Abstract:Fertility preservation for young breast cancer patients has always been a hotspot in oncofertility research and clinical practice. In order to provide effective scientific medical services of fertility preservation for the patients, a consensus on implementation plan of fertility preservation for young breast cancer patients has been developed by experts with specialization in breast disease, reproductive medicine and genetics in Hunan, after gathering the important achievements in the relevant researches as well as guidelines at home and abroad, in combination with clinical practice experiences, and a thorough discussion. The content of the consensus includes: explanation of the relationship between disease and treatment and fertility; introduction of the currently available fertility preservation methods; establishment of a clinical guideline for patient selection, evaluation and indications; and recommendation of the clinical process for implementing interdisciplinary management. 

Abstract:Postoperative follow-up is an important part of the whole treatment process of differentiated thyroid cancer (DTC). In recent years, the degree of attention to its follow-up mode paid by scholars in relevant fields has increasingly intensified, for which unceasing efforts have also been made by the academic associations at different levels. However, the clear way of thinking and development direction are uncertain so far. The authors, from a clinical perspective, analyze the current situation in postoperative management of DTC, and based on the follow-up patterns in foreign countries and the difficulties encountered during follow-up works, discuss how to develop the postoperative follow-up strategies for DTC in line with China’s conditions.

Abstract:Objective: To investigate the postoperative survival and factors affecting the prognosis of medullary thyroid carcinoma (MTC). 
Methods: The data of 78 MTC patients admitted to Shengjing Hospital affiliated to China Medical University from January 2001 to December 2017 were retrospectively analyzed. The survival rates of the patients were calculated based on the follow-up results, and the prognostic factors were determined by using univariate and multivariate regression analyses.
Results: Of the 78 patients, follow-up was obtained in 74 cases for 3 to 189 months. Ten patients died of the disease and all the remaining patients were alive. The 1-, 3-, 5-, 10-, and 15-year survival rates of the patients were 98.6%, 93.5%, 88.4%, 73.2%, and 73.2%, respectively. Univariate analysis showed that the sex (χ2=6.873, P=0.009) and cervical lymph node metastasis (χ2=4.047, P=0.048), distant metastasis (χ2=23.530, P<0.001), and clinical stage of the tumor (cTNM stage) (χ2=16.067, P<0.001) affected the prognosis of patients; multivariate analysis showed that distant metastasis (HR=54.956, 95% CI=6.341–476.257, P<0.001) and cTNM stage (HR=2.214,
95% CI=1.061–4.619, P=0.034) were independent factors affecting the survival of MTC patients.
Conclusion: Distant metastases and advanced E cTNM stage are important factors for unfavorable prognosis of MTC, and early diagnosis and treatment can ensure the long-term survival of the patients.

Abstract:Objective: To investigate the clinical value of intraoperative frozen section analysis for prelaryngeal/Delphian lymph nodes (DLN) and pretracheal lymph nodes (PLN) in surgery for papillary thyroid carcinoma (PTC).
Methods: The clinical data of 245 patients with PTC diagnosed by preoperative fine-needle aspiration biopsy and accepted the first-time surgery in the Department of Thyroid and Breast Surgery of the Second Affiliated Hospital, Kunming Medical University from January 2015 to December 2016 were collected. All patients underwent intraoperative frozen section examination for both DLN and PLN, and then surgical procedures were decided according to the metastasis status of the DLN and PLN.
Results: DLN and PLN were detected in the intraoperative frozen sections for all the 245 patients, with the number of lymph nodes ranged from 2 to 11, and DLN and PLN metastases were found in 126 patients (51.43%). Paratracheal lymph node metastases were found in 165 patients, and lateral cervical metastases were found in
26 patients by postoperative pathological examination. Seventy-six patients underwent unilateral lobectomy with isthmusectomy plus ipsilateral central neck dissection, 42 patients underwent total thyroidectomy plus central neck dissection of the affected side, 101 patients underwent total thyroidectomy plus bilateral central neck dissection, and 26 patients underwent total thyroidectomy plus bilateral central neck dissection along with lateral neck dissection. Results of statistical analyses demonstrated that capsular invasion was an independent risk factor for DLN and PLN metastases (OR=9.62, P=0.021).
Conclusion: DLN and PLN can be considered as the sentinel lymph nodes of PTC, and their metastases are closely related to paratracheal lymph node and lateral cervical lymph node metastases. The intraoperative frozen section examination for DLN and PLN will help to choose the best surgical procedure and thereby provide more precise treatment for PTC.

