Experience in the prevention and treatment of lymphatic leakage after scarless endoscopic thyroidectomy-lateral neck dissection in thyroid cancer / 中华内分泌外科杂志

Objective:To compare the surgical outcomes between scarless endoscopic thyroidectomy-lateral neck dissection (SET-LND) and open LND for papillary thyroid cancer (PTC) with lymph node metastasis and to share the experience in the prevention and treatment of lymphatic leakage after LND.Methods:Totally 90 PTC patients (25 males) who underwent LND in the Second Affiliated Hospital of Zhejiang University School of Medicine from Jan. 2021 to Aug. 2022 were retrospectively enrolled, with an average age of (28.06±4.89) years. They were divided into the SET-LND group ( n=50) and the open LND group ( n=40). The intraoperative blood loss, operation time, drainage volume on the first and the second days, postoperative lymphatic leakage, tumor (T), and node (N) were observed. The categorical variable data were compared between groups by χ 2 test, and the continuous variable data confirming normal distribution were compared between groups by independent sample t-test. Results:The operation time of the SET-LND group was (284.00±74.65) min, significantly longer than that of the open LND group (145.38±43.26) min ( t=-10.42, P<0.001). The intraoperative blood loss ( t=-1.309, P=0.194), postoperative hospital stay ( t=-0.136, P=0.892), drainage volume on the first day ( t=-1.074, P=0.286), and drainage volume on the second day ( t=-1.595, P=0.114), postoperative lymphatic leakage ( χ2=0.001, P=0.989), T ( t=0.367, P=0.714), N ( t=-1.614, P=0.110) were not significantly different between the two groups. Conclusion:Two surgical methods of LND have similar therapeutic effects and no significant difference was observed in the incidence of postoperative lymphatic leakage between the two groups.

Neck dissection and free flap repair technique for tongue cancer without neck scar / 实用口腔医学杂志

Neck dissection and reconstruction are two important aspects of oral cancer treatment.There are various surgical methods for neck dissection and reconstruction,but all of them are performed by open surgery.This article reports a full endoscopic neck dis-section through the retroauricular hairline approach,the radical resection of the intraoral tumor and the repair of the defect by superfi-cial circumflex iliac artery perforator flap with in situ vascular anastomosis intraorally.The incision is located in the hairline,hidden and invisible,and there is no exposed surgical scar on the neck after surgery.This paper introduces the technique of scarless neck dissection combined with free skin flap repair for the treatment of oral cancer and discusses its advantages and disadvantages.

Transoral thyroid and parathyroid surgery in Brazil: where are we? / Cirurgia transoral de tireóide e paratireóide no Brasil: onde estamos?

ABSTRACT Introduction: thyroid surgery through the transoral vestibular approach is a reality in many countries. While several competing remote access techniques have been developed in the last 20 years, many were not reproducible. Transoral Endoscopic Neck Surgery (TNS) has been shown to be reproducible in different centers around the world, and approximately five years after its description it has been adopted relatively quickly for various reasons. To date, there are at least 7 Brazilian studies published, including a series of more than 400 cases. The aim of this work is to study the progression of Transoral Neck Surgery in Brazil and describe the profile of surgeons involved in this new approach. Methods: this is a retrospective study with descriptive statistics. A REDCap based survey about transoral endoscopic thyroidectomy and parathyroidectomy vestibular approach (TOETVA/TOEPVA) was done with 66 Brazilian surgeons regarding surgeon profile, numbers of cases performed by geographic region, what kind of training was necessary prior to the first case and behavior of the surgeon proposing these new approaches. Results: response rate of this survey was 53%. To date, 1275 TOETVA/TOEPVA cases had been performed in Brazil, 1229 thyroidectomies (96.4%), 42 parathyroidectomies (3.3%) and 4 combined procedures (0.3%). Most of the cases were done in the southeast region (821, 64.4%), 538 (42.2%) cases in the State of São Paulo and 283 (22.2%) cases in the State of Rio de Janeiro. Conclusions: TOETVA is becoming popular in Brazil. Younger surgeons, especially those between 30 and 50 years old were more likely to adopt this approach.

