Abstract:Objective:To study the regularity of cervical lymph metastasis of papillary thyroid cancer and select a reasonable extent of lymph node dissection.Methods :Clinical data of 457 papillary thyroid cancer patients at our hospital between Jun,2003 and Sep,2007 were retrospectively reviewed.Results:All patients routinely underwent bilateral thyroidectomy and deep and central cervical lymph node dissection (Ⅲ,Ⅳ＋Ⅵ region). The total rate of cervical lymph node metastasis was 63.67 %（291/457）, metastases that occurred in central region and deep jugular lymph nodes was 59.08% (270/457) and 29.76% (136/457),respectively.The rate of cervical lymph node metastasis was markedly increased with diameter of primary neoplasm＞1 cm or tumor penetrating through the thyroid capsule (P＜0.05).Conclusions:For papillary thyroid cancer,the most common cervical lymph node metastasis is the central region,then the deep jugular(Ⅲ＋Ⅳ region) lymph nodes.For primary operation, it is necessary to routinely dissect the bilateral central lymph nodes,and it is reasonable to dissect the ipsilateral deep jugular lymph nodes when diameter of primary neoplasm is ＞1 cm or tumor penetrate through the thyroid capsule.

Abstract:Objective:To investigate the relation between calcification of nodular goiter and thyroid carcinoma.Methods :The clinical data of 1 024 cases of calcified nodular goiter, of which 544 cases (53.1%) were malignant, who were seen in our hospital during the past five years and were examined by highresolution ultrasonography preoperatively, were retrospectively reviewed.Results:There was no difference in the percentage of malignant calcified nodules between the male and female groups (58.3% and 52.5%, respectively；P＞0.05 ).There was a significant difference in the percentage of malignant calcified nodules between the patients of 45 years and older with those younger than 45 years (39.2% and 69.3%,respectively；P＜0.05).There was a significant difference in the percentage of malignant calcified nodules between the patients with solitary and multiple nodules (69% and 49.2%, respectively；P＜0.05).Moreover, there was a significant difference in the percentage of malignant calcified nodules between the group with microcalcification and the group with nonmicrocalcification (79.1% and 41.2%, respectively；P＜0.01).Conclusions:More than half the number of calcified thyroid nodules detected by ultrasonography have malignant pathological change, and once it is discovered that the nodular goiter has calcification,one should highly consider the possibility of malignancy. Microcalcification is a highly specific sign that predicts thyroid papillary carcinoma.When calcification appears in thyroid nodules or in regional lymph nodes, immediate surgery is required.

Abstract:Objective:To analyze the clinical characteristics, diagnosis and treatment of thyroid microcarcinoma.Methods :The clinical data of 52 cases of thyroid microcarcinoma operated from 2003 to 2008 were analyzed retrospectively.Results:All of the 52 cases were confirmed as thyroid microcarcinoma by postoperative pathologic exam; 30 cases (57.7%) were discovered by intraoperative frozen section and 22 cases were not. Microcalcification ratio on ultrasound was 35.19%. 11 cases were diagnosed as malignant tumor on ultrasound scan preoperatively. Lobectomy of involved lobe with subtotal thyroidectomy of contralateral lobe was performed in 38 cases, 3 cases of bilateral total thyroidectomy, 3 cases of unilateral lobectomy and isthmectomy, 5 cases of ipsilateral subtotal lobectomy and 3 cases of ipsilateral lobectomy with isthmectomy were performed. Combined central region lymph nodes dissection was adopted in 27 cases (positive 11/27，40.74%). Followup rate was 96.2%, with time ranging from 3 months to 5 years. No recurrence or mortality was discovered.Conclusions:(1)B type ultrasound is the first choice for preoperative screening. (2) lpsilateral thyroid lobectomy with contralateral subtotal thyroidectomy combined with central region lymph node dissection is advocated.

