A controlled study of the hygienic technical evaluation of the transaxillary approach for inflation-free single-port lumpectomy versus conventional transcervical anterior open surgery in radical thyroid cancer resection.

OBJECTIVE: To evaluate sanitary techniques for radical thyroid cancer surgery via the transaxillary approach without inflation single-port endoscopic surgery (TAWISES) and the conventional open anterior cervical approach (COACAS) in a controlled manner. METHODS: This work was a retrospective analysis of the clinical data of 60 patients admitted to our hospital for unilateral radical thyroid cancer surgery between 01/2021 and 12/2022. The control group underwent COACAS (30 patients), and the experimental group underwent TAWISES (30 patients). The patients' operative time, intraoperative bleeding volume, 24-h postoperative pain index, drainage tube carrying time, hospitalization duration and complication rate were compared and analyzed. The patients were followed up for 3, 6 and 12 months postoperatively and evaluated based on numbness, muscular tightness, pain and other discomfort in the neck, as well as satisfaction with social adaptation and cosmetic incisions. The recurrence status was assessed for 1 year in both groups of patients. A questionnaire survey was conducted to assess patient acceptance of the two surgical approaches. The economic characteristics (cost-effectiveness and cost-utility) of the different approaches in our region were evaluated comprehensively. RESULTS: The length of the incision, drainage tube carrying time and hospitalization duration were greater in the experimental group than in the control group (P < 0.05). The differences in complication rate, intraoperative bleeding volume, 24-h postoperative pain index and recurrence rate were not statistically significant between the two groups (P > 0.05). Neck discomfort was greater in the control group, and the difference was statistically significant at the 3-month postoperative follow-up (P < 0.05). The differences at the 6- and 12-month postoperative follow-ups were not statistically significant (P > 0.05). However, mild discomfort was significantly more common in the experimental group (63.33% > 36.67%, 80% > 53.33%, P < 0.05). The experimental group had better social adaptability, greater total medical costs, and better overall patient medical satisfaction than did the control group (P < 0.05). The acceptance of TAWISL was greater than that of COACAS (P < 0.05). CONCLUSION: Compared with COACLAS, TAWISES is safe and effective and better meets the cosmetic, psychological and social adaptation needs of patients. TAWISES is also more cost effective and can be better utilized for the population in our region, filling the gap in surgical modalities for thyroid cancer in in our region.

Clinical application of WeChat MDT in the perioperative period of secondary hyperparathyroidism / 中华内分泌外科杂志

Objective:To observe the application effect of the multi-disciplinary team (MDT) process and program supported by WeChat group in the perioperative period of secondary hyperparathyroidism (SHPT) .Methods:A total of 80 SHPT patients who were hospitalized in Hunan Provincial People’s Hospital and Qidong County People’s Hospital from Jul. 2017 to Oct. 2019 were selected and divided into MDT group (40 cases) and control group (40 cases) according to the principle of complete randomization. In MDT group, there were 21 females and 19 males, aged (48.80±9.08) years old, ranging from 26 to 74 years; in the control group, there were 23 females and 17 males, aged (47.90±8.89) years old, ranging from 24 to 74 years. The control group were given a conventional treatment plan, and the MDT group were implemented with the WeChat MDT process on this basis. The perioperative preparation time, operation time, intraoperative blood loss, postoperative extubation time, and continuous full parathyroid were compared between the two groups. The levels of intact parathyroid hormone (iPTH) and blood calcium and phosphorus were compared with the postoperative complications and patient satisfaction in the two groups. The data in this study were analyzed using SPSS 23.0 statistical software.Results:The preoperative preparation time (4.35±1.12) d, operation time (130.00±32.58) min, intraoperative blood loss (15.75±7.89) ml, and postoperative extubation time (3.80±0.82) d in the MDT group were significantly lower than the preoperative preparation time of the control group (6.86±1.85) d, operation time (162.57±41.65) min, intraoperative blood loss (60.75±11.5) ml, postoperative extubation time (5.97±1.25) d ( P<0.05) 1 week after operation, the iPTH (20.86±1.52) pg/ml and blood calcium level (2.23±0.24) mmol/L of the MDT group were significantly lower than those of the control group (103.47±8.27) pg/ml and blood calcium level (2.87±0.21) mmol/L ( P<0.05) , meanwhile the blood phosphorus level of the MDT group (1.52±0.56) mmol/L was significantly higher than the blood phosphorus level of the control group (1.18±0.25) mmol/L ( P<0.05) . The number of complications in the MDT group (20 cases) was significantly lower than the number of complications in the control group (48 cases) ( P<0.05) ; and the satisfaction of treatment in the MDT group (100.00%) was significantly better than that of the control group (80.00%) ( P<0.05) . Conclusion:The WeChat MDT diagnosis and treatment process and treatment plan are safe and effective, which can effectively shorten the operation time, reduce the operation risk, reduce postoperative complications, and increase patient satisfaction. It can be further promoted in the clinic.

