Abstract:

Secondary hyperparathyroidism (SHPT) is a clinical syndrome that is described as the excessive secretion of parathyroid hormone by the parathyroid glands in response to the long-term stimulation of hypocalcemia and hyperphosphatemia resulting from various causes. Some cases, due to ineffective medication or other general treatments, will progress to refractory SHPT, for which favorable results may be achieved by surgery or local interventional procedures. In this paper, the authors explore the efficacy of surgical and local interventional treatment of SHPT and discuss the prospects of application of these methods of treatment.

Abstract:Objective: To assess the efficacy and safety of total parathyroidectomy (PTX) with forearm autograft for secondary hyperparathyroidism (SHPT) due to chronic renal failure. Methods: The clinical data of 30 patients with end-stage chronic renal failure and SHPT undergoing PTX with forearm autograft from December 2011 to December 2015 were retrospectively analyzed. Of the patients, the improvements of clinical symptoms and changes in serum level of intact parathyroid hormone (iPTH), calcium, phosphorus and calcium-phosphorus product after surgery as well as the postoperative complications and recurrence were analyzed. Results: Operation was performed successfully in all patients. After operation, the clinical symptoms of these patients were all remarkably improved, their serum levels of iPTH, calcium, phosphorus and calcium-phosphorus product were all significantly decreased compared with preoperative values (all P<0.05). Transient recurrent laryngeal nerve injuries occurred in 12 patients, and all recovered without treatment. Postoperative recurrence occurred in 8 patients (2.7%) and 7 of them underwent repeat operation, after which the symptoms were improved. Conclusion: PTX with forearm autograft is a safe and effective treatment for SHPT caused by chronic renal failure.

Abstract:Objective: To investigate the clinical application value of intraoperative neuromonitoring (IONM) in the prevention of recurrent laryngeal nerve (RLN) injury during repeated operation for thyroid carcinoma. Methods: One hundred and thirty-seven patients scheduled to undergo a repeated operation for thyroid cancer from January 2012 to December 2014 were selected. Of the patients, RLN in 41 cases was identified by naked- eye inspection only during operation (control group), and in 96 cases was identified by naked- eye inspection combined with IONM (study group). The RLN recognition and injury rates, postoperative drainage and incidence of parathyroid damage between the two groups were compared. Results: The RLN recognition rate was 100% (96/96) in study group and 82.3% (34/41) in control group, and the difference had statistical significance (P<0.05). In study group versus control group, the incidence of RLN damage (1.0% vs. 9.8%) and postoperative drainage (38.1 mL vs. 44.1 mL) were significantly reduced (both P<0.05). The difference in incidence of parathyroid injury between the two groups had no statistical significance (8.3% vs. 12.2%, P>0.05). Conclusion: Application of IONM during repeated surgery for thyroid cancer can effectively improve RLN recognition and reduce the incidence of RLN injury, as well as reduce the incidence of complications.

Abstract:Objective: To investigate the application value of nano-carbon tracing in lymph node dissection and protection of parathyroids during endoscopic surgery for thyroid carcinoma. Methods: One hundred and twenty-six patients with papillary thyroid carcinoma undergoing endoscopic thyroid surgery during January 2013 to January 2015 in Xiangya Hospital, Central South University were enrolled and randomly assigned to control group (40 cases), methylene blue group (41 cases) and carbon nanoparticle group (45 cases). Patients in control group underwent regular operation, while those in the other two groups were injected with corresponding tracer during operation. The number of retrieved lymph nodes and metastatic lymph nodes and inadvertent parathyroidectomy in each group were calculated. Further, both stained and unstained lymph node specimens from methylene blue group and carbon nanoparticle group were pathologically examined. Results: No anaphylactic reactions occured in the two groups of patients receiving tracer injection. The number of detected lymph nodes in carbon nanoparticle group was significantly higher than that in either control group (t=5.164, P<0.05) or methylene blue group (t=4.763, P<0.05). Further, the detection rate of tiny lymph nodes (<2 mm) in carbon nanoparticle group was significantly higher than that in methylene blue group (29.3% vs. 13.2%; χ2=18.231, P<0.05), while no tiny lymph nodes were detected in control group. There was no significant difference in rate of lymph node metastases among the three groups (P>0.05), but the staining rate of metastatic lymph nodes in carbon nanoparticle group was significantly higher than that in methylene blue group (92.2% vs. 78.8%; χ2=5.605, P<0.05). Eighteen inadvertently resected parathyroid glands were found in control group, while no inadvertent removal of parathyroid glands occurred in both methylene blue and carbon nanoparticle groups. Conclusion: Nano-carbon is superior to methylene blue in targeting lymph nodes and the tracing effect may help surgeons conduct a more thorough lymph node dissection. Meanwhile, its application can effectively avoid inadvertent parathyroidectomy. So, its clinical application is recommended.

