Malignant struma ovarii: from a perspective of thyroid surgery / 中华内分泌外科杂志

Struma ovarii is a highly specialized form of monoderal ovarian teratoma, in which thyroid tissue has exceeded all other tissues or only thyroid tissue malignant struma ovarii is a very rare disease. Studies have confirmed that the pathogenesis is basically consistent with primary thyroid cancer. Preoperative diagnosis is difficult and the diagnosis should be based on postoperative paraffin pathology. It’s important to emphasize that the histologic malignance does not represent malignant ovarian behavior. Transabdominal hysterectomy+bilateral salpingo-oophorectomy has a better prognosis, and there are different opinions on the management of the mainstream thyroid. Most patients take active thyroid excision followed by chemotherapy and radiotherapy and 131I for postoperative follow-up in accordance with the principle of primary thyroid cancer.

Totally gasless transoral video-assisted thyroidectomy: initial report of 24 cases / 中华内分泌外科杂志

Objective:To evaluate the feasibility of the gasless transoral endoscopic thyroidectomy using an innovative space maintaining method.Methods:From Dec. 2018 to Apr. 2019, patients from Anhui Tumor Hospital treated with gasless transoral endoscopic thyroidectomy were retrospectively analyzed. Index such as intraoperative blood loss, operative time, postoperative hospital stay, and complications were recorded.Results:A total of 24 patients were included into this analysis. All operations were successfully completed. The mean blood loss was (41.3±26.4) ml, operation time was (191.8±40.8) min, postoperative hospital stay was (6.3±1.0) d. Nobody had drinking cough, recurrent laryngeal nerve palsy, massive bleeding, hypoparathyroidism or infection with use of preventive antibacteria. Transient lower jaw numbness was found in 8 patients and almost recovered within one month.Conclusions:Gasless transoral endoscopic thyroidectomy with the suspension device seems to be feasible and safe. Further study is needed to verify its validity.

Clinical value of carbon nanoparticles in prophylatic central compartment lymph node dissection in treatment of cN0 papillary thyroid carcinoma / 中华内分泌外科杂志

Objective To investigate the clinical significance of the carbon nanoparticles (CN) in prophylactic central compartment lymph node dissection (PCCND) in treatment of clinically node-negative (cN0) papillary thyroid carcinoma.Methods A total of 102 cN0 patients in our department from Dec.2016 to Jun.2017 were enrolled in our study and randomly allocated to the control group (n=51) and the CN group (n=51).All the patients have received (near) total unilateral lobectomy or bilateral thyroidectomy plus the affected side PCCND.The baseline characteristics,lymph node-related indices (including number of total dissected lymph nodes and metastatic lymph nodes at central area) and postoperative complication indices were collected and compared between the 2 groups.Results The differences of baseline characteristics between CN group and the control group were not significant (all P＞0.05).The total number of dissected lymph nodes was 573 in CN group and 334 in the control group.The average lymph nodes in each patient was 11.2±5.46 in CN group,which was higher than 6.5±4.3 of the control group (P＜0.001).The average count of positive lymph nodes was higher in CN group than in the control group (2.0±3.3 vs 0.8±1.5) (P＜0.05).Transient hypocalcaemia happened to 2 patients in CN group and 9 patients in the control group (P=0.025).Conclusions CN can increase the number of lymph nodes in central neck dissection and the rate of metastatic lymph nodes resection.It can decrease the risk of transient parathyroid injury.CN is clinically valuable in treatment of cN0 papillary thyroid cancer undergoing PCCND.

