMLNM group and 25 cases were in the non-SMLNM group. Preoperative Ctn level (P=0.003), preoperative CEA level (P=0.010), distant metastasis (P=0.022), extracapsular lymph node invasion (P=0.013), the number of central lymph node metastases (P=0.002) were related to sMLNM, but the multivariate analysis did not find any independent risk factors. The optimal threshold for predicting sMLNM by pre-operative Ctn is 1500 pg/ml and AUC is 0.759 (95% CI: 0.646, 0.872). The sensitivity, specificity, positive predictive value, and negative predictive value of diagnosis are 61.2%, 77.3%, 89.1%, 39.5%, respectively. In patients who underwent mediastinal lymph node dissection through transsternal approach, the metastatic possibility of different levels from high to low were level 2R (82.3%, 28/34), level 2L (58.8%, 20/34), level 4R (58.8%, 20/34), level 3 (23.5%, 8/34), level 4L (11.8%, 4/34). Postoperative complications occurred in 41 cases (43.6%), and there was no perioperative death in all cases. 14.8% (12/81) of the patients achieved biochemical complete response (Ctn≤12 pg/ml) one month after surgery, 5 of these patients were in sMLNM group. Conclusions: For patients who have highly suspicious sMLNM through imaging, combining with preoperative Ctn diagnosis can improve the accuracy of diagnosis, especially for patients with preoperative Ctn over 1 500 pg/ml. The superior mediastinal lymph node dissection for the primary sternotomy should include at least the superior mediastinal levels 2-4 to avoid residual lesions. The strategy of surgery needs to be cautiously performed. Although the probability of biochemical cure in sMLNM cases is low, nearly 40% of patients can still benefit from the operation at the biochemical level.

Potential risk factors predicting perioperative mortality in patients with gastric pull-up reconstruction / 中华耳鼻咽喉头颈外科杂志

Objective@#To investigate the potential risk factors for the death of patients underwent gastric pull-up reconstruction following total pharyngoesophagectomy during perioperative periods.@*Methods@#A total of 71 patients, including 64 males and 7 females, aged from 35 to 72 years old, with hypopharyngeal or cervical esophageal carcinoma, who underwent gastric pull-up reconstruction after pharyngoesophagectomy between October 2008 and October 2017, were reviewed retrospectively. Seventeen factors which may have potential influence on the mortality of patients during perioperative periods were evaluated by single factor Logistic regression analysis, and then those factors with obvious difference in statistics were further analyzed by multi-factor Logistic regression.@*Results@#The rate of perioperative mortality was 9.9% (7/71). Single factor Logistic regression analysis indicated that the age of patients, abnormal electrocardiogram, TNM stages, alanine aminotransferase and D-Dimer changes, postoperative bleeding were risk factors for the death of patients(P values were 0.023, 0.004, 0.026, 0.021, 0.015 and 0.002, respectively). Multi-factor Logistic regression showed that postoperative bleeding and D-Dimer changes were 2 independent risk factors for perioperative death(P=0.021 and 0.047, respectively).@*Conclusions@#Many potential factors may affect the perioperative mortality of patients underwent gastric pull-up reconstruction following total pharyngoesophagectomy. Postoperative bleeding and significantly elevated D-Dimer level were independent risk factors for the death of patients, indicating poor prognosis.

Clinical analysis of secondary cervical lymph node dissection in papillary thyroid carcinoma / 中华肿瘤杂志

Objective@#To investigate the value of secondary cervical lymph node dissection in papillary thyroid carcinoma (PTC).@*Methods@#PTC patients with recurrence re-operated in a previously dissected area at our hospital during 2000-2016 were included in this analysis. Patients were divided according to the operative interval of 6 months. The level and number of lymph node metastasis and the number of lymph node dissection were analyzed to calculate the ratio of lymph node metastasis.@*Results@#A total of 336 PTC patients received 360 side lateral cervical lymph nodes dissection. The ratio of recurrence in unilateral lateral neck is 92.9%(312/336). The ratio of recurrence in multiple levels (more than two regions) were 47.5% (171/360). The recurrence ratio of level Ⅱ, Ⅲ, Ⅳ and Ⅴ were 55.6%(200/360), 44.2%(159/360), 59.7%(215/360) and 10.3%(37/360), respectively. Lymph node metastases were inclined to level Ⅱ (33.6%) and Ⅳ (35.8%). The mean number of lymph node dissection and metastasis in the group of operative interval ≤ 6 months was 26.56 per case and 4.37 per case, respectively. The mean number of lymph node dissection and metastasis in the group of operative interval >6 months was 16.80 per case and 3.20 per case, respectively. The number of lymph node dissection and metastasis between these two groups were significantly different (P=0.001, P<0.001).@*Conclusions@#Lymph node metastasis of PTC patients with secondary cervical lymph node dissection are inclined to level Ⅱ and level Ⅳ. Moreover, multi-level metastasis is not rare. Level Ⅱ and level Ⅳ require more attention in the first operation. Most of the patients undergo reoperation because of residual lymph nodes from the previous treatment. Normalization and completeness of the initial dissection are particularly important to PTC patients.