Clinical diagnosis and treatment plan of medullary thyroid carcinoma / 中华内分泌外科杂志

Objective:To explore the key factors affecting the formulation of treatment and prognosis of medullary thyroid carcinoma.Methods:Patient data, clinical characteristics and the results of follow-up of typical cases of 23 patients with medullary thyroid carcinoma admitted to Hunan Provincial People’s Hospital Breast and Thyroid Surgery from Apr. 2007 to Mar. 2020 were retrospectively analyzed. The therapeutic schedule and prognosis of medullary thyroid carcinoma were discussed in combination with ATA guidelines and others.Results:Of the 23 patients with MTC, 22 (95.65%) had elevated serum calcitonin, 15 (65.22%) had elevated carcinoembryonic antigen, 3 (13.04%) had suspected abnormal lymph nodes, and 2 (8.70%) had capsule invasion. Thyroid lobectomy, thyroid lobectomy with lateral lymph node dissection in level VI, total thyroidectomy, total thyroidectomy with lateral lymph node dissection in level VI, total thyroidectomy with bilateral lymph node dissection in level VI, total thyroidectomy with bilateral lymph node dissection in level VI with lymph node dissection in level I, II, III, IV, V or VII were performed in 1, 2, 3, 1, 13, 3 cases respectively. 8 cases had postoperative recurrence (34.78%) , of which 7 cases were caused by the first operation. The level of Ctn increased significantly in 2 cases before operation, who underwent total thyroidectomy with bilateral lymph node dissection in level VI, and no recurrence was found after operation.Conclusions:The key to the biological cure of medullary thyroid carcinoma is standardized surgical treatment. The surgery method cannot be determined simply by calcitonin. The modern treatment of medullary thyroid carcinoma needs to follow the principle of standardization and individualization at the same time.

Therapeutic effect evaluation of the modified nipple orthotic device in the treatment of type Ⅱ and Ⅲ inverted nipple / 中华整形外科杂志

Objective@#To investigate the clinical application and efficacy of treatment in inverted nipple with a kind of lactation function preserved method of minimally invasive surgery.@*Methods@#96 patients with type Ⅱ and type Ⅲ inverted nipple admitted by our hospital from January 2013 to December 2017 were selected for treatment by modified self-made nipple orthotic device. Following up 7 months to 5 years to observe the effect of nipple correction and lactation function.@*Results@#87 cases of the patients received satisfactory therapeutic effect, and the lactation function was not affected; 2 cases of type Ⅱ and 3 cases of type Ⅲ inverted nipple were evaluated as medium, with mild nipple retraction; 4 cases were worn for less than 1 month, and the outcome was poor.@*Conclusions@#The modified nipple orthotic device is suitable for type Ⅱ and Ⅲ patients with inverted nipple, which is simple and effective method in nipple inversion.

