Abstract:Background and Aims: The age of onset has a certain association with the prognosis of a number of tumors, but there are obvious differences among different tumors, even among different subtypes of the same cancer. Triple-negative breast cancer (TNBC), as a poor prognostic subtype of breast cancer, has always been an important concern. This study was to designated to analyze the relationship between age and the prognosis of the TNBC patients. 
Methods: According to the inclusion and exclusion criteria, the clinical data of 317 patients with stage I-III TNBC undergoing surgery in Peking Union Medical University Hospital from January 2011 to December 2014 were collected for a retrospective study. The whole cohort were divided into ≤40 years old group and >40 years old group according to the age of onset of the patients. The differences in clinicopathologic characteristics, local-regional recurrence-free survival (LRRFS), distance metastasis-free survival (DMFS), disease-free survival (DFS) and overall survival (OS) between the two groups of patients were compared, and the factors including age affecting the DFS and OS of the TNBC patients were analyzed. Further, the differences in age and other clinicopathologic factors between patients with early distant metastasis (DM) and late DM were compared.
Results: In terms of clinicopathologic features, the histological grade was poorer, the incidence of  vessel tumor embolus was higher, tumor stage was more advanced and the proportions of cases receiving chemotherapy and radiotherapy were higher in ≤40 years old group than those in >40 years old group (all P<0.05). Survival analysis showed that the DMFS (64.3% vs. 83.2%), DFS (55.7% vs. 79.2%) and OS (71.8% vs. 86.2%) were worse in ≤40 years old group than those in >40 years old group (all P<0.05), while there was no statistical difference in LRRFS between the two groups (87.5% vs. 94.9%, P>0.05). Both age ≤40 years and number of positive lymph nodes ≥4 were independent risk factors for the prognosis of TNBC patients (DFS: HR=1.983, 95% CI=1.280–3.071, P=0.002; HR=2.064, 95% CI=1.091–3.904, P=0.026; OS: HR=1.799, 95% CI=1.052–3.076, P=0.032; HR=4.062, 95% CI=1.841–8.963, P=0.001). Age showed no significant influence on the early or late occurrence of DM (P>0.05).
Conclusion: Age is an independent risk factor for poor prognosis in TNBC patients. Patients with age ≤ 40 years old at the time of diagnosis may face worse outcomes than those over 40 years old. Therefore, more attention should be paid to the young TNBC patients, for whom, more rigorous treatment and follow-up plan should be made to realize a patient-tailored precision therapeutic strategy.

Abstract:Background and Aims: Triple negative breast cancer (TNBC) has an extremely poor prognosis because of the lack of effective therapeutic targets and limited treatment options in clinical practice. This study was designated to investigate the expression of FAT atypical cadherin 4 (FAT4) in TNBC tissue and its clinical significance, so as to provide a new treatment strategy for this disease.  
Methods: The mRNA and protein expressions of FAT4 in fresh paired tumor and adjacent tissue samples from 10 TNBC patients were determined by RT-PCR and Western blot, respectively. Then, FAT4 expressions in the paraffin-embedded specimens of paired tumor and adjacent tissue from 60 TNBC patients were examined by immunohistochemical staining, and the relations of FAT4 expression with the clinicopathologic features and prognosis of the TNBC patients were analyzed.
Results: In the 10 paired fresh tissue samples, the relative expression levels of FAT4 mRNA and protein were significantly lower in TNBC tissue than those in adjacent tissue (both P<0.05), using adjacent tissue as a reference, the mRNA expression value was 0.482±0.092 and protein expression value was 0.437±0.082 respectively. In the 60 paraffin-embedded specimens, the positive expression rate of FAT4 protein in TNBC tissue was significantly lower than that in adjacent tissue (23.33% vs. 71.67%, χ2=28.104, P<0.001); the FAT4 protein expression was significantly associated with lymph node status (P=0.034), tumor size (P=0.001), TNM stage (P=0.028), histological grade (P=0.023) and Ki-67 index (P=0.031), but irrelevant to age (P=0.744) and menstrual status (P=0.933); the disease-free survival (DFS) in TNBC patients with positive FAT4 expression was significantly longer than that in those with negative FAT4 expression (42.0 months vs. 34.6 months, P=0.037); Cox multivariate proportional hazard model shown that high FAT4 expression of was an independent protective factor for DFS in TNBC patients (HR=0.52, 95% CI=0.29–0.98, P=0.041).
Conclusion: FAT4 expression is decreased in TNBC tissue, and low FAT4 expression is closely related to the malignant biological characteristics and unfavorable outcomes of TNBC patients. 