Abstract:Objective:To evaluate the prognostic factors of of medullary thyroid carcinoma (MTC), and explore the treatment measures on increasing survival rate.Methods :The records of 33 MTC patients treated at our hospital in past 14 years were retrospectively analyzed. The effects of clinical and pathological factors on the overall survival rate were evaluated by univariate and multivariate analyses.Results:The overall 5year survival rate was 63.03%. Based on univariate analysis,age,lymph node invasion,distant metastasis,tumor stage,and the extent of primary surgical resection were related with prognosis. In multivariate analysis,however,only age and the extent of the primary surgical resection were found to be statistically significant factors related to survival.Conclusions:The extent of the primary surgical resection and age are independent predictors of survival of patients with MTC. Vigilance of MTC in old patients with thyroid neoplasm and ensurance of radical tumor operation are the key points for increasing the overall survival of MTC.

Abstract:Objective:To investigate the perioperative management of refractory hyperthyroidism, and how to decrease severe postoperative complications in these patients.Methods :The clinical data of 21 patients whose medical treatment was ineffective or could not control preoperative thyroid heperfunction were analyzed retrospectively, and perioperative management was studied.Results:Among the 21 patients, 13 patients required large doses of antithyroid drugs and other drugs because the symptoms were serious and they received Lugol's solution for at least 2 weeks after the thyroid function was controlled to normal. Eight patients had to discontinue antithyroid drug medication because of the adverse drug effects and thus their thyroid function was not controlled to normal, they were given Lugol′s solution for 2-3 weeks even though their T3 and T4 levels were abnormal and then changed to compound iodine solution by continuous I V drip for 3-5 days before the operation. All the patients underwent bilateral subtotal thyroidectomy and were discharged without complications.Conclusions:For the patients whose thyroid function can not be controlled to normal, compound iodine given by continuons intravenous drip is an effective perioperative management. Individualized perioperative management and, timely treatment of early signs of postoperative hyperthyroidism are the key to success of operation.

Abstract:Objective:To investigate the effect of operation for hyperthyroidism assoiciated with hypokalemic periodic paralysis (HPP).Methods :We retrospectively analysed the clinical data of 121 cases of hyperthyoidism associated with HPP. Among them 81 patients received subtotal thyroidectomy after taking Lugol solution for 2 weeks；40 patients received nonoperative therapy.Results:The plasma potassium，T3,T4,TSH and BMR levels of patients who received subtotal thyroidectomy were all normal 1 week postoperatively, Only 2 patients suffered symptoms of relapse at follow up of 0.5-10 years, with cure rate of 97.5％; 8 of the patients who received nonoperative therapy recovered, with cure rate of 20.0%.Conclusions:Operation for hyperthyroidism associated with HPP could cure HPP and hyperthyroidism simultaneously.The therapeutic efficacy of operation is rapid and stable, and is markedly better than that of nonoperative therapy.

Abstract:Objective:To evaluate the clinical application of video assisted endoscopic thyroidectomy by transsubclavian approach.Methods :Sixtwo patients with thyroid adenoma, goiter or hyperthyroidism received thyroidectomy with endoscopic instruments through transsubclavian approach from December 2007 to July 2008. The age of the patients was from 12 to 65 years (mean 34 years).Results:All 62 cases had successful operation with no conversion.There were no severe surgical complications such as nerve damage or hemorrhage. Average operation duration was (120±32) min for the first 25 cases and (50±13.3)min for the later 37 cases. The stay time of hospitalization after operation was (4±0.5) days.Conclusions:The endoscopic thyroidectomy has the advantages of no neck scar, faster recovery and satisfactory cosmetic effect, and the technique is easy to learn.

Abstract:Objective:To investigate the efficacy of miniincision thyroidectomy using LigaSure.Methods :Miniincision thyroidectomy with LigaSure was performed in 58 cases with thyroid diseases from Jan, 2006 to Dec, 2007.Results:The mean operation time was 45 (35-70 )min.The mean blood loss was 15(5-30)mL．The average drainage during 24 hours after operation was 20(10-30)mL. No hoarseness or hypocalcemia ocurred after operation．The average hospital stay was 3 (2-4)days.Conclusions: Using LigaSure for thyroidectomy can reduce the volume of bleeding, decrease complications rate， operation time and recovery time，and provides less trauma and a good cosmetic outcome.

