Bone marrow-derived exosomes promote inflammation and osteoclast differentiation in high-turnover renal osteodystrophy.

Introduction: Renal osteodystrophy (ROD) is a type of bone metabolic disorder in patients with chronic kidney disease (CKD). Inflammation is associated with bone loss in ROD. However, its precise mechanism has not yet been elucidated. The present study was conducted to investigate whether exosomes (Exos) in bone marrow (BM) are involved in the pathogenesis of high-turnover ROD.Methods: Bone mass, osteoclast number, and pro-inflammatory cytokines levels of BM supernatant were detected in adenine-induced ROD rats. The effect of Exos derived from BM (BM-Exos) of ROD (ROD-Exos) on inflammatory genes and osteoclast differentiation of BM-derived macrophages (BMMs) were further examined. Then, exosomal miRNA sequencing was performed and an miRNA-mRNA-pathway network was constructed.Results: we found increased osteoclasts and decreased bone mass in ROD rats, as well as inflammatory activation in the BM niche. Furthermore, BMMs from ROD rats displayed overproduction of proinflammatory cytokines and increased osteoclast differentiation, accompanied by nuclear factor κB (NF-κB) signaling activation. Mechanistically, we found that ROD-Exos activates NF-κB signaling to promote the release of proinflammatory cytokines and increase osteoclast differentiation of BMMs. Meanwhile, a total of 24 differentially expressed miRNAs were identified between BM-Exos from ROD and normal control (NC). The miRNA-mRNA-pathway network suggests that rno-miR-9a-5p, rno-miR-133a-3p, rno-miR-30c-5p, rno-miR-206-3p, and rno-miR-17-5p might play pivotal roles in inflammation and osteoclast differentiation. Additionally, we validated that the expression of miR-9a-5p is upregulated in ROD-Exos.Conclusion: The BM niche of ROD alters the miRNA cargo of BM-Exos to promote inflammation and osteoclast differentiation of BMMs, at least partially contributing to the pathogenesis of high-turnover ROD.

Optimization of landscape pattern in the main river basin of Liao River in China based on ecological network.

As a main stream method of landscape pattern optimization, the ecological network plays an important role in maintaining ecosystem stability, improving landscape connectivity, and promoting landscape sustainable development. Based on landscape connectivity index and morphological spatial pattern analysis (MSPA), a comprehensive evaluation system of ecological patches was constructed in the main river basin of Liao River, and ecological sources were extracted. According to the habitat characteristics of the study area, the ecological cumulative resistance surface was constructed, and the ecological corridors and nodes were extracted by the minimum cumulative resistance (MCR) model. The ecological network of the study area was comprehensively evaluated by using the network analysis method, and the importance level of the ecological corridor was divided by the gravity model, so as to put forward the optimization suggestions of the landscape pattern based on the ecological network. The results showed that the ecological network in the main river basin of Liao River is composed of 20 ecological sources, 108 ecological corridors, and 72 ecological nodes, with the distribution characteristics of dense east and sparse west. The main landscape components are cropland and woodland. The closure degree, line point rate, and connectivity index of the ecological network are 0.27, 1.50, and 0.51, respectively, and the cost ratio is 0.23. In the optimization of landscape pattern, priority should be given to the restoration of primary ecological sources and ecological corridors, followed by the ecological construction of secondary and tertiary ecological sources and ecological corridors, the rational use of engineering technology for habitat remodeling, and the adoption of the "patch-corridor-substrate" model to improve the stability and landscape connectivity of the regional ecosystem. The construction of ecological network in the main river basin of Liao River is of great significance to regional ecological security and biodiversity conservation, and provides data support for optimizing the landscape pattern of the basin and promoting regional sustainable development.

Unconventional genetic code systems in archaea.

Archaea constitute the third domain of life, distinct from bacteria and eukaryotes given their ability to tolerate extreme environments. To survive these harsh conditions, certain archaeal lineages possess unique genetic code systems to encode either selenocysteine or pyrrolysine, rare amino acids not found in all organisms. Furthermore, archaea utilize alternate tRNA-dependent pathways to biosynthesize and incorporate members of the 20 canonical amino acids. Recent discoveries of new archaeal species have revealed the co-occurrence of these genetic code systems within a single lineage. This review discusses the diverse genetic code systems of archaea, while detailing the associated biochemical elements and molecular mechanisms.

Brain Tumor Segmentation Based on Bendlet Transform and Improved Chan-Vese Model.

Automated segmentation of brain tumors is a difficult procedure due to the variability and blurred boundary of the lesions. In this study, we propose an automated model based on Bendlet transform and improved Chan-Vese (CV) model for brain tumor segmentation. Since the Bendlet system is based on the principle of sparse approximation, Bendlet transform is applied to describe the images and map images to the feature space and, thereby, first obtain the feature set. This can help in effectively exploring the mapping relationship between brain lesions and normal tissues, and achieving multi-scale and multi-directional registration. Secondly, the SSIM region detection method is proposed to preliminarily locate the tumor region from three aspects of brightness, structure, and contrast. Finally, the CV model is solved by the Hermite-Shannon-Cosine wavelet homotopy method, and the boundary of the tumor region is more accurately delineated by the wavelet transform coefficient. We randomly selected some cross-sectional images to verify the effectiveness of the proposed algorithm and compared with CV, Ostu, K-FCM, and region growing segmentation methods. The experimental results showed that the proposed algorithm had higher segmentation accuracy and better stability.

Bioinformatics analysis of downstream circRNAs and miRNAs regulated by Runt-related transcription factor 1 in papillary thyroid carcinoma.

Background: This study sought to clarify the role of Runt-related transcription factor 1's (RUNX1's) regulation of downstream circular ribonucleic acid (circRNA) in the occurrence and development of papillary thyroid carcinoma (PTC) and to explore its mechanism of action. Methods: The levels of RUNX1 were analyzed in PTC tumor tissues and adjacent non-tumor tissues in different types and at different stages via reverse-transcription quantitative polymerase chain reaction (RT-qPCR). The expression pattern and functional role of RUNX1 were analyzed in PTC cells via RT-qPCR, Western blotting, and Transwell assays. This study explored the differential expression of circRNA and microRNA (miRNA) in cells after knocking down RUNX1 through high-throughput sequencing and examined the changes in downstream signaling pathways through Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses. Results: RUNX1 was upregulated in PTC tissues, and the expression levels of RUNX1 were related to PTC stage. The knockdown of RUNX1 inhibited the proliferation, migration, and invasion of cells. The high-throughput sequencing results showed that after RUNX1 knockdown, 29 circRNAs (11 upregulated and 18 downregulated) and 20 miRNAs (8 upregulated and 12 downregulated) had the most significant differential expression. The GO analysis of the differential circRNA downstream genes showed that the iron channel-related pathways, endosomal transport, learning, and memory pathways had the largest number of differential genes, and the most significant changes. The KEGG analysis showed that there were 2 pathways with P values <0.05; that is, the glycosaminoglycan synthesis and transcription dysregulation pathways. The GO analysis of the differential miRNA downstream genes showed that the protein binding and cytoplasmic pathways had the largest number of differential genes and the greatest level of difference. The KEGG analysis showed that the tumor-related pathways, phosphatidylinositol-3-kinase and protein kinase B, glycoprotein, cytoskeleton, Ras, and Rap1 pathways changed the most significantly. Conclusions: RUNX1 is highly expressed in PTC. We conducted high-throughput sequencing to analyze the effect of knocking down RUNX1 on the levels of circRNA and miRNA in PTC. The GO and KEGG analyses revealed that the iron channel-related pathways, endosomal transport, learning and memory, glycosaminoglycan synthesis, and transcriptional disorder-related signaling pathways were enriched.

NiCoPd Inlaid NiCo-Bimetallene for Efficient Electrocatalytic Methanol Oxidation.

Pd-based metallenes have attracted great attention recently as newly burgeoning two-dimensional (2D) materials, attributed to their significantly increased active surface areas and intrinsic electrocatalytic activities. Therefore, they could be used as a potential candidate as the high-performance electrocatalyst for methanol oxidation reactions (MORs) in the direct methanol fuel cell. Herein, a new strategy is proposed to fabricate NiCoPd inlaid NiCo-bimetallene (NiCoPd/NiCo-bimetallene) by the structure directing effect of 18-crown-6 ether under an ultrasonic-pulse interface together with the HCHO reduction and atom-diffusion-aging process. NiCoPd ternary-alloys with uniformly dispersed Pd active sites are decorated onto NiCo-bimetallenes, achieving remarkably enhancing the effective utilization of Pd atoms. What is more, the intrinsic activity is enhanced by the "bifunctional mechanism" of NiCo-bimetallene adsorption of intermediate species and increased Pd-active sites. Moreover, the anti-CO poisoning ability is optimized through the "alloying ligand effect" of NiCoPd. Therefore, the NiCoPd/NiCo-bimetallene exhibits excellent mass activity for MOR, which is higher than commercial Pd/C. This work suggests a new way of the Pd-based metallenes catalyst approach to the efficient electrocatalytic MOR.

Recent Advances on Synthesis of CoCO3 with Controlled Morphologies.

Cobalt carbonates and derivatives represent most promising cost-effective materials for energy storage, conversion and upgrading. Morphology determines the performances, as size, shape and electronic configuration are key factors for tunable properties in the area of batteries, catalysis, magnetics and plasmonics. However, there is lack of insights in literature on morphological control of cobalt carbonates during hydrothermal and solvothermal conditions. Therefore, this review provides detailed discussion on synthesis, formation mechanism and morphological control of nanosheets, wires, spheres and cubes of cobalt carbonates. Furthermore, the influence of experimental conditions and plausible mechanism which govern the growing processes were further discussed in details. The outcome of this short review will offer insights into rational design of inexpensive metal carbonates for numerous other energy and environment applications.

Identification of prognostic biomarkers for papillary thyroid carcinoma by a weighted gene co-expression network analysis.

AIM: Whole transcriptome analysis was conducted to identify differentially expressed RNAs and regulatory networks associated with papillary thyroid carcinoma (PTC). METHODS: A weighted gene co-expression network analysis based on high-throughput sequencing data for six pairs of PTC and adjacent tissue samples was conducted to understand the biological functions and regulatory networks involving long non-coding RNAs (lncRNAs), circular RNAs (circRNAs), microRNAs (miRNAs), and messenger RNAs (mRNAs). RESULTS: We detected 131, 338, 31, and 556 differentially expressed circRNAs, lncRNAs, miRNAs, and mRNAs, respectively. We identified modules that were significantly positively and negatively related to cancer and lymph node metastasis. Gray and turquoise modules were positively correlated with cancer phenotypes (p < 0.05), whereas yellow, brown, and blue modules were negatively correlated with cancer (p < 0.05). Gray module was positively correlated with lateral lymph node metastasis (p = 0.02). Kaplan-Meier analyses revealed that the levels of transmembrane protein 63C (TMEM63C), lysyl oxidase-like 1 (LOXL1), collagen type V alpha 1 chain (COL5A1), ADAM metalloproteinase with thrombospondin type I motif 2 (ADAMTS2), and LysM-domain containing 3 (LYSMD3) were significantly associated with overall survival (p < 0.05). Significant increase in the expression of COL5A1 and LOXL1 in tumor tissues was validated by quantitative real-time polymerase chain reaction (p < 0.05). COL5A1 and LOXL1 promoted PTC cell growth and invasion in vitro. CONCLUSIONS: We identified COL5A1 and LOXL1 as potential prognostic biomarkers, providing new insights into the occurrence and progression of PTC.