Abstract:Objective: To determine the risk factors for cervical lymph node metastasis and the scope of lymph node dissection in thyroid microcarcinoma (TMC). Methods: The clinical data of 269 TMC patients admitted from January 2009 to June 2013 were retrospectively analyzed. Of the patients, all cases underwent primary lesion resection plus central lymph node dissection and 27 cases underwent lateral cervical dissection. The relations of each clinicopathologic factor of the patients with cervical lymph node metastasis were analyzed. Results: Among the 269 patients, 107 cases (39.8%) had cervical lymph node metastasis, of whom 103 cases (96.3%) had central lymph node metastasis and 25 cases (23.4%) had lateral cervical lymph node metastasis. Univariate analysis showed that male sex, tumor size >5.0 mm and extrathyroidal invasion were significantly associated with cervical lymph nodes metastasis of TMC (all P<0.05); multivariate analysis identified that tumor size>5.0 mm (OR=3.358, P<0.05) and extrathyroidal invasion (OR=5.230, P<0.05) were independent risk factors for cervical lymph nodes metastasis. Conclusion: In TMC patients with tumor size >5.0 mm or extrathyroidal invasion, the incidence of central lymph node metastasis is increased and, in these cases, central lymph node dissection is necessary.

Abstract:

Objective: To investigate the relationship between Hashimoto’s thyroiditis (HT) and papillary thyroid carcinoma (PTC). Methods: The clinical data of 495 patients who underwent surgical treatment and diagnosed as PTC by postoperative pathological examination from January 2010 to May 2015 were reviewed. The clinicopathologoic characteristics between patients with and without concomitant HT were compared. Results: Among the 495 PTC patients, 108 cases (21.81%) had concomitant HT. Results of univariate analysis showed that in PTC patients with concomitant HT compared with those without HT, female cases were more frequent (90.7% vs. 71.6%), the preoperative levels of thyroid stimulating hormone (4.04 μIU/mL vs. 2.76 μIU/mL) and thyroid peroxidase antibody (TPOAb) (94.31 IU/mL vs. 33.65 IU/mL) were elevated, maximum tumor diameter was shorter (1.10 cm vs. 1.31 cm) and the number of cases with early clinical stage was increased (stage I: 87.1% vs. 76.8%), and all differences had statistical significance (all P<0.05). Logistic regression analysis showed that gender, TSH level, TPOAb level and clinical stage were independent predictors for PTC combined with HT (all P<0.05). Conclusion: PTC patients with concomitant HT present with female predominance, earlier clinical stage, and small size, suggesting that the combined HT may not increase the invasiveness of PTC, and may have a relatively good prognosis. However, the TSH level is increased in patients with concomitant HT, which suggests that HT may be one of the risks for PTC.

Abstract:Objective: To investigate the expression of epithelial membrane antigen (EMA) in tissue of papillary thyroid carcinoma (PTC) and Hashimoto’s thyroiditis and the clinical significance. Methods: The EMA protein expression in specimens of PTC tissue from 54 patients and tissue specimens of PTC adjacent Hashimoto's thyroiditis in 15 cases and metastatic lymph nodes in 12 cases, and normal thyroid tissues from 10 subjects were determined by immunohistochemical staining. The relations of EMA protein expression with the clinicopathologic features of the patients were analyzed. Results: EMA protein expression was found in the cytoplasm and cell membrane/inner surface of cell membrane. The positive expression rate of cytoplasm EMA in normal thyroid tissue, tissue of Hashimoto’s thyroiditis, PTC and lymph node metastases was 80.0%, 25.0%, 64.8%, and 35.7% respectively, and the difference had statistical significance (P<0.05). The cytoplasm EMA positive expression was significantly associated with the tumor size of the patients (P<0.05). The positive expression rate of EMA in the cell membrane/inner surface of cell membrane in normal thyroid tissue, tissue of Hashimoto’s thyroiditis, PTC and lymph node metastases was 10.0%, 100.0%, 44.4% and 64.3% respectively, and the difference had statistical significance (P<0.05); the EMA positive expression in the cell membrane/inner surface of cell membrane was irrelevant to any clinicopathologic factors of the patients (all P>0.05). Conclusion: High EMA expression in the cell membrane/inner surface of cell membrane may suggest a high possibility of transformation of Hashimoto’s thyroiditis to PTC. Decreased EMA expression in the cytoplasm can probably be used as an auxiliary index for screening of thyroid microcarcinoma.

