Analysing the risky factors of central lymph node metastasis in papillary thyroid microcarcinoma / 国际外科学杂志

Objective To evaluate the relationship between clinicopathological features and central lymph nodes metastasis in patients with papillary thyroid microcarcinoma (PTMC),and aim to provide an appropriate operation in clinic.Methods The clinical data of 536 patients undergoing surgical treatment in Department of Thyroid Surgery,the First Affiliated Hospital of Zhengzhou University from January 2015 to December 2017,who had pathologically confirmed popillary thyroid microcarcinoma (PTMC) were retrospectively analyzed.Thyroidectomy and isthmectomy with central compartment neck dissection were performed in all patients.The patients were divided into two groups according to whether there existed central lymph node metastasis,and compared the differences of gender,age,number of cancer lesions,tumor breakthrough envelope,BRAFV600E gene mutation,and tumor maximum diameter in the central lymph node metastasis,respectively,by t-test x2-test.Univariate logistic regression analysis and multivariate binary logistic regression analysis were conducted to find risky factors.Results There existed difference between two groups by completing the gender,age,the BRAFV600E gene mutation and maximal tumor diameter(P ＜ 0.05).Univariate logistic regression analysis indicated that gender (P =0.046),age (P ＜ 0.01),maximal tumor diameter(P ＜0.01) and the BRAFV600E gene mutation(P =0.016) were significant predictors for central lymph nodes metastasis.And multivariate binary logistic regression analysis revealed that the rate of lymph node metastasis significantly increased in cases of larger tumor diameter(P ＜0.01),BRAFV600E gene mutation(P =0.035) and ageing below 45 years old (P ＜ 0.01).Conclusions The treatment for central lymph node metastasis of PTMC should be different considering elements including BRAF600E gene mutation prophylactic,ageing below 45 years old and larger tumor diameter.Therefore central lymphadenectomy should be performed when the primary lesion was resected.

Significance and expression of metdherin in gastric adenocarcinoma and its regulating mechanism of invasion and migration / 国际外科学杂志

Objective This study aimed at observing expression and clinical significance of metadherin in gastric adenocarcinoma and exploring the potentially regulating mechanism of metadherin in invation and migration of gastric cancer.Methods Expressions of metadherin and E-cadherin in primay lesion of gastric cancer were detected by immunohistochemistry and their correlation to clinicopathologic characteristics and prognosis were analyzed by Chi-square tests.Transwell assay and wound healing assay were applied for the ability of invasion and metastasis in gastric cancer cells.Then,the down-regulatied metadherin expression in MKN45 cells by RNA interference (siRNA) was carried out and furthermore,the regulation role of metadherin in epithelial-mesenchymal transition was analyzed also in invasion and migration of gastric cancer cells.Results The positive expression of metadherin was correlated to invading depth (P =0.029),lymph node metastasis (P =0.001),TNM stage (P =0.014) and inhibiting E-cadherin expression (P =0.001).The patients with positive metabherin shared poorer prognosis.Furthermore,the down-regulated metabherin in MKN45 cells would result in the increasing expression of E-cadherin,as well as decreasing expression of N-eadherin,Slug and Snail.At the same time,the abilities of invasion (P =0.027) and migration (P =0.008) of MKN45 cells was decreased.Conclusion metabherin induces EMT in metastasis of gastric adenocarcinoma via activating either Slug or Snail but not twist,which would result in the poorer prognosis.

Comparison of efficacy of Oxaliplatin combined with Tegafur Gimeracil Oteracil Potassium Capsule and mFOLFOX6 method in the treatment of gastric cancer with liver metastasis / 国际外科学杂志

Objective To compare the efficacy and influence on the immune function of oxaliplatin combined with tegafur gimeracil oteracil potassium capsule and mFOLFOX6 method in the treatment of gastric cancer with liver metastasis.Methods One hundred and thirty-four gastric cancer with liver metastasis patients who underwent treatment from Jan.2014 to Jan.2016 in Yulin First Hospital were selected as the participants and randomly divided observation group (67 cases) and control group (67 cases).The control group was treated by mFOLFOX6 method,while the observation group was treated by oxaliplatin combined with tegafur gimeracil oteracil potassium capsule.After treatment,the curative effects were evaluated.The life quality in each group as performed by KPS method before the treatment and in every period of treatment.Before and after the treatment,the levels of CD3 +,CD4 +,CD8 + and CD19 + were detected in two groups and the toxicity was compared.The SPSS 22.0 software was used to analyze relevant data,the measurement data was described by (x ± s) and using t-test,the enumeration data was described by percentage,using the Chi-square test.Results The total effective rate was 52.2％ in the observation group,higher than the 38.8％ in the control group (P ＜ 0.05).After the third and fourth course of treatment,the karnofsky perfomance status score were (81.3 ± 9.7) and (83.2 ± 9.9),were significantly higher in the observation group than which in the control group (P ＜ 0.05).After the treatment,the levels of CD3 +,CD4+,CD8+ andCD19+ were (54.21 ±6.38)％,(24.11 ±2.41) ％,(21.33±3.16) ％ and (7.18 ±1.13) ％ in the observation group,and higher than the control group (P ＜ 0.05).During the treatment,there were no serious toxicity occurs in the patients and the rates of toxicity were significantly lower in the observation group than which in the control group (P ＜ 0.05).Conclusion Oxaliplatin combined with tegafur gimeracil oteracil potassium capsule has a better effect and safety for therapy in the treatment of gastric cancer with liver metastasis than mFOLFOX6.

