Discussion on how to optimize active surveillance for low-risk papillary thyroid microcarcinoma in China / 中华外科杂志

Active surveillance, as a first-line treatment strategy for low-risk papillary thyroid microcarcinoma, has been recommended by guidelines worldwide. However, active surveillance has not been widely accepted by doctors and patients in China. In view of the huge challenges faced by active surveillance, doctors should improve their understanding of the "low risk" of papillary thyroid micropapillary cancer, identify some intermediate or high-risk cases, be familiar with the criteria and methods of diagnosis for disease progression, and timely turn patients with disease progression into more active treatment strategies. By analyzing the long-term cost-effectiveness of active surveillance, it is clear that medical expense is only one cost form of medical activities, and the health cost (thyroid removal and surgical complications) paid by patients due to"over-diagnosis and over-treatment" is the most important. Moreover, the weakening of the patients' social function caused by surgical procedures is a more hidden and far-reaching cost. The formulation of health economic policies (including medical insurance) should promote the adjustment of diagnosis and treatment behavior to the direction which is conducive to the long-term life and treatment of patients, improving the overall health level of society and reducing the overall cost. At the same time, doctors should stimulate the subjective initiative of patients, help them fully understand the impact of various treatment methods on their psychological and physical status, support patients psychologically, and strengthen their confidence in implementing active surveillance. By strengthening multi-disciplinary treatment team and system support, doctors can achieve risk stratification of papillary thyroid microcarcinoma, accurate judgment of disease progress, timely counseling for psychological problems, and long-term adherence to active surveillance. Improving the treatment level of advanced thyroid cancer is the key point of improve the prognosis. It is important to promote the development of active surveillance for low-risk papillary thyroid microcarcinoma. In the future, it is necessary to carry out multi-center prospective research and accumulate research evidence for promoting the standardization process of active surveillance. Standardized active surveillance will certainly benefit specific papillary thyroid microcarcinoma patients.

Comparison of clinical effects of endoscopic thyroidectomy using the modified gasless transsubclavian approach and traditional open surgery for cN0 unilateral papillary thyroid carcinoma / 中华外科杂志

Objective: To compare the clinical effects of endoscopic thyroidectomy using a modified gasless transsubclavian approach and the traditional neck approach for unilateral papillary thyroid carcinoma (cN0). Methods: The clinical data of 135 patients with cN0 papillary thyroid carcinoma who underwent unilateral thyroidectomy in the Department of Thyroid Surgery, the First Hospital of Jilin University from October 2020 to November 2022 were retrospectively analyzed. There were 37 males and 98 females, aging (43.2±8.8) years (range: 21 to 59 years). There were 51 cases using the modified gasless transsubclavian approach (TS group) and 84 cases using the traditional neck approach (TN group). Comparative analyses were performed between the operative results of the 2 groups by t-test, Wilcoxon rank sum test, and χ2 test. Results: All endoscopic operations were successfully completed without conversion to the traditional neck approach. Compared to the TN group, the TS group had a longer operation time (M(IQR)) (73.5 (22.5) minutes vs. 90.0 (30.0) minutes, Z=-5.831, P<0.01), more postoperative drainage (60 (25) ml vs. 95 (45) ml, Z=-6.275, P<0.01), higher hospitalization costs (22 687 (3 488) yuan vs. 26 652 (2 431) yuan, Z=-6.944, P<0.01), and a higher rate of parathyroid autotransplantation (15.5% (13/84) vs. 60.8% (31/51), χ2=29.651, P<0.01). There was no significant difference in the total exposure rate of the central compartment, postoperative hospitalization time, the number of dissected lymph nodes, the number of metastatic lymph nodes, C-reactive protein ratio before and after operation, and preoperative and postoperative parathyroid hormone (all P>0.05). Conclusions: Endoscopic thyroidectomy using the modified gasless transsubclavian approach is safe for cN0 papillary thyroid carcinoma, with longer operating time, more postoperative drainage, higher hospitalization costs, and moredifficulty in preserving the inferior parathyroid gland in situ compared to traditional open surgery.

