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Objective:To optimize the preparation technic of Chuanxiong Rhizoma with vacuum steam method, and to investigate the anti-inflammatory and analgesic activity of Chuanxiong Rhizoma decoction pieces with Central Composite Design-Response Surface Method. Methods:Taking the content of ferulic acid as the evaluation index and the moistening temperature, moistening time and vacuum time as the observation indexes, the moistening technic of Chuanxiong Rhizoma was optimized by Response Surface Method, and selected the optimized plan. The anti-inflammatory and analgesic activities of Chuanxiong Rhizoma were investigated by auricle swelling induced by xylene and writhing induced by glacial acetic acid. Results:The optimum vacuum moistening technic was that the softening temperature was 80 ℃, the softening time was 50 min and the vacuum time was 45 min. The content of ferulic acid in Chuanxiong Rhizoma produced by this technic is highand could decreased the times of wrinkle reaction induced by acetic acid in mice, prolonged the latent period, and obviously or partially inhibitied the ear swelling degree induced byxylene in rats. Conclusions:The Response Surface Method technic of Chuanxiong Rhizoma is easy to operate with high accuracy. The vacuum steam treatment was more obvious than traditional technology group. It provides reference for the subsequent production of Chuanxiong Rhizoma decoction pieces and have the certain value for its promotion and application.
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Objective To explore risk factors for posttreatment recurrence of lateral cervical lymph node metastasis in papillary thyroid cancer (PTC).Methods The clinical data of 617 consecutive PTC patients with initial presentation of lateral neck metastasis (N1b) at the time of surgery from 1996 to 2009 in our department were retrospectively reviewed.All of the cases received surgery and postoperative L-thyroxine therapy,81 patients were administered postoperative radioactive iodine adjuvant therapy.The risk factors for recurrence including local recurrence and distant metastasis were determined using both univariate and multivariate analyses considering several clinicopathologic variables.Results The median follow-up period was 93 months,466 and 134 patients were followed up for more than 5 and 10 years respectively.148 (24.0％) patients experienced recurrence with 28 (4.5％) death.Multivariate analyses revealed that age (≥55 years),primary tumor size,the size of metastatic lymph nodes (＞3 cm) were independent risk factors of local recurrence and distant metastasis (P ＜ 0.05).The numbers of metastatic lymph nodes (＞ 10) was the risk factor of local recurrence in patients with N1bPTC (P =0.001;RR =2.022).Conclusion Age,primary tumor size,the size of metastatic LN and the numbers of LN metastases were independent risk factors for recurrence.
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Objective@#To analyze the long-term outcome of patients with pyriform sinus squamous cell carcinoma treated with planned preoperative (chemo-) radiotherapy plus laryngeal function sparing surgery.@*Methods@#Patients with stage Ⅲ/Ⅳ pyriform sinus squamous cell carcinoma treated with planned preoperative (chemo-) radiotherapy plus laryngeal function sparing surgery during 1999 to 2000 were retrospectively analyzed. Data including concurrent chemotherapy or not, postoperative pathological diagnosis, postoperative complications, recurrence and survival were collected. Twenty patients were treated with preoperative radiotherapy while 14 patients with preoperative chemo-radiotherapy.@*Results@#Among 31 cases of postoperative pathological diagnosed as pyriform sinus, 12 (38.7%) cases without tumor residue, 7 (22.5%) cases with severe radiation response and 12 (38.7%) cases with tumor residue. The 5-year cumulative local recurrence rate, regional recurrence rate and distant metastasis rate was 14.5%, 13.7% and 23.5%, respectively. Five-year cumulative overall survival rate and recurrence-free survival rate were 69.6% and 65.4%, respectively. Nine deaths were attributed to distant metastasis (8 cases) and regional recurrence (1 case).@*Conclusion@#Most patients with pyriform sinus squamous cell carcinoma acquire long-term survival after treated with planned preoperative (chemo-) radiotherapy plus laryngeal function sparing surgery, and distant metastasis is the main cause of death.