Abstract:Objective: To compare the ablation features and variations among microwave ablation (MWA), radiofrequency ablation (RFA) and laser ablation (LA) in pig thyroid in vitro, so as to provide reference for clinical decision-making. Methods: One hundred and fifty freshly harvested pig thyroid glands were equally divided into 3 groups, and then underwent MWA (20 W 5 min), RFA (5 W) and LA (3 W 1200 J), respectively. In each group, the real-time temperature at the target area was measured and real-time ultrasound observation was conducted during ablation procedure, and after ablation, the specimens were cut open along the needle passage, and the gross appearance was observed, ablation volume was determined and pathological examination was performed. Results: Comparison among the three groups showed that the ablation volume was largest in MWA group (1 597.09 mm3), followed by LA group (780.89 mm3), and was smallest in RFA group (162.20 mm3), and the difference between either of them had statistical significance (all P<0.05). The temperature rise curve of MWA or RFA was swift and steep, and that of LA was gentle and long, but its maximum temperature was highest (200.9 ℃ ). In ablation zone, no evident tissue destruction as well as carbonization and vaporization cavity was seen in RFA group, carbonization but no vaporization cavity was found in MWA group, and both carbonization and vaporization cavity presented in LA group. The ablation lesion from inside to outside presented coagulation necrosis and congestion reaction zone in RFA group, was carbonization, coagulation necrosis and congestion reaction zone in MWA group, and was vaporization cavity, carbonization, coagulation necrosis and congestion reaction zone in LA group, respectively. Conclusion: The ablation scope, temperature rise curve and pathological changes in the ablation zone are different among MWA, RFA and LA, and understanding their characteristics may be helpful to the rational use of these three ablation techniques.

Abstract:Objective: To investigate the relationship between miR-34a and VEGF expressions in breast cancer and the clinical significance. Methods: The miR-34a and VEGF expression in 40 paired specimens of breast cancer and adjacent tissue were detected, and the relations of miR-34a expression with clinicopathologic factors and VEGF expression in breast cancer were analyzed. The influence of miR-34a on transcriptional activity of VEGF in breast cancer MCF-7 cells was determined by dual-luciferase reporter assay system. In MCF-7 cells after transfection with miR-34a mimics, the changes in cell proliferation and expression of VEGF and its down-stream Akt protein were determined. Results: In breast cancer tissue compared with adjacent tissue, the miR-34a expression was decreased while VEGF expression was increased significantly (both P<0.05), and the miR-34a expression was significantly related to TNM stage of breast cancer tissue (P<0.05) and was negatively correlated to VEGF expression in breast cancer tissue (r2=0.4469, P=0.0033). After miR-34a mimics transfection in MCF-7 cells, the transcriptional activity of VEGF was inhibited, proliferation rate was reduced, and the VEGF expression and phosphorylation level of Akt protein was down-regulated significantly (all P<0.05). Conclusion: MiR-34a expression in breast cancer tissue is decreased, which reduces the inhibition on VEGF and its down-stream Akt phosphorylation, and thereby facilitate the growth of breast cancer.