Exosomal hsa-miR-129-2 and hsa-miR-889 from a 6-microRNA Signature Might be a Potential Biomarker for Predicting the Prognosis of Papillary Thyroid Carcinoma.

BACKGROUND: Papillary thyroid carcinoma (PTC) is a subtype of thyroid cancer with increasing incidence over time. OBJECTIVE: This study aimed to build a risk score (RS) system for PTC patients. METHODS: PTC microRNA (miRNA) and messenger RNA (mRNA) expression data were extracted from The Cancer Genome Atlas (TCGA) database. The 491 PTC samples were randomly divided into training and validation sets. Using the limma software package, differentially expressed mRNAs (DEGs) and miRNAs (DEMs) between the tumor and control groups were screened. In order to construct an RS system, a survival package was used to select independent miRNAs related to prognosis. Enrichment analysis was performed, and a miRNA-mRNA co-expression network was constructed. High-throughput sequencing was also used to verify the prognostic miRNAs in exosomes. RESULTS: We found 1363 DEGs and 171 DEMs between the tumor and control groups. After identifying 26 DEMs significantly related to prognosis, 6 independent prognosis-associated miRNAs were selected to build an RS system. The areas under the curves of the overall survival rates of the training, validation, and entire sets were 0.847, 0.772, and 0.819, respectively. By conducting pathway analysis using the miRNA-mRNA co-expression network, one overlapping factor and five overlapping pathways were obtained. In addition, high-throughput sequencing revealed that the hsa-miR-129-2, hsa-miR-548j, hsa-miR-6734, and hsa-miR-889 expression levels in TCGA tumor tissues and exosomes were consistent, and those of hsa-miR-129-2 and hsa-miR- 889 between patients and controls were significantly different in exosomes. CONCLUSION: The six-miRNA RS system in exosomes may comprise independent signatures for predicting PTC patient prognosis.

Fat mass and obesity-associated protein regulates RNA methylation associated with depression-like behavior in mice.

Post-transcriptional modifications of RNA, such as RNA methylation, can epigenetically regulate behavior, for instance learning and memory. However, it is unclear whether RNA methylation plays a critical role in the pathophysiology of major depression disorder (MDD). Here, we report that expression of the fat mass and obesity associated gene (FTO), an RNA demethylase, is downregulated in the hippocampus of patients with MDD and mouse models of depression. Suppressing Fto expression in the mouse hippocampus results in depression-like behaviors in adult mice, whereas overexpression of FTO expression leads to rescue of the depression-like phenotype. Epitranscriptomic profiling of N6-methyladenosine (m6A) RNA methylation in the hippocampus of Fto knockdown (KD), Fto knockout (cKO), and FTO-overexpressing (OE) mice allows us to identify adrenoceptor beta 2 (Adrb2) mRNA as a target of FTO. ADRB2 stimulation rescues the depression-like behaviors in mice and spine loss induced by hippocampal Fto deficiency, possibly via the modulation of hippocampal SIRT1 expression by c-MYC. Our findings suggest that FTO is a regulator of a mechanism underlying depression-like behavior in mice.

Three LHPP gene-targeting co-expressed microRNAs (microRNA-765, microRNA-21, and microRNA-144) promote proliferation, epithelial-mesenchymal transition, invasion, and are independent prognostic biomarkers in renal cell carcinomas patients.

