Abstract:With the rapid increase in incidence of thyroid cancer and the volume of thyroidectomy, the demands for ambulatory thyroidectomy are growing, where the processes of admission, surgery and discharge are completed within 24 h. At present, ambulatory thyroidectomy mode has been undertaken at a few advanced medical institutions in China and other countries, which is considered as an advanced management mode, owning the advantages of being safe, high-efficient and convenient as well as reducing the length of hospital stay and hospitalization costs, and improving the patients’ satisfaction under strict indication criteria. However, the substantive development and popularization of the ambulatory thyroidectomy mode will be confronted with many difficulties and problems under our existing health care system and doctor-patient relationship conditions, such as surgery complications, health insurance policy, hospital management system, postoperative recovery management, medical document writing and medical ethics. So, ambulatory thyroidectomy is currently only suitable for being conducted as clinical research at thyroid centers with sufficient surgical experience under reliable conditions.

Abstract:Objective: To compare the efficacy of laparoscopic and open surgery in treatment of low-risk thyroid papillary carcinoma, so as to provide reference for its treatment method selection. 
Methods: The clinical data of 538 patients with low-risk thyroid papillary carcinoma undergoing surgical treatment in the Second Xiangya Hospital of Central South University from November 2010 to November 2015 were retrospectively analyzed. Of the patients, 243 cases underwent laparoscopic thyroidectomy (laparoscopic group) and 295 cases underwent open thyroidectomy (open surgery group). The main clinical variables were compared between the two groups of patients.
Results: There were no significant differences in terms of general data between the two groups (all P>0.05). No significant differences were observed in operative time, intraoperative blood loss, amount of postoperative drainage, number of retrieved lymph nodes in the central compartment, time to tube removal, and length of hospitalization between the two groups either by overall comparison or stratified comparison according to the resection scope (all P>0.05). No significant differences were noted in respect of the incidence of postoperative bleeding, hoarseness, subcutaneous hematoma, coughing when drinking water, hypocalcemic tetany and wound infection (all P>0.05), but the incidence of postoperative neck discomfort in laparoscopic group was significantly lower than that in open surgery group (P<0.05). The pain scores on postoperative day 1, 2, and 3, and the 3-year survival rate and recurrence rate all showed no significant differences between the two groups (all P>0.05). The postoperative cosmetic grading scores in laparoscopic group were significantly superior to those in open surgery group (all P<0.05).
Conclusion: Laparoscopic surgery is safe and effective for the treatment of low-risk papillary thyroid carcinoma, and it can reduce the discomfort in the neck, and better meet the cosmetic requirements of the patients compared to traditional open surgery. It can be considered as a preferred surgical procedure for low-risk thyroid.

Abstract:Objective: To explore the safety, feasibility and clinical effect of the endoscopic thyroid surgery through sutureless intermuscular approach (SISA). 
Methods: The clinical data of 20 patients undergoing thyroid surgery from January 2018 to October 2018 were retrospectively analyzed. All patients underwent endoscopic SISA thyroidectomy by the same surgeon, and it was performed by exposing the thyroid through opening the underlying intermuscular spaces between the strap muscles of the neck.
Results: Operations were successfully completed in all the 20 patients, without any intraoperative conversion to other procedures. Three patients with thyroid adenoma underwent unilateral major thyroid lobectomy, of the 13 patients with nodular goiter, 5 cases underwent unilateral major thyroid lobectomy and 8 cases underwent bilateral major thyroid lobectomy, and 4 patients with primary hyperthyroidism underwent bilateral major thyroid lobectomy. The operative time was (65±23.3) min, the intraoperative blood loss was (5.5±1.9) mL; the external branch of superior laryngeal nerve was exposed in 26 sides (81.2%, 26/32), and the recurrent laryngeal nerve was exposed in 30 sides (93.7%, 30/32). No postoperative complication occurred, and the volume of drainage on postoperative day (POD) 1 was (54.5±32.46) mL, the VAS pain score on POD 1 was 0 1, and the length of postoperative hospital stay was 2–3 d. Followed-up was conducted for 3 months after surgery, neck paresthesia and neck skin traction phenomenon during swallowing was found in one case, but no recurrence occurred and the cosmetic results were favorable.
Conclusion: The endoscopic SISA thyroid surgery is safe and feasible, with the advantages of no need of cutting the linea alba cervicalis, avoidance of suturing, mild pain, easy exposure of nerves, and insignificant postoperative neck adhesion.  

