Quantification and Pattern of Central Compartment Lymph Nodes in pN1a Papillary Thyroid Cancer Patients.

Background: The background is to investigate the results of central compartment lymphadenectomy for pN1a papillary thyroid carcinoma (PTC) with regard to quantification and pattern of resected lymph nodes thereby providing basis for future compartment VI surgical intervention. Methods: The study comprised 443 pN1a PTC patients whose clinicopathological characteristics and central compartment lymphadenectomy results were compared and correlated with the primary thyroid cancer and lymph node metastasis (LNM) features. Ultimately, multivariate analysis was conducted to identify statistically significant impact factors for a high metastatic ratio (MR). Results: Dissected lymph nodes (DLNs) were more frequently identified in right level VI than left (P < .05) although there was no difference in in the number of resected metastatic lymph nodes (MLNs). Male sex, multifocality, extrathyroidal extension (ETE), and fewer DLNs were related to a high MR. There was a positive correlation between DLN and MLN, and a negative correlation between DLN and MR. Disease multifocality and ETE were identified more frequently in the left than the right thyroid lobe. Conclusion: The outcome of central compartment lymphadenectomy in pN1a PTC patients is associated with several factors, and a thorough dissection of lymph nodes improves the rate of metastatic lymph node resection.

Analysis of risk factors for posterior laryngeal recurrent nerve metastasis in micropapillary thyroid carcinoma.

Posterior recurrent laryngeal nerve (RLN) lymph node dissection remains controversial in the operation of thyroid cancer, especially in cases of papillary thyroid microcarcinoma (PTMC). The present study aimed to evaluate the risk factors for posterior RLN lymph node metastasis in patients with PTMC. Two hundred and thirty-nine patients pathologically diagnosed with PTMC after surgery between June 2016 and June 2017 were included. Risk factors including age, sex, tumor diameter, multiple tumor focus, membrane invasion and lateral cervical lymph node metastasis condition, were analyzed, and their corresponding OR values were calculated. The results indicated that posterior RLN lymph node metastasis was pathologically identified in 27/239 patients. Membrane invasion (p = 0.024), VIa lymph node metastasis (p < 0.01), and lateral cervical lymph node metastasis (p < 0.01) were considered to be risk factors for posterior RLN lymph node metastasis. It is concluded that membrane invasion, VIa lymph node metastasis, and lateral cervical lymph node metastasis significantly increased the incidence of posterior RLN lymph node metastasis. Complete dissection of the posterior RLN lymph node was essential for patients with these risk factors.

Is There a Regular Pattern in the Recovery of Parathyroid Function After Thyroid Cancer Surgery?

PURPOSE: To investigate whether there is a pattern of recovery of parathyroid function after thyroid cancer surgery. PATIENTS AND METHODS: The study included 183 patients with papillary thyroid cancer (PTC) who underwent "total thyroidectomy (TT)" plus "unilateral central lymph node dissection (UCLND)" or "bilateral central lymph node dissection (BCLND)". The intact parathyroid hormone (iPTH) and serum calcium (sCa) were analyzed several times within 1 month after surgery to explore the recovery pattern of parathyroid gland function. Then, these 183 cases were divided into group A (97 cases) with UCLND and group B (86 cases) with BCLND to analyze whether the impairment and recovery of parathyroid function were different between the two subgroups. RESULTS: Postoperative hypoparathyroidism was seen in 115 out of 183 cases. iPTH values decreased significantly on postoperative day (POD) 1 compared with preoperative values, dropped to the lowest point on POD 3, showed an increasing trend on POD 5 and 14, and increased to 85.0% of preoperative values at POD30, whereas changes in sCa differ from changes in iPTH, which showed the lowest sCa value on POD1, and rebounded on the POD3 with the intervention of calcium supplementation, and continued to rise on the POD5 and POD14, and the sCa value reached 96.6% of the preoperative level at POD30. Subgroup analysis showed that temporary hypoparathyroidism was more pronounced in group B than in group A. SCa and iPTH levels in both subgroups showed the same trend of first decrease and then increase. CONCLUSION: The recovery of hypocalcemia and hypo-iPTHemia in the first month after thyroid cancer surgery shows a trend of decreasing and then increasing, and knowing the recovery of parathyroid function at different time points is of great value to surgeons and patients alike.

Preoperative risk factors and recommendations for surgical intervention in cN0 papillary thyroid microcarcinoma.