Clinical comparison of transaxillary and transsubclavian endoscopic surgery for cN0 papillary thyroid carcinoma / 中华内分泌外科杂志

Objective:To compare the clinical effects of endoscopic thyroidectomy using the modified gasless transaxillary approach (TA group) and transsubclavian approach (TS group) in the treatment of cN0 papillary thyroid carcinoma (PTC) .Methods:A total of 190 PTC patients (mean age 39.88±9.35 years,38 males, 152 females), who underwent unilateral thyroidectomy in the Department of Thyroid Surgery, the First Hospital of Jilin University from Oct. 2020 to Oct. 2022 were retrospectively analyzed, including 65 cases in TA group, 43 cases in TS group and 82 cases through traditional neck approach (TN group). The endoscopic group (TA+TS) consists of the TA group and the TS group. Comparative analyses were performed on operation time, full exposure rate of central compartment, postoperative hospitalization time, postoperative drainage, hospitalization costs, the number of dissected lymph nodes and postoperative complications. The t-test or Wilcoxon rank sum test, the χ2 test or the exact probability method were used for statistical analysis. Results:All endoscopic operations were successfully completed without conversion to traditional neck approach. ① Compared with the TN group, the endoscopic group (TA+TS) had longer operation time[TN group =74.5 (65-87) min, (TA+TS) group =102 (89-121) min, P<0.001], lower full exposure rate of central compartment (TN group=100%, (TA+TS) group=89.8%, P=0.008), more postoperative drainage[TN group=60 (45-76) ml, (TA+TS) group =100 (80-130) ml, P<0.001], higher hospitalization costs[TN group=￥23638 (22158-25901), (TA+TS) group =￥26967 (25572-28284), P<0.001], and higher parathyroid autotransplantation rate (TN group=4.9%, (TA+TS) group =50.9%, P<0.001). There were no significant differences in the number of dissected lymph nodes, the number of metastatic lymph nodes, preoperative and postoperative parathyroid hormone (PTH) ( P>0.05). ② Compared with the TS group, the TA group had longer operation time[TA group=110 (97-127) min, TS group=89 (80-111) min, P<0.001], lower full exposure rate of central compartment (TA group=83.1%, TS group=100%, P=0.012), longer postoperative hospitalization time[TA group=3 (3-4) d, TS group=3 (3-3) d, P=0.002], more postoperative drainage[TA group=110 (82-140) ml,TS group=95 (65~120) ml, P=0.046] and higher hospitalization costs (TA group=￥27510±2578,TS group=￥26609±1878, P=0.038). There were no significant differences in the number of dissected lymph nodes, the number of metastatic lymph nodes, preoperative and postoperative PTH, and parathyroid autotransplantation between the two groups ( P>0.05) . Conclusions:Endoscopic thyroidectomy through axillary/subclavian approach is safe and feasible for the treatment of cN0 PTC. There was no significant difference in the number of dissected central lymph nodes compared with conventional surgery, and the incision was well concealed. In comparison, transsubclavian endoscopic surgery has better clinical application value, with shorter operation time, higher full exposure rate of central compartment and faster postoperative recovery.

Investigation and analysis of clinical blood supply in Xi′an / 中国输血杂志

【Objective】 To explore the development and changes of blood use in various hospitals through statistical analysis of clinical blood use data in Xi′an, so as to provide basis for the decision making of blood banks to formulate and adjust the blood donation recruitment, collection, preparation and supply plan. 【Methods】 The clinical blood supply data of Shaanxi Blood Center from 2015 to 2019 were collected, and statistical analysis was conducted in terms of red blood cells, plasma, platelets, and cryoprecipitate. 【Results】 The blood supply in Xi′an showed an upward trend from 2015 to 2019, and the blood supply in 2019 was the highest in history(737 852 U). Both tertiary hospitals and secondary hospitals had shown an increasing trend in blood consumption, and the average consumption of red blood cells and plasma per person in operation kept decreasing year by year. The consumption of red blood cells in municipal hospitals and private hospitals had increased greatly, and the average consumption of red blood cells per person in operation had shown a downward trend. The amount of platelet use in all kinds of hospitals increased significantly. The proportion of platelet supply in the total annual blood supply kept increasing year by year. The ratio of platelet consumption to red blood cells consumption (hereinafter referred to as platelet-to-red blood cells ratio) in tertiary hospitals was higher than that in secondary hospitals. The platelet-to-red blood cells ratio of all kinds of hospitals had increased year by year. 【Conclusion】 The increase in the number of clinical diagnosis and treatment is the main reason for the increasing demand for clinical blood supply year by year. On this basis, the government and blood banks can predict the clinical blood demand and adjust the plan of blood donation in time. There is still much room for improvement in the annual platelet collection in Xi′an. Hospitals with higher levels of clinical disciplines have relatively high plate-to-blood ratios.The ratio of plasma to red blood cells consumption in tertiary hospitals is abnormal, there might be unreasonable use of blood.