Short-term complications in reconstruction of the postoperative defects with free jejunum graft in patients with pharyngeal, laryngeal or cervical esophageal cancers / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the clinical effects and short-term complications of using free jejunum graft (FJG) to reconstruct the defects by resections of pharyngeal, laryngeal or cervical esophageal cancers.@*METHOD@#Fifty-eight cases of pharyngeal, laryngeal or cervical esophageal cancers were reconstructed with FJG. All cases were analyzed retrospectively.@*RESULT@#The success rate of FJG transplantations was 91.4% (53/58). The incidence of post-operative short-term complication was 43.1% (25/58), which was not related to age or BMI. The most common complication was anastomotic leakage (18.9%), which was not related to per-operative radiation therapy. However, BMI > 25 cases had significantly higher incidence of anastomotic leakage than BMI ≤ 25 cases (P = 0.009). The second and third most common complications were respiratory system complications (10. 3%) and FJG necrosis (8. 6%). Para-operative death rate was 3.4% (2/58). Two-year overall survival rates of hypopharyngeal cancer and cervical esophageal cancer were 49% and 67% respectively. The group with no short-term complications had a slightly better survival rate than the group with short-term complications from the Kaplan-Meier curve, but there was no significant difference (P = 0.103).@*CONCLUSION@#FJG is ideal to reconstruct cervical digestive tract circumferential defects with a high success rate and a low mortality. However, the post-operative complication rate is high. Intensive observation, early detection and timely treatment of complications are crucial.

Epithelial-myoepithelial carcinoma of salivary glands, report of 23 cases / 中国耳鼻咽喉头颈外科

OBJECTIVE Epithelial-myoepithelial carcinoma (EMC) is a rare malignant neoplasm of the salivary glands. The aim of the study was to investigate the diagnosis, treatment and prognosis of EMC of the parotid gland.METHODSThe clinical data of 23 cases of EMC of the parotid gland from 1999 to 2013 were analyzed retrospectively. Of all the patients, 13 cases received radical surgery only, 9 cases received postoperative radiotherapy, and one case received postoperative chemotherapy. Kaplan-Meier survival curve was used to analyze the clinical data. RESULTSThe overall survival rate at 5-year was 81.0% and the overall no recurrence survival rate at 5-year was 67.3%. The recurrence rate was 39.1% (9/23). The 5-year no recurrence survival rate of radical surgery group was 55.6%, compared with 80.0% in the combined modality therapy group, there was no significant deference (χ2=2.232, P=0.135).CONCLUSIONThe postoperative recurrence rate of EMC is high. Radical surgery could be the main treatment of EMC, when the surgical margin couldn't be achieved, adjuvant radiotherapy or chemotherapy might be helpful.

Management of vascular crisis of free flaps after reconstruction of head and neck defects caused by tumor resection / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To discuss the management of vascular crisis of free flaps after reconstruction of head and neck defects caused by tumor resection.</p><p><b>METHODS</b>A total of 259 cases of free flap reconstruction performed in the Cancer Hospital of Chinese Academy of Medical Sciences from 2010 to 2013 were retrospectively analyzed, including 89 cases of anterolateral thigh flaps, 48 cases of radial forearm flaps, 46 free fibula flaps, 5 cases of inferior epigastric artery perforator flaps, 5 cases of free latissimus dorsi flaps, one case of lateral arm flap, and one case of medial femoral flap. The surveillance frequency of free flaps was q1h on post-operative day (POD) 1, q2h on POD 2 and 3, and q4h after POD 3. Vascular crises were reviewed for analysis.</p><p><b>RESULTS</b>The incidence rate of vascular crisis was 8.1% (21/259), with 15 males and 6 females. The average age was 54.8 years old (17-68), and the average time of vascular crisis was 100.8 h post-operation (3-432). There were 7 cases of free jejunum flaps and 14 dermal free flaps. Seven of these 21 cases with vascular crisis were rescued by surgery. The success rate of salvage surgery within 72 hours from the primary operation was 54.5% (6/11), significantly higher than that of salvage surgery performed later than 72 hours from primary operation (10.0%, 1/10, P=0.043). There were 14 cases of flap necrosis, two of which died of local infection.</p><p><b>CONCLUSION</b>Early detection of vascular crisis can effectively improve the success rate of salvage, so as to avoid the serious consequences caused by free flap necrosis.</p>