Abstract:Objective: To investigate the clinical value of using parathyroid gland identification (PGI) system in rapid identification of parathyroid gland during thyroid surgery.  
Methods: The clinical data of 251 patients who underwent thyroid surgery in Jiangyuan Hospital Affiliated to Jiangsu Institution of Nuclear Medicine from March 2016 to May 2018 were collected. In all patients, the suspicious parathyroid gland tissues underwent fine-needle aspiration, and PGI system was used to identify whether the aspirated tissues were parathyroid gland or not by detecting the parathyroid hormone (PTH) concentration in the washing liquid of the aspirated tissues during operation. Meanwhile, a small portion of each aspirated tissue was cut off for frozen pathological analysis. Using the results of frozen pathological examination as the standard, the accuracy of the PGI system for parathyroid identification was statistically analyzed.
Results: A total of 434 tissue samples were detected by the PGI system, including ineffective detection in 16 samples and effective detection in 418 samples. In the effective detected samples, 311 samples were identified as parathyroid tissue and 107 samples were identified as non-parathyroid tissue by the PGI system; 314 samples were identified as parathyroid tissue and 104 samples were identified as non-parathyroid tissue by frozen pathological examination. These two detection methods showed a significant consistency (к=0.969, P<0.001). The sensitivity, specificity, positive predictive value, negative predictive value, misdiagnosis rate, missed diagnosis rate and accuracy rate of PGI system for parathyroid identification were 99.0% (309/312), 98.1% (104/106), 99.4% (309/311), 97.2% (104/107), 1.9% (2/104), 1.0% (3/312) and 98.8% (413/418), respectively. In all patients, no bleeding or infection was noted, and no permanent hypoparathyroidism and recurrent laryngeal nerve paralysis occurred after operation.
Conclusion: The PGI system can be used to distinguish parathyroid tissue during thyroid surgery. It has the advantages of rapid performance, high accuracy, simple procedure and less tissue damage. So, it is recommended to be used in clinical practice.

Abstract:Objective: To investigate the factors affecting the sample satisfaction rate of ultrasound-guided fine needle aspiration biopsy (US-FNAB) of thyroid nodules, and the influences of different gauges of puncture needle and different types of vascularity of the thyroid nodule on the sample satisfaction rate. 
Methods: The clinical data of 310 patients with thyroid nodules (a total of 337 nodules) undergoing US-FNAB from June 2015 to September 2017 were analyzed. The relations of sample satisfaction rate with puncture needle gauge and type of vascularity of thyroid nodule as well as other factors were analyzed, and the differences in sample satisfaction rate of thyroid nodules with different vascularity using different gauges of puncture needle were also compared.
Results: Among the 337 samples of nodules, 295 samples (87.5%) were satisfying, and 42 samples (12.5%) were not satisfying. Results of statistical analysis showed that the unsatisfaction rate in hypervascular nodule was significantly increased (P=0.001), but the puncture needle gauge and all other factors had no significant relation with sample satisfaction rate (all P>0.05). In the 161 samples of hypervascular nodule, the sample needles satisfaction rates by using 23G and 25G needles were 73.3% and 88.4% (P<0.05); in the 176 samples of hypovascular nodule, the satisfaction rates by using 23G and 25G needles were 96.8% and 88.9% (P<0.05). In the 170 samples drawn by 23G needle, the satisfaction rates for hypervascular and hypovascular nodule were 73.3% and 96.8%; in the 167 samples drawn by 25G needle, the satisfaction rates for hypervascular and hypovascular nodule were 88.4% and 88.9% (P>0.05).
Conclusion: The hypervascular nodule is more likely to result in unsatisfied sample. The needle gauge has no obvious influence on the sample satisfaction rate of FNAB, and both 23G and 25G needles can meet the requirement of US-FNAB. However, the 23G needle is more suitable for the hypovascular nodules, and the 25G needle is more suitable for the hypervascular nodules.

Abstract:Objective: To investigate the risk factors of lateral neck lymph node metastasis in patients with papillary thyroid microcarcinoma (PTMC).    
Methods: The preoperative color Doppler results and clinicopathologic data of 462 patients with clinical lymph node negative (cN0) PTMC were retrospectively analyzed. The risk factors for lateral neck lymph node metastasis were determined by χ2 test and Logistic regression analysis.  
Results: In the entire group of patients, the rate of central neck lymph node metastasis was 38.5% and the rate of lateral neck lymph node metastasis was 23.6%. The results of univariate analysis showed that sex (χ2=7.312, P<0.05), tumor diameter (χ2=14.321, P<0.001), thyroid capsule invasion (χ2=21.689, P<0.001), multiple tumors (χ2=13.086, P<0.001), tumor location (χ2=19.028, P<0.001) and central neck lymph node metastasis (χ2=69.421, P<0.001) were significantly associated with lateral lymph node metastasis. The results of multivariate Logistic regression analysis indicated that male sex (OR=1.758), tumor diameter ≥7 mm (OR=1.710), thyroid capsule invasion (OR=3.337), multiple tumors (OR=1.778), central neck lymph node metastasis (OR=7.504) and tumor in the superior pole (OR=4.084) were independent risk factors for lateral neck lymph node metastasis (all P<0.05). The risk of lateral neck lymph node metastasis was increased with the increase of the number of affected central neck lymph nodes (≥3: OR=19.957).
Conclusion: In patients with cN0 PTMC, lateral lymph node metastasis is related to a number of factors. For those who have one or more of them, lateral neck lymph node exploration of the affected side is recommended in the first surgery.

Abstract:Objective: To investigate the prevalence of thyroid cancer (TC) in patients with type 2 diabetes mellitus (T2DM) and the relevant risk factors.   
Methods: A total of 1 662 T2DM patients (T2DM group) hospitalized from June 2016 to December 2018, and 604 subjects (control group) undergoing health maintenance examination and with exclusion of diabetes during the same period were enrolled. The prevalence rates of TC between the two groups were compared, and the relevant variables between T2DM patients with and without TC were also compared.
Results: In T2DM group, the prevalence rate of TC was higher than that in control group (7.46% vs. 1.32%), which was also higher in female patients than that in male patients (54.0% vs. 46.0%) and higher in patients ≥45 years than that in those <45 years (77.4% vs. 22.6%), and all differences had statistical significance (all P<0.05). The percentage of postoperatively diagnosed TC in the same TI-RADS classification in T2DM group showed an increasing trend compared to control group (effective statistical analysis could not be performed due to the extremely small sample number in the control group). In T2DM group the body mass index and levels of fasting blood glucose, postprandial 2-h blood glucose, glycosylated hemoglobin, thyroid stimulating hormone, triglyceride, neuron-specific enolase and cytokeratin 19 fragment in patients with TC were significantly higher than those in patients without TC (all P<0.05). All tumors in the 124 cases of the T2DM group were classified as papillary carcinoma.
Conclusion: The risk of TC is significantly increased in patients with T2DM, especially in female patients and those ≥45 years. Good blood glucose and lipid control, and maintenance of thyroid function within normal range in T2DM patients may have certain significance for the prevention of TC. Regular thyroid B-ultrasound examination is recommended in patients with T2DM.

Abstract:Objective: To evaluate the diagnostic value of routine ultrasonography combined with elastosonography in diagnosing papillary thyroid microcarcinoma (PTMC).  
Methods: The studies concerning routine ultrasonography combined with elastosonography for diagnosis of PTMC both in Chinese and in English were searched in several national and international online databases. Search period was set from 2013 to August 2018. After strict screening and data extraction by two reviewers according to the predefined inclusion and exclusion criteria, the risk of bias of the included studies was assessed by QUADAS-2 tool, and Meta-analysis was performed using STATA12.0 and Meta-Disc 1.4 software.
Results: Sixteen studies were finally included involving 2 826 lesions. Random effects model was used for Meta-analysis due to the substantial heterogeneity of the included studies. The obtained results showed that the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio for diagnosis of PTMC were 0.91 (95% CI=0.89–0.92), 0.90 (95% CI=0.89–0.92), 8.94 (95% CI=5.45–14.65), 0.09 (95% CI= 0.05–0.16) and 103.05 (95% CI=52.06–203.98) respectively, and the area under the SROC curve was 0.9657 (the Q index was 0.9130). The Deek’s plot showed no significant publication bias (P=0.485).
Conclusion: Routine ultrasonography combined with elastosonography has a relatively high diagnostic efficiency for detecting PTMC, which provides a feasible method for diagnosis of PTMC.