Significance of the definition and detailing of the central neck compartment in the treatment of thyroid carcinoma / 中华耳鼻咽喉头颈外科杂志

The cervical lymph node metastasis is a risk factor for the high recurrence rate and low survival rate in patients with thyroid carcinoma (especially for age ≥45 years old), which is the most common head and neck carcinoma. The neck lymphatic metastasis, mostly occurring in the central neck compare, is diagnosed among 20%-90% of patients with differentiated thyroid carcinoma. To definite the anatomic boundaries of the central lymph nodes and their subgroups is significantly important for thyroid carcinoma, such as the determination of surgical extent, the evaluation of prognosis and the choice of different treatment strategies. This paper aims to describe the anatomic boundaries and the components of the central neck compartment and the role of individual subgroups in thyroid carcinoma. We think that the central neck compartment is bounded superiorly by the hyoid bone, inferiorly by the innominate artery on the right and the corresponding axial plane on the left, laterally by the carotid arteries. The superior mediastinal lymph nodes should be the important subgroups of the central neck compartment in thyroid carcinoma. When the prophylactic central lymph node dissection for involved lymph nodes is performed in thyroid carcinoma, we should pay more attention to the superior mediastinal lymph nodes.

Analysis on the Influencing Factors of Traditional Chinese Medical (TCM) Treatment-Seeking Behavior of the Elders in Zhejiang Province / 世界科学技术-中医药现代化

This study aimed at investigating the utilization of TCM services and exploring the influencing factors,such as education,economic condition,health condition,attitude to TCM treatment and TCM health literacy,of TCM treatment-seeking behavior in the elders in Zhejiang Province.In this study,a cross-sectional study with stratified sampling was adopted for the further investigation of the elders over 55 years by questionnaire.The questionnaire contained four aspects:1.demographic information:gender,age,education,pension mode,medicare and self-evaluation of economic level;2.health status:self-evaluation of health and current diseases;3.attitude to TCM treatment:Would you accept the TCM health services? 4.health literacy:self-made KAB questionnaire including health knowledge,attitude and behavior.Nine hundred and fifty questionnaires were issued and 945 valid questionnaires were returned.Among them,four hundred and eighty-four cases were male and 461 were female.The average age was 72.0 ± 8.9 years with a low level of education,mainly junior high school or lower (88.3％).Over the past year,only 50.11％ elders sought for TCM treatment.Generally speaking,age,gender,education,pension mode and health behavior showed no significant association with TCM treatment.The elders seeking for TCM treatment over the past year held favorable attitude to TCM treatment and high economic status,yet,with poor health status,high prevalence and health literacy (or health attitudes).It was concluded that the utilization rate of TCM services in the elders in Zhejiang Province was not optimist,probably resulting from the lack of publicity and market competitiveness of TCM.Therefore,TCM services should be promoted to meet the health needs of the elders and enhance the utilization rate of TCM services for the achievement of a significant role in the aging society in China.

High risk factors related to central lymph node metastasis in papillary thyroid microcarcinoma / 国际肿瘤学杂志

In recent years, a large number of studies have found that central lymph node metastasis of the papillary thyroid microcarcinoma (PTMC) is significantly related with some risk factors.These high risk factors include age below 45 years old, BRAF gene mutation, vascular epithelial growth factor-C high expression, tumor diameter≥5 mm, multifocal and bilateral tumor, thyroid capsule invasion and so on.These high risk factors involve in disease process, and interact with each other.The studies of the high risk factors can help us to predict the risk of central lymph node metastasis in the patients with PTMC, thus to effectively guide the patients' treatment.

Clinical application of lateral thoracic wall adipofascial flap in immediate mammoplasty / 中华内分泌外科杂志

