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In general, the volume of a parathyroid adenoma is small and rarely causes local symptoms of compression. This case of huge parathyroid adenoma presents with dyspnea as the chief complaint and does not have a series of symptoms of hyperparathyroidism, which deserves our attention.
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PURPOSE: The present study aimed to investigate correlations between uridine glucuronosyltransferase 2B7 (UGT2B7) -161 single nucleotide polymorphism C to T (C>T) and the occurrence of cardiotoxicity in Chinese breast cancer (BC) patients undergoing epirubicin/cyclophosphamide-docetaxel (EC-D) adjuvant chemotherapy. MATERIALS AND METHODS: 427 BC patients who had underwent surgery were consecutively enrolled in this prospective cohort study. All patients were scheduled to receive EC-D adjuvant chemotherapy regimen, and they were divided into UGT2B7 -161 CC (n=141), UGT2B7 -161 CT (n=196), and UGT2B7 -161 TT (n=90) groups according to their genotypes. Polymerase chain reaction was performed for determination of UGT2B7 -161 genotypes. Cardiotoxicity was defined as an absolute decline in left ventricular ejection fraction (LVEF) of at least 10% points from baseline to a value less than 53%, heart failure, acute coronary artery syndrome, or fatal arrhythmia. RESULTS: LVEF values were lower at cycle (C) 4, C8, 3 months after chemotherapy (M3), M6, M9, and M12 compared to C0 (all p < 0.001), in BC patients undergoing EC-D adjuvant chemotherapy. Cardiotoxicity was recorded for 4.2% of the overall population and was lowest in the UGT2B7 -161 TT group (1.1%), compared to UGT2B7 -161 CT (3.1%) and UGT2B7 -161 CC (7.8%) group (p=0.026). Multivariate logistic regression revealed that UGT2B7 -161 T allele could independently predict a low occurrence of cardiotoxicity in BC patients undergoing EC-D adjuvant chemotherapy (p=0.004). CONCLUSION: A UGT2B7 -161 T allele serves as a potential biomarker for predicting a low occurrence of cardiotoxicity in BC patients undergoing EC-D adjuvant chemotherapy.
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Humans , Alleles , Arrhythmias, Cardiac , Asian People , Breast Neoplasms , Breast , Cardiotoxicity , Chemotherapy, Adjuvant , Cohort Studies , Coronary Vessels , Drug Therapy , Genotype , Glucuronosyltransferase , Heart Failure , Logistic Models , Polymerase Chain Reaction , Polymorphism, Single Nucleotide , Prospective Studies , Stroke Volume , UridineABSTRACT
Objective To detect the oxidative and anti-oxidative imbalance of Hashimoto′s thyroiditis (HT) with specific thyroid function through specific serum.Methods 41 patients with normal thyroid function of Hashimoto′s thyroiditis and 43 healthy controls were enrolled in our hospital from May 2016 to May2017.Through specific serum tests, such as derived active oxygen metabolism (d-ROM) and biological antioxidant potential (BAP), advanced glycation end products (AGE) and advanced oxidized protein products (AOPP) were used to assess oxidative stress.Results The levels of d-ROM and AGEs were significantly increased (P＜0.05) and BAP was significantly lower in both groups compared with HT patients (P＜0.001).In univariate analysis, serum TSH, TgAb and TPOAb were significantly associated with d-ROMs (P＜0.05).HDL-C, serum TSH, TgAb and TPOAb were significantly associated with BAP (P＜0.05).Total cholesterol and LDL-C were significantly associated with AGEs (P＜0.05).Multivariate analysis showed that serum TPOAb was a predictor of d-ROMs (P＜0.001), BAP (P＜0.001), and AGEs (P=0.003).In addition, HDLC was also an independent predictor of BAP levels (P=0.012, R2=2.354, 95％CI:1.191-5.433).While LDL-C was an independent predictor of AGEs (P =0.004, R2=1.102, 95％CI:0.915-1.253).Conclusion HT patients increased oxidant, antioxidants decreased.And AGEs were significantly higher, AGEs levels can be used as a new HT oxidative stress a reliable biomarker.
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Objective To investigate and analyze the experience of planting and maintaining implantable venous access ports(IVAP) in management of post-operative breast cancer patients. Methods Breast cancer pa-tients receiving IVAP after surgery from Mar. 2011 to Jun. 2014 were retrospectively analyzed. The relative com-plications were documented and summarized during implanting operation. Results 468 patients received IVAP, among whom 451 patients underwent piercing implantation via right internal jugular vein, 15 patients underwent piercing implantation via right subclavian vein, and 2 patients underwent piercing implantation via left internal jugular vein. The mean cathe tering leng th was 12.8 cm for patients receiving IVAP via right internal jugular vein, ranging from 12 to 15 cm. Thereinto, 30(6.4%) patients experienced shot-term complications including 16 cases of puncture difficulty, 5 cases of accidental arterial puncture, 2 cases of extravasation, 2 cases of blood aspiration dif-ficulty and 5 cases of arrhythmia. Three cases had long-term complications as the following:one case of catheter-re-lated infection, one case of catheter lost, and one case of incision rupture. Conclusions IVAP is a safe and effec-tive intravenous infusion device. It is crucial to choose individualized implanting access and length by professional surgical team.