Injury of aldehyde dehydrogenase 2 in organ ischemia-reperfusion injury through autophagy / 中华肝胆外科杂志

With the rapid development of organ transplantation in China,the donation after cardiac death (DCD) donor organs are widely used.However,the quality of these organs is relatively poor,so the way to preserve and maintain organ still remains a severe problem.Among them,ischemic reperfusion injury (IRI) impairs the organs severely.Acetaldehyde dehydrogenase 2 (ALDH2) protects organs from stress conditions,including ischemia-reperfusion injury,and the activation and autophagy inhibition also protects the organs from stress conditions as well.Recent studies showed that ALDH2 can regulate autophagy to inhibit the organ injury during ischemia-reperfusion.Our study aims to discuss the new findings in this mechanism.

Inhibitory effect of Sophora subprosrate polysaccharide on mitochondria oxidative stress induced by PCV-2 infection in RAW264.7 cells.

In the present study, the inhibitory effect of Sophora subprosrate polysaccharide (SSP) on PCV-2-induced mitochondrial respiratory burst in RAW264.7 cells was first investigated. The findings suggested that SOD activity and the anti-superoxide anion radical activity of the RAW264.7 cells were significantly decreased after PCV-2 infection, and MnSOD mRNA levels were significantly decreased, while NOX2 mRNA levels and protein expression were increased. Meanwhile, the O2•- levels and mitochondrial membrane potentials were significantly increased. After treatment with SSP, significant increases in the activities of SOD, anti-superoxide anion radical activities, and MnSOD mRNA levels in the PCV-2 infected cells were observed. Meanwhile, significant increases in NOX2 mRNA levels and protein expression, O2•- levels and mitochondrial membrane potentials were also observed. The results showed that PCV2 infection resulted in the mitochondria oxidative stress of RAW264.7 cells as indicated by an increasing mitochondrial membrane potential, which was then inhibited by SSP. It was concluded that RAW264.7 cells treated with SSP could suffer from mitochondrial damage, which may be mediated by the inhibition of the mitochondrial membrane potential.

Intraoperative parathyroid hormone examination in parathyroidectomy for primary hyperparathyroidism / 中华内分泌外科杂志

Objective To explore the effect of intraoperative parathyroid hormone (IOPTH) examination on parathyroidectomy for primary hyperparathyroidism.Methods The clinical data of 41 PHPT patients who received IOPTH monitoring (IOPTH group) from Jan.2009 to Dec.2014 were retrospectively analyzed.The clinical manifestation,examination and changes of parathyroid hormone and calcium before and after operation were collected.Results There were 12 males and 29 females.36 cases had parathyroid adenoma,and 5 cases were parathyroid carcinoma.23 cases were positive in 24 cases of 99Icm-MIBI parathyroid adenoma radionuclide examination,and 2 cases were positive in 3 cases of parathyroid carcinoma radionuclide 99Tcm-MIBI inspection (P＝ 0.213).10 mins after tumor resection,PTH in all cases decreased by 50％ or more than that before tumor resection except for one case of parathyroid carcinoma.23 cases appeared hypocalcemia in 36 cases of parathyroid adenoma after surgery and 2 cases appeared hypocalcemia in 5 cases of parathyroid cancer patients (P＝0.361).No postoperative hoarseness,cough,bleeding occoured.Patients were followed up from 6 to 72 months.Hypocalcemia symptoms recovered 2 weeks to 3 months after surgery.No permanent hypoparathyroidism occured.One case of parathyroid carcinoma died of hypercalcemia 5 months after surgery.The remaining 40 cases survived without recurrence or death.Conclusions Intraoperative PTH monitoring can help doctors analyze whether all the hyperthyroidism glands have been removed,which can help to avoid miss diagnosis of multiple gland disease and unnecessary bilateral neck exploration.This method is highly accurate so it is recommended for routine use in PHPT surgery.