Abstract:Objective:To study the significance of dissection and exposure of the recurrent laryngeal nerve (RLN) in thyroid surgery. Methods :The clinical data of 1 082 patients who had undergone operations on thyroid were retrospectively reviewed. All cases were routinely operated with dissection and exposure of RLN.Results:Six cases had injury of RLN (0.5%),3 cases showed parathyroid insufficiency（0.3%）and 2 cases had injury of the superior laryngeal nerve(0.2%) ofter operation.The incidence of operative complications in thyroid surgery was closely related with if exposure of the RLN.Conclusions:Exposure of the recurrent laryngeal nerve is a key measure to decrease injury of parathyroids, superior laryngeal nerve and recurrent laryngeal nerve during thyroid surgery.

Abstract:Objective:To investigate the expression and the significance of a group of metastasisassociated proteins in invasive ductal breast carcinoma (IDC).Methods :Tissue microarray containing 247 IDC specimens was constructed. The expressions of αB crystallin, CD44v6, MMP2 and TIMP2 were detected by immunohistochemistry, and the relation between the expression of these proteins and the clinicopathologic character was analyzed.Results:(1) The expression rates of αB crystallin, CD44v6, MMP2 and TIMP2 in IDC were 70.0%, 61.5%, 57.5% and 57.1% respectively, and significantly higher than those of normal breast tissues (P＜0.001); (2) Univariate analysis indicated that there were significant positive correlations between the expression of αB crystallin, CD44v6, MMP2 and lymph node metastasis of breast carcinomas(r value is 0.317，0.623 and 0.705 respectively), and significant negative correlations with TIMP2 (r=-0.532). (3) Logistic stepwise regression analysis indicated that the expression of αB crystallin, CD44v6, MMP2 and TIMP2 were significantly related with the lymph node metastasis, and the predicted percentage for the metastasis was 89.5% by these four proteins together.Conclusions:The expressions of αB crystallin, CD44v6, MMP2 and TIMP2 was significantly correlated with the metastasis of IDC. It is possible to estimate the metastatic potency of breast carcinoma by testing metastasisassociated proteins.

Abstract:Objective:To establish a reliable method for isolation and culture of murine adult oval cells.Methods :Oval cell response was stimulated by treatment with N2acetylaminofluorene(2AAF) diet and partial hepatectomy. A modification of a twostep perfusion protocol and isopycnic centrifugation were used to isolate oval cells from livers. Immunofluorescence and doublefluorescence immunostaining were used for identification of oval cells.Results:Isolated oval cells were grown as colonies in vitro and had been cultured for three months. Isolated cells were identification by immunofluorescence and doublefluorescence immunostaining, which also indicated isolated cells were bipotential.Conclusions:This method mentioned above is a reliable method for isolation and primary culture of oval cells, which would provide a useful tool for investigating oval cell biology.

Abstract:Objective:To investigate the changes of expression of apoptosisrelated proteins Bcl2, Bax and Fas of the transplantated hepatocytes after intraperitoneal transplantation in rats using porcine hepatocytes cultured with polylactic acidOcarboxymethylated chitosan nanoparticles.Methods :Recirculating collagenase perfusion method was used to isolate porcine hepatocytes. At 48h after Dgalactosamine intraperitoneal injection, 5 mL polylactic acidOcarboxymethylated chitosan nanoparticlescultured porcine hepatocytes embedded in collagen gel (group A) and 5 mL porcine hepatocytes embedded in collagen gel (group B) were transplanted into peritoneal cavity of SD rats, respectively. The amount of transplanted porcine hepatocytes was 5.0×107 hepatocytes in two groups. The expression of Bcl2, Bax and Fas in transplanted hepatocytes three days after transplantation was detected with immunohistochemistry.Results:At 1, 2 and 3d after transplantation, the rates of Bcl2 positive cells in group A was significant higher than those in group B, whereas the rates of Bax and Fas positive cells in group A were significant lower than those in group B (P＜0.05).Conclusions:Polylactic acidOcarboxymethylated chitosan nanoparticles can upregulate antiapoptosis protein expression and downregulate apoptosis proteins expression of xenotransplanted porcine hepatocytes inrats, and the antiapoptosis effect is better.

