Clinical analysis of gasless transoral endoscopic thyroidectomy via oral vestibular approach for papillary thyroid carcinoma / 中华普通外科杂志

Objective:To study the safety and feasibility of gasless transoral endoscopic thyroidectomy though vestibular approach using self-retaining retractor for papillary thyroid carcinoma.Methods:The clinical data of 39 papillary thyroid carcinoma patients undergoing gasless transoral endoscopic thyroidectomy were collected at Department of Head and Neck Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from Nov 2020 to Jun 2021.Results:All cases successfully underwent laparoscopic surgery without conversion to open surgery. The mean duration of operation was (142±35) min, and the postoperative mean hospital stay was (4.1±0.8) days. The mean maximum diameter of the tumor was (8.5±4.5) mm, and the mean number of lymph node harvest of by central compartment dissection was 7.7±5.9. Postoperative complications were transient hypoparathyroidism in 2 cases but recovered in 1 month. Scalp hydrop in 1 patient,fading subsequently. Transient sensory change around the lower lip in 3 cases, which recovered in 6 months. No patient suffered from recurrent laryngeal nerve palsy or hematoma, no permanent hypoparathyroidism occurred, nor of the postoperative bleeding .Conclusion:The gasless transoral endoscopic thyroidectomy viaoral vestibular approach is a feasible approach in selected papillary thyroid carcinoma patients.

A study on the metastasis related location of superior mediastinal lymph nodes in thyroid cancer / 中华普通外科杂志

Objective:To explore superior mediastinal lymph node zoning of thyroid cancer for accurate anatomical definition as a reference for surgical access. Methods:A method for zoning superior mediastinal lymph nodes for thyroid cancer was proposed. From Sep 2018 to Nov 2019, 36 cases of thyroid cancer with superior mediastinal lymph nodes metastases were reviewed. The diagnosis, surgical approaches, pathology, characteristics of lymph node metastasis, complications and follow-up results were analyzed.Results:The superior mediastinal lymph nodes were grouped into 10 areas: 1, 2Ra, 2Rb, 2La, 2Lb, 3A, 3P, 4R, 4La and 4Lb. According to the location of the superior mediastinum metastatic lymph nodes, direct vision approach through the neck incision, laparoscope-assisted approach, thracoscepy, laparoscope-assisted combined with thrascopy approach or conventional median sternotomy was performed for regional lymph node dissection. The average follow-up time was (10±4) months. No residual or recurrence of tumor in superior mediastinal area was found.Conclusions:The zoning of the superior mediastinal lymph nodes in thyroid cancer can be used as a guide for surgical approach to lymph node dissection .

Predictive model for cervical lymph node metastasis of papillary thyroid carcinoma based on ultrasound and thyroglobulin infine-needle aspirate fluid detection / 中华超声影像学杂志

Objective:To establish a predictive model of lateral lymph node metastasis in patients with papillary thyroid carcinoma(PTC), and further to compare the diagnostic efficiency of this model with the suspected abnormal lymph node thyroglobulin in fine-needle aspirate fluid (FNA-Tg) for lateral lymph node metastasis.Methods:The preoperative clinical and ultrasonographic data of 110 patients (257 lymph nodes) who underwent PTC cervical lymph node dissection were retrospectively analyzed. According to the postoperative pathological results, they were divided into lateral lymph node metastasis and non-metastasis group. Regression analysis was used to screen out independent risk factors affecting lateral lymph node metastasis and establish a predictive model. The ROC curve was used to evaluate the diagnostic efficacy and the best diagnostic cut-off point.Results:Prediction model: Logit( P)=-2.987+ 2.189(S/L ratio of lymph nodes)+ 1.748(hilum absent)+ 2.030(hyperechoic)+ 1.849(vascular abnormalities). The sensitivity, specificity, accuracy and AUC of the prediction model in the diagnosis of lateral lymph node metastasis were 92.1%, 83.9%, 87.9% and 0.929, respectively. The Homser-Lemeshow goodness of fit test showed that the Logistic model has a good fitting effect. The sensitivity, specificity, accuracy, and AUC of FNA-Tg in the diagnosis of lateral lymph node metastasis were 87.4%, 95.4%, 90.3% and 0.968, respectively. The sensitivity, specificity, accuracy, and AUC of the combined diagnosis of the predictive model and FNA-Tg were 92.9%, 96.9%, 94.2% and 0.989, respectively. Conclusions:The model has a good predictive value for PTC cervical lymph node metastasis. Combined with FNA-Tg, it can improve its diagnostic efficiency and provide more valuable information for the decision-making of clinical surgical procedures.