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Objective To investigate the significance of sonographic patterns of thyroid calcification in diagnosis of thyroid nodule.Methods 235 patients with 355 thyroid nodules were retrospectively analyzed.Nodule calcification size,distribution and pattern were observed.Results The incidence of calcification in benign and malignant nodules was 30.3％ (89/294)and 73.7％ (45/61) respectively.The difference had statistical significance(x2 =24.3,P ＜0.01).The rate of microcalcification in cancer was 47.5％ (29/61),higher than that in benign one 3.1％ (9/294)(x2 =99.1,P ＜ 0.01).Coarse calcification in benign nodules and malignant lesion was 27.2％ (80/294)and 26.2％ (16/61)respectively.The difference had no statistical significance(x2 =0.42,P ＞0.05).Conclusions Microcalcification of thyroid nodules is a specific index for thyroid carcinoma.Any type of sonographically detected calcification represents risk of malignancy.Not only microcalcification,these cases should raise the suspicion of malignancy in coarse calcification,especially involving a solitary nodule and irregular shape.
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Objective To investigate the value of intraoperative neuromonitoring(IONM) for preventing recurrent laryngeal nerve(RLN) injury in thyroid surgery.Methods 1087 consecutive patients undergoing thyroid surgery at Wuhan Central Hospital from Oct 2010 to Dec 2012 were evaluated.277 cases(the study group) underwent thyroidectomy with RLN identification by naked eye plus IONM.810 cases(the control group)underwent thyroidectomy with RLN identification by naked eye only.Results In the control group,733 RLNs (90.49％,733/810)were successfully identified and 77 RLNs were failed to be identified.In the study group,all the 277 RLNs(100％,277/277)were successfully identified.28 cases had postoperative temporal RLN injury,among whom 26 cases were in the control group and 2 cases were in the study group.18 cases in the control group and 2 cases in the study group recovered in 2 weeks after surgery.The rest recovered in 2 months after surgery.RLN injury rate was significantly lower in the study group than in the control group.There was no significant difference in RLN injury for low-risk surgical patients between the 2 groups; however,the study group had advantages in RLN injury than the control group for high-risk patients.Conclusions IONM in thyroid surgery can improve the recognition rate of RLN during thyroidectomy.IONM can significantly reduce the incidence of RLN injury,especially in high-risk surgery.
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Objective To summarize the experience of how to preserve parathyroid glands and their function in thyroidectomy. Methods Data of 872 patients with thyroid carcinoma who entered our hospital from May. 2006 to Oct. 2009 were retrospectively analyzed. Results Parathyroid damage rate was 2. 06% (18/872)and permanent hypoparathyroidism was 0. 23% (2/872). All occurred in total thyroidectomy. Conclusions Preserving blood supply for parathyroid and avoiding direct contusion or misresection are important for preventing hypoparathyroidism in thyroidectomy. Calcium supplementation should be given to patients with obviously low serum calcium level after surgery to prevent permanent hypoparathroidism.
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Objective To discuss the operative technical details in reducing complications after thyroid diseases reoperation, especially how to choose operative method and preserve laryngeal recurrent nerve and parathyroid gland. Methods The study protocols of 183 patients undergoing reoperation for thyroid disease from Jan. 2000 to Mar. 2009 were reviewed. There were 115 cases of benign and 68 cases of malignant thyroid diseases to observe the postoperative complications. Results The rates of temporary and permanent laryngeal recurrent nerve injury were 4.92% (9/183) and 1.64% (3/183), respectively. The rates of temporary and permanent hypocalcemia were 4.37% (8/183) and 0.55% (1/183), respectively. The rate of postoperative internal hemorrhage was 0.55%(1/183). Conclusions The thyroid reoperation was more difficult and can seduced a high rate surgical complication. The thyroid reoperation can be successfully performed if the operators could pay attention to the operative skill.
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Objective To investigate the anatomic feature and exposing methods of recurrent laryngeal nerve(RLN) in thyroid surgery. Methods The data of 327 cases of thyroid tumor were analyzed retrospectively. The anatomic feature, injury and prevention of RLN were discussed. Of all the cases, 293 RLNs (242 cases) were anatomically exposed. Results The temporary injury rates of RLN was 1.65% (4/242) in the exposed group and 8.23% (7/85) in the unexposed group with a persistent injury rate of 2.35%(2/85). The differences of temporary injury rates and persistent injury rates between the two groups were statistically significant (P<0.05). 67.23% (197/293) of the RLNs had two branches before entering larynx, 61.09%(179/293) of RLNs were posterior to the inferior thyroid artery and 31.39% (92/293) anterior to the inferior thyroid artery, 4.09% (12/293) passed through the bifurcation of inferior thyroid artery, and 4. 13% (10/293) were not related to the inferior thyroid artery. The incidence of non-recurrent laryngeal nerve (inferior laryngeal nerve) was 0.68% (2/293). Conclusions The anatomic relation of RLN is relatively complicated along its journey. The injury of RLN could be reduced with designed exposal during the thyroid surgery.
