[Posterior sternocleidomastoid border approach of gasless transaxillary endoscopic thyroidectomy in patients with papillary thyroid carcinoma: comparison with sternocleidomastoid fascia approach].

Objective: To examine the posterior sternocleidomastoid border approach which elevated whole sternocleidomastoid in gasless transaxillary endoscopic thyroidectomy. Methods: The clinical data of 46 patients with papillary thyroid carcinoma treated with gasless transaxillary endoscopic thyroidectomy from May 2019 to June 2020 at Department of Head and Neck Surgery, Sichuan Cancer Hospital was analyzed retrospectively. There were 9 males and 37 females, aged (38.6±12.0) years (range: 19 to 74 years). Fourteen and 32 cases performed posterior sternocleidomastoid border and sternocleidomastoid fascia approach, respectively. Comparative analysis were performed on clinical characters, surgical outcomes, postoperative complications, postoperative pain score, and quality-of-life of postoperative 1 month by t test, Wilcoxon rank sum test, Fisher exact test and χ2 test,respectively. Resuts Complete exposure of central compartment was higher (11/14 vs. 34.4%(11/32),χ²=7.624, P=0.006), more lymph nodes was retrieved (4.2±2.9 vs. 2.0±2.5, t=2.663, P=0.011) in posterior sternocleidomastoid border approach. There were no significant differences between groups in postoperative complications such as recurrent laryngeal nerve palsy (1/14 vs. 3.1%(1/32), P=0.521) and transient hypoparathyroidism (0 vs. 6.2%(2/32), P=1) and pains and quality-of-life. Conclusion: Posterior sternocleidomastoid border approach of gasless transaxillary endoscopic thyroidectomy is safe and reliable and has the advantage of central compartment dissection without increasing trauma.

[Progression of diagnosis and treatment of medullary thyroid carcinoma].

Objective: To review and summarize recent update on preoperative diagnostic criteria, treatment and postoperative follow-up for medullary thyroid carcinoma. Methods: The relevant literatures and guidelines about medullary thyroid carcinoma were analyzed and summarized. Results: In the early stages of the disease radical surgery still dominated. Ultrasound results suggested that prophylactic lateral neck dissection was required for patients with high risk factors or high levels of carcinoembryonic antigen and calcitonin need prophylactic. Early hereditary medullary carcinoma could receive prophylactic thyroidectomy based on RET gene test results. Advanced progressive medullary thyroid carcinoma could be treated with palliative surgery,molecular targeted drugs and chemotherapy. Conclusions: The prognosis of medullary thyroid carcinoma is poor and lymph node metastasis is easy to occur early. The extent of initial operation should be enough. Locally advanced or distant metastatic medullary thyroid carcinoma can be treated with palliative surgery,molecular targeted drugs and chemotherapy.

[Discussion about the safety of outpatient thyroid surgery].

Thyroid tumors are one of the most common diseases, and the thyroidectomy surgery increases. The outpatient surgery is the new trend in clinic. Is it suited for the thyroidectomy? In this article, we will analyse the setting of hospital, surgeon, surgery, patients, and so on, to prove the safety for the outpatient thyroidectomy. After the analysis, the safety of outpatient thyroidectomy surgery will be ensured only if strictly controlling the condition of hospital, surgeons and patients, and following the relation indications.

Autoantibody against integrin αv ß3 contributes to thrombocytopenia by blocking the migration and adhesion of megakaryocytes.

Essentials The pathogenesis of immune thrombocytopenia (ITP) has not been fully clarified. We analyzed the role of anti-αvß3 autoantibody in the pathogenesis of ITP in patients. Anti-αvß3 autoantibody impeded megakaryocyte migration and adhesion to the vascular niche. Anti-αv ß3 autoantibody potentially contributes to the pathogenesis of refractory ITP. SUMMARY: Background The pathogenesis of immune thrombocytopenia (ITP) has not been fully clarified. Anti-αvß3 integrin autoantibody is detected in chronic ITP patients, but its contribution to ITP is still unclear. Objectives To clarify the potential role of anti-αvß3 integrin autoantibody in chronic ITP and the related mechanism. Methods Relationship between levels of anti-αvß3 autoantibody and platelets in chronic ITP patients was evaluated. The influence of anti-αvß3 antibody on megakaryocyte (MK) survival, differentiation, migration and adhesion was assessed, and the associated signal pathways were investigated. Platelet recovery and MKs' distribution were observed in an ITP mouse model pretreated with different antibodies. Result In this study, we showed that the anti-αvß3 autoantibody usually coexists with anti-αIIbß3 autoantibody in chronic ITP patients, and patients with both autoantibodies have lower platelets. In in vitro studies, we showed that the anti-αvß3 antibody had no significant effect on the survival and proliferation of MKs, whereas it decreased formations of proplatelet significantly. Anti-αvß3 antibody impeded stromal cell derived facor-1 alpha (SDF-1α)- mediated migration and inhibited the phosphorylation of protein kinase B. Anti-αvß3 antibody significantly inhibited MKs' adhesion to endothelial cells and Fibrogen. The phosphorylation of focal adhesion kinase and proto-oncogene tyrosine-protein kinase Src induced by adhesion was inhibited when MKs were pretreated with anti-αvß3 antibody. In in vivo studies, we showed that injection with anti-αv antibody delayed platelet recovery in a mouse model of ITP. Conclusions These findings demonstrate that the autoantibody against integrin αv ß3 may aggravate thrombocytopenia in ITP patients by impeding MK migration and adhesion to the vascular niche, which provides new insights into the pathogenesis of ITP.