Objective To explore the operative indication , therapeutic effects and feasibility of immedi-ate mammoplasty with lateral thoracic steato-fascia flap.Methods A retrospective study was carried out on clini-copathologic data of 26 patients receiving nipple-areola complex preserving modified radical mastectomy and im-mediate mammoplasty with lateral thoracic wall adipofascial flap and 5 patients receiving segmental mastectomy and immediate mammoplasty with lateral thoracic wall adipofascial flap because of benign breast diseases .In these patients receiving nipple-areola complex preserving modified radical mastectomy , 22 patients received lateral tho-racic wall adipofascial flap , and 4 patients received lateral thoracic wall adipofascial flap combined with silicone prosthesis .The surgical complications and cosmetic effects were evaluated by both subjective and objective stand -ard postoperatively .Results 24 patients were satisfied with the appearance of their breasts and the two sides seemed to be symmetrical .There was no flap or nipple necrosis .The patients received adjuvant chemotherapy after surgery.No local recurrence or distant metastasis occurred during the follow up (2 to 12 months).Five patients with benign breast diseases were very satisfied with their breast appearance after surgery .Conclusion For patients in early stage breast cancer receiving modified radical mastectomy with nipple-areolar complex preserved and patients with benign breast diseases having segmental mastectomy , immediate mammoplasty with lateral thoracic wall adipo-fascial flap is a good method which can help to keep well breast apperance without additional incision , and it is also economical , feasible , and can reduce patients'psychological pressure due to loss of the breast .

Fine-needle aspiration combined with molecular biomarkers in the diagnosis of thyroid nodules / 国际肿瘤学杂志

The check methods of thyroid nodules include palpation,serum thyroid hormone and high-frequency ultrasound.When the diagnosis is difficult,fine-needle aspiration (FNA) is carried to differentiate benign and malignant nodules.In clinical practice,approximately 20％ of FNA-derived cytology reports can not meet the standard of benign or malignant.Some specific molecular biomarkers are applied to the derivative detection of FNA,which achieve considerable progress and improve the preoperative diagnostic rate.

Exposure and protection of recurrent laryngeal nerve in the reoperation for thyroid diseases / 中华内分泌外科杂志

Objective To investigate the exposure and protection of recurrent laryngeal nerve (RLN) in the reoperation for thyroid diseases.Methods Clinical data of 214 cases undergoing thyroid reoperation were retrospectively analyzed.The patients with a short interval between the 2 thyroid operations or with external-infiltrated thyroid cancer were approached at the lateral strap muscles and the leading edge of the sternocleidomastoid.RLNs were exposed in the lateral region of superior mediastinum tracheoesophageal groove or at the point where RLN enters to throat.RLNs of patients with lymph node metastasis were exposed beside the enlarged lymph nodes.The patients with a long interval between the 2 thyroid operations and with benign tumor or tumor without external infiltration were exposed their thyroids at the anterior midline and then RLNs were exposed at the posterior lateral of the middle thyroid veins or at the inferior thyroid artery.Results Among the 214 cases,344 RLNs were anatomically exposed including 188 right and 156 left.84 cases had single exposure and 130 cases had bilateral exposure.44 RLNs were exposed at the point where RLN enters to throat,104 RLNs at the posterior lateral of the middle thyroid veins,40 RLNs at the inferior thyroid artery,124 RLNs at the lateral region of superior mediastinum tracheoesophageal groove,and 32 RLNs beside the enlarged lymph nodes.For the 2 cases suffering hoarse voice the day after they underwent thyroid operation in other hospital,suture ligation at the the entrance point was found when they received the reoperation in our hospital.Three of the total 344 RLNs (0.87％ ) had RLN branch injury in the entire group.Conclusion It is possible to reduce RLN injury during the reoperation for thyroid disease if surgeons are familiar with the dissection of RLN under normal or pathological condition,avoid adhesive or scar tissues,and select the appropriate anatomic approach.