RESUMO Introdução: a cirurgia de tireoide por via transoral vestibular é uma realidade em muitos países. Embora várias outras técnicas de acesso remoto tenham sido desenvolvidas nos últimos 20 anos, muitas não eram reprodutíveis. A cirurgia endoscópica cervical transoral (TNS - Transoral Neck Surgery) tem se mostrado reprodutível em diferentes centros ao redor do mundo sendo que, aproximadamente cinco anos após sua descrição, foi adotada de forma relativamente rápida por vários motivos. Até o momento, existem pelo menos 7 estudos brasileiros publicados, incluindo uma série de mais de 400 casos. O objetivo deste trabalho é estudar a evolução da Cirurgia Transoral do Pescoço (TNS) no Brasil e descrever o perfil dos cirurgiões envolvidos nesta nova abordagem. Métodos: trata-se de um estudo descritivo. Uma pesquisa online hospedada no REDCap sobre tireoidectomia e paratireoidectomia endoscópica transoral por abordagem vestibular (TOETVA/TOEPVA) foi realizada com 66 cirurgiões brasileiros. Foram levantados dados sobre o perfil do cirurgião, número de casos realizados por região geográfica, que tipo de treinamento foi necessário antes do primeiro caso e comportamento do cirurgião durante o relacionamento com o paciente ao abordar essas novas técnicas. Resultados: a taxa de resposta desta pesquisa foi de 53%. Até o momento, 1.275 casos de TOETVA/TOEPVA foram realizados no Brasil, sendo 1.229 tireoidectomias (96,4%), 42 paratireoidectomias (3,3%) e 4 procedimentos combinados (0,3%). A maioria dos casos foi realizada na região sudeste (821, 64,4%), 538 (42,2%) casos no estado de São Paulo e 283 (22,2%) casos no estado do Rio de Janeiro. Conclusões: a TOETVA está se popularizando no Brasil. Cirurgiões mais jovens, especialmente aqueles entre 30 e 50 anos, são mais propensos a adotar essa abordagem.

Primera tiroidectomía transoral vestibular endoscópica (TOETVA) en la Argentina / First transoral endoscopic thyroidectomy vestibular approach in Argentina

Se realizó una lobectomía transoral vestibular endoscópica (TOETVA) en una paciente femenina de 53 años interesada particularmente en su resultado cosmético, que presentaba un nódulo de 40 mm en el lóbulo tiroideo izquierdo. Mostró una excelente evolución posoperatoria. Se realizó la revisión de la bibliografía acerca de este abordaje y se informa el primer caso del país.

A 53-year-old female patient with a 40-mm nodule in the left thyroid lobe underwent surgery using the transoral endoscopic thyroidectomy vestibular approach (TOETVA) because she was particularly interested in the cosmetic results. She evolved with excellent postoperative outcome. We review the literature dealing with this approach and report the first case in our country.

Two-plasmid scarless genetic modification in Escherichia coli hfq and rne-710 / 生物工程学报

Gene modification is an important technique to understand gene function. We firstly constructed Δhfq::Spe and Δrne-710::Spe mutant strains of Escherichia coli MG1655. The fragment lacking of hfq and rne-710 was ligated to the auxiliary plasmid and separately replace the spectinomycin box by homologous recombinase system to obtain the Δhfq and Δrne-710 mutant strains. The combination of two-plasmid scarless genetic modification and fusion PCR led to a new way for the long DNA fragment gene deletions.

Optimization of culture medium for scarless healing of fetal mouse wounds and analysis of regions with active cell proliferation / 中华皮肤科杂志

Objective To optimize the culture medium for scarless wound healing in outbred fetal Kunming (KM) mice,and to locate and preliminarily analyze the region with active cell proliferation.Methods After 6 pregnant mice were sacrificed at the gestational age of 15 days,a total of 180 skin grafts were obtained from the back of 60 fetal mice,and wounds on the skin grafts were made uniformly with minimally invasive sterile device.Then,these skin grafts with wounds were randomly and equally divided into 6 groups to be treated with high-glucose Dulbecco's modified Eagle's medium (DMEM),DMEM + 5％ fetal bovine serum (FBS),DMEM + 10％ FBS,low-glucose Eagle's minimum essential medium (MEM),MEM + 5％ FBS,and MEM + 10％ FBS for 3 days,respectively.Then,these skin grafts were embedded in optimal cutting temperature (OCT) compound,and subjected to hematoxylin and eosin (HE) staining to select the optimal culture condition for wound healing.Under the optimal culture condition,the region with active cell proliferation was located by labeling and tracking cutaneous stem cells with 5-ethynyl-2-deoxyuridine (EdU),and activator protein-1 (AP-1) expression was detected by immunofluorescent staining.Results After 3-day cultivation,wound healing rates significantly differed among the DMEM group,DMEM + 5％ FBS group,DMEM + 10％ FBS group,MEM group,MEM + 5％ FBS group and MEM + 10％ FBS group (0,3.33％,6.67％,3.33％,46.67％ and 26.67％,respectively,x2 =41.39,P ＜ 0.05).Additionally,the MEM + 5％ FBS group showed a significantly higher wound healing rate than the other groups except the MEM + 10％ FBS group (all P ＜ 0.01).Logistic regression analysis showed that the type of basal medium (MEM:OR =11.717,95％ CI:3.274-41.934,P ＜ 0.001) and FBS concentrations (5％ FBS:OR =24.625,95％ CI:3.027-200.299,P =0.003;10％ FBS:OR =13.449,95％ CI:1.618-111.813,P =0.016) were factors influencing fetal wound healing.Under the culture condition of 5％ FBS + MEM,the dermis and epidermis healed well without epidermal thickening.The cutaneous stem cell labeling technique showed that the papillary dermis and basal layer of the epidermis were the two major regions with active cell proliferation in the wound of fetal mouse skin.Moreover,AP-1 was expressed abundantly in these two regions as well.Conclusions The culture condition of 5％ FBS + MEM is considered to be optimal for in vitro wound healing in fetal mice.The papillary dermis and basal layer of the epidermis are two major regions with active cell proliferation during wound healing in fetal mouse skin,and play important roles in wound healing process.