Study on the prediction of cervical lymph node metastasis risk in preoperative thyroid papillary carcinoma by ultrasonic elemental observation of thyroid nodules / 中华超声影像学杂志

Objective@#To evaluate the correlation between ultrasound features of papillary thyroid carcinoma (PTC) and lymph node metastasis by preoperative ultrasound elemental observation of thyroid nodules.@*Methods@#Three hundred and seventy-six patients who underwent primary thyroid surgery and confirmed by ultrasound and pathological data as single-focal PTC from Jannary to December 2017 in Sir Run Run Shaw Hospital of Zhejiang Univbersity College of Medicine were retrospectively analyzed. According to the presence or absence of lymph node metastasis, they were divided into central and lateral lymph node metastasis group and non-metastasis group. Independent risk factors for central lymph node metastasis (CLNM) and lateral lymph node metastasis (LLNM) were analyzed by χ2 test and multivariate Logistic regression.@*Results@#Multivariate analysis showed that the posterior margin of the cancer was <0.25 cm from the posterior wall of the thyroid gland as an independent risk factor for CLNM (P=0.025). Compared with the tumor volume ≤0.38 cm3, the cancer volume >0.38 cm3 (P=0.000), was more prone to CLNM. And multivariate analysis showed that the anterior margin of the cancer was <0.17 cm (P=0.006) from the anterior thyroid capsule and the inner wall of the foci was <0.26 cm (P=0.014) as independent risk factors for LLNM. Compared with the maximum diameter of the tumor lesion ≤1 cm, the maximum diameter >2 cm (P=0.001) group was more prone to LLNM. Compared with the tumor volume ≤0.38 cm3, the tumor volume >0.38 cm3 (P=0.000) was more prone to LLNM.@*Conclusions@#The larger volume of single focal PTC carcinoma and the closer to the posterior thyroid capsule are independent risk factors for CLNM. The larger volume and diameter of single focal PTC, and the closer to the anterior and medial wall capsule are independent risk factors for LLNM.

Study on the prediction of cervical lymph node metastasis risk in preoperative thyroid papillary carcinoma by ultrasonic elemental observation of thyroid nodules / 中华超声影像学杂志

Objective To evaluate the correlation between ultrasound features of papillary thyroid carcinoma(PTC)and lymph node metastasis by preoperative ultrasound elemental observation of thyroid nodules.Methods Three hundred and seventy-six patients who underwent primary thyroid surgery and confirmed by ultrasound and pathological data as single-focal PTC from Jannary to December 2017 in Sir Run Run Shaw Hospital of Zhejiang Univbersity College of Medicine were retrospectively analyzed. According to the presence or absence of lymph node metastasis,they were divided into central and lateral lymph node metastasis group and non-metastasis group.Independent risk factors for central lymph node metastasis (CLNM) and lateral lymph node metastasis (LLNM) were analyzed byχ2 test and multivariate Logistic regression.Results Multivariate analysis showed that the posterior margin of the cancer was <0.25 cm from the posterior wall of the thyroid gland as an independent risk factor for CLNM(P=0.025). Compared with the tumor volume ≤0.38 cm3 ,the cancer volume >0.38 cm3(P=0.000),was more prone to CLNM.And multivariate analysis showed that the anterior margin of the cancer was <0.17 cm(P =0.006)from the anterior thyroid capsule and the inner wall of the foci was <0.26 cm (P =0.014) as independent risk factors for LLNM.Compared with the maximum diameter of the tumor lesion ≤1 cm,the maximum diameter >2 cm (P =0.001) group was more prone to LLNM.Compared with the tumor volume ≤0.38 cm3 ,the tumor volume >0.38 cm3(P =0.000)was more prone to LLNM.ConclusionsThe larger volume of single focal PTC carcinoma and the closer to the posterior thyroid capsule are independent risk factors for CLNM.The larger volume and diameter of single focal PTC,and the closer to the anterior and medial wall capsule are independent risk factors for LLNM.

Quantitative Determination of Levofloxacin by PVC Membrane Ion-Selective Electrode / 中国药房

OBJECTIVE:To determine the content of levofloxacin by PVC membrane selective electrode. METHODS: A glass electrode coated with levofloxacin PVC membrane was prepared for the first time with the molecular complex of levofloxacin iodide and bismuth iodide as electric active material, and a series study was performed on its responsibility. RESULTS: The electrode gave Nernst response to levofloxacin over the concentration range of 5.0?10-3～1.0?10-5 moL?L-1 with a slope rate of 56.5mV?pC-1, a suitable pH of 2.5～4.0, and an average recovery rate of 98.31%～101.6%(2.80%～4.90%). CONCLUSION: The electrode was simple in operation, and it has a rapid response and good reproducibility, and it is applicable for the quantitative determination of levofloxacin.

Treatment of humeral proximal fracture with locking proximal humeral plate / 中华创伤杂志

Objective To summarize the clincal effect of open reduction and internal fixation with locking-proximal-humerus-plate(LPHP)to treat proximal humeral fractures.Methods A total of 19 eases with proximal humeral fractures were treated with LPHP from August 2003 to February 2006 in this study.Their mean age was 58.6 years old.According to Neer classification,two cases were with two- part fractures,nine with three-part fractures and eight with four-part fractures including seven cases with osteoporosis.Redaction and fixation was done via deltopeetoral-groove approach.Bone graft was applied for five eases.Results The follow-up period was 3 to 32 months(mean 17 months).All cases were healed and the union period of 3-5 months.According to the Near shoulder score,the results showed that ten cases were excellent,6 cases good,with excellent rate of 84%.Conclusion The LPHP method is suitable for osteoporosis and comminuted proximal humeral fractures and enhances the treatment effect.