Clinicopathological study on the nipple-areolar complex involvement in operable breast carcinoma in 407 cases / 中华内分泌外科杂志

ObjectiveTo investigate the clinicopathological characteristics of nipple-areolar complex (NAC) involvement in patients with operable breast carcinoma and to determine the indications and risk factors of NAC-sparing modified radical mastectomy. Methods407 female patients with primary breast cancer were included in the study.Data like tumor position, tumor size, the distance from the tumor to the margin of areolar (D) were recorded.NAC sample in vitro was collected and routine pathological examination was performed.Statistical methods were employed to analyze the relation between the clinicopathological factors and NAC involvement.ResultsThe rate of NAC involvement was 13.27％ (54/407).NAC involvement had no statistically significant correlation with age or histological type, but had statistical correlation with tumor position, D value, tumor size, TNM stage, clinical manifestation of NAC, and status of axillary lymph nodes(P ＜ 0.05).ConclusionsTumor position, D value, tumor size, TNM stage, clinical manifestation of NAC and status of axillary lymph nodes are the major influential factors for NAC involvement.The indications of NAC-sparing modified mastectomy:1.in Ⅰ or Ⅱa TNM stage; 2.patients have strong will to preserve NAC or breast appearance; 3.noncentric tumor (D≥2 cm) ; 4.the maximum diameter of tumor should be less than 3 cm; 5.no abnormal manifestation like nipple discharge, eczematoid change or nipple inversion happened.6.no occult involvement in subareolar tissues was found by frozen pathology.

Nipple-areola complex preseving modified radical mastectomy and immediate breast reconstruction with latissimus dorsi fat flap for early breast cancer / 中华内分泌外科杂志

ObjectiveTo discuss the benefits of nipple-areola complex(NAC) preseving radical modified mastectomy and immediate reconstruction with latissimus dorsi fat flap for early breast cancer. MethodsFrom Jan 2006 to Dec 2008, 16 patients underwent NAC preseving modified radical mastectomy and immediate breast reconstruction with latissimus dorsi fat flap.ResultsAll patients recovered smoothly.No fat flap or back skin necrosis happened.The reconstructed breasts had good apperance with 93.8％ satisfaction rate.During the follow-up of 44 months (ranging from 36 to 60 months), all patients were disease-free.ConclusionsThe operation of NAC preseving modified radical mastectomy and immediate reconstruction with latissimus dorsi fat flap is safe and effective.It can improve the life quality of patients by satisfing the needs of both beauty and tumor resection.

The significance of central region lymph nodes dissection for differentiated thyroid carcinoma / 中华内分泌外科杂志

Objective To explore the rule of central region lymph nodes metastasis in differentiated thyroid carcinoma (DTC) and the significance of central region lymph nodes neck dissection in surgical operation for DTC.Methods The clinical and pathological data of 122 lymph nodes in 109 patients (31 female and 78 male) with DTC undergoing neck lymph nodes ( central region lymph nodes included) dissection from Jan.2003 to Jun.2007 in our hospital were analyzed retrospectively.According to preoperative physical examination and imaging analysis,patients were divided into clinical cervical lymph nodes metastasis ( cN + ) group and clinical no cervical lymph nodes metastasis (cNO) group and compared respectively with their pathological data after surgery.Resuits Of the 122 lymph nodes,lymph node metastasis rate was significantly higher in region Ⅵ than in region Ⅱ,Ⅲ and Ⅳ.The difference had statistical significance (P ＜0.01 ).65.6％ (80/122) metastasis was in the central region.81.2％ (56/69) patients in cN + group and 45.3％ (24/53) patients in cN0 group had central region lymph nodes metastasis.Conclusions Central region lymph nodes metastasis is common for patients with DTC.Routine neck dissection in central region should be done in DTC operation.

Expression and clinical pathological significance of BCSG1in invasive breast cancer / 中华内分泌外科杂志