BACKGROUND: Renal cell carcinoma (RCC) is one of the highly malignant tumors in the world. Global Cancer Statistics 2020 estimated that there were 179,368 deaths from kidney tumors. Therefore, exploring the prognostic biomarkers of RCC is of great significance for RCC patients. This study aims to explore the potential mechanism and prognostic value of phospholysine phosphohistidine inorganic pyrophosphate phosphatase (LHPP) gene-targeting co-expression microRNAs in RCC patients. METHODS: A total of 60 RCC patients were included. Quantitative real-time PCR (qRT-PCR), western blotting, and immunohistochemistry were used for LHPP, microRNA-765, microRNA-21, and microRNA-144 levels evaluation. Cell Counting Kit-8 assay, dual-luciferase reporter gene assay, invasion assay, and RNA fluorescence in situ hybridization were used for functional analyses. RESULTS: Compared with adjacent tissues, LHPP levels in cancer tissues were significantly increased (p < .001). Herein, we confirmed that microRNA-765, microRNA-21, and microRNA-144 were direct biological targets of LHPP. MicroRNA-765 (r = -0.570, p < 0.001), microRNA-21 (r = -0.495, p < .001), and microRNA-144 (r = -0.463, p < .001) expression levels were negatively correlated with LHPP expression levels. The high expression levels of microRNA-765, microRNA-21, and microRNA-144 in RCC tissues were associated with poor differentiation, recurrence, and poor prognosis (p < .05). In vitro, microRNA-765, microRNA-21, and microRNA-144 act as oncogenes to promote proliferation, invasion, and epithelial-mesenchymal transition (EMT) through targeting LHPP. CONCLUSIONS: MicroRNA-765, microRNA-21, and microRNA-144 are independent risk biomarkers for RCC patients. Inhibiting the expression levels of microRNA-765, microRNA-21, and microRNA-144 can reduce the proliferation, EMT, and invasion of RCC cells. Therefore, the above three microRNAs are expected to become molecular biomarkers for RCC therapy.

Rheological and microstructural characterization of wheat dough formulated with konjac glucomannan.

BACKGROUND: This work aimed to investigate the effects of different levels of konjac glucomannan (KGM) on the thermomechanical and pasting properties, water distribution, gelatinization, texture, and microstructural characteristics of wheat flour and dough. RESULTS: The thermomechanical properties assessed with a Mixolab showed that KGM could increase the water absorption and degree of softening and decrease the stability time of wheat dough. In addition, wheat flour starch with KGM underwent significant (P < 0.05) gelatinization changes according to the rapid viscosity analyzer and differential scanning calorimetry results. These results demonstrated that KGM enhanced the thermal stability and anti-aging capacity of wheat flour. All doughs with KGM exhibited viscoelastic behavior but lower hardness and gumminess. Low-field nuclear magnetic resonance showed that water, with a tight binding force, migrated to the weaker binding forces in the dough. A noticeable disruption of the gluten network was observed at the highest level of KGM. However, an intermediate level of KGM addition (10 or 15 g kg-1 flour) still rendered dough with satisfactory properties. CONCLUSION: A certain amount of KGM could enhance the thermal stability and anti-aging ability of wheat flour, improve the viscoelastic behavior, and decrease the hardness and gumminess of dough. In general, the mixing of flour and dough with KGM addition of 10 or 15 g kg-1 flour was of good quality. © 2021 Society of Chemical Industry.

"Three-propulsion" suspension method for endoscopic thyroid surgery gasless axillary approach.

Gasless endoscopic thyroidectomy through unilateral axillary approach has advantages of clear vision, simple manipulation, short learning curve, hidden surgical incision, no postoperative neck scar, and less swallowing discomfort. During the procedure the separation path goes through thoracic muscle surface, sternocleidomastoid gap and jugular vein, which may meet various variations of neck muscles, blood vessels and nerves. With the "three-propulsion" suspension cavity construction method the procedure advances the dissection from the axillary incision to clavicle, from the clavicle to sternocleidomastoid gap and from the sternocleidomastoid gap to thyroid. Combined with intraoperative hanging upward hook it can establish a good cavity for the subsequent surgical operation. This article introduces the main steps, key points and attentions of the "three-propulsion"suspension cavity construction method in gasless endoscopic thyroidectomy through unilateral axillary approach.

Catalytic Deoxygenation of Xylitol to Renewable Chemicals: Advances on Catalyst Design and Mechanistic Studies.