Abstract:Objective: To investigate the effect of resveratrol on TNF-α promoter region in human monocyte THP-1 cells tolerated to bacterial lipopolysaccharide (LPS). Methods: The LPS-tolerated THP-1 cells were induced, next the untreated THP-1 cells (control group), LPS-tolerated THP-1 cells (tolerance group) and resveratrol treated LPS-tolerated THP-1 cells (tolerance plus resveratrol group) were stimulated with LPS respectively, and then, the TNF-α mRNA expression and the bindings of transcription factors to the promoter region of TNF-α were determined. Results: After LPS stimulation, the TNF-α mRNA level was increased rapidly in control group, and increased slowly in tolerance group, but were slightly decreased in tolerance plus resveratrol group, which was significantly lower than that in either former group (both P<0.05). Results of chromatin immunoprecipitation (ChIP) showed that before LPS simulation, the levels of p65 along with acetylated p65 (ace-p65), RelB and G9a binding to the promoter region of TNF-α in both tolerance group and tolerance plus resveratrol group were significantly higher than those in control group (all P<0.05), while the binding level of p50 had no significant difference among the three groups (P>0.05); after LPS simulation, the levels of p65 and ace-p65 binding to the promoter region of TNF-α were significantly increased in control group, but significantly decreased in tolerance plus resveratrol group, and level of G9a binding to the promoter region of TNF-α was decreased in control group (all P<0.05), and all other factors had no significant change compared with those before LPS stimulation (all P>0.05). Conclusion: Resveratrol can inhibit TNF-α mRNA expression in LPS-tolered THP-1 cells, which may be partially associated with its inhibiting the bindings of p65/ace-p65 to TNF-α promoter. So, Resveratrol may potentially be used in supplementary treatment of sepsis.

Abstract:Objective: To investigate the indication, efficacy and feasibility of using lateral thoracic subcutaneous-fascial-muscular flap for immediate mammoplasty after modified radical mastectomy with nipple-areola complex (NAC) preservation. Methods: Forty-three patients with flat or small breasts and pre-stage IIIA breast cancer underwent NAC preserving modified radical mastectomy followed by immediate mammoplasty with lateral thoracic subcutaneous-fascial-muscular flap or combined breast reconstruction with prosthesis. The postoperative cosmetic results and complications were evaluated, and the therapeutic effects were assessed by follow-up exam. Results: Operation was successfully performed in all the 43 patients. The average operative time was 1.7 (1.3-2.2) h, average length of overall hospital stay was 17 (13-24) d and average length of postoperative hospital stay was 13 (10-18) d. Postoperative follow-up was performed for 2-12 months, no nipple necrosis occurred and flap infection occurred in two cases; no local recurrence or distant metastasis occurred. The overall patient satisfaction score was 8.5 and the excellent and good rate for objective assessment of breast appearance was 86% (37/43). Conclusion: Using lateral thoracic subcutaneous-fascial-muscular flap for immediate mammoplasty after NAC preserving modified radical mastectomy has the feature of easy performance, short operative time and technical feasibility. It is especially suitable for patients with flat or small breasts and pre-stage IIIA breast cancer.

Abstract:Objective: To investigate the relationship between different molecular subtypes of breast invasive ductal carcinoma (IDC) and axillary lymph node metastasis. Methods: According to the molecular classification criteria of breast cancer, the 243 patients with primary breast IDC undergoing surgical treatment were divided into luminal A, luminal B [further subdivided into HER-2 (–) and HER-2 (+)], HER-2 over expression and triple-negative type. Combining with the clinical pathological data, the distribution characteristics of various molecular subtypes, and the relations of different molecular subtypes with axillary lymph node metastasis were analyzed. Results: Among the 243 patients, cases with Luminal B [HER-2 (–)] type accounted for the majority (78 cases, 32.1%), and Luminal A type was the next (58 cases, 23.87%), followed by triple-negative (41 cases, 16.87%), HER-2 over expression (34 cases, 13.99%) and Luminal B [HER-2(+)] type (32 cases, 13.17%), successively. Axillary lymph node metastasis occurred in 94 cases (38.68%), and the incidence of axillary lymph node metastasis was statistically different among patients with different molecular subtypes (P<0.05). It was highest in those with luminal B [HER-2 (–)] (42 cases, 53.85%) or Luminal B [HER-2 (+)] type (15 cases, 46.88%), with no statistical difference between them (P>0.05), followed by Luminal A (19 cases, 32.76%), triple-negative (12 cases, 29.27%) and HER-2 over expression type (6 cases, 17.65%), successively; no significant difference was found in distribution of the molecular subtypes either in group of patients with involvement of 1 lymph node to 3 lymph nodes or ≥ 4 lymph nodes (both P>0.05), although the number of cases with Luminal B [HER-2 (+)] type was highest and HER-2 over- expression type was lowest in the former, while the number of cases with HER-2 over- expression type was highest and Luminal B [HER-2(+)] type was lowest in the latter. Conclusion: In breast IDC, molecular subtype has certain reference value for assessing axillary lymph node metastasis and judging disease status, and it can probably be used as a basis for making individualized diagnosis and treatment strategy.