Related factors on skip metastasis of neck lymph node in papillary thyroid carcinoma / 中华外科杂志

Objective@#To investigate the correlation between skip metastasis of neck lymph node and clinicopathological features in papillary thyroid carcinoma.@*Methods@#Totally 272 papillary thyroid carcinoma patients with lateral lymph node metastases who received surgical procedure at Department of Thyroid Surgery, the First Hospital of the Jilin University from January 2014 to June 2016 were analyzed retrospectively. There were 105 male and 167 female patients, aging from 16 to 73 years with a mean age of (42±8) years. There were 29 patients (10.7%) with skip metastasis. And then the correlation between skip metastasis of neck lymph node and clinicopathological features was analyzed by χ2 test and multivariate Logistic regression test.@*Results@#The rate of skip metastasis in all patients was 10.7% (29/272). By summarizing the distribution of the lateral lymph nodes about the patients with skip metastasis, 16 cases metastasized in single level (55.2%), meanwhile 6 in two levels (20.7%) and 7 in three levels (24.1%). Strong correlation between age, tumor location and skip metastasis was found using χ2 test (χ2 values were 14.056 and 21.362 respectively, both P values were 0.000). Age (>45 years) (OR=4.318, 95% CI: 1.767 to 10.552, P=0.001), microcarcinoma (OR=2.623, 95% CI: 1.013 to 6.795, P=0.047)and the tumor located in the upper of the thyroid (OR=11.982, 95% CI: 2.533 to 56.173, P=0.002) were risk factors to the skip metastasis through multivariable Logistic regression analysis.@*Conclusions@#Age >45 years old, microcarcinoma or tumor located in the upper part of the thyroid gland was more likely present with skip metastasis. Skip metastases are often involved in the lateral multi-level. Therefore, confronted patients with one of these risk factors, the occurrence of skip metastasis should be awared when the lateral lymph node was large abnormally. Accordingly, it may be appropriate to extend the indications of fine needle aspiration for lateral lymph node in order to prevent missed diagnosis.

Surgical treatment of secondary hyperparathyroidism in patients with chronic kidney disease / 中华全科医师杂志

Secondary hyperparathyroidism is the most common complication of patients with chronic kidney disease.For patients poorly responding to medical treatment,parathyroidectomy would be the best choice.This article reviews the indications and modalities of surgical treatment for secondary hyperparathyroidism in patients with chronic kidney disease.

Graves' disease associated with papillary thyroid microcarcinoma:a retrospective case-control analysis / 中华内分泌外科杂志

Objective To investigate the clinical characteristics,diagnosis and treatment for Graves' disease associated with papillary thyroid microcarcinoma(PTMC) by retrospectively analyzing domestic and foreign literatures.Methods 32 patients of Graves' disease associated with PTMC treated at the Department of Thyroid Surgery,the First Bethune Hospital of Jilin University from Jun.2008 to Jun.2013 were collected.32 cases of PTMC with normal thyroid function were randomly selected by a random number table method from the same period as control.Results The experimental group had 32 patients aging from 24 to 71 years old,among whom 3 were males,and 29 were females with the male to female ratio was 1∶9.7.15 cases in the experimental group had positive central lymph node metastasis and the other 17 cases were negative,while in the control group 7 cases were positive and 25 cases were negative.The mean number of positive lymph nodes was 3 ± 2.88 in the experimental group and 1.71 ± 1.25 in the control group.The ratio of positive lymph node metastasis(the number of positive lymph nodes/the total number of lymph nodes,and the total number of central lymph nodes was ＞3)was (50.34 ±27.09) ％ in the experimental group and(33.5 ±30.79)％ in the control group.For the above 3 values of central lymph node metastasis,the experimental group were all higher than those of the control group (P =0.035,0.039,0.018 respectively).Conclusions Compared with patients of PTMC,patients of Graves' disease associated with PTMC are more likely to have central lymph node metastasis,more number of positive lymph node and higher metastasis ratio.In order to prevent the postoperative recurrence of Graves' disease and thyroid carcinoma local lymph node,total thyroidectomy plus central lymph node dissection should be the ideal operation method.