Biomarcadores inflamatórios e indicadores de estresse oxidativo em cadelas submetidas à ovariossalpingohisterectomia convencional, por NOTES híbrida e NOTES total / Inflammatory biomarkers and oxidative stress indicators in bitches subjected to conventional ovarysalpingohysterectomy, by hybrid NOTES and by total NOTE

Objetivou-se comparar a resposta inflamatória e o perfil oxidativo da técnica de ovariossalpingohisterectomia (OSH) convencional com duas técnicas de Cirurgia Endoscópica por Orifícios Naturais (NOTES). Foram utilizados 15 fêmeas, alocadas em três grupos de cinco animais. No primeiro grupo, a OSH foi realizada por celiotomia convencional, no segundo, por NOTES total e, no terceiro, por NOTES híbrida. Foram realizadas as coletas sanguíneas antes do procedimento cirúrgico (basal), 3, 6, 12, 24, 48 e 72h pós-operatórias. A atividade da catalase manteve-se alta nos três grupos estudados, entretanto a peroxidação lipídica, medida pelos níveis dos produtos de reação com o ácido tiobarbitúrico (TBARS), ocorreu mais acentuadamente no grupo convencional e foi quase que imperceptível no grupo de NOTES total. Nos três grupos estudados, ocorreu elevação na atividade da butirilcolinesterase e acetilcolinesterases, bem como aumento leucocitário neutrofílico nas primeiras horas pós-cirúrgicas. Conclui-se que a inflamação sistêmica acontece de forma similar nas três técnicas operatórias, com ressalva para as realizadas por NOTES total que mantiveram as mais baixas taxas oxidativas.

This study aimed at comparing the inflammatory response and the oxydative profile of the conventional ovarysalpingohysterectomy (OSH) technique to Totally Natural Orifice Transluminal Endoscopic Surgery (NOTES) and Hybrid NOTES. Group of fifteen female dogs was used for each technique. Blood samples were taken before the surgical procedure (basal) and 3, 6, 12, 24, 48 and 72h postoperative. The catalase activity was increased in the three studied groups. Nevertheless, lipid peroxidation, measured by TBARS (thiobarbituric acid reactive substances) levels, was higher in the conventional group and almost indistinguishable in the total NOTES group. In the three analyzed groups, both butyrylcholinesterase and acetylcholinesterase activities were increased as well as the neutrophil counts during the first post-surgical hours. It is possible to conclude that systemic inflammation occurs in a similar way in the three operative techniques; however, total NOTES technique presents lower levels of cellular oxidative damage, particularly if compared to the conventional approach.

Transumbilical single port laparoscopic appendectomy using basic equipment: a comparison with the three ports method / 대한외과학회지

PURPOSE: Single port laparoscopic surgery is a rapidly evolving laparoscopic surgical approach. We report a comparison of transumbilical single port laparoscopic appendectomy (TUSPLA) and conventional laparoscopic appendectomy (CLA) in a Korean military hospital. METHODS: This single-center retrospective study of 63 patients who received laparoscopic appendectomy was conducted between May 2011 and October 2011. Nineteen patients received TUSPLA and 44 patients received CLA. Clinical outcomes such as operation time, hospital stay, postoperative pain, diet, and postoperative complication were reviewed. RESULTS: There were no statistically significant differences between TUSPLA and CLA patients, respectively, in operation time (58.9 minutes vs. 52.3 minutes, P = 0.262), duration of hospitalization (10.2 days vs. 10.6 days, P = 0.782), mean visual analogue scale score (2.6 vs. 2.5, P = 0.894), and return to diet (1.6 days vs. 1.7 days, P = 0.776). There were two cases (10.5%) of short-term complications in the TUSPLA group and four cases (9.1%) of short-term complications in the CLA group. All patients were fully recovered at discharge. CONCLUSION: TUSPLA is a feasible alternative for CLA. When a glove port is used, no special instruments are needed. Thus, it can be performed in a hospital equipped with basic laparoscopic surgical instruments.