Abstract:Objective: To investigate and compare the efficacy of using nanocarbon tracer technique and modified endoscopic-assisted thyroidectomy (Miccoli surgery) and their parathyroid protection effects in total thyroidectomy for patients with papillary thyroid carcinoma (PTC).
Methods: The clinical data of 117 PTC patients undergoing total thyroidectomy were retrospectively analyzed. Of the patients, 31 cases underwent nanocarbon mark during operation (nanocarbon group), 56 cases underwent modified Miccoli surgery (Miccoli group), and the other 30 cases underwent conventional surgery (conventional group). The surgical variables, pre- and postoperative serum levels of calcium and parathyroid hormone (PTH), postoperative scores of visual analogue scale (VAS) and numerical scoring system (NSS), and the incidence of transient or permanent superior laryngeal nerve (SLN) and recurrent laryngeal nerve (RLN) injuries, as well as the occurrence of hypoparathyroidism, hypocalcemia and tumor recurrence were compared among the three groups.
Results: The preoperative data were comparable among the three groups. The operative time was significantly prolonged, but the length of incision and intraoperative blood loss and amount of postoperative drainage were significantly reduced in Miccoli group compared with the other two groups (all P<0.05). There were no significant differences in number of lymph node dissected and length of postoperative hospital stay among the three groups (P>0.05), but the number of metastatic lymph nodes detected in nanocarbon group was significantly higher than that in conventional group (P<0.05). On 1 h to 7 d after operation, the serum calcium and PTH levels in both nanocarbon group and Miccoli group were significantly higher than those in conventional group (all P<0.05), while no significant differences were noted between the former two groups (all P>0.05); the VAS scores in Miccoli group were significantly lower than those in the other two groups, and in nanocarbon group were significantly lower than those in conventional group (all P<0.05). There were no significant differences in serum calcium and PTH levels as well as VAS scores among the three group at one month after operation (all P>0.05). At 3 and
6 months after operation, the NSS scores in Miccoli group were significantly lower than those in the other two groups, and in nanocarbon group were significantly lower than those in conventional group (all P<0.05). All patients were followed up for 18 to 41 months. There was no significant difference in incidence of SLN injury among the three groups (P>0.05); the incidence of RLN injury, hypoparathyroidism and hypocalcemia in either nanocarbon group or Miccoli group were significantly lower than those in conventional group (all P<0.05), but all showed no significant differences between nanocarbon group and Miccoli group (all P>0.05). The recurrence rates had no significant differences among the three groups (P>0.05).
Conclusion: The nanocarbon technique and modified Miccoli procedure can both effectively protect the parathyroid function in total thyroidectomy for PTC patients. The nanocarbon technique has better thoroughness in lymph node dissection, while the modified Miccoli procedure is more minimally invasive.

Abstract:Objective: To investigate the expression of cathepsin H (CTSH) in papillary thyroid carcinoma (PTC) and its clinical significance.
Methods: The 50 paired specimens of PTC and adjacent thyroid tissue as well as 50 specimens of normal thyroid tissue were collected. The expressions of CTSH mRNA and protein as well as the positive expression rates of CTSH protein in these specimens were determined by qRT-PCR, Western blot and immunohistochemical staining, respectively. Then, the relations of CTSH protein expression with the clinicopathologic variables of PTC patients were analyzed.
Results: Both CTSH mRNA and protein expression levels as well as the positive expression rate of CTSH protein in PTC tissue were significantly higher than those in tumor adjacent tissue and normal thyroid tissue (all P<0.05), while above indexes showed no significant differences between tumor adjacent tissue and normal thyroid tissue (all P>0.05). In PTC patients, the positive expression rate of CTSH protein in cases with capsular invasion or lymph node metastasis was significantly higher than in those without capsular invasion or lymph node metastasis (both P<0.05).
Conclusion: The CTSH expression is increased in PTC tissue, and the increased CTSH expression may be closely associated with the malignant progression of PTC.

Abstract:Objective: To analyze the non-coding RNAs and mRNAs as well as signaling pathways associated with the prognosis of thyroid cancer by bioinformatics approaches.
Methods: The clinical information of 568 thyroid cancer patients along with the non-coding RNA (lncRNAs, miRNAs) and mRNA data of their tissue samples were downloaded from the Cancer Genome Atlas (TCGA) database, and differentially expressed non-coding RNAs and mRNAs were screened, and functional enrichment analysis and pathway analysis were performed on the differentially expressed mRNAs. The competing endogenous RNA (ceRNA) regulatory network of lncRNA-miRNA-mRNA was constructed; Survival analysis based on the clinical information was conducted for obtaining the non-coding RNAs and mRNAs associated with the prognosis of thyroid cancer. 
Results: A total of 497 differentially expressed lncRNAs (93 up-regulated and 404 down-regulated), 72 differentially expressed miRNAs (5 up-regulated and 67 down-regulated) and 1 097 differentially expressed mRNAs (233 up-regulated and 864 down-regulated) were screened. Functional enrichment analysis showed that the differentially expressed mRNAs were mainly enriched in the biological processes such as single-organism process, single-organism cellular process and response to stimulus, the cell function such as receptor binding, molecular function regulator, calcium ion binding, and the molecular components of cells such as cellular component, membrane and extracellular region. Pathway enrichment analysis showed that the differentially expressed mRNAs were mainly enriched in pathways such as neuroactive ligand-receptor interaction, cytokine-cytokine receptor interaction and transcriptional misregulation in cancer. In the constructed ceRNA regulatory network of lncRNA-miRNA-mRNA, there were two lncRNA (MIR181A2HG, OPCML-IT1), one miRNA (miRNA-184) and two mRNA (E2F1, SALL3) were significantly related to the overall survival rate (all P<0.05).
Conclusion: The identified non-coding RNAs and mRNAs as well as signaling pathways may closely be related to the prognosis of thyroid cancer, which may also open a new avenue for studying the mechanism of the occurrence and development of thyroid cancer.

Abstract:Objective: To investigate the effects of down-regulating the expression of ubiquitin-protein ligase E3A (UBE3A) on the biological behaviors in three negative breast cancer (TNBC) cells.
Methods: Three constructed UBE3A shRNA sequences were respectively transfected into the human TNBC MDA-MB-231 cells through lentiviral vectors, and the shRNA sequence with highest interference efficiency was selected for experiments after interference efficiency tests. In MDA-MB-231 cells after transfected with the selected UBE3A shRNA sequence, the changes in proliferation, invasion and cell cycle were determined by CCK-8 assay, Transwell invasion assay and flow cytometry respectively, using the MDA-MB-231 cells without any treatment and transfected with a scrambled sequence as blank control and negative control.
Results: The lentiviral vectors with UBE3A shRNA expression were successfully constructed and the UBE3A shRNA sequence with highest interreference efficiency was picked up (the inhibitory rate was 89.5% for UBE3A gene and 45.3% for UBE3A protein). Compared with the cells in blank control group, the proliferative and invasion abilities were significantly decreased with significant S-phase cell cycle arrest in MDA-MB-231 cells with UBE3A down-regulation (all P<0.05); all the observed indexes in cells of negative control group showed no significant changes (all P>0.05).
Conclusion: Down-regulating UBE3A expression can induce cell cycle arrest in TNBC cells and thereby inhibit their proliferation and invasion abilities, and suggests that UBE3A expression plays an important role in the malignant biological behaviors of TNBC cells.

Abstract:Objective: To investigate the relationship between the convergence sign in automated breast volume scanner (ABVS) and tumor-associated clinicopathologic variables in patients with invasive ductal breast carcinoma (IDBC).
Methods: The ultrasonographic images and clinicopathological data of 160 IDBC patients (160 masses) confirmed by postoperative pathology were collected. The relations of the convergence sign present in the coronal plane of ABVS with the clinicopathologic variables of the patients were analyzed. 
Results: Of the 160 patients, convergence sign was seen in 56 cases (35.0%) and absent in 104 cases (65.0%). There were no significant differences in proportions of presence of the convergence sign between groups concerning age, tumor size and menopausal status (all P>0.05). The proportions of presence of the convergence sign were increased in groups for histological I-II grade and axillary lymph node metastases as well as positive estrogen receptor, positive progesterone receptor, negative epidermal growth factor receptor and negative Ki-67 (all P<0.05). The proportions of presence of the convergence sign showed no statistical difference between groups concerning different statuses of human epidermal growth factor receptor 2 (P>0.05).
Conclusion: The convergence sign of the IDBC mass in the coronal plane of ABVS can, to some extent, indicate the clinicopathologic features of the tumor, which may provide imaging evidence for the selection of personalized diagnosis and treatment as well as prognosis estimation for breast cancer in clinical practice.

Abstract:Objective: To investigate the expressions of epidermal growth factor receptor (EGFR) and lactate dehydrogenase (LDHA) in the local immune microenvironment of pancreatic cancer and significance by bioinformatics approaches. 
Methods: The clinical information of 178 pancreatic cancer patients along with the expression data of EGFR, LDHA and signaling molecules associated with pancreatic cancer as well as the infiltration levels of distinct immune cell subsets in their tissue samples were retrieved by mining the TIMER (Tumor IMmune Estimation Resource) web server, and the protein expression abundances of EGFR and LDHA together with the signaling molecules associated with pancreatic cancer were examined by using the Human Protein Atlas. The influences of EGFR and LDHA expressions as well as the infiltration levels of immune cell subsets and other clinical factors on prognosis of the patients were analyzed by Log-rank test and Cox regression model, and the relationship between EGFR and LDHA and their relations with the signaling molecules associated with pancreatic cancer were also analyzed.
Results: The mRNA expression levels of both EGFR and LDHA in pancreatic cancer tissue were significantly higher than those in normal pancreatic tissue (both P<0.05); there was a positive correlation between EGFR and LDHA mRNA expressions in pancreatic cancer tissue (P<0.001). High EGFR mRNA expression, high LDHA mRNA expression and low level of CD4+ T cells were significantly associated with poor overall survival in pancreatic cancer patients (all P<0.05). LDHA was an independent prognostic factor for pancreatic cancer (P<0.001). EGFR was positively correlated with the expressions of the signaling molecules associated with pancreatic cancer that included FOXM1, CSF1 and CSF1R mRNA, and LDHA was positively correlated with the expressions of FOXM1, CSF1 and CSF1R (all P<0.05). The protein expression abundances of EGFR, LDHA, P38, FOXM1 and CSF1R in pancreatic cancer tissue were all markedly higher than those in normal pancreatic tissue.
Conclusion: The expressions LDHA and EGFR are increased in pancreatic cancer tissue, and both of them, especially the LDHA, may influence the prognosis of the patients by regulating the expressions of the signaling molecules associated with pancreatic cancer and the local immune microenvironment.