Risk factors of seroma formation in breast surgery and its prevention and treatment methods / 国际外科学杂志

Objective To identify risk factors for seroma formation and to explore the related prevention and treatment methods.Methods We collected clinical and pathological data of 92 breast cancer patients undergoing modified radical mastectomy in Hu'nan Provincial People's Hospital,from January to September 2016.Seroma formation was studied in relation to age,tumor size,nodal involvement,the number of lymph nodes removed,flap fixation and external compression dressing.Count date were evaluated by the frequency and percentage,comparison between the groups was analyzed by the chi-square test.Multivariate analysis was performed using Logistic regression analysis.Results Seroma occurred in 45.7％ of patients.Age,tumor size,nodal involvement,the number of lymph nodes removed,flap fixation were risk factors of modified radical mastectomy postoperative seroma.In multivariate logistic regression analysis an association of postoperative seroma formation was noted with the number of lymph nodes removed(OR =1.123,95％ CI:1.036-1.218,P ＜ 0.01),age(OR =1.060,95％ CI:1.006-1.116,P＜0.05),flap fixation(OR=0.363,95％CI:0.135-0.977,P ＜0.05).Conclusion The findings suggest that older patients,with extensive lymph node dissection may more likely to form postoperative seroma,flap fixation can reduce the incidence of seroma.

Evaluation of the clinical value of carbon nanoparticles as lymph node tracer in differentiated thyroid carcinoma requiring reoperation.

BACKGROUND: The incidence of parathyroid injury in patients with differentiated thyroid carcinoma (DTC) who underwent reoperation is significantly higher than that incurred from the initial surgery. The aim of this study was to investigate the clinical value of carbon nanoparticles (CN) as tracers for lymph nodes to guide cervical lymph node dissection and protect the parathyroid during reoperation for DTC. METHODS: Our study recruited 116 patients with DTC who previously underwent thyroidectomy and later received remedial surgical treatment at the Department of Breast and Thyroid Surgery, Hunan Provincial People's Hospital, China, between February 2011 and February 2014. Those patients were randomly divided into the experimental group (the CN group) with 64 cases and the control group with 52 cases. Carbon nanoparticle suspension (CNS, 0.1-0.3 ml) was intraoperatively injected into the residual thyroid or enlarged lymph nodes in the CN group; in the control group, CNS was not applied intraoperatively. The differences in identification of the parathyroid glands, the number of lymph nodes resected intraoperatively, and the incidence of common complications after thyroidectomy in both groups were recorded and analyzed. RESULTS: The accuracy of identification of the parathyroid in the CN group and control group was 92.2 % and 28.8 %, respectively, and the identification rate of three glands or more in both groups was 75 % and 36.5 %, respectively; those differences were statistically significant between the two groups (P < 0.05). There was also a significant difference between the two groups in the number of lymph nodes removed in the central and lateral cervical compartments (P < 0.05). There was no increase in common complications after the second surgery compared with the previous surgery; in addition, there was a decline in the incidence of transient hypoparathyroidism (HPT) (P < 0.05). CONCLUSIONS: By tracing the thyroid and cervical regional lymph nodes with carbon nanoparticles, the parathyroid glands can be easily identified and protected to reduce the complications of transient hypoparathyroidism resulting from reoperation for residual or missed DTC. Carbon nanoparticle tracers also facilitate radical resection of lymph nodes at the central and lateral compartments of the neck.