Effect of Heparin on Expression of mRNA of MMP 1,2,9 in Adult Rat Wound

PURPOSE: This study was to investigate how the heparin, which has been known to induce neovascularization by MMP in the infarcted tissue of the myocardium, had influence on the expression of mRNA of MMP 1,2,9 of the skin wound of rat. METHODS: Full depth skin wounds were created on the dorsum of Sprague-Dawley 60 rats. The experimental rats were divided into two groups according to the concentration of heparin(100microgram/ml in 20, 300microgram/ml in 20). Heparin soaked gelatin sponges in different concentration were inserted into the pocket of experimental rats and the wounds were closed. Normal saline soaked gelatin sponges were used in control rats. Wounds were harvested at 48 and 72 hours after closure. We performed histologic study in H-E stain. RNA was isolated from the harvested tissue and then real time polymerase chain reaction was performed to determine the gene expression of MMP-1,2,9. RESULTS: We observed that inflammatory cell decreased in heparin soaked group and heparin increased the expression of MMP-1,9 mRNA of dorsal wound of rat at 72 hours (p<0.05). CONCLUSION: This result suggest that heparin may be used inducing another factor inducing scarless wound healing by increasing MMP.

Transumbilical Laparoscopic Cholecystectomy(Report of 18 Cases) / 中国普外基础与临床杂志

Objective To investigate the feasibility of laparoscopic cholecystectomy through the transumbilical approach.Methods The clinical data of 18 patients underwent endoscopic cholecystectomy through only one transumbilical incision at West China Hospital were retrospectively analyzed.Results All of the operations were successfully completed without conversion to routine laparoscopic surgery or open surgery.The operation time was 40-130(58?10)min.There was no intraoperative complication.The patients did well postoperatively and were discharged 1 day after operation.There was no postoperative complications and without visible abdominal scar on 1 month follow-up.Conclusions Laparoscopic cholecystectomy through the transumbilical approach is technically feasible and safe.But this technique is difficult,the patients should be selected carefully.

Localization and expression of TGF-? _(1,2) in fetal and adult skins / 中国病理生理杂志

AIM: To explore the localization and expression of transfo rming grow th factor-? 1,2 (TGF-? 1,2 ) and alpha-smooth muscle actin (?- ASMA) in fetal a nd adult skins. METHODS: Skins of 15 cases of fetuses with different gestational ages and 5 cases of adults were taken, embedded with paraffin wax, and sectione d. Immunohistochemistry method and pathological method were used to detect the e xpression intensity and distribution of TGF-? 1,2 and ?-ASMA. RESULTS: Positive immunohistochemical signals of TGF-? 1,2 and ?-A SMA were found in fetal and adult skins. In skins derived from young fet us, the positive signals of these three proteins were very weak. Along with the incr ement in gestational age, the positive cellular rates of TGF-? 1,2 and ?- ASMA were elevated pro gressively. In elder fetal and adult skins, TGF-? 1,2 were mostly distributed i n epidermal cells, endothelial cells and some fibroblasts, while ?-ASMA was mainly located in myofibroblasts and sweat gland epithelial cells. CONCLUSION: The endo genous TGF-? 1,2 might be involved in the cutaneous development at embryoni c stage, in the cutaneous structure maintenance at adult stage, and in the wound healing af ter injury.

Gene expression of epidermal growth factor, c-fos and c-myc in fetal and children skins / 解放军医学杂志

Objective To investigate gene expression of epidermal growth factor (EGF), its receptor (EGFR) and two protooncogenes (c-fos and c-myc), in fetal skin at different development stages and children skin and to delineate their potential biological significance. Methods Fetal skin biopsies of human embryo were obtained from spontaneous abortions at different gestational ages from 13 to 32 weeks and children skin specimens were collected from patients undergoing plastic surgery. After morphological characteristics of skin at different development stages were detected with histological methods, gene expressions of EGF, EGFR, c-fos and c-myc in skin at different development stages were examined with reverse transcription-polymerase chain reaction analysis (RT-PCR). Results Gene expression of EGF, EGFR, c-fos or c-myc could all be detected in fetal and childern skins. In fetal skin, the gene expression of these 4 genes was weak. Gene expression of these genes in skin was progressively enhanced with increasing gestational age. In children skin, the mRNA contents of these 4 genes were significantly increased in comparison with those in fetal skin (P