Abstract:Objective: To investigate the feasibility of using combined tracing method of indocyanine green (IGG) fluorescence and methylene blue dyeing in sentinel lymph node biopsy (SLNB) of breast cancer. Methods: Two hundred and seventy-six breast cancer patients admitted between March 2014 and October 2015 were selected. Of the patients, 131 cases underwent SLNB with ICG combined with methylene blue (combination group), while 145 cases underwent SLNB with methylene blue alone (methylene blue group); all cases underwent level I and II axillary lymph node dissection after SLNB. Results: The general clinical data had no statistical difference between the two group of patients (all P>0.05). In combination group, the detection rate of sentinel lymph nodes (SLNs) was significantly higher than that in methylene blue group (96.9% vs. 89.7%, P=0.017), the average number of detected SLNs was significantly greater than that in methylene blue group (3.0 vs. 2.1, P=0.011) and the false negative rate was lower than that in methylene blue group (7.1% vs. 10.9%), but the latter did not reach a statistical significance (P=0.813). Statistical analysis of the data of the whole group showed that the false negative rate between the two groups in cases with detected number of SLNs less than or equal to 2 was significantly higher than in those with detected number of SLNs equal to or more than 3(17.5% vs. 2.1%, P=0.033). Conclusion: Compared with methylene blue dyeing alone, the combined tracing of IGG fluorescence and methylene blue dyeing for SLNB in breast cancer has advantages of high detection rate and average number of detected SLNs as well as real-time lymphatic imaging. So it is recommended to be used under the circumstance of no conventional access for using radionuclide method.

Abstract:Objective: To investigate the impact of the change of Ki-67 expression after neoadjuvant chemotherapy (NCT) on prognosis of breast cancer and its relation with the breast cancer molecular subtypes. Methods: The clinical data of 121 patients with stage IIA-IIIC breast cancer undergoing NCT from 2010 to 2013 were reviewed. The relationship between the change of Ki-67 expression after NCT and prognosis of breast cancer as well as the difference of Ki-67 change among different molecular subtypes were analyzed. Results: Ki-67 expression before NCT was positively correlated to tumor size (r=0.181, P=0.047), histological grade (r=0.340, P<0.001) and HER-2 expression (r=0.335, P<0.001) of the patients. The 3-year disease-free survival (DFS) was 73.4%, which in patients with reduced, increased and unchanged Ki-67 expression after NCT was 82.6%, 61.1% and 68.4% respectively, and the difference was statistically significant (P=0.034), while among patients with different molecular subtypes was 70.7% for luminal A, 71.4% for luminal B, 80.7% for HER-2 positive, and 78.7% for basal like, and the difference had no statistical significance (P=0.857). Nationality, pre-treatment of HER-2 status, and pathologic axillary lymph node and change of Ki-67 expression after NCT were the independent influential factors for DFS of breast cancer patients (all P<0.05). Conclusion: The change of Ki-67 expression after NCT is an independent influential factor for DFS in breast cancer patients, but its change shows no obvious relation with breast cancer molecular subtypes.

