Endoscopic hemithyroidectomy plus prophylactic central neck dissection via breast approach versus gasless transaxillary approach in treating low-risk papillary thyroid cancer: a retrospective series.

Hemithyroidectomy plus prophylactic central neck dissection (pCND) has been adopted as a de-escalating surgical strategy for low-risk papillary thyroid cancer (PTC). This study aimed to evaluate and compare the outcomes of these two different endoscopic approaches in the treatment of PTC with hemithyroidectomy plus pCND. This retrospective study reviewed medical records of 545 patients receiving breast approach (ETBA) (n = 263) or gasless transaxillary approach (ETGTA) (n = 282) in treating PTC. Demographics and outcomes were compared between the two groups. Preoperatively, the two groups were similar in demographics. Regarding surgical outcomes, no differences were found in terms of intraoperative bleeding, total amount of drainage, duration of drainage, postoperative pain, hospital stay, vocal cord palsy, hypoparathyroidism, hemorrhage, wound infection, chyle leakage, or subcutaneous ecchymosis. Conversely, ETBA recorded fewer skin paresthesia (1.5% vs. 5.0%, respectively) but longer operative times (138.1 ± 27.0 vs. 130.9 ± 30.8 min,) and more swallowing disturbances (3.4% vs. 0.7%) compared to ETGTA (p < 0.05). No difference in scar cosmetic results, but ETBA had lower neck assessment score than ETGTA (2.6 ± 1.2 vs. 3.2 ± 2.0, p < 0.05). For low-risk PTC, endoscopic hemithyroidectomy plus pCND using either ETBA or ETGTA is both feasible and safe. Although the two approaches are comparable in terms of most surgical and oncological outcomes, ETBA is superior to ETGTA in terms of neck cosmetic results and skin paresthesia but is associated with more swallowing disturbances and requires a longer operative time.

Cellulosic hydrocarbons production by engineering dual synthesis pathways in Corynebacterium glutamicum.

BACKGROUND: Lignocellulose provides the only practical carbohydrates feedstock for sustainable bioproduction of hydrocarbons as future alternative of fossil fuels. Production of hydrocarbons from lignocellulose is achieved by a biorefinery process chain including pretreatment to breakdown the crystalline structure for cellulase-catalyzed hydrolysis, detoxification of inhibitory compounds generated during pretreatment, enzymatic hydrolysis to fermentable monosaccharide sugars, and fermentation to hydrocarbon products. The major barriers on fermentative production of hydrocarbons from lignocellulose include two aspects: one is the inherent stress of pretreatment-derived inhibitors on microbial cells, the other is the toxicity of hydrocarbons to cell membranes. The microbial cell factory should be tolerant to both inhibitor stress and hydrocarbons toxicity. RESULTS: Corynebacterium glutamicum was selected as the starting strain of hydrocarbons synthesis since it is well adapted to lignocellulose hydrolysate environment. The dual hydrocarbon synthesis pathways were constructed in an industrial C. glutamicum S9114 strain. The first pathway was the regular one in microalgae composed of fatty acyl-acyl carrier protein (fatty acyl-ACP) reductase (AAR) and aldehyde deformylating oxygenase (ADO) with fatty acyl-ACP as precursor. The second pathway was the direct decarboxylation of free fatty acid by fatty acid decarboxylase (OleT) using the rich fatty acids from the disruption of the transcriptional regulator fasR gene. The transmembrane transportation of hydrocarbon products was avoided by secretively expressing the fatty acid decarboxylase (OleT) to the extracellular space. The hydrocarbons generation from glucose reached 29.2 mg/L, in which the direct decarboxylation pathway contributed more than 70% of the total hydrocarbons generation, and the AAR-ADO pathway contributed the rest 30%. CONCLUSION: The dual hydrocarbon synthesis pathways (OleT and AAR-ADO pathways) were constructed in the inhibitors tolerant C. glutamicum S9114 strain for hydrocarbon production using lignocellulose feedstock as the starting feedstock. When corn stover was used for hydrocarbons production after dry acid pretreatment and biodetoxification, the hydrocarbons generation reached 16.0 mg/L. This study provided a new strategy for hydrocarbons synthesis using microbial cell factory suitable for lignocellulose feedstock.