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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.
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Objective:To determine the compositions of Pingwei microemulsion through the formula screening and optimization, and carry out the pharmacodynamic validation. Methods:Three levels of mixed volatile oil,dregs water extract and glycyrrhizin were determined by single factor investigation. With the ulcer inhibition rate as an indicator,the orthogonal test was carried out to determine the amount of each component in the formula,and the pharmacodynamic validation was performed on the mouse model of gastric ulcer induced by indomethacin and the rat model of ulcer induced by ethanol hydrochloride.Results:The amount of each component in the formula was determined as follows:SFE-CO2mixed volatile oil of Atractylodes Lancea (Thunb.) DC., Magnolia officinalis Rehd. Et Wils. and Pericarpium Citri Reticulatae was 0.8 ml,glycyrrhizin was 60 mg,and the water extract after SFE-CO2extraction of Atrac-tylodes Lancea (Thunb.) DC.,Magnolia officinalis Rehd. Et Wils. and Pericarpium Citri Reticulatae was 2.0 g. Conclusion: The preparation process of Pingwei microemulsion is feasible,and Pingwei microemulsion has a good anti-ulcer effect,equalling to the posi-tive control Sanjiuweitai.
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Objective@#To explore whether early oral feeding after total laryngectomy is safe and effective by evaluating the incidence of pharyngocutaneous fistula (PCF) and the hospital duration. @*Methods@#A retrospective cohort study was conducted, including 52 patients underwent total laryngectomy, plus partial tongue base resection (n=2), partial pharyngectomy (n=1), or pedicle flap (n=2) between January 2012 and October 2017. Patients who had a history of preoperative radiotherapy, chemotherapy or chemoradiotherapy, previous surgery for larynx or pharynx and who had severe complications were excluded. Early oral feeding started between 48 h and 72 h postoperatively, while delayed oral feeding started within postoperative day 8-10. The incidences of PCF in two groups were compared to evaluate whether PCF and early oral feeding was related. Multi-variables analysis was conducted to evaluate risk factors for PCF. @*Results@#PCF rate was 19.2% among all patients, 11.1% in patients with early oral feeding and 23.5% in patients with delayed oral feeding. No significant statistically difference in PCF rate was found between two groups (χ2=0.506, P=0.477). Multi-variables analysis showed that oral feeding time (early or delayed) was not a independent risk factor of PCF (Two classification response variable Logistic regression, P=0.200, OR=0.242, 95%CI[0.028-2.118]). But low preoperative albumin level was observed as an independent risk factor for PCF (P=0.039, OR=0.848, 95% CI [0.726-0.992]). A negative correlation was observed between preoperative albumin level and PCF. And also there was not a significant difference in hospital duration between patients with early oral feeding and delayed oral feeding(U=268, P=0.464). @*Conclusion@#For patients total laryngectomy with no previous history of radiotherapy, chemotherapy, chemoradiotherapy, early oral feeding after surgery is safe and effective.
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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.