Research of preoperative D-dimer value in patients with gastric cancer in judging gastric cancer metastasis and assessing prognosis / 国际外科学杂志

Objective To explore the value of preoperative D-dimer in patients with gastric cancer in judging gastric cancer metastasis and assessing prognosis.Methods Clinicopathological data of 132 patients with gastric cancer in the First Affiliated Hospital of Anhui Medical University between Jan.2010 and Jan.2011 was analyzed retrospectively in this study.All patients were divided into two groups according to the cutoff value (1.465 mg/L)of D-dimer and the relationships between D-dimer and clinicopathological data were determined by chi-square test.Moreover,the association of preoperative D-dimer and the prognosis was analyzed by Kaplan-Meier analysis and Log-rank test.Univariate and multivaritate Cox model were used to analyze the factors which might affect the survival of the patients and significant independent factors.Results A total of 132 patients were enrolled in this study in accordance with the inclusion criteria.D-dimer was positively correlated with the depth of invasion (x2 =4.996,P ＜ 0.05),age (x2 =4.311,P ＜ 0.05) and distant metastasis of gastric cancer (x2 =16.641,P ＜0.01),but not with thc gcndcr,lymph node metastasis,tumor size,the degree of differentiation and TNM stage (P ＞ 0.05).The mean D-dimer level was (1.39 ± 0.7) mg/L in distant metastasis patients and (0.97 ±0.83) mg/L in non distant metastasis patients (P =0.023),the mean plasma D-dimer level in patients alive at the 5 years after the surgery was (0.78 ± 0.58) mg/L,which was significantly lower than the amounts determined for the deceased patients (0.75 ± 0.58) mg/L (P ＜ 0.01).The Kaplan-Meier curves showed that the patients with gastric cancer had a longer time in the low D-dimer group than in the high D-dimer group,showing a significant difference between the two groups (P ＜ 0.01).Univariate analysis showed that the overall survival rate was significantly correlated with the gender,D-dimer,tumor size,the depth of invasion,lymph node metastasis and TNM stage (P all ＜ 0.05).The D-dimer was proved to be independent risk factor for the prognosis of gastric cancer by multivariate analysis(P ＜ 0.05).Conclusion According to the analysis,D-dimer may be valuable biomarker for metastasis patients,besides,D-dimer was an independent prognostic factor for patients with gastric cancer.

Clinical analysis of risk factors for central compartment lymph node metastasis in stage cNO papillary thyroid microcarcinoma and preventive dissection / 国际外科学杂志

Objective To discuss the clinical characteristics for central compartment lymph node metastasis in stage cNO papillary thyroid microcarcinoma and significance and feasibility of preventive dissection,aimed to provide reference for clinical treatment.Methods Reviewed the clinical data of 277 patients with stage cNO papillary thyroid microcarcinoma from Jul.2011 to Dec.2015 underwent surgery in the Department of General Surgery of Lianyungang East Hospital.Evaluated the necessity of prophylactic central lymph node dissection.Adopted chi square test and Logistic regression to analyze its relationship with patients' gender,age,tumor number,tumor size,enveloped infiltration,single and bilateral tumor.All 277 patients underwent primary radical resection with ipsilateral central lymph node dissection.The specimen of resection was analyzed by routine pathology.Results The positive rate of thyroid papillary microcarcinoma lymph node metastasis was 36.8 ％ (102/277).The elements of male patients (P =0.023),age ＜ 45 years (P ＜ 0.001) and tumor diameter ＞ 0.5 cm (P =0.019)had high positive rate.The multivariable analysis showed that male patients (OR =2.63,P ＜ 0.001),age ＜ 45 years (OR =2.25,P =0.016),tumor diameter ＞ 0.5 c m (OR =2.13,P =O.009) were independent risk factors for CLN metastasis.Forty-three (15.5％) cases had transient parathyroid function.No Permanent recurrent nerve paralysis and hyperparathyroidism occurred in this group.Conclusions Prophylactic central lymph node dissection is helpful for accurate staging of tumor classification and risk assessment,has important significance,on the follow-up of patients after treatment of choice.For male patients,age ＜ 45,tumor diameter ＞ 0.5 cm,enveloped infiltration,the central compartment lymph node dissection may be necessary.