Abstract:胰腺/移植； 再灌注； 锌； 热休克蛋白

Abstract:Objective:To investigate the effect of TLCK(NalphatosylLlysylchloromethylketone) on acute hemorrhagic necrotizing pancreatitis(AHNP) associated with lung injury.Methods :Seventy SD rats were randomized into seven groups(n=10 in each group): group1, normal control group (rats were treated with 0.9% sodium chloride i.v.); group 2, AHNP control group (AHNP rats were treated with 0.9% sodium chloride i.v.)； group 3, AHNP rats were treated with 5μg/kg TLCK; group 4, AHNP rats were treated with 10μg/kg TLCK; group5, AHNP rats were treated with 20 μg/kg TLCK; Group3, 4,5were treated with TLCK i.v. immediately after the establishment of SAP rat model；group 6, AHNP rats were treated with TLCK i.v. 30 minutes before the establishment of AHNP model；group 7, AHNP rats were treated with TLCK i.v. 30 minutes after the establishment of AHNP rat model；Group 6,7 were treated with 10 μg/kg TLCK.Group 1－7 were used to select the best dosage and administration time of TLCK by observing the survival rate for seven days. Then, according to the result of selecting, the SD rats were divided into three groups(n=6 in each group): group N, Sham operated control group(0.9% sodium chloride was reversely injected into SD rat′s pancreas and rats were treated with 0.9% sodium chloride i.v.); group P: AHNP group; group T: TLCK treatment group(AHNP rats were treated with 10 μg/kg TLCK immediately after the establishment of AHNP rat model).The rats of the last three groups were killed 6 hours after 　operation. Alveolar macrophages(AMs) were harvested by bronchoalveolar lavage. The protein content of bronchoalveolar lavage fluids (BALF), the myeloperoxidase (MPO) of lung tissue, and tumor necrosis factor α(TNFα) secreted by AMs were determined. The expression of NFκB in AM was checked as well as lung histology.Results:The survival rate of group 1-7 was100％, 0％, 70％, 100％, 80％, 0％, and 90％ respectively. The level of MPO of lung tissue and protein content of BALF ingroup N were lower than that, in groups P and T (P＜0.05). and in group T had lower level than that in group A (P＜0.05). The activity of TNFα in group P was higher than in group Tand group N. Moreover, the activity of TNFα in group N was notably lower than in group T (P＜0.05). The expression of NFκB was upregulated in group P and downregulated in group T and with no detection in group N.Conclusions:TLCK could inhibit the expression of NFκB and decrease the excretion of inflammatory cytokines, then ameliorate the lung injury associated with AHNP. The optimum dosage of TLCK is 10μg/kg and is best administrated immediately when ANHP occurred.

Abstract:Objective:To observe the effect of transplantation of rat islets which cultured in hypothermia microgravity rotary cell culture system(HRCCS) on rats with diabetes mellitus.Methods :The isolated and purified rat islets were divided into three groups: Temperature (37 ℃)culture for 21 days in flaskculture (control group); temperature(37 ℃)culture for 21 days in RCCS (experimental group1 E1); after low temperature (26 ℃)culture for 14 days in HRCCS, then temperature(37 ℃)culture for 7 days in RCCS (experimental grop 2, E2). Survival rate of islets in three transplanted groups was measured by AOPI doublestaining. Cultured islets were identified by dithizone (DTZ) staining, and insulin contents of different culture liquids were measured by radioimmunoassay. Then the cultured islets was implanted into rat recipients and the transplantation effect was observed for 10 weeks.Results:Survival rate of islants in group E2 (67.4±4.6%) was higher than that in group E1 (50.3± 3.5)% and control group (28.1±3.3)% (all P＜0.05). The insulin content and insulin stimulation index in group E2 were higher than those in and group E1 and control group. The survival rate of islets in group E2 (67.4±7.6)% was higher than that in group E1 (28.1±3.3)% and control group (50.3±3.5)% (all P＜0.05). Transplantation of group E1 and E2 islets into diabetes rats coulde restored blood glucose to normal in all recipients within one week, and all recipients maintained normal glucosetolerant curve throughout the observation time. But the effect of group E2 islets transptation on didabetes rats was better than that in group E1 islets transplation; and the effect of control group islets transplantion for controlling blood glucose is not so good. Conclusions:Rat islets cultured in 26℃microgravity rotary cell culture system(26℃RCCS) could improve the effect of islet transplantation.