Analyiss of lymph nodes metastasis in papillary thyroid carcinoma and its surgical approaches / 中华内分泌外科杂志

Objective To investigate the characteristics of lymph nodes metastasis in papillary thyroid carcinoma (PTC) and to discuss surgical approach.Methods All patients underwent total thyroidectomy,central lymph nodes and lateral lymph nodes dissection in Department of Thyroid Surgery,the First Hospital of the Jilin University,from Dec.2011 to Dec.2012.Results With the increase of the number of positive central lymph nodes,lateral cervical lymph node metastasis rate increased as well and accompanied multi region metastasis trend.In 102 cases of lateral positive cervical lymph node patients,55 cases were in level Ⅱ,accounting for 53.92％,62 cases were in level Ⅲ,accounting for 60.78％,76 cases were in level Ⅳ,accounting for 74.51％,and 17 cases were in level V,accounting for 16.67％.In lateral lymph nodes metastasis,we found level Ⅳ was the most vulnerable area,followed by level Ⅲ,level Ⅱ and level Ⅴ.Conclusions Prophylactic central lymph node dissection should be performed in PTC patients.Patients with central lymph node metastasis especially with the number of positive lymph nodes ＞ 3 should be performed ipsilateral level Ⅱ-Ⅴ lymph node dissection.

Development of the mouse spinal cord and neuroapoptosis / 解剖学报

Objective To investigate the neural proliferation , differentiation and apoptosis of the developing spinal cord of the mouse and to discuss the mechanism of spinal cord ’ s development .Methods 5-Bromodeoxyuridine ( BrdU) assay was used to mark the proliferative neural stem cells , and the immunofluorescent stainings ( DCX, NeuN and Caspase8) were carried out to visualize the newborn neurons , mature cells and apoptotic cells in the spinal cord with 173 mice arrange from E18 to P90.Results BrdU positive neural stem cells appeared evenly in the spinal cord at early days . With age increasing , the neural stem cells differentiated into neuroglial cells and neurons .The newborn neurons in the subventricular zone migrated toward the intermediate zone ( putative gray matter ) and differentiated into mature neurons gradually .With neurons ’ concentrating towards the center , the gray matter formed an “H” shape .In the meantime , with neural differentiation , some apoptotic neurons appeared among the newborn neurons and mature neurons . Double immunostaining showed that most apoptotic neurons were newborn neurons , suggesting the neuroapoptosis more likely occurred in newborn neurons .The statistical data showed that the number of DCX , NeuN and Caspase-8 positive cells reduced with age increasing , suggesting neural differentiation and neuroapoptosis decreased during spinal cord ’ s development .Conclusion Neural proliferation , neural differentiation and neuroapoptosis occur in developing spinal cord . They work together to regulate the formation and development of the spinal cord .

Effect of Sophora subprosrate polysaccharide on oxidative stress induced by PCV2 infection in RAW264.7 cells.

In this study, an oxidative stress model was first developed in a mouse macrophage cell line (RAW264.7 cells) by infecting the cells with porcine circovirus type 2 (PCV2). The regulatory effect of Sophora subprosrate polysaccharide (SSP) on PCV2-induced oxidative stress was investigated. The results showed that after infection with PCV2, reactive oxygen species (ROS) and nitric oxide (NO) production, myeloperoxidase (MPO) activity, and inducible nitric oxide synthase (iNOS) expression were significantly increased. Meanwhile, the ratio of reduced glutathione to oxidized glutathione (GSH/GSSG) and hydroxyl radical prevention capacity were greatly reduced. These data indicate successful creation of an oxidative stress model in RAW264.7 cells. A dramatic decrease in cell viability was observed in the cells exposed to oxidative stress compared to the control. When the cells were treated with SSP in concentrations of 100, 200 or 400 µg/mL post PCV2 infection, an increase in the GSH/GSSG ratio and hydroxyl radical prevention capacity was observed. We also observed decreased ROS and NO production, MPO activity, and iNOS expression in the infected cells. Our results demonstrated that PCV2 infection was able to induce oxidative stress in RAW264.7 cells and that SSP could reduce the negative effects resulting from the PCV2 infection.

Inhibitory effect of Sargassum polysaccharide on oxidative stress induced by infectious bursa disease virus in chicken bursal lymphocytes.