Clinical features and comprehensive treatment of skull base osteosarcoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyze the clinical features and treatment of skull base osteosarcoma.</p><p><b>METHODS</b>The clinical data of 18 patients with skull base osteosarcoma, who were admitted to the CAMS Cancer Hospital from January 2005 to November 2013, were retrospectively analyzed. The patients were followed up by telephone, outpatient review and other means. Fifteen patients were followed up, 4 cases received surgery only, and 11 cases received surgery with adjuvant chemotherapy and/or radiotherapy. Kaplan-Meier survival curve analysis was used to analyze the clinical data and Log rank method was used for verification.</p><p><b>RESULTS</b>Nine patients died among the 15 patients who were followed up for 3-103 months (mean 25.0 months): seven patients died of local recurrence, and two patients died of distant metastasis, and six patients were still alive. Four patients received surgery only, with a median survival time of 25.0 months, and 11 patients received comprehensive treatment, with a median survival time of 47.0 months (P = 0.02). Five patients received sub-total resection, with a mean survival time of 47.0 months, and 10 patients received total resection, with a mean survival time of 45.0 months (P = 0.37). The 1- and 2-year recurrence rates were 46.6% and 68.9%, respectively. The overall 1-, 2-, 3- and 5-year survival rates were 82.4%, 61.8%, 36.0% and 36.0%, respectively, with a median survival time of 30.0 months.</p><p><b>CONCLUSIONS</b>To compare the long bone and head and neck osteosarcoma with skull base osteosarcoma, the skull base osteosarcoma has a lower total resection rate, a higher recurrence rate, and a poorer prognosis. Radical surgery and comprehensive treatment are appropriate for skull base osteosarcoma.</p>

Analysis of the diagnosis and treatment of myoepithelial carcinoma of the parotid gland: report of 17 cases / 中华肿瘤杂志

<p><b>OBJECTIVE</b>Myoepithelial carcinoma (MC) is a rare malignant neoplasm of the salivary gland. The aim of this study was to analyze the diagnosis, treatment and prognosis of MC of the parotid gland.</p><p><b>METHODS</b>The clinicopathological data of 17 cases of MC of the parotid gland treated in our hospital from 1999 to 2013 were analyzed retrospectively. Of all the 17 patients, 9 cases received radical surgery only, 5 cases received postoperative radiotherapy, 2 cases received preoperative radiotherapy, and one case received chemotherapy. The survival rate was calculated by Kaplan-Meier analysis.</p><p><b>RESULTS</b>Among the 17 patients, 11 patients had post-operative recurrence (11/17, 64.7%), Of these 11 cases, 5 cases (45.5%) had recurrence within one year after the first operation. During the follow-up for 12-180 months (median 50 months), six cases died (two patients died of distant metastases and 4 cases died of local recurrence). The overall 1-year, 2-year and 5-year survival rates were 94.1%, 74.2% and 64.9%, and the overall 1-year, 2-year and 5-year recurrence-free survival rates were 70.6%, 48.1% and 40.1%, respectively.</p><p><b>CONCLUSIONS</b>Radical surgery is the main treatment modality for myoepithelial carcinoma of the parotid gland. For the patients with extensive lesions or after palliative surgery, adjuvant radiotherapy or chemotherapy might be helpful. However, its therapeutic efficacy remains to be proved.</p>

Nearby perforator flaps as alternative choices for anterolateral thigh flap when lacking useful perforator / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the proposal using nearby perforator flaps as alternative reconstructive choices for anterolateral thigh (ALT) flap when lacking useful perforator.</p><p><b>METHODS</b>From August 2010 to August 2012, 8 cases with head and neck cancer were found lacking reliable perforator during ALT flap elevation, a tensor fascia latae (TFL) flap or an anteromedial thigh (AMT) flap was used to complete the reconstruction.</p><p><b>RESULTS</b>All 8 alternative flaps were successfully harvested, other donor sites were not needed. Flap harvest time was 50-85 min. Of 5 TFL flaps, pedicle lengths were 6-10 cm, and the diameters of the arteries and veins were 2.5-3.0 mm and 2.5-3.5 mm respectively. Of 3 AMT flaps, pedicle lengths were 10-15 cm, the rectus femoris branch was used as pedicle in 1 flap, with artery and vein more than 1.0 mm in diameter, and the descending branch of the lateral circumflex femoral artery was used as pedicle in other 2 flaps, the diameters of the arteries were 3.5 and 3.0 mm respectively, the diameters of the veins were 3.5 mm. The donor sites were directly closed in 7 cases and skin graft was performed in another case. All the flaps were alive and no complication was found in the donor sites.</p><p><b>CONCLUSION</b>TFL or AMT flap is an good alternative to ALT flap lacking useful perforator.</p>