Relationship between BRAFV600E gene and TERT promoter mutations with cervical lymph node metastasis in papillary thyroid carcinoma / 国际外科学杂志

Objective To clarify the role of BRAFV600E and TERT promoter mutations in cervical lymph node metastasis in papillary thyroid carcinoma.Methods The data of 432 patients with thyroid papillary carcinoma who underwent surgery from February 2017 to September 2017 at the First Affiliated Hospital of Zhengzhou University were analyzed retrospectively.The mutation of BRAFV600E and TERT promoter was detected by Sanger sequencing.The effect of BRAFV600E and TERT on cervical lymph node metastasis in patients with papillary thyroid carcinoma was analyzed by Chi-square test.Results The mutation rates of BRAFV600E and TERT promoter were 77.8％ (336/ 432) and 5.3％ (23/432) respectively in 432 papillary thyroid carcinoma patients.The probability of cervical lymph node metastasis in patients with BRAFV600E mutation was significantly higher than that in non-mutation patients (P ＜ 0.05).The probability of cervical lymph node metastasis in patients with TERT promoter mutation was significantly higher than that in non-mutated patients (P ＜ 0.05).Patients with both BRAFV600E and TERT promotermutation had a significantly higher incidence of cervical lymph node metastases than patients with the BRAFV600E mutation alone (P ＜ 0.05).Conclusions The mutations of BRAFV600E and TERT promoter are closely relevant to the occurrence of cervical lymph node metastasis in papillary thyroid carcinoma.Preoperative fine-needle aspiration cytology and postoperative routine pathological molecular diagnosis can help clinicians to develop a more rational treatment strategy,and a more accurate assessment of the risk of relapse.

Diferencias de protección frente al riesgo biológico laboral en función del tamaño de la empresa / Differences of occupational biohazard protection risk in relation to company size

Objetivo Obtener información sobre el nivel de exposición y protección de los trabajadores a los agentes biológicos laborales, en el sector sanitario, granjas, industria cárnica, laboratorios, plantas de tratamiento de residuos, industria alimentaria y centros veterinarios valorando sus diferencias en relación al tamaño de la empresa. Método Se realizó un estudio en el que participaron 590 trabajadores pertenecientes a 59 empresas españolas en las que se pasó un cuestionario inicial con 3 preguntas dirigidas a las empresas contestadas por los responsables de prevención y otro cuestionario con 34 preguntas para ser contestado por los trabajadores expuestos. Se realizó una validación mediante análisis del alfa de Cronbach global del segundo cuestionario para valorar la consistencia interna y fiabilidad de los cuestionarios. Resultados La muestra definitiva obtenida fue de 518 trabajadores de 51 empresas en las que existía exposición a agentes biológicos. El cuestionario obtuvo un alfa de Cronbach superior a 0,7. Se encontraron diferencias significativas en la gestión del riesgo biológico laboral en función del tamaño de la empresa (p-valor<0,05). Conclusiones Los resultados obtenidos ofrecieron una adecuada consistencia interna del cuestionario. Por otro lado la exposición laboral a agentes biológicos es un factor que debe tenerse en cuenta puesto que no está desarrollada por completo porque tanto las empresas como los profesionales de la prevención no tienen herramientas disponibles que permitan su fácil realización y por lo tanto la gestión de los riesgos biológicos general no es adecuada.(AU)

Objective To obtain information on the level of exposure and protection of workers to biological agents working in the health sector, farms, meat industry, laboratories, sewage treatment plants, food industry and veterinary centers, valuing their differences in relation to the size of the company. Method A study in which 590 workers belonging to 59 Spanish companies. An initial questionnaire with 3 questions was sent to companies and answered by those responsible for prevention, and another questionnaire with 34 questions to be answered by exposed workers was also sent. Validation was performed by analysis of overall alpha of the second questionnaire to assess the internal consistency and reliability of Cronbach of the questionnaires. Results The final sample included 518 workers in 51 companies in which there was exposure to biological agents. The questionnaire obtained a Cronbach's alpha greater than 0.7. Significant differences in biological risk management work depending on the size of the company (p-value <0.05) were found. Conclusions Our results provide an adequate internal consistency of the questionnaire. Furthermore occupational exposure to biological agents is a factor to be taken into account since it is not fully developed. This is because neither businesses nor prevention professionals have tools available that allow easy implementation, and, therefore, management of overall biological hazards is inadequate.(AU)