Clinical application of near-infrared fluorescence positive imaging combined with intraoperative rapid PTH determination in parathyroid identification and functional protection / 中华内分泌外科杂志

Objective:To investigate the feasibility and clinical significance of near-infrared fluorescence positive imaging combined with intraoperative rapid parathyroid hormone (PTH) determination in identification and function protection of the parathyroid gland during thyroidectomy.Methods:According to the inclusion and exclusion criteria, patients in the Affiliated Lihuili Hospital of Ningbo University, who needed bilateral thyroidecto-my and central lymph node dissection due to suspected bilateral thyroid cancer from Mar. 2020 to Oct. 2020 were selected for a prospective clinical study. They were randomly divided into the study group (near-infrared fluorescence positive imaging combined with intraoperative rapid PTH determination) and the control group (intraoperative experience identification) . The number of parathyroid glands found during operation, PTH before and after the operation, blood calcium, blood phosphorus, the presence of parathyroid tissues in routine pathological section examinations, and postoperative symptoms were collected. SPSS 25.0 statistical software was used for analysis, the measurement data were expressed by mean±standard deviation ( ± s) , t test was used for comparison between groups, and χ2 test was used for counting date. Results:In the study group of 33 cases, 135 suspicious parathyroid glands were exhibited during operation, with an average of (4.09±0.52) ; Hand and foot numbness occurred in 1 case (3.03%) ; On the 1st after the operation, PTH was (23.68±9.48) ng/L. In the control group of 31 cases, 109 parathyroid glands were identified by naked eyes, with an average of (3.52±0.63) ; Hand and foot numbness occurred in 6 cases (19.35%) ; On the 1st after the operation, PTH was (17.93±11.58) ng/L. The differences were statistically significant ( P<0.05) . But no statistical significance was found in operation duration (79.45±30.18) min, postoperative hospitalization days (5.85±2.27) days, PTH (27.10±9.80, 33.08±10.21) ng/L, blood calcium (2.11±0.10,2.25±0.09) mmol/L, and blood phosphorus (1.20±0.20,1.15±0.12) mmol/L on the 3rd day and the 6th month after the operation. Conclusion:Near-infrared fluorescence positive imaging combined with intraoperative rapid PTH determination can improve the recognition rate of the parathyroid gland and reduce postoperative complications, which is a safe, effective and rapid method for intraoperative parathyroid gland recognition.

Study on Automatic Plan Method for Radiotherapy after Breast-conserving Surgery Based on TiGRT System / 中国医疗器械杂志

To study an automatic plan(AP) method for radiotherapy after breast-conserving surgery based on TiGRT system and and compare with manual plan (MP). The dosimetry parameters of 10 patients and the evaluation of scoring table were analyzed, it was found that the targets dose of AP were better than that of MP, but there was no statistical difference except for CI, The V5, V20 and V30 of affected lungs and whole lungs in AP were lower than all that in MP, the Dmean of hearts was slightly higher than that of MP, but the difference was not statistically significant, the MU of AP was increase by 16.1% compared with MP, the score of AP evaluation was increase by 6.1% compared with MP. So the AP could be programmed and automated while ensuring the quality of the plan, and can be used to design the plans for radiotherapy after breast-conserving surgery.

Clinical efficacy of trastuzumab for injection on locally advanced breast cancer and related indexes / 中国生化药物杂志

Objective To investigate the effect of trastuzumab for injection on apoptosis and the expression of related genes in locally advanced breast cancer and related indexes.Methods 166 patients with locally advanced breast cancer were selected and divided into two groups, 83 cases in the control group treated with neoadjuvant chemotherapy before operation, 83 cases in the experimental group received trastuzumab for injection on the basis of the control group, serum tumor marker levels, tumor cell apoptosis index and proliferation activity, Bcl-2, Bax gene expression levels, the clinical effect and incidence of adverse reactions were compared after the treatment.Results The effective rate in the control group(78.32%)was lower than the experimental group(90.36%), with significant difference (P<0.05).Compared with the control group, serum levels of CA153,CA125,CEA,TSGF were lower in the experimental group after chemotherapy, levels of apoptosis index(AI) in tumor tissue was higher, levels of S-phase fraction (SPF), proliferation index ( PI) were lower after treatment, Bcl-2 gene in tumor tissue expression level was lower, Bax gene expression level was higher after treatment, all with significant difference (P<0.05).There was no significant difference in the incidence of adverse reactions between two groups. Conclusion The trastuzumab for injection treatment can significantly improve the total remission rate of patients with locally advanced breast cancer , reduce the levels of serum tumor markers, can down-regulate the expression of apoptosis related gene Bcl-2, up-regulate the expression of Bax gene, promote the apoptosis of tumor cells.

Endoscopic thyroidectomy for cN0 papillary thyroid carcinoma, report of 90 cases / 中华普通外科杂志

Objective To discuss the feasibility of endoscopic thyroidectomy via breast approach for papillary thyroid carcinoma.Methods From April 2009 to December 2013,clinical data of 90 papillary thyroid carcinoma cases undergoing endoscopic thyroidectomy was analyzed retrospectively.Results There was no conversion to open surgery,the mean operation time was 97 min,the mean intraoperative blood loss was 10 ml,the mean postoperative drainage volume was 65 ml,the mean hospital stay was 4.5 d,the mean lymph node number dissection of central compartment was 5.3.No obviously chest pain and numbness occurred.No skin flap ecchymosis,necrosis,effusion,and hematoma occurred.No hypocalcemia convulsions occurred.Transient hoarseness occurred in 3 cases which recovered within 1 to 2 months.Follow-up time ranged from 1 to 5 years,the median follow-up time was 41 months,with no tumor recurrence and lymph node enlargement.All patients were satisfied with the cosmetic results.Conclusions Endoscopic thyroidectomy via breast approach is a safe and feasible procedure in treating papillary thyroid carcinoma (cN0).