Abstract:Objective:To evaluate the treatment efficacy and the necessity of radiofrequency ablation (RFA) followed by transarterial chemoembolization (TACE) for patients with unresectable primary liver cancer (PLC).Methods :From April, 2004 to January, 2008, 65 patients with unresectable PLCs underwent TACE after RFA. Fifty＆four cases were male, and 11 female. The maximum diameter of the tumor was 1.5 cm to 10 cm. Fourteen tumors were small (≤3 cm), 17 were medium (3.1–5.0 cm) and 34 were large (＞5cm) or multinodular (≥3 nodules). The liver function (ChildPugh) was class A in 51 cases, and class B in 14 cases. Fiftyeight cases were hepatocellular carcinoma and the other 14 cases were cholangiocarcinoma. RFA was performed by a RITA expandable electrodes device and followed by TACE using Seldinger′s technique. RFA response was evaluated with computed tomography performed one month after RFA, and then treatment efficacy was evaluated by observation of surviral.Results:Classified by RFA response, patients received complete ablation in 24 cases, nearly ablation in 15 cases and partial ablation in 26 cases. The treatment efficacy of RFA plus TACE was curative in 22 cases, subcurative in 13 cases and palliative in 26 cases. The relationships between RFA response and treatment efficacy were significantly correlated (r=0.877，P＜0.001). The total survival rate after RFA plus TACE at 1, 2 and 3year was 78.2%, 65.3% and 44.0%, respectively. The 3year survival rate for patients who received complete ablation, nearly ablation and partial ablation was 73.5%，45.0% and 0.0%, respectively. The smaller the tumor, the more complete was the tumor ablated, and the results were better.Conclusions:TACE following RFA has therapentic effect and is nccessary for patients with medium or large PLC to eradicate residual tumor and micrometastasis.

Abstract:Objective:To investigate the effect and the prognostic factors of radiofrequency ablation(RFA) for primary liver cancer(PLC).Methods :RFA was performed in 195 patients with PLC, and the efficency was evaluated with univariate analysis. Cox′s regression analysis model was used to analyze the factors affecting the prognosis.Results:In the whole group of patients, the 1, 2, 3 and 5year overall survival rate was 80.5%,67.4％,49.1% and 32.7% respectively,and in the patients with small PLC(the size≤3 cm),the 1, 2, 3 and 5year overall survival rate was 91.7%,81.2％,60.5% and 40.4% respectively. The Cox regression models indicated that the independent factors in determining the prognosis were: Liver function of ChildPugh stage, tumor size and occlusion of hepatic inflow during RFA.Conclusions:RFA is an effective miniinvasive treatment for patients with PLC, and especially for the patients with small PLC. The efficency of RFA for small PLC has the same outcome as that of surgical resection of the tumor. Liver function of ChildPugh stage, tumor size and occlusion of hepatic inflow during RFA are the independent prognostic factors.

Abstract:Objective:To investigate the effect of different operations for cardia carcinoma on the postoperative anastomotic stoma complications.Methods :Between December, 2000 and May, 2007,the clinical data 156 patients with carcinoma of gastric cardia who received different operations were analyzed retrospectively.Results:The thoracoabdominal incision was performed in 57 cases, abdominal incision in 68 and left thoracic incision in 31 cases.The occurrence rate of anastomotic stoma complications in the patients with thoracoabdominal,abdominal and left thoracic incision was 7.0%(4/57)，7.4%(5/68)，and 12.9%(4/31), respectively.The occurrence rate of anastomotic stoma complications in the patients using 25 mm endend autosuture was 4.2％(4/95), in using of the 28mm autosuture group was 16.1% (P=0.0102).Conclusions:The occurrence rate of anastomotic stoma complications can be reduced by choosing correct operation methods and using autosuture correctly.