Abstract:Background and Aims: Surgical resection is the preferred treatment for breast cancer. The use of sentinel lymph node biopsy (SLNB) in place of axillary lymph node dissection (ALND) can reduce the incidence of postoperative complications. The success (or not) of SLNB is closely related to the selection of tracer. At present, methylene blue and 99mTc sulfur colloid or the combination of the two are the most commonly used in clinical practice, however, both tracer agents have their drawbacks. A number of clinical trials have been performed to assess the new tracer agents, such as indocyanine green (ICG), superparamagnetic iron oxide (SPIO), indigocarmine, carbon nanoparticles, among which ICG has been most extensively studied. Nevertheless, there are few Meta-analysis on the clinical value of combining multiple tracers. Therefore, this study was designated to evaluate the application value of dual-tracer method of ICG combined with methylene blue in SLNB of breast cancer in China by Meta-analysis.  
Methods: The publicly published studies comparing using dual-tracer method of ICG combined with methylene blue and single-tracer method of methylene blue performed by Chinese medical institutes were searched in China National Knowledge Infrastructure, Wanfangdata, VIP database, PubMed and Cochrane Library, encompassing the time period from the dates of inception to August 2019. The search results were screened in accordance with exclusion criteria, and the methodological qualities of the included studies were assessed. The differences in detection rate of sentinel lymph nodes (SLNs), number of detected SLNs, false negative rate, sensitivity and specificity between the two tracer methods were compared. Publication bias analysis was assessed by funnel plot. 
Results: A total of 15 studies were finally included, including 12 articles in Chinese and 3 articles in English, and all of them were domestic studies. Meta-analysis results showed that the detection rate of SLNs (OR=5.39, 95% CI=3.46–8.39, P<0.000 01), number of detected SLNs (SMD=1.06, 95% CI=0.76–1.36, P<0.000 01), sensitivity (OR=5.31, 95% CI=2.68–10.55, P<0.000 01) and specificity (OR=2.71, 95% CI=1.35–5.45, P=0.005) were significantly increased and the false negative rate (OR=0.15, 95% CI=0.08–0.29, P<0.000 01) was significantly decreased by using dual -tracer method of ICG plus methylene blue compared with single-tracer method of methylene blue. The detection rates of SLNs reported in the 15 articles were used to assess publication bias, and the funnel plot showed that the possibility of publication bias was low. 
Conclusion: The dual-tracer method of ICG combined with methylene blue has a high application value in SLNB of breast cancer in China. With the progress of research, more clinical studies will be included for Meta-analysis in the future, so that this method can be expected to be widely used in clinical practice.

Abstract:Background and Aims: Despite that the epidemic of novel coronavirus pneumonia (COVID-19) has been under effective control in China, the number of cases outside our country is continuously growing. So, the prevention and control situation is still grim. This study, taking the Department of Breast Surgery in the First Affiliated Hospital of Army Medical University as an example, was designed to analyze and summarize the operations of breast surgery in a comprehensive tertiary hospital during the epidemic, so as to provide effective reference and experiential practice for conducting safe and efficient breast surgery work during epidemic and post-epidemic periods. 
Methods: Thirty-seven patients with breast cancer admitted in the Department of Breast Thyroid Surgery of the First Affiliated Hospital of Army Medical University during the COVID-19 epidemic period of January 31, 2020 to February 20, 2020 were selected. The data of the patients including the clinical characteristics, protective measures and treatment effects were retrospectively analyzed. The main points of methods for patients' admission to hospital, preoperative preparation, intraoperative protection and postoperative recovery, as well as the self-protection and psychological counseling of the medical staff were summarized. The effects of specialized treatment and epidemic prevention and control were identified by follow up. The details for how to improve the cognition of potential risk for infectious diseases, and how to strengthen the prevention and control of epidemic disease and occupational protection during the post-epidemic period were analyzed from the aspects of surgical indications, aerosol management and clinic protection in combination with the diagