Endoscopic Central Lymph Node Dissection via Breast Combined with Oral Approach for Papillary Thyroid Carcinoma: A Preliminary Study.

OBJECTIVE: To investigate the feasibility and necessity of endoscopic thyroidectomy with central lymph node dissection via the combined breast and trans-oral approaches. METHODS: Six patients with papillary thyroid carcinoma who underwent endoscopic total thyroidectomy with central node dissection via combined breast and trans-oral approaches from November 2014 to January 2015 in Zhongshan Hospital, Xiamen University, were analyzed. RESULTS: After completion of endoscopic central lymph node dissection via the traditional breast approach, eight pieces of lymph nodes could still be dissected via the trans-oral approach. Two of these eight pieces were positive for thyroid cancer metastasis. CONCLUSIONS: It is advisable to perform endoscopic central lymph node dissection for thyroid carcinoma via the breast approach combined with the trans-oral approach.

17ß-estradiol attenuates reduced-size hepatic ischemia/reperfusion injury by inhibition apoptosis via mitochondrial pathway in rats.

The aim of this study was to investigate the effect of 17ß-estradiol (E2) on hepatocyte apoptosis after reduced-size hepatic ischemia/reperfusion (I/R) injury and its mechanism. A rat model of reduced-size hepatic I/R injury was established. Sprague-Dawley rats were randomly allocated into sham, I/R, and E2 + I/R group. 17ß-Estradiol (4 mg/kg) or the vehicle was administered i.p. 1 h before ischemia and immediately after operation. For each group, 10 rats were used to investigate the survival during a week after reperfusion. Blood samples and liver tissues were obtained in the remaining animals after 3, 6, 12, and 24 h of reperfusion to assess serum aspartate aminotransferase and alanine aminotransferase levels, liver tissue malondialdehyde concentration, superoxide dismutase activity, and histopathologic changes. Apoptosis ratio; expression of cytochrome c, Bcl-2, and Bax proteins; and enzymatic activities of caspase 9 and caspase 3 were performed in the samples at 12 h after reperfusion. The serum aspartate aminotransferase and alanine aminotransferase levels and tissue malondialdehyde concentration were increased in the I/R group, whereas the increase was significantly reduced by E2. The superoxide dismutase activity, depressed by I/R injury, was elevated back to normal levels by treatment with E2. Severe hepatic damage was observed by light microscopy in the I/R group, whereas administration of E2 resulted in tissue and cellular preservation. Furthermore, E2 inhibited hepatocellular apoptosis by upregulating the ratio of Bcl-2 and Bax expression, reduced cytosolic cytochrome c level, and decreased caspase 9 and caspase 3 activities. The 7-day survival rate was significantly higher in the E2 + I/R group than in the I/R group. These results indicated that E2 protects liver tissues from reduced-size hepatic I/R injury by suppressing mitochondrial apoptotic pathways.

The role of prophylactic antibiotics in laparoscopic cholecystectomy in preventing postoperative infection: a meta-analysis.

BACKGROUND: Although laparoscopic cholecystectomy (LC) is a common and widely applied technique, the use of antibiotics during the perioperative period in infection prevention remains controversial. In our study, a meta-analysis was performed to assess the impact of antibiotic prophylaxis on the postoperative infection rate in LC. METHODS: A literature search was conducted on studies published between January 1966 and March 2010 that involved LC and prophylactic administration of antibiotics. Only randomized trials that compared perioperative antibiotic prophylaxis with placebo or no treatment in low-risk patients undergoing LC were selected. Eighteen studies qualified according to the inclusion criteria, but only 12 were of adequate quality according to the Jadad scale to be included for the meta-analysis. Data were analyzed via the Peto odds ratio (OR) method and run using RevMan 4.2 software. The precision of the estimation of OR by individual studies was used to calculate their contribution (or weighting) to the pooled OR. RESULTS: The results of the 12 studies did not have significant heterogeneity, and thus, the fixed effect model was used for data analysis. Compared with placebo or no treatment, there was no significant risk reduction in the antibiotic prophylaxis group with regard to overall infections (OR=1.11; 95% confidence interval [CI], 0.68-1.82; P=.67), wound infections (OR=1.07; 95% CI, 0.59-1.94; P=.99), major infections (OR=2.88; 95% CI, 0.3-28.09; P=.36), distant infections (OR=1.01; 95% CI, 0.43-2.36; P=.99), or positive bile cultures (OR=0.76; 95% CI, 0.54-1.08; P=.12). However, prophylactic antibiotics did shorten length of hospital stay (weighted mean difference=-0.16; 95% CI, -0.22 to -0.09; P<.01). CONCLUSION: Prophylactic antibiotics are not necessary for elective LC in low-risk patients.