[Application of virtual reality in surgical treatment of complex head and neck carcinoma].

Objective: To investigate the application of virtual reality technology in the preoperative evaluation of complex head and neck carcinoma and he value of virtual reality technology in surgical treatment of head and neck carcinoma. Methods: The image data of eight patients with complex head and neck carcinoma treated from December 2016 to May 2017 was acquired. The data were put into virtual reality system to built the three-dimensional anatomical model of carcinoma and to created the surgical scene. The process of surgery was stimulated by recognizing the relationship between tumor and surrounding important structures. Finally all patients were treated with surgery. And two typical cases were reported. Results: With the help of virtual reality, surgeons could adequately assess the condition of carcinoma and the security of operation and ensured the safety of operations. Conclusions: Virtual reality can provide the surgeons with the sensory experience in virtual surgery scenes and achieve the man-computer cooperation and stereoscopic assessment, which will ensure the safety of surgery. Virtual reality has a huge impact on guiding the traditional surgical procedure of head and neck carcinoma.

Analysis of drug resistance-associated proteins expressions of patients with the recurrent of acute leukemia via protein microarray technology.

INTRODUCTION: To detect the expressions of drug-resistance related proteins in bone marrow mononuclear cells of acute leukemia (AL) patients using protein microarray and to analyze the clinical value of protein microarray in predicting prognosis of AL patients. PATIENTS AND METHODS: A total of 48 AL patients received chemotherapy were divided into four groups: recurrent acute myeloid leukemia group (R-AML; n=15); AML continue remission group (AML-CR; n = 13); recurrent acute lymphocytic leukemia group (R-ALL; n=13); and ALL-CR group (n=7). Fifteen age-matched patients with non-hematologic disease were used as controls. RESULTS: Expression levels of P-gp, LRP/MVP, BCL-2, GST-π, PCNA, CXCR4 were increased significantly in both AML-R and ALL-R groups (p < 0.05). Besides, LFA-1 and TRAIL-R were also up-expressed significantly in ALL-R group (p < 0.05). In addition, the levels of P-gp, GST-π expressed in AML-R group were higher than those in AML-CR group (p < 0.05) and P-gp, LRP/MVP, GST-π, LFA-1 and CXCR4 in ALL-R were expressed higher than those in ALL-CR group (p < 0.05). CONCLUSIONS: The recurrent of AL were related closely to the over expression of drug resistance-related proteins. Protein microarray can be used in the prediction of AL recurrence and would be beneficial in guiding individual therapy and patient prognosis.

A case of adult-onset Still's disease presenting with multifocal central serous chorioretinopathy.

Adult-onset Still's disease (AOSD) is a rare systemic inflammatory disorder of unknown etiology with no specific histological features. In this study, we reported a 43-year-old woman who developed AOSD with multifocal central serous chorioretinopathy (CSC). Up to now, the patient is still on close follow-up. Besides, we reviewed the literature emphasized on the ophthalmological features of AOSD.

Stem cell collection in unmanipulated HLA-haploidentical/mismatched related transplantation with combined granulocyte-colony stimulating factor-mobilised blood and bone marrow for patients with haematologic malignancies: the impact of donor characteristics and procedural settings.

Unmanipulated haploidentical/mismatched related transplantation with combined granulocyte-colony stimulating factor-mobilised peripheral blood stem cells (G-PBSCs) and granulocyte-colony stimulating factor-mobilised bone marrow (G-BM) has been developed as an alternative transplantation strategy for patients with haematologic malignancies. However, little information is available about the factors predicting the outcome of peripheral blood stem cell (PBSC) collection and bone marrow (BM) harvest in this transplantation. The effects of donor characteristics and procedure factors on CD34(+) cell yield were investigated. A total of 104 related healthy donors received granulocyte-colony stimulating factor (G-CSF) followed by PBSC collection and BM harvest. Male donors had significantly higher yields compared with female donors. In multiple regression analysis for peripheral blood collection, age and flow rate were negatively correlated with cell yield, whereas body mass index, pre-aphaeresis white blood cell (WBC) and circulating immature cell (CIC) counts were positively correlated with cell yields. For BM harvest, age was negatively correlated with cell yields, whereas pre-BM collection CIC counts were positively correlated with cell yield. All donors achieved the final product of >or=6 x10(6) kg(-1) recipient body weight. This transplantation strategy has been shown to be a feasible approach with acceptable outcomes in stem cell collection for patients who received HLA-haploidentical/mismatched transplantation with combined G-PBSCs and G-BM. In donors with multiple high-risk characteristics for poor aphaeresis CD34(+) cell yield, BM was an alternative source.