Objective To investigate the expression of breast cancer specific gene 1( BCSG1) in breast cancer tissues and its clinical significance.Methods The expression of BCSG1in 51cases of breast cancer tissues and 35 cases of adjacent tissues was determined by fluorescence quantitative polymerase chain reaction (FQ-PCR) and immunohistochenistry.Results FQ-PCR showed the expression level of BCSG1mRNA in breast cancer and adjacent tissues was 1.072 ± 0.178 and 0.324± 0.135 respectively.Immunohistochemistry showed the expression rate of BCSG1protein in breast cancer and adjacent tissues was 74.5％ (38/51) and 14.3％ (5/35).The expression of BCSG1mRNA and protein was dramatically increased in breast cancer tissues compared with that in normal background breast tissues (P ＜ 0.05).BCSG1mRNA and protein expression was significantly different in patients with lymph node metastasis and higher Nottingham prognostic index (P ＜ 0.05 ),and there was no significant difference with the pathological type of breast cancer,or status of ER,PR,and c-erbB2 ( P ＞ 0.05 ).Conclusions BCSG1is highly expressed in breast cancer tissues,which is closely related to the development and clinical prognosis of breast cancer.BCSG1is very likely to play an important role in the pathogenesis of breast cancer.

Delphian node metastasis in papillary thyroid cancer / 中华普通外科杂志

Objective To explore the clinical value of Delphian node (DN) metastasis in papillary thyroid cancer(PTC).Method In this study,86 cases of unilateral PTC proved by frozen pathology and initially undergoing surgical treatment were enrolled to evaluate Delphian nodes metastasis in its correlation with age,sex,tumor size,extra-thyroid extension and central and lateral compartment nodes.Results All patients underwent homolateral thyroidectomy plus contralateral subtotal thyroidectomy,central compartment and region Ⅲ and Ⅳ lymphadenectomy.There were no mortality and major morbidities.The following-up rate was 91.9％ (79/86).The mean following-up time was 45 months,and there was no tumor recurrence and metastasis.DN-postive was in close relation to extra-thyroid extension ( 60％ vs.24％ ;P =0.019)positive central compartment ( 80％ vs.27％ ;P ＜ 0.01 ) and lateral compartment lymph node metastasis (40％ vs.5％ ;P ＜ 0.01 ).DN-postive was also in close relation to the number of metastastic nodes ( average 7 vs.2 numbers of node;P =0.002 ) and the size of the node (2.1 cm vs.0.8 cm;P =0.02).Conclusions DN-postive has close relationship with extra-thyroid extension and central and lateral compartment nodes in PTC patients.

BRAFV600E gene mutation in papillary thyroid cancer / 国际肿瘤学杂志

The BRAFV600E mutation in papillary thyroid carcinoma is the most common genetic event,which is an invasive tumor clinical phenotype and a poor prognosis indicator.The BRAFV600E mutation detection has an important guiding significance for the differential diagnosis of malignant thyroid nodules on preoperative,guiding the surgical resection range of thyroid cancer,judging the patient(s) prognosis and guiding the subsequent treatment of postoperative.

Function and mechanism of high mobility group protein A1 in tumor / 国际肿瘤学杂志

High mobility group protein A1 ( HMGA1 ) are members of a superfamily of non-histone chromatin proteins,which exist widely in eukaryotic nuclei and are mainly involved in transcriptional regulation of gene expression.Recent researches show that almost all human malignant tumors have abnormal expression of HMGA1,which may have an important role in the development of cancer,but the exact mechanism is not clear yet.In cancer research,transfection system which constructed on the basis of HMGA1 will have potential value,and also could shed some light on the treatment of cancer.

Nipple-areola complex sparing modified radical mastectomy for breast cancer: report of 159 cases / 中华普通外科杂志