Xylitol is commonly known as one of the top platform intermediates for biomass conversion. Catalytic deoxygenation of xylitol provides an atomic and energetic efficient way to produce a variety of renewable chemicals including ethylene glycol, 1,2-propanediol, lactic acid and 1,4-anhydroxylitol. Despite a few initial attempts in converting xylitol into those products, improving catalyst selectivity towards C-O and C-C cleavage reactions remains a grand challenge in this area. To our best knowledge, there is lack of comprehensive review to summarize the most recent advances on catalyst design and mechanisms in deoxygenation of xylitol, offering important perspective into future development of xylitol transformation technologies. Therefore, in this mini-review, we have critically discussed the conversion routes involved in xylitol deoxygenation over solid catalyst materials, the nanostructures of supported metal catalysts for C-H, C-C and C-O bond cleavage reactions, and mechanistic investigation for xylitol conversion. The outcome of this work provides new insights into rational design of effective deoxygenation catalyst materials for upgrading of xylitol and future process development in converting hemicellulosic biomass.

Recent Advances on Purification of Lactic Acid.

With increasing interest in developing biodegradable polymers to replace fossil-based products globally, lactic acid (LA) has been paid extensive attention due to the high environment-compatibility of its downstream products. The mainstream efforts have been put in developing energy-efficient conversion technologies through biological and chemical routes to synthesize LA. However, to our best knowledge, there is a lack of sufficient attention in developing effective separation technologies with high atom economics for purifying LA and derivatives. In this review, the most recent advances in purifying LA using precipitation, reactive extraction, emulsion liquid membrane, reactive distillation, molecular distillation, and membrane techniques will be discussed critically with respect to the fundamentals, flow scheme, energy efficiency, and equipment. The outcome of this article is to offer insights into implementing more atomic and energy-efficient technologies for upgrading LA.

Intracystic papillary carcinoma of the breast in males: Three case reports.

RATIONALE: Intracystic papillary breast carcinoma is extremely rare in males with a favorable prognosis. Clinical and mammographic manifestations of IPC are not specific, and no consensus has been reached on its management. PATIENT CONCERNS: Three cases of IPC of the breast in male patients who underwent surgery are presented. In each patient, clinical manifestations, radiological appearance, surgical procedures, pathological diagnosis, and prognosis were investigated. DIAGNOSIS: Ultrasonography showed a complex mass with cystic and nodular solid components in 2 patients and a solid hypoechoic mass in the other 1. Contrast-enhanced ultrasonography(CEUS) was performed for 1 patient demonstrated a solid component of the characteristic enhancement patterns. The final diagnosis of IPC was made after an excisional biopsy. INTERVENTIONS: A mastectomy with sentinel lymph node mapping was carried out in 2 patients, and it was negative for metastatic disease. The third patient received a mastectomy without an investigation of the axillary lymph node status. OUTCOMES: All the patients are disease-free during a median follow-up of 67 months (range, 13-120) months. LESSONS: It is difficult to diagnose IPC of the male breast before surgery, excisional biopsy is necessary. CEUS can be useful to diagnose IPC in male patients in the preoperative evaluation. Sentinel node biopsy may be considered in patients with IPC associated with DCIS or invasive carcinoma.

Identification of exosomal miR-455-5p and miR-1255a as therapeutic targets for breast cancer.

Accumulated evidence has demonstrated exosomes of cancer cells carry microRNAs (miRNAs) to non-malignant cells to induce metastasis. The present study aimed to identify crucial exosomal miRNAs for breast cancer (BC) using microarray data (GSE83669 and GSE50429) from Gene Expression Omnibus database, including exosomal samples from human BC cells (MCF7, MDA-MB-231) and normal mammary epithelial cell line (MCF10, MCF-10A), as well as original cell samples. Differentially expressed miRNAs (DEMs) were identified using EdgeR package, and mRNA targets were predicted using miRWalk2 database. The target genes were overlapped with BC genes from Comparative Toxicogenomics Database (CTD) to construct BC-related interaction network. Potential functions were analyzed by DAVID. The expression of crucial miRNAs and target genes were confirmed in other microarray datasets or TCGA sequencing data. Their associations with survival and other clinical characteristics were validated by Kaplan-Meier plotter and LinkedOmics database. As a result, 9 and 8 DEMs were identified to be shared in two datasets for exosomal and original cells, respectively. Further comparison showed that miR-455-5p was specifically differentially expressed in exosomes, and miR-1255a was commonly expressed in exosomal and original cells samples. miR-455-5p could interact with CDKN1B to influence cell cycle process and miR-1255a could regulate SMAD4 to participate in TGF-ß signaling pathway. High expressed miR-455-5p (basal-like) and miR-1255a (overall) were associated with poor overall survival, while the high expression of their target genes was associated with excellent overall, recurrence-free or distant metastasis-free survival. In conclusion, the present study preliminarily indicates that exosomal miR-455-5p and miR-1255a may be novel therapeutic targets for BC.

Prognostic value of numbers of metastatic lymph node in medullary thyroid carcinoma: A population-based study using the SEER 18 database.

Lymph node (LN) metastases are widely considered as a vital assessment of disease progression, as well as an essential indicator for biochemical cure of medullary thyroid carcinoma (MTC). Prognostic effect of numbers of metastatic LN has not been fully studied and the optimal cut-point of LN numbers has not been established. This population-based study designed to investigate prognostic value of numbers of positive LN and determinate the prognostic factors.Data were generated from Surveillance, Epidemiology, and End Results (SEER) database between 1998 and 2013. X-tile program was applied and cut points for division of LN numbers as low-, medium- and high-risk were 0, 1 to 10, and ≥11. The relationship between numbers of metastatic LN, age, tumor size, extent of tumor, and radiotherapy on overall survival (OS) and disease-specific survival (DSS) were evaluated.A total of 1466 diagnosed primary MTC patients without metastases were eligible for analysis in current study. 945 (64%) patients were classified as no positive LNs, 327 (22%) as 1 to 10 positive LNs, 194 (14%) as ≥11 positive LNs. Patients with older age, tumor size, ≥11 positive LN were associated with unfavorable OS. Those dispensed with radiation had statistically better prognosis than the others. When stratified by age, there was a significant difference in patients ≥45 years within LN categories (log-rank P < .001). When stratified by tumor size, a significant correlation was noted between rising numbers of involved nodes and falling rates of OS in tumor measuring >2cm setting (2-4 cm setting, log-rank P = .003 and >4 cm setting, log-rank P = .014, separately). There was no statistical difference of the area under the curve (AUC) for OS and DSS prediction between LN group and N stage, suggesting the 2 LN systems had the same predictive power for OS and DSS.Numbers of metastatic LN showed prognostic power in survival analysis and remained an independent survival predictor which can be evaluated in MTC treatment decisions for optimum assessment.

Medullary thyroid carcinoma with breast metastasis: Two case reports.

RATIONALE: Medullary thyroid carcinoma (MTC) is an aggressive subtype of thyroid cancer with frequent hematogenous metastasis. While its metastasis is usually observed in the lung, liver, or bone, it rarely migrates to the breast. PATIENT CONCERNS: Here we report 2 cases with a complaint of breast lump after initial treatment of MTC. DIAGNOSES: In both patients, the MTC characteristics of breast nodules were confirmed by pathologic analysis of biopsy specimens. INTERVENTIONS: The genetic mutations within the metastatic breast lesion were evaluated. Wide local excision was thus performed to 1st case, while no therapeutic intervention for another patient due to the wide-spread presence of the disease. OUTCOMES: No sign of relapse or metastasis was found in 1st case during a 14-month follow-up. For 2nd case, the breast nodule grew to 14 mm within 3 months before remaining stable for 10 months. LESSONS: MTC can be a very indolent disease despite its aggressiveness. Reoperation should be considered for patients with local recurrence or resectable distant metastasis of MTC. The findings for both cases supported serum calcitonin as an important marker for the evaluation of disease. Future studies are needed to advance our understanding of its molecular features and improve strategies for its diagnosis and treatment.