Working space establishment with Miccoli's approach: characteristics of the lifting force produced by a working space marker ln the proesss of its cavity-forming / 中华内分泌外科杂志

ObjectiveTo comprehend the change of the characteristics of lifting force produced by a working space marker in process of its cavity-forming. Methods37 patients were successively operated with the surgical mode of minimally invasive video-assisted thyroidectomy (22/37 cases received a lobotomy and others un derwent a partial thyroidectomy) from January to August, 2010. Instead of hand-retraction, a mechanical armworking space marker type I ( WSM-I, MIEO Medinstr Co. Ltd, China) was applied to establish a working space. After pathway making, an interlayer-cavity above the lobe was created by the space maker and endoscopic view was properly built. Following all these steps, a simulated space making procedure was performed in a way of stepwise hook-lifting (5 mm rising per time). The lifting force ( LF)was measured during the process with a modflied force-measure device (FB-50, DESIK company, Germen). Then recorded data were assessed and analyzed statistically. Results①Ascending scope of LF in the process of entire space-forming was 0-27.5 Newton (N).②Along with hook rising, LF ascended correspondingly and 2 specific values emerged: One was 11. 2 ±3.5 N,as the lifting height approached 1.5 cm ( also a approximate position of essential space-forming ( Pe), at which themusculo-cutaneoustissuejustbecame tight) ; the other was 17.5 ± 4.3 N , as the lifting height approached 1.75 cm ( also a approximate position of maximal space-forming (Pmax), at which the musculo-cutaneous tissue appeared real tight, but not in a status of extreme tightness). ③Two types of LF ascending were found when the values transferred to a curve diagram : a palliative linearity increasing while lifting height varied from 0 to 1.5 cm (PO to Pe) and a rapid exponent-like increasing while lifting height varied from 1.5 to 1.75cm ( Pe to Pmax). ④ Dependability analyses yielded a diverse statistical outcome: negative significance of the comparison between incision length and LF value ( P ＞ 0. 05 ), and positive significance of the comparison between skin thickness and LF value ( P ＜ 0. 01 ). Conclusions①LF produced by WSM-I while establishing a working space is proper and relatively small, since the maximal value is merely 27.5N, far less than the stress produced by ordinary cosmetic skin expansion. ②The whole space-forming process can be divided into 2 stages according to the characteristic of LF ascending which correspond also separately to the “essential cavity-forming” and “the maximum cavity-forming” in the real establishing of a working space. ③Attention should be paid to the later stage since in which a rapid LF increasing occurs while the appearance of musculo-cutaneous tissue changes from “just become tight” to “real appear tight”. ④LF control, especially the fine readjustment at or about Pmax should be of necessity in individual space-forming, and then, ideal working space establishment can be archived at a pre cisely balanced LF point: maximum cavity volume acquired and minimal tissue expansion stress produced.

Changes of serum osteoprotegerin and bone mineral density in diabetic nephropathy patients / 中国组织工程研究

BACKGROUND: At present, the relationship between diabetic nephropathy and osteoprotagerin remains poorly understood. OBJECTIVE: To investigate the correlation between bone mineral density (BMD) and serum osteoprotagerin changes in patients with 2 type diabetic nephropathy. METHODS: Totally 104 patients with 2 type diabetes were divided following 5 groups according to glomerular filtration rate: simple diabetes, mild renal injury, moderate renal injury, severe renal injury, and renal failure groups. Additional 20 healthy people were selected as the control group. The level of serum osteoprotegerin was measured by ELISA. Meantime, levels of serum calcium, phosphonium, alkaline phosphatase, creatinine, urea nitrogen, and glycosylatad hemoglobin were measured by. the automatic biochemistry analyzer. The bone mineral density of entopic L_(2-4) was determined by dual X-ray bone density equipment. The whole data was analyzed by multiple regression correlation analysis. RESULTS AND CONCLUSION: The level of serum osteoprotegerin in patients with diabetic nephropathy was obviously greater than that of the healthy people (P < 0.05), but BMD of the mild renal injury, moderate renal injury, severe renal injury, and renal failure groups was obviously lower than that of the healthy people (P < 0.05). Generally, the worse renal function accompanied by higher osteoprotegerin level, and lower BMD. There was a negative correlation between ostaoprotegerin level and BMD in patients with diabetic nephropathy (r=-0.497, P < 0.01). However, the relationships between osteoprotegedn level and diabetic duration (r=0.566, P < 0.01), serum creatinine level (r=0.772, P < 0.01), serum urea nitrogen level (r=0.708, P < 0.01), serum phosphonium level (r=0.329, P < 0.01), or serum intact parathyroid hormone level (F=0.702, P < 0.01) were positive. Meantime, the serum phosphonium level had negative correlation to serum calcium level (r=-0.505, P < 0.01). it demonstrated that when the renal function got worse in diabetic nephropathy patients, the serum osteoprotegerin level was increasing accompanied by BMD decreasing. The osteoprotegerin level presents a negative correlation to BMD and serum calcium level, but positive to diabetic duration, serum creatinine, serum urea nitrogen, serum phosphonium and serum intact parathyroid hormone levels.