Abstract:Objective: To explore the feasibility and safety of ambulatory thyroid surgery under the protocol of enhanced recovery after surgery (ERAS).
Methods: The clinical data of 1 023 patients who underwent thyroid surgery under strict selection criteria in the ambulatory ward of Xiangya Hospital of Central South University between January 2015 and August 2018 were retrospectively analyzed. The ERAS protocol was implemented in all patients before, during and after surgery.
Results: Of the 1 023 patients, 806 cases (78.8%) were females and 217 cases (21.2%) were males, with a mean age of (40±10) years; 275 cases (26.9%) underwent endoscopic surgery and 748 cases (73.1%) had open surgery. The average operative time was (114.32±38.41) min, the average hospitalization time was (20.6±6.9) h, and the average intraoperative blood loss was (26.62±31.31) mL. Wound swelling and neck compression symptoms occurred in one patient undergoing bilateral areolar endoscopy 4 h after operation due to bleeding from the chest subcutaneous tunnel, which were improved by aspiration drainage and local compression. Transient hypocalcemia and symptomatic hypocalcemia occurred in 335 cases (32.7%) and 123 (12.0%) after operation, and the incidence of hypocalcemia and symptomatic hypocalcemia for endoscopic surgery was 29.45% and 8.73%, and for open surgery was 33.96% and 13.23%, respectively. Temporary recurrent laryngeal nerve injury was found in 28 cases (2.7%) (including 7 cases undergoing endoscopic surgery and 21 cases undergoing open surgery). No permanent hypocalcemia or recurrent laryngeal nerve injury was noted in any of the patients after operation. Postoperative wound infection occurred in 2 patients (0.73%) undergoing endoscopic surgery and one patient (0.13%) undergoing open surgery, respectively. No cases of postoperative esophageal leakage, trachea leakage, chylous leakage, dyspnea and asphyxia were observed in these patients.
Conclusion: Under strict selection criteria, and ERAS concept guidance for whole treatment process, ambulatory thyroid surgery is a safe and feasible, as well as convenient and efficient surgical approach.

Abstract:Objective: To assess the clinical application value of fine-needle aspiration (FNA) plus assaying parathyroid hormone (PTH) in the washing liquid of FNA samples for identification of parathyroid gland during thyroidectomy. 
Methods: Thirty-one patients undergoing thyroid surgery during December 2014 to May 2015 were enrolled. During operation, FNA was performed and the nature of the tissues (parathyroid gland, thyroid gland, muscle, fat, lymph node and thymus) of FNA samples was judged by naked eye, and then, the PTH levels in the washing liquid of the aspirated tissues were measured and the corresponding tissues were sent for pathological examination simultaneously. The PTH levels in the washing liquid from different aspirated tissues were compared, and the sensitivity and specificity of measurement of PTH in the tissue washing liquid for identification of parathyroid gland were analyzed.
Results: A total of 186 FNA samples were obtained, including 28 parathyroid and 158 non-parathyroid tissues. The average concentration of PTH was 1431.83 (214–5 000) pg/mL for parathyroid, 20.26 (10.36–30.57) pg/mL for thyroid, 22.26 (13.38–31.24) pg/mL for muscle, 22.51 (13.25–29.83) pg/mL for fat, and 20.67 (10.23–
31.60) pg/mL for lymph node. The concentration of PTH in parathyroid tissue was significantly higher than those in non-parathyroid tissues (all P<0.001), which showed no significant differences among the non-parathyroid tissues (P>0.05). Both sensitivity and specificity of the concentration of PTH in the tissue washing liquid >37.92 pg/mL
were 100% for identification of parathyroid tissue. No permanent hypoparathyroidism occurred in any of the patients undergoing FNA.
Conclusion: Determination of PTH in the washing liquid of FNA samples is a reliable, safe, and simple method for discrimination of parathyroid and non-parathyroid tissue during thyroidectomy.

Abstract:Objective: To assess the application efficacy of using incision of the fascia over the serratus anterior muscle on the inferolateral border of the pectoralis major muscle for silicone prosthesis breast reconstruction.
Methods: The clinical data of 124 patients with breast cancer undergoing total mastectomy and prosthesis implantation for breast reconstruction from February 2014 to January 2015 were reviewed. Of the patients,
23 cases underwent traditional modified radical mastectomy, 22 cases underwent skin sparing total mastectomy, and 79 cases underwent nipple sparing total mastectomy. All patients received breast reconstruction with silicone prosthesis though incision of fascia over the serratus anterior muscle on the inferolateral border of pectoralis major muscle. The surgical variables, postoperative results, complications and long-term outcomes were analyzed.
Results: Operation was successfully completed in all the 124 patients. The operative time was 65–120 min, with an average of (83.62±14.18) min, and the intraoperative blood loss was 45–105 mL, with an average of (78.14±17.47) mL. After operation, the excellent/good rate of the appearance evaluation for the reconstructed breast was 82.25% (102/124). Seroma occurred in 7 patients, which was relieved after drainage; incision dehiscence was observed in 5 cases and was resolved by anti-inflammatory treatment, dressing change and resuture; prosthesis removal was required in none of the patients. Followed-up was performed for 22 to
50 months, and 9 patients were lost to follow-up, all of whom had disease free survival before lost to follow-up. During follow-up, 5 patients developed bone metastases, pulmonary metastases and liver metastases occurred in one case each, and no local recurrence was found in any of them.
Conclusion: Using incision of the fascia over the serratus anterior muscle on the inferolateral border of the pectoralis major muscle for silicone prosthesis breast reconstruction is safe, effective and easy to be performed, and is recommended to be widely adopted.