Abstract:Objective: To investigate the regulatory effect of the activation of G protein-coupled estrogen receptor (GPER) on expression of fibroblast growth factor 2 (FGF2) in cancer-associated fibroblasts (CAFs) in breast cancer and the effect of its induced paracrine on growth of cancer cells.  
Methods: The expression localizations of GPER in CAFs and CAFs with GPER mutation cultured alone or co-cultured with ER+ breast cancer MCF-7 cells or ER- breast cancer MDA-MB-468 cells were determined by immunofluorescence assays. The mRNA expression and secretion levels of FGF2 in CAFs cultured alone or co-cultured with breast cancer cells and CAFs with GPER mutation co-cultured with breast cancer cells after treatment with 17 β-estradiolum (E2) or GPER specific agonist G1 were detected by real-time qPCR and ELISA, respectively; the changes in proliferative abilities in the two types of breast cancer cells co-cultured with CAFs after treatment with E2 or G1 were examined by flow cytometry and CCK-8 assays, and the interventional effects of FGF2 neutralizing antibody were also observed.
Results: In alone culture condition, GPER was located in the nucleus of the CAFs or CAFs with GPER mutation, while evident cytoplasmic translocation of GPER was seen in CAFs but not in CAFs with GPER mutation after co-culture with the both types of breast cancer cells. After treatment with E2 or G1, the expression levels of FGF2 mRNA in CAFs and FGF2 contents in the culture supernatants were significantly increased in co-culture conditions (all P<0.05), but above changes were not observed in CAFs cultured alone and CAFs with GPER mutation under co-culture conditions. The proliferative abilities were significantly enhanced in both types of breast cancer cells in co-culture with CAFs after treatment with E2 or G1 (all P<0.05), but these effects were abolished by adding FGF2 neutralizing antibody.
Conclusion: In breast cancer microenvironment, there is cytoplasmic translocation of GPER, which may contribute to the activation of estrogen/GPER/FGF2 pathway, and thereby promote the progression of breast cancer.

Abstract:Objective: To assess expressions of cIAP1, XIAP and caspase-3 in breast cancer tissue and their relations with clinicopathologic factors and prognosis.  
Methods: The protein expressions of cIAP1, XIAP and caspase-3 in 99 specimens of breast cancer tissue, 10 specimens of breast fibroadenoma tissue and 6 specimens of tumor-adjacent normal mammary tissue were determined by immunohistochemical staining. The relations of the 3 proteins with clinicopathologic features and prognosis of breast cancer patients were analyzed, by combination with the data of breast cancer patients in Kaplan-Meier Plotter database.
Results: The results of immunohistochemical staining showed that the expression levels of cIAP1, XIAP and caspase-3 protein in breast cancer tissue were all significantly higher than those in normal mammary tissue (all P<0.05), while no significant differences were noted in the expression levels of the 3 proteins between breast cancer tissue and breast adenofibroma tissue, and between breast cancer tissues from patients undergoing and not undergoing neoadjuvant chemotherapy (all P>0.05). The expression of cIAP1 was significantly associated with the menstrual status and age of patients, and the expression of XIAP was significantly related to the expression intensity of Ki-67 (all P<0.05). The results of Kaplan-Meier Plotter database analysis showed that the cIAP1 expression level exerted no significant influence on the relapse-free survival (RFS) time of breast cancer patients (P>0.05), while the RFS time in breast cancer patients with high XIAP expression level was longer than that in breast cancer patients with high XIAP expression level, and in patients with high caspase-3 expression level was shorter than that in those with low caspase-3 expression level (both P<0.05). 
Conclusion: The expressions of cIAP1, XIAP and caspase-3 may be closely related to the occurrence and development of breast cancer, and XIAP and caspase-3 may potentially be prognostic indicators for breast cancer.

Abstract:Objective: To investigate the potential biological function of ubiquitin-protein ligase E3A (UBE3A) in breast cancer cells through proteomics and bioinformatics methods. 
Methods: The triple-negative breast cancer MDA-MB-231 cells were transfected with shRNA-UBE3A sequences (UBE3A knock-down group) or scrambled shRNA sequences (control group), respectively. Then, the differentially expressed proteins between the two groups of cells were separated and identified by two-dimensional electrophoresis (2-DE) and matrix-assisted laser desorption/ionization (MALDI-TOF-TOF-MS/MS); bioinformatics analyses of the differentially expressed proteins were performed using DAVID Functional Annotation and String online tools.
Results: Twenty-eight differentially expressed proteins were obtained and identified by 2-DE and MALDI-TOF-TOF-MS/MS, and 23 proteins were matched in DAVID database, in which, 4 were up-regulated, 24 were down-regulated in UBE3A knock-down group versus control group. Twenty-three proteins were recognized by DAVID database, in which, 23 (100%), 20 (87.7%) and 23 (100%) proteins could be annotated by biological pathway, cellular components and annotation of molecule functions especially, some of them were clearly related to the ubiquitin-proteasome system and glucose metabolism. String analysis showed that there were direct or indirect relations among the 23 proteins.
Conclusion: UBE3A may participate in regulation of the biological behaviors of breast cancer cells via the ubiquitin-proteasome system and glucose metabolism pathway.