Minimally invasive endoscopy-assisted neck dissection to treat lateral cervical metastasis of thyroid papillary carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>Traditional open surgery for lateral neck dissection for patients with papillary thyroid carcinoma (PTC) leaves an unsightly scar. It is necessary to apply small incision to complete lateral neck dissection with endoscopy-technique for PTC and to evaluate its feasibility and safety.</p><p><b>METHODS</b>Between March 2010 and May 2011, 6 cases of PTC with no definite lymph node metastasis at level II-IV and 12 cases of PTC at T1-T4 with definite lymph node metastasis at level II-V received minimally invasive endoscopy-assisted lateral neck dissection. After accomplishing thyroidectomy and central compartment dissection, ipsilateral level II-IV,VI orII-VI dissection via small neck incision was performed.</p><p><b>RESULTS</b>This procedure was carried out successfully in all 18 patients. The incision was 5 cm every patient. Postoperative pT1 was 5 cases, pT2 5 cases, pT3 6 cases, pT4 2 cases, pN0 5 cases, N1b 13 cases. Mean operative time for lateral neck dissection was 3.6 hours (ranging 2.5-5.0 hours). No significant blood loss or complications occurred. Thirteen patients showed lymph node metastases in both central or lateral neck. The mean number of harvested nodes was 33.1 (ranging 16-61). No residual or recurrent disease was found in 2-3 years follow-up time.</p><p><b>CONCLUSION</b>Minimally invasive video-assisted comprehensive neck dissection for metastatic papillary thyroid carcinoma is feasible and safe with excellent cosmetic results.</p>

Fatal hemorrhage following surgery for head and neck carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the surgical management of fatal hemorrhage following head and neck surgery for cancer.</p><p><b>METHODS</b>The clinical data of 32 cases of fatal hemorrhage following head and neck surgery from 1976 to 2008 in our department were analyzed retrospectively.</p><p><b>RESULTS</b>Hemorrhage was caused by carotid blowout in 20 cases. The carotid ligation was performed in 13 cases, only 6 cases got long-term survival. In 12 cases, hemorrhage was caused by tracheo-innominate artery fistula, only 2 cases received surgical management, and no long-term survivors.</p><p><b>CONCLUSION</b>Fatal hemorrhage following head and neck surgery is an uncommon but frequently fatal complication, and the successful management of it depends on early diagnosis and correct treatment.</p>

Parathyroid glands are differentiated from lymph node by activated-carbon particles / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To probe into an new methods preserving parathyroid gland of patients with thyroid carcinoma.</p><p><b>METHODS</b>Thirty-six patients with thyroid carcinoma that primary treated were random divided into two groups: trial group and control group. Emulsion of activated-carbon particles was injected into the thyroid gland of trial group patients. After thirty minutes, central compartment dissection was performed in the all patients. The black stained tissue in the dissection specimen of trial group was separated. Total lymph node, metastasis lymph node and parathyroid gland in the black stained tissue, and non-black stained tissue in the central compartment dissection specimen of trial group and central compartment dissection specimen of control group were counted respectively.</p><p><b>RESULTS</b>Nineteen and twenty central compartment dissection was performed in trial group and control group respectively. There are 177 lymph nodes included 83 metastasis lymph nodes in the black-stained tissue of central compartment dissection specimen of trial group. No parathyroid gland was found in the black-stained tissue. Nine lymph nodes included 2 metastasis lymph nodes and 7 parathyroid glands were found in the non-black stained tissue of central compartment dissection specimen of trial group. There were 124 lymph nodes included 80 metastasis lymph nodes and 8 parathyroid glands in central compartment dissection specimen of control group. There are statistic difference between the amount of lymph node in black stain tissue and that of control group (t = 0.340, P = 0.003). Rate of staining lymph node were 95.2 percent.</p><p><b>CONCLUSIONS</b>Lymph node of VI group can be stained black by activated carbon particles, and parathyroid gland cannot be stained black. Maybe, parathyroid gland can be preserved by removing the black stain lymph node and retaining the non-black stained tissue.</p>