ObjectiveTo evaluate nipple-areola complex sparing modified radical mastectomy for breast cancer.MethodsClinical data of 159 breast cancer cases undergoing NAC sparing modified radical mastectomy from Jan 1998 to Dec 2009 were retrospectively analyzed.ResultsNAC sparing modified radical mastectomy was successfully carried out in 141 out of the 159 cases ( 88.68％ ).In 14 cases (8. 81％ ) the original operative protocol was changed to modified radical mastectomy or radical mastectomy during the operations because NAC ischemia in 4 (2. 52％ )cases, NAC occult involvement or dysplasia in 5 cases (3. 14％ ), Ⅲ level lymph node metastasis was found in 3 cases (1.89％). Postoperative complete nipple necrosis occurred in 4 (2. 52％ ) cases. Other significant postoperative complications included nipple necrosis in 20 cases ( 12. 58％ ), skin flap necrosis and infection in 11 cases ( 6.92％ ), subcutaneous hydrops in 10 cases (6. 29％ ). All patients got follow-up ranging from 15 to 96 months,median follow-up was 51 months. Local region recurrences were observed in 5 cases (3. 14％ ), distant metastasis in 2 cases ( 1.26％ ). There was no recurrence in the region of NAC.ConclusionsNipple-areola complex sparing modified radical mastectomy is oncologically safe by strict preoperative selection criteria and strict operative procedure.

Variants of papillary thyroid carcinoma / 国际肿瘤学杂志

Histological variants of papillary carcinoma are numerous,and most variants have the same clinical behavior with classical PTC.Howwver prognosis of a few variants are poor,such as Tall cell variant,Columnar cell variant,Solid/Trabecular variant etc.There are some controversy in the diagnosis of some variants.For example,Follicular variant is easily misdiagnosed as Follicular adenoma,Clear cell variant ma y beconfused with Renal cell carcinoma.Moreover,there are some divergences about proportion of cell and cell height in diagnosis of Tall cell variant,and so on.

KAI1 gene expression in papillary thyroid carcinoma and its significance / 中华内分泌外科杂志

Objective To explore the relationship between KAI1 gene expression in papillary thyroid carcinoma and clinicopathological features and prognosis. Methods KAI1 mRNA expression was detected by Real Time Polymerase Chain Reaction in 21 cases papillary thyroid carcinoma tissues and 21 cases adjacent normal tissues, as well as 7 cases benign thyroid disease tissues. KAI1 protein expression was detected by immunohistochemisty in 60 cases papillary thyroid carcinoma tissues and 20 cases thyroid adenoma tissues. Results KAI1 mRNA expression in papillary thyroid carcinoma was significantly higher than that in adjacent normal tissues (P ＜ 0. 05) and benign thyroid lesion tissues (P ＜ 0. 05). Positive expression rate of KAI1 protein was 68. 3% in papillary thyroid carcinoma and 25% in thyroid adenoma tissues. The difference was statistically significant (P ＜0. 01). In papillary thyroid carcinoma, positive expression rate of KAI1 protein in the group without lymph node metastasis was higher than that in group with lymph node metastasis (P＜0.05). There was no difference in positive expression rate of KAI1 protein for male or female patients (P ＞0. 05). KAI1 protein expression in papillary thyroid carcinoma was not related to patients' ages, tumor size, TNM staging or capsule invasion (P ＞ 0. 05). Conclusions The abnormal expression of KAI1 mRNA and protein is correlated to the genesis and progress of papillary thyroid carcinoma,which provides a clue for treatment and prognosis assessment of papillary thyroid carcinoma

Prevention and treatment of the complications of nipple-areola complex sparing modified radical mastectomy / 中华内分泌外科杂志

Objective To discuss the prevention and treatment of the complications of modified radical mastectomy with nipple-areola complex (NAC) sparing. Methods The clinical data of 124 breast cancer patients who had a NAC sparing modified radical mastectomy from January 1998 to December 2008 were analyzed retrospectively. The causes of complications were evaluated and the proposal of prevention and treatment was put forward. Results Of the 124 patients, 18 had nipple necrosis (14.52%), 9 had skin infections and necrosis (7.26%), 7 subcutaneous hydrops(5.65%), 5 upper extremity lymphedema (4.03%), 3 chest muscle contracture with ipsilateral upper limb dyskinesia (2.42%), and 2 operative residual cavity hemorrhage(1.61%). Conclusion All the post-operative complications listed above could be possibly avoided by more careful operation procedure.