Effects of methylprednislone on alveola septal apoptosis in autoimmune emphysema rats / 中国生化药物杂志

Objective To investigate the effects of methyprednislone on the expression of tumor alveolar septal cell apoptosis in autoimmune emphysema rats,in order to provide a theoretical basis for Chronic obstructive pulmonary disease(COPD)pathogenesis and it’s treatment.Methods 24 rats were randomly divided into three groups:normal control group (n=8 ),model group (n=8 )and intervention group (methylprednisolone sodium succinate,n=8).Intraperitoneal injection of primary cultured human umbilical vein endothelial cells were given to establish the autoimmune emphysema models,intervention group was injected with methylprednisolone at the meantime,and normal control group was received adjuvant only.Pathological changes were observed in lung tissues stained by hematoxylin eosin,mean liner intercept(MLI)and mean alveolar numbers(MAN)were measured.The localization of VEGF and VEGFR-2 in lung tissues were detected by immunohistochemical analysis.Terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling(TUNEL)technique was carried out to detect the alveolar septal cells apoptosis. Results The MLI in model group was higher than that in normal control group,while MAN was lower(P<0.05 );MLI in intervention group was lower than that in model group,but the MAN was higher (P<0.05 ).The localization of VEGF and VEGFR-2 in lung tissues in model group were lower than that in normal control group,and those in intervention group were higher than that in model group,the difference were all statistically significant(P<0.05 ).AI of alveolar septal cell in model group was higher than that in normal control group,which in intervention group was higher than that in model group,the difference were all statistically significant(P<0.05).Conclusion The decreasing of VEGF and VEGFR-2 in lung tissues may cause alveolar septal cell apoptosis and contribute to the pathogenesis of autoimmune emphysema of rats.Methyprednislone can alleviate the form of autoimmune emphysema in rats,which may be ralated to the regulation of VEGF and VEGFR-2 expression and inhibition of alveolar septal cell apoptosis.

Study on serum levels of vitamin D and calcium and expression of tissue calcium-sensing receptor in the breast cancers / 中国医师杂志

ObjectiveTo explore the relationship among 25-hydroxyvitamin D,serum calcium,calcium-sensing receptor,and breast cancer. Methods The expressions of calcium-sensing receptor (CaSR) in primary breast cancer,breast benign tumors,and normal breast tissue beside tumors were determined by immunohistochemistry S-P method as well as the concentration of serum 25 (OH) D and serum calcium in breast cancer and breast benign tumors by Enzyme-linked immunosorbent assay (ELISA),Tribromoarsenazo Ⅲ method.ResultsSerum 25 (OH) D level of breast cancer was significantly lower than the breast benign tumors [ (34.13 ± 14.14) nmol/L vs (50.29 ± 25.65 ) nmol/L,t =2.870,P =0.001 ].Serum level of 25 ( OH ) D in lymph node metastasis positive patient was lower than that in negative group [ (30.8 ± 9.71 ) nmol/L vs (43.7 ± 23.59) nmol/L,t =2.467,P =0.021 ].The positive expression of CaSR in breast cancer(88.9％ )was higher than breast benign tumors(60％,x2 =6.717,P ＜ 0.01 ) and normal breast tissue beside tumors (60％,x2 =5.628,P ＜ 0.05 ).ConclusionsConcentration of serum 25 (OH)D and expression of calcium-sensing receptor in the tissues may be associated with occurrence,development and prognosis of breast cancer.

The expression and clinical significance of CXCR3/CXCL10 in human breast cancer / 中国医师杂志

Objective To investigate the expression and clinical significance of CXCR3/CXCL10in human cancer.Methods CXCR3 and CXCL10 were detected in 60 paraffinic tissues of patients with primary breast cancer,20 of mammary fibroma and 20 of mastopathy by immunohistochemistry S-P method and two stage method.Results The expression of CXCR3 (40/60,66.7％ ) and CXCL10 (45/60,75％)in breast cancer was higher than that in mastopathy [CXCR3(8/20,40％ )x2 =4.44,P =0.035 ;CXCL10( 10/20,50％ )x2 =4.36,P =0.037)].The expression of CXCR3 was related to status of axillary lymph node metastasis,clinical stage and the expression of HER-2 (x2 =4.15,P =0.042; x2 =7.74,P =0.021 ;x2 =4.27,P =0.039).The expression of CXCR3 had positive relationship to the number axillary lymph node metastasis( rs =0.375,P =0.003 ),clinical stage ( rs =0.451,P =0.000).Conclusions CXCR3 may be related to the progression and metastasis of breast cancer,and it may be used as a marker of breast cancer prognosis.