The effect of angiotensin-(1-7) on the mRNA expression of PDGF and TGF-beta1 in the kidney of diabetic rats / 中国应用生理学杂志

<p><b>AIM</b>To study the effect of angiotensin-(1-7) on the kidney of diabetic rats by observing the mRNA expression of PDGF and TGF-beta1.</p><p><b>METHODS</b>SD rats were divided into three groups: Group C (uni-nephrectomy control group), Group D (diabetic model control group), Group T (Ang-(1-7) treated group). We evaluated blood glucose,urea nitrogen, creatinine and urine albumin excretion respectively, studied the renal morphology by light microscope, and detected the gene expression of PDGF, TGF-beta1 in renal tissue by RT-PCR technique.</p><p><b>RESULTS</b>There was significant difference between the group D and T about the RW/BW, renal morphology, the total urine protein and the mRNA expression of PDGF and TGF-beta1.</p><p><b>CONCLUSION</b>Ang-(1-7) can relieve the renal process of diabetic rats.</p>

Clinical analysis of dermatofibrosarcoma protuberans in head and neck / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the prognosis of dermatofibrosarcoma protuberans (DFSP) in head and neck after deferent treatment.</p><p><b>METHODS</b>The clinical data of 28 cases of DFSP in head and neck from 1982 to 2005 were analyzed retrospectively. Eleven cases were treated with wide excision, and 17 with limited excision. Twenty four cases had surgical resection alone (S), and 4 preoperative or postoperative radiotherapy (S + R) of 40-65 Gy. Eighteen cases received immediate reconstruction.</p><p><b>RESULTS</b>The overall recurrence rate was 21.4% (6/28), the recurrence rate of wide excision group was 0 (0/11), compared with 35.3% (6/17) in the limited excision group (P = 0.033); the recurrence rate of S + R group was 0 (0/4), compared with 25.0% (6/24) in S group, but there was no significant deference (P = 0.357). The overall 5-year survival rate was 88.9%. The 5-year recurrence free survival rate was 100% in wide excision group, compared with 59.6% in the limited excision group (chi2 = 3.933, P = 0.047).</p><p><b>CONCLUSIONS</b>Wide excision could significantly reduce the recurrence rate of DFSP in head and neck, when the adequate margin couldn't be achieved or the excision margin was positive, adjuvant radiotherapy might be helpful. The immediate reconstruction was necessary when the defect was large.</p>

Effect of wortmannin on endothelial cell proliferation and migration induced by high glucose Müller cell conditioned medium / 中华病理学杂志

<p><b>OBJECTIVE</b>To investigate the effect of wortmannin on endothelial cells proliferation and migration induced by high glucose Müller cell conditioned medium (HGMCM).</p><p><b>METHODS</b>Immunofluorescence, flow cytometry and Boyden chamber migration models were used to analyze the effect of wortmannin on endothelial cells.</p><p><b>RESULTS</b>50 nmol/L wortmannin could significantly inhibit the proliferation and migration of endothelial cells induced by HGMCM. The percentage of endothelial cells in S phase was obviously decreased [from (37.82 +/- 0.57)% to (21.91 +/- 0.23)%, P < 0.01], while there was an increase in the percentage of cells in G(0)/G(1) phase [from (54.57 +/- 1.19)% to (65.59 +/- 0.41)%, < 0.01] and G(2)/M phase (< 0.05).</p><p><b>CONCLUSION</b>Wortmannin can inhibit proliferation and migration of endothelial cells induced by HGMCM, suggesting that wortmannin carries an anti-angiogenetic ability in diseased retina.</p>

Studies on the expression of type Ⅲ collagen in abdominal aortic aneurysm tissues and normal aortic tissues / 中国普通外科杂志

Objective To investigate the expression of type Ⅲ collagen in abdominal aortic aneurysm tissues and normal aortic tissues. Methods RT PCR and immunohistochemistry were applied to detect the expression of type Ⅲ collagen in abdominal aortic aneurysm (AAA) tissues( n =5) and normal aortic (NA) tissues( n =3) . Results Expression of type Ⅲ collagen was increased in AAA group compared with normal group with AAA/NA= 7 251( P

Progress of the methods for inducing animal model of abdominal aortic aneurysm and researches on the etiology / 中国普通外科杂志

This paper reports the methods of inducing animal model of abdominal aortic aneurysm(AAA) and the research on etiology.The formation of AAA is the result of cooperation of multifactors such as genetic and biochemistric facfors.Different animal models of AAA can provide a possibility in researching the etiology and pathogenesis of AAA etc, and useful in judging the therapy and prognosis .