The evaluation and management of papillary thyroid microcarcinoma (PTMC) have always been challenging and controversial. Our retrospective study aimed to investigate the metastatic trend and risk factors of cN0 papillary thyroid microcarcinoma patients and provide advice for surgical strategies. The clinicopathological features of 556 cN0 PTMC patients undergoing thyroidectomy combined with central compartment dissection (CCD) were compared by the χ2 test and risk factors were identified by binary logistic regression analysis. Numbers of dissected lymph nodes (DLN) and metastatic lymph nodes (MLN) were analyzed using the Mann-Whitney U test to compare metastatic trends between different lobes. Male gender, tumor maximum diameter (TMD) larger than 5 mm, multifocality, and capsular/extracapsular invasion were metastatic risk factors of central compartment metastasis (CCM) (p<0.05). The number of DLN in the right level VI was larger than in the left (p<0.05), while the number of MLN was similar (p>0.05). The chance of CCM was higher when the number of DLN was larger than 5 (p<0.05). After identified metastatic trends and risk factors, we recommend surgery for patients deciding on aggressive treatment, especially for cases where a combination of risk factors is present. And to ensure no residual metastatic lymph nodes and reduce secondary surgery rates, adequate lymphadenectomy on the diseased side would be a better choice considering the standard of care.

[Silencing of COX-2 in nasopharyngeal carcinoma cells with a shRNAmir lentivirus vector].

OBJECTIVE: To construct a miR-155-based lentivirus vector to induce cyclooxygenase-2 gene silencing in nasopharyngeal carcinoma (NPC) cells by expressing anti-COX-2 shRNAmir. METHODS: miR-155-based anti-COX-2 shRNAmir template was synthesized and inserted into pLVTHM plasmid. The recombinant pLVTHM/shRNAmir was transfected into 293FT cells for packaging the lentivirus vector. After infection with the lentivirus vector, the GFP-positive cells were screened by flow cytometry, and COX-2 mRNA level was detected by RT-PCR. RESULTS: Restriction digestion and DNA sequencing confirmed successful construction of the anti-COX-2 vector pLVTHM/shRNAmir. A subline of C666-1 cells was established after infection with the lentivirus vector, and the COX-2 expression in the cells was stably silenced. CONCLUSION: The shRNAmir lentivirus vector constructed may serve as an effective COX-2 inhibitor, which may facilitate future studies of gene therapy of NPC.

[Pepsin immunoassay in the sputum for detection of laryngopharyngeal reflux].

OBJECTIVE: To study whether the presence of gastric pepsin in the sputum might be used as a reliable criteria of laryngopharyngeal reflux. METHODS: Fifty-six patients with the symptoms of laryngopharyngitis and fifteen healthy people were recruited. Fifty-six patients were divided into laryngopharyngeal reflux group and chronic laryngitis group by the reflux symptom index (RSI), by the reflux finding score (RFS) and by their treating experiment taking omeprazole 20 mg bid for 2 weeks. Sputum in all three groups was obtained in the morning. Pepsin in the sputum was measured by enzyme-linked immunoadsorbent assay. RESULTS: The positive rate of pepsin in sputum among LPR group, chronic laryngopharyngitis group and normal group were 93.8% (30/32), 75.0% (18/24), 20.0% (3/15) respectively, and the median concentration of pepsin were 5.3 [1.3; 53.4] ng/ml, 0.8 [0.1; 17.2] ng/ml, 0.0[0.0;0.0] ng/ml (H = 23.29, P = 0.000). Compared with co-diagnosis as gold standard, the sensitivity of RSI, RFS treating experiment and the pepsin immunoassay was 59.4%, 84.4%, 81.3% and 93.8%, and the specificity of those was 87.2%, 61.5%, 95.8% and 46.2% respectively. CONCLUSIONS: Detection of pepsin in sputum by immunoassay might provide a high sensitive, noninvasive method for laryngopharyngeal reflux.

[Alveolar soft part sarcoma of the tongue root: a case report].

Alveolar soft part sarcoma is a rare, aggressive malignancy of uncertain histological origin with a propensity for vascular invasion and distant metastasis. The case presented involves a 31-year-old woman with alveolar soft part sarcoma in the tongue root. The clinical features, pathogenesis, diagnosis and treatment were discussed.

[Determination of serum superoxide dismutase, glutathione peroxidase, total antioxidative capacity, malondialdehyde in patients with pneumonia].

OBJECTIVE: To determine the levels of serum superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), total antioxidative capacity (T-AOC) and malondialdehyde (MDA) in patients with pneumonia. METHODS: Sixty-eight patients with pneumonia were divided into group of acute pneumonia, group of chronic bronchitis complicated by lung infection, and group of bronchopneumonia. The levels of serum SOD, GSH-Px, T-AOC and MDA were detected by colorimetry in the 68 patients and 76 normal control subjects. RESULTS: The serum levels of SOD, GSH-Px and MDA were all significantly higher, while T-AOC significantly lower in the 3 patient groups than in the normal subjects. Significant difference in the measurements was also noted between the 3 groups (P < 0.01). CONCLUSION: The determination of serum SOD, GSH-Px, T-AOC and MDA may be helpful for the diagnosis and treatment of pneumonia.