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<p><b>OBJECTIVE</b>To analyze the clinical features of familial non-medullary thyroid cancers, and to discuss their management.</p><p><b>METHODS</b>Sixty thyroid cancer patients with familial non-medullary thyroid cancer (FNMTC) history during Sep. 2003 to Sep. 2012 were collected as study group, and another 60 sporadic thyroid cancer patients were randomly chosen as control. We compared the differences of their clinical features.</p><p><b>RESULTS</b>All the patients were diagnosed as thyroid papillary carcinoma. The study group included 40 female and 20 male patients. There were 16 cases in stage T1, 37 in stage T3, and 7 in stage T4. The patients were 21-66-year old ( median age 42-years). The control group included 49 female and 11 male patients. The patients were 24- to 78-year old, and the median age was 45.5 years. 43.3% of the patients in the study group and 18.3% of the patients in the control group had bilateral carcinomas (P = 0.003). There were multifocal lesions in 53.3% of the patients in the study group and 35.0% of the control group, local invasion in 73.3% of the patients in the study group and 55.0% of the control group, and coexisting benign thyroid diseases in 81.7% of the patients of the study group and 50.0% of the control group (P < 0.05 for all). There were cervical lymph node metastases in 60.0% of the patients in the study group and 38.3% in the control group (P = 0.018). In the study group, 32 cases were of parent-offspring type and 28 cases of sibling type. Among the parent-offspring type patients, the median onset age of the first generation offsprings was 58 years, and that of the second generation offsprings was 32 years (P < 0.001).</p><p><b>CONCLUSIONS</b>Familial nonmedullary thyroid cancer, especially in parent-offspring type patients, is more aggressive than sporadic nonmedullary thyroid cancer, and often involves bilateral lobes, has multifocality, and combines with benign thyroid diseases. We recommend a total thyroidectomy for treatment, and to screen all the family members >20 years old, with ultrasonography for early diagnosis and treatment.</p>
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Adult , Aged , Female , Humans , Male , Middle Aged , Carcinoma , Pathology , Carcinoma, Papillary , Case-Control Studies , Lymphatic Metastasis , Thyroid Neoplasms , PathologyABSTRACT
Objective To investigate the optimal methods of detecting micrometastasis of sentinel lymph node(SLN) in papillary thyroid carcinoma(PTC).Methods Data of 51 consecutive PTC patients without clinical evidence of cervical lymph node metastasis were analyzed.They were conducted with SLN localization with blue dye,technetium-labeled sulfur colloid or the combination of them from Aug.2007 to Sep.2010.55 SLNs from 18 cases were selected.No metastasis was found to these 55 SLNs by routine pathological section.The 55 SLNs were serially sectioned at a 50 μm interval and stained by both HE and immunohistochemistry for detecting micrometastasis.Results SLN was successfully identified in all the 51 cases,with SLN identification rate of 100％.Among the 18 cases without metastasis to SLN by routine pathological section,5 cases were found micrometastasis by step sectioning plus immunohistochemically stains.The false negative rate was reduced from 15.4％ by routine pathological section to 2.6％ by step sectioning plus immunohistochemically stains.Conclusion Cytokeratin immunohistochemistry on series sections is a reliable method in detecting SLN micrometastasis in PTC.
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ObjectiveTo evaluate combined radioisotope and methylene blue dye method for identifying sentinel lymph node (SLN) for modified radical neck dissection of papillary thyroid carcinoma (PTC). MethodFifty-one consecutive PTC patients without clinical evidence of locoregional lymph node involvement were enrolled in the study between August 2007 and September 2010.5 h ( rangel.5 - 8 h) before the surgery,one single intratumoral injection of 74 MBq in a volume of 0.4 ml 99mTc -Dextran was administered under ultrasound guidance and 1％ methylene blue dye was injected into the parenchyma surrounding the primary tumor intraoperatively.Preoperative lymphoscintigraphy,intra-operative hand-held gamma probe detecting and blue dyed lymph node were used to identify the SLN.All SLNs were sent for frozen-section and the specimens of routine selective neck dissection were stained with haematoxylin and eosin (H&E). ResultsSLNs were identified in 48 of 51 cases (94.1％ ) with combination method.SLN identification rate were 66.7％by methylene blue dye method and 90.2％by radioisotope method respectively.Final pathologic examination revealed that 30 cases ( 58.8％ ),including 3 cases who had negative SLNs,had lateral neck occult lymph node metastasis.The rate of occult lymph node metastasis in level Ⅱ,level Ⅲ,level Ⅳ and level Ⅴ were 17.6％,52.9％,29.4％ and 0％.Thus,the sensitivity,specificity,accuracy, and positive and negative predictive values of SLN biopsy were 90％, 100％,94.1％,100％ and 87.5％,respectively. ConclusionsSLNB is feasible and safe,the findings correlate with lateral lymph node status.Therefore,SLN biopsy is a good method for estimating the status of lateral lymph node in patients with clinical negative lymph node papillary thyroid carcinoma.