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Objective To investigate the operation technique, feasibility and clinical outcome of endoscopic clearance of axillary lymph node with liposuction(E-ALNC) in 32 patients with breast cancer. Methods From January 2005 to December 2008, a total of 32 patients with breast cancer were treated with E-ALNC.The clinical data of the patients were analyzed retrospectively and compared with those of 46 patients who have undergone traditional axillary lymph node clearance(T-ALNC)during the same period. Results Both groups were Ⅰ～Ⅱ breast cancer. There were no interim open surgery, massive bleeding, subcutaneous emphysema,fat embolism and other complications in E-ALNC. There was no significant difference between E-ALNC and T-ALNC in lymph number removed(15.5 in E-ALNC) and operation time(80 min in E-ALNC). But there was less bleeding (380ml) and lower postoperation complication rate in E-ALNC. Conclusions The E-ALNC and T-ALNC can have the same effect in the breast conserving surgery.The method makes patients attain a physiological and psychological minimal invasiveness. Besides assuring the quality of axillary lymph node clearance, the method can reduce the occurrence of surgical complication and improve the patients'life quality. E-ALNC can replace the routine surgery and can be carried out in the qualified hospitals.
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Objective To investigate the pathogenic constitution of thyroid nodular diasease and it' s di-agnosis and treatment.Methods A retrospective analysis was performed on data of 576 patients accepted hospi-tal therapy with thyroid nodular diasease from January 2004 to June 2008.Results Definite diagnosis of all easeswere made by surgery biopsy or fine needle aspiration-cytology.529 eases were benign lesions, another 47 eases were malignant lesions.Condusions Ultra-sound , FNAC and frozen sections have important value in differenti-al diagnosis for the thyroid nodules, nodular goiter is most common, and which have a close relationship with thy-roid carcinoma.Regular surgical resection would reduce the recurrence of thyroid nodular diasease and avoid missed diagnosis for thyroid carcinoma.
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Aspergillus niger lipases are important biocatalysis widely used in industries for food processing and pharmaceutical preparation. High-level expression recombinants can lead to cost effective lipase large scale production. Full length gene synthesis is an efficient measure to enhance the expression level of the gene. In order to reduce the non-specific binding between oligonucleotides and bases mutation caused by the complicate secondary structure of DNA and excessive PCR amplification, a frequently phenomenon in one-step gene synthesis, we used a two-step method including assembly PCR (A-PCR) and digestion-ligation step to synthesis Aspergillus niger lipase gene lipA. Assisted by DNA2.0 and Gene2Oliga software, we optimized the codon usage and secondary structure of RNA and induced enzyme sites Cla I (237 site) and Pst I (475 site) into the gene. In the first step, fragments F1 (237 bp), F2 (238 bp) and F3 (422 bp) were separately synthesized by assembly PCR. In the second step, fragments F1, F2 and F3 were separately digested by Cla I and Pst I, and then ligated into a full length lipA gene. Two-step method efficiently enhanced successful ratio for full-length gene synthesis and dispersed the risk for gene redesign. The synthesized gene was cloned into pPIC9K vector and transferred into Pichia pastoris. After methanol inducement, the expression level of the codon optimized lipA-syn gene reached 176.0 U/mL, 10.8-fold of the original lipA gene (16.3 U/mL) in Pichia pastoris GS1115. The recombinant offers the possibility for lipase large-scale production.
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Base Sequence , Carboxylic Ester Hydrolases , Genetics , Cloning, Molecular , Genes, Synthetic , Genetic Engineering , Methods , Genetic Vectors , Genetics , Molecular Sequence Data , Pichia , Genetics , Metabolism , Recombinant Proteins , GeneticsABSTRACT
Objective To discuss the appropriate excision area of the thyroid microcacinoma. Methods 46 patients with thyroid microcarcinoma confirmed by pathology result were analyzed, in which 28 patients under-went thyroid lobectomy of lesion side and subtotal lobectomy of the other;8 patients were treated with subtotal lo-bectomy of both side;3 patients were treated with lobectomy of one side and partial resection of the other, while the rest 7 patients underwent the surgery of lesion side lobectomy and neck dissection plus subtotal lobectomy of the other side. Results No complicaitons were observed. All patients were follow-uped for 1 ～ 5 years. 2 patients were disgnosed as recurrance 3 years and 4 years after the operation respectively. The rest survived without recur-rance. Conclusions The appropriate surgery approach for thyroid microcacinoma might be lesion side lobectomy and subtotal lobectomy of the other side.