The relationship of vitamin D receptor and β-catenin pathway in intestinal tumor growth / 中国医师杂志

Objective To explore the effect of vitamin D receptor (VDR) in intestinal tumor development and the relationship between VDR and β-catenin signaling pathway. Methods The interaction of vitamin D receptor and β-catenin were detected by co-immunoprecipitation assay after human colonic carcinoma cells SW480 were treated with vitamin D in vitro for 4 hours. The expression of E-cadherin protein was detected by Western blot after treated for 24 hours. To compare APCmin/+VDR-/- and APCmin/+ mice in vivo, the expression of VDR,β-catenin and BrdU proteins in intestinal tumor were determined by immunohistochemistry. The expression of β-catenin protein in tumor and adjacency intestinal was further determined by Western blot. Results After SW480 cells were treated with vitamin D, vitamin D receptor and β-catenin protein showed binding, the expression of E-cadherin protein further increased (Gray value the control group 145.57±4.21,Gray value of the experimental group 109.35±3.56,t＝32.63,P＜0.05). Immunostaining and Western blot detection（Gray value 166.47±2.36） showed a marked increase of β-catenin level(Gray value 140.51±2.57) in APCmin/+VDR-/- tumor compared to APCmin/+ tumor(145.41±3.62,182.35±3.24,t＝2.65,4.36,P＜0.05). Conclusions The role of vitamin D suppressing intestinal tumor may be achieved through VDR affectingβ-catenin signaling pathway.

Degradation of mono-fluorophenols by an acclimated activated sludge.

Acclimated activated sludge was examined for its ability to degrade mono-fluorophenols as the sole carbon source in aerobic batch cultures. The acclimated activated sludge degraded fluorophenol efficiently. It degraded 100 mg/l 3-fluoropheno and 4-fluorophenol in 16 h with, respectively, 99.85% and 99.91% fluoride anion release and it degraded 50 mg/l 2-fluorophenol in 15 h with 99.26% fluoride anion release. The aerobic biodegradability of the mono-fluorophenols decreased in the order: 4-fluorophenol > 3-fluorophenol > 2-fluorophenol, resulting mainly from a different octanol/water partition coefficient and different steric parameter of the fluorophenols. The mechanism study revealed that the initial step in the aerobic biodegradation of mono-fluorophenols by the activated sludge was their transformation to fluorocatechol. Following transformation of the fluorophenol to fluorocatechol, ring cleavage by catechol 1, 2-dioxygenases proceeded via an ortho-cleavage pathway, then defluorination occurred.

Biodegradation of meta-fluorophenol by an acclimated activated sludge.

An acclimated activated sludge was examined for its ability to degrade meta-fluorophenol as sole carbon source in aerobic batch cultures. The mechanism study revealed that the initial step in the aerobic biodegradation of meta-fluorophenol was their transformation to fluorocatechol. Following transformation of the fluorophenol to fluorocatechol, ring cleavage by catechol 1,2-dioxygenases proceeded via an ortho-cleavage pathway, then defluorination occurred.

Liquid flow field measurement in a tube with a combination of stenosis and bifurcation / 生物医学工程学杂志

Two-D liquid velocity field in a tube with a combination of a stenosis and a bifurcation was measured with refractive index matching technique using Laser Doppler Velocimeter (LDV). The flow ratio of main tube to bypass was 1:4. It is found that the axial velocity profile has two peaks in the XOY plane which is skewed to the main tube wall facing the flow from the bypass, and it manifests itself in the form of "M" in the XOZ plane. A two counter-rotating vortices in the main tube cross section downstream the conjunction region is also detected.