Abstract:Objective: To study the influence of Huaier granule adjuvant therapy on immune function and postoperative survival status in patients with triple negative breast cancer (TNBC) after modified radical mastectomy. Methods: Ninety-five TNBC patients undergoing adjuvant chemotherapy after modified radical mastectomy were divided into observational group (56 cases) and control group (39 cases). Patients in the observational group received oral administration of Huaier granule during and after chemotherapy and radiotherapy (20 g, 3 times daily for 1.5 years), while those in the control group did not receive any traditional Chinese medicine preparations during adjuvant therapy. The quality of life, disease free survival (DFS) during treatment and follow-up period and serum T cell subset composition at 3, 6, 12 and 24 months after surgery between the two groups were compared. Results: In observational group compared with control group, the improvement rate of Karnofsky score was significantly increased and DFS was significantly prolonged (all P<0.05). There was no significant difference in the percentage of CD3+ cells between the two groups at any time points after surgery (all P>0.05), but the percentages of CD4+ and NK cells and CD4+/CD8+ ratio in observational group were all significantly higher than those in control group at each time point (all P<0.05). Compared with their preoperative value, in observational group, the percentage of CD3+ cells at 3 months after surgery of treatment was significantly decreased (P<0.05), but began to return to normal 6 months later (all P>0.05), and the percentages of CD4+ and NK cells and CD4+/CD8+ ratio were significantly increased during 6 to 24 months after surgery (all P<0.05); in the control group, the percentages of CD3+ cells were significantly reduced during 3 to 6 months after surgery (all P<0.05), and began to recover 12 months later (all P>0.05), and the percentage of CD4+ cells and CD4+/CD8+ ratio were significantly lowered during 3 to 12 months after surgery (all P<0.05). Conclusion: For TNBC patients, Huaier granule administration during postoperative adjuvant therapy may help improve the immune function, increase quality of life and prolong the DFS.

Abstract:Objective: To investigate the clinicopathologic characteristics and diagnostic criteria of primary breast lymphoma (PBL). Methods: The cases diagnosed as PBL from January 2009 to March 2015 were collected, their clinical data, and pathological and immunohistochemical features were analyzed, and the diagnosis and differential diagnosis of this condition were discussed with a literature review. Results: All the 8 cases were female, and age of onset ranged from 35 to 82 years. The tumor was located in left breast in 6 cases, in right breast in one case, and in both breasts in one case. The most common presentation was painless mobile mass with distinct borders. Seven cases were diagnosed as diffuse large B-cell lymphoma (DLBCL), and one was diagnosed as mucosa-associated lymphoid tissue lymphoma (MALT). Immunohistochemical staining showed that CD20 and CD79a positive expressions were found in all cases, 7 cases had mum-1 positive expression and 4 cases had Bcl-2 positive expression. After treatment, 4 patients were followed up for 3 to 25 months and all were alive. Conclusion: PBL is a rare condition, and DLBCL is the most common type. Its diagnosis depends on pathological and immunohistochemical examinations. Full awareness of this entity is important for avoiding misdiagnosis.

Abstract:In recent years, thyroid carcinoma is one of the most common malignant tumors worldwide, with papillary adenocarcinoma as the predominant pathological type and surgery as the main treatment option. Metastases frequently occur first in the central compartment where the sentinel lymph nodes are located. For patients with central compartment lymph node metastasis, central neck dissection has been becoming widely accepted by domestic and international scholars. However, as for cN0 tumor, whether or not prophylactic central neck dissection should be done is controversial. Here, the authors address the issues that include the anatomical features of the central compartment, and metastatic characteristics and high-risk factors as well as different views regarding prophylactic central neck dissection in cN0 papillary thyroid carcinoma, so as to enhance the understanding of this disease and provide reference for improvement in its treatment.

Abstract:

Because of variation of the position of the parathyroid glands and their fragile supplying blood vessels, and they are similar to fat granule or lymph nodes, it is easy to accidentally resect them or destroy their blood supply during surgery for thyroid cancer with central neck dissection, leading to postoperative hypoparathyroidism that seriously affects the patient's quality of life. How to identify parathyroid injury and protect the parathyroid function are major problems of concern of thyroid surgeons. Routine parathyroid autotransplant for preventing hypoparathyroidism during central neck dissection is still controversial. Is the use of nano-carbon of significance for avoiding parathyroid injury? Here, the authors address the above issues to provide reference on how to identify parathyroid injury and protect parathyroid function during central neck dissection.

Abstract:Breast cancer is currently one of the most common malignant tumors in women worldwide. Triple-negative breast cancer (TNBC) is a special type of breast cancer which is highly aggressive, and associated with poor prognosis and lack of systemic treatment options at present. Here, the authors address the latest progress in treatment of this condition.