The aim of this study was to investigate the inhibitory effect of Sargassum polysaccharide on oxidative stress induced by infectious bursa disease virus (IBDV) in chicken bursal lymphocytes. The levels of IL-1ß, IL-8, IL-10, TNF-α, MCP-1, reduced glutathione and reactive oxygen species in chicken bursal lymphocytes treated with IBDV or both IBDV and Sargassum polysaccharide were measured, and the activities of superoxide dimutase and glutathione peroxidase were evaluated. Our results showed that oxidative stress appeared when chicken bursal lymphocytes were incubated with IBDV for 8h at 100 TCID(50). Sargassum polysaccharide inhibited oxidative stress by increasing the amount of reduced glutathione, promoting the activities of superoxide dimutase and glutathione peroxidase and reducing the level of reactive oxygen species. The polysaccharide also raised IL-1ß, IL-8, IL-10 and TNF-α levels in cells infected with IBDV. These findings suggest that Sargassum polysaccharide acts against infection by elevating antioxidant capacity and cytokine levels in chicken bursal lymphocytes.

Immunomodulatory effect of a Sophora subprosrate polysaccharide in mice.

The aims of the present study were to investigate the immunomodulatory effect of a Sophora subprosrate polysaccharide (SSP1) on splenic lymphocyte proliferation, production of cytokines and antioxidant capacities in dexamethasone-induced immunosuppressed mice. The results showed that SSP1 stimulated proliferation and IFN-gamma secretion of murine splenic lymphocytes at concentrations of 50, 100, 200 or 400 mg/L in vitro. SSP1 increased the levels of interleukin-6 and tumor necrosis factor-alpha in immunosuppressed mice induced by subcutaneous injection of dexamethasone at 1.25 mg/kg. Administration of SSP1 by intraperitoneal injection significantly raised spleen index, glutathione level, glutathione peroxidase activity and lysozyme activity in the immunosuppressed mice. This suggests that SSP1 may play an important role in regulating immunological functions in mice.

Protective effect of a Potentilla anserine polysaccharide on oxidative damages in mice.

Potentilla anserine polysaccharide (PAP) was studied in vivo to investigate its antioxidant activity using the model of dexamethasone-induced oxidative stress in mice. The investigation demonstrated that PAP at 50, 100 or 200mg/kg body weight for 7 days respectively increased thymus index and spleen index, glutathione level, superoxidase dismutase activity and total antioxidant capacity in both thymus and spleen and decreased the content of H(2)O(2) in spleen and NO in both thymus and spleen of mice. The results revealed that PAP was able to overcome dexamethasone-induced oxidative stress and might play an important role in repairs of oxidative damage in immunological system.

[Inhibitory action of Potentilla anserine polysaccharide fraction on H2O2-induced apoptosis of murine splenic lymphocytes].

A water-soluble polysaccharide fraction from root of Potentilla anserine was obtained. Gas chromatogram, FT-IR, physical and chemical characteristics of the Potentilla anserine polysaccharide fraction (PAPF) were analyzed. The protective effects of PAPF against the H2O2 induced process of apoptosis of murine splenic lymphocytes were investigated in vitro. Morphological assessment of apoptosis was performed with light microscope and laser scanning confocal microscope. DNA fragmentation was visualized by agarose gel electrophoresis. The amount of apoptotic cells was measured by flow cytometry. The results showed that PAPF is composed of rhamnose, arabinose glucose and galactose. H2O2 (200 micromol x L(-1)) induced apoptosis of murine splenic lymphocytes with the cell volume reduced, cytoplasm and nuclear shrunk and DNA stained non-uniformly. Condensed chromatin and formation of apoptotic body were observed in the apoptotic cells. Apoptotic bodies in the cells treated with PAPF and H2O2 were less than those in H2O2 treatment alone. DNA fragmentation assay showed that PAPF (50, 100, 200, and 400 microg x mL(-1)) obviously reduced H2O2-induced ladder bands. Flow cytometry analysis showed that H2O2 increased the populations of apoptotic sub-G1 cells from 5.60% (control) to 45.40%, and PAPF decreased H2O2-induced apoptosis to 37.80%, 22.70%, 17.70%, and 8.50%, respectively. In conclusion, PAPF reduced H2O2-induced oxidative damage in a dose dependent manner.