Abstract:Objective: To investigate the clinical efficacy of using ultrasound-guided Mammotome revolve device in treatment of early-stage breast cancer.
Methods: The clinical data of 51 patients who underwent complete lesion excision by ultrasound-guided Mammotome revolve device and then radical surgery because pathologically diagnosed as breast cancer after lesion excision between January 2015 and June 2018 were collected. The residual tumor in the margin of the resection cavity and the risk factors for residual tumor were analyzed.
Results: Of the 51 patients, residual tumor was detected in 15 cases (29.4%). After diagnosis of breast cancer, 37 patients underwent mastectomy, and 14 patients received breast-conserving radical surgery with resection of the needle passage, and no residual tumor was found in the needle passage by pathological examination in any of the 14 cases. The results of univariate analysis showed that the history of breast cancer, histological type of the tumor, histological grade, hormone receptors and status of the axillary lymph nodes had no significant influence on tumor residues(all P>0.05); tumor diameter (P=0.046), age(P=0.036) and high Ki-67expression(P=0.039) were associated with tumor residues. Results of multivariate analysis revealed that high Ki-67 expression was an independent risk factor for tumor residues (OR=4.83, P=0.038).
Conclusion: There is a relatively high rate of residual tumor after early-stage breast cancer excision by ultrasound-guided Mammotome revolve device, so indications should be rigorously followed to reduce the chance of residual tumor.However, its clinical value needs to be further evaluated.

Abstract:n recent years, the incidence of thyroid cancer has continually increased worldwide. Accurate disease staging and risk stratification have great guiding significance in the treatment decision making and postoperative management of thyroid cancer. The tumor-nodes-metastases (TNM) staging system developed by the American Joint Commission on Cancer (AJCC) has gained widespread acceptance and application at present time. The 8th edition of the AJCC TNM staging system for thyroid cancer was issued in 2016, and has been formally used in clinical practice on January 1st, 2018. Compared with the 7th edition, several amendments have been made in the 8th edition. The authors address the essential points of the updates and the evaluation effectiveness of the 8th edition respectively and, also mention the different views and attitudes of the academic society towards its overall application value, for fully evaluating the 8th edition, and thereby expecting to help the readers to gain a comprehensive understanding of this new staging system.

Abstract:Single-site endoscopic thyroidectomy (SSET) emerged from the development of endoscopic thyroid surgery and the growth of aesthetic requirements of the patients. SSET has both advantages of being minimally invasive and cosmetic in addition to its per se safety and effectiveness, which follows the mainstream trend of modern surgery. In recent years, SSET has developed rapidly, especially in East Asia, but there are still many issues that need to reach an agreement, including the choice of surgical approach, the improvement of operational skills, the renewal of concepts, and the development of surgical equipment. At present, personalized SSET plan should be provided to the patients according to both doctor's skills and patient's specific condition.

Abstract:High-resolution ultrasound shows high sensitivity and excellent specificity to identify the nature of the thyroid nodules with advantages of being efficient, economical and noninvasive. Thus, it is the first-choice method for qualitative, quantitative, and locational diagnosis of thyroid nodules and the reference to the indications for fine needle aspiration. For effectively ascertaining the benign or malignant nature of the thyroid nodules and standardizing the application and management of thyroid nodule ultrasound, thyroid imaging reporting and data system (TIRADS) has emerged and developed over ten years to date. TIRADS not only changes the traditional understanding of thyroid nodules of the professional world as either being benign or malignant through the grading management, but also will become an important means of propelling the standardization, precision, and individualized diagnosis and treatment of thyroid diseases.