Abstract:Objective: To analyze the expression of microtubule-associated protein tau (MAPT) in breast cancer and its clinical significance though bioinformatics approach.    
Methods: Data about MAPT expression in breast cancer were downloaded from the public databases that included TCGA, bc-GenExMiner, GEO and Kaplan Meier Plotter. The MAPT expression profiles and their relations with the types of breast cancer as well as the treatment and prognosis of breast cancer were analyzed. 
Results: The result of overall analysis showed that MAPT expression was higher in breast cancer tissue than that in normal breast tissue (P<0.01), but the results of stratified analysis showed that MAPT expression was increased in breast cancer with low malignancy, early clinical stage or sensitivity to endocrine therapy and conversely, the opposite was true. Breast cancer with high MAPT expression was more sensitive to tamoxifen but more likely resistant to paclitaxel (P<0.01). The result of overall analysis showed that the overall survival and relapse-free survival in patients with high MAPT expression were longer than those in patients with low MAPT expression (HR=0.65, 95% CI=0.48–0.89, P<0.05; HR=2.91, 95% CI=1.54–5.51, P<0.05), but the results of stratified analysis showed that consistent result was only achieved in patients with Luminal A breast cancer, while the irrelevant or opposite results were seen in patients with other types of breast cancer.
Conclusion: MAPT expressions are diversified in different types of breast cancer, which were closely associated with drug resistance and prognosis of breast cancer. So, it is of certain clinical significance for treatment selection and the prognostic assessment of breast cancer.

Abstract:Objective: To investigate the risk factors for non-sentinel lymph node (NSLN) metastasis in early breast cancer with sentinel lymph node (SLN) macrometastasis.  
Methods: The data of 196 patients with clinical early-stage breast cancer and SLN macrometastasis treated from January 2014 to December 2016 were retrospectively collected. The associations of the clinicopathologic variables with NSLN metastasis were analyzed.
Results: Of the 196 patients, NSLN metastasis occurred in 53 cases (25.5%). Univariate analysis showed that NSLN metastasis was not associated with age, menstrual status, primary tumor location, histological grade, vascular tumor thrombus, Ki-67 expression, HER-2 expression, and immunohistochemical type (all P>0.05), but was significantly related to primary tumor size and positive SLN number (both P<0.05). Multivariate regression analysis showed that the positive SLN number was an independent risk factor for NSLN metastasis (P=0.000, OR=2.355).  
Conclusion: The primary tumor size and positive SLN number are important factors for NSLN metastasis in clinical early-stage breast cancer with SLN macrometastasis. For patients with primary tumor size greater than 
2 cm, especially with more than two positive SLN, axillary lymph node dissection is recommended.

Abstract:Parathyroid glands are important endocrine organs for regulation of the calcium and phosphorus metabolism, attached to the posterior side of both left and right lobes of the thyroid gland, or imbedded within the thyroid gland. Parathyroid injury can lead to a series of symptoms mainly associated with hypoparathyroidism, which seriously affect the patients’ quality of life. Therefore, during surgery of the neck such as thyroidectomy, the intraoperative localization of the parathyroid glands is extremely important, which can effectively avoid  parathyroid gland injury. Here, the authors mainly address the progress of intraoperative localization of the parathyroid glands in five aspects that include the intraoperative rapid detection of parathyroid hormone, near-infrared fluorescence imaging, nanocarbon negative contrast imaging, 99mTc-methoxyisobutyl isonitrile imaging and optical coherence tomography, so as to provide help for better intraoperative protection of the parathyroid glands.

Abstract:Postoperative hypoparathyroidism (HypoPT) mainly occurs after total thyroidectomy or parathyroidectomy. Hypoparathyroidism leads to hypocalcemia, and thereby affects the patients’ quality of life. Here, the authors address the research progress concerning the risk factors, clinical manifestations and treatment methods of HypoPT, so as to provide reference for its proper clinical treatment.

Abstract:Male breast cancer is a rare clinical entity, its incidence is much lower than that in women, and is closely related to factors such as family history of breast cancer, BRCA2 gene mutation and increased circulating estrogen levels. The treatment effect of this condition has been significantly improved by the integrated application of multiple treatment modalities that mainly include surgical management, endocrine therapy, chemotherapy and radiotherapy. Here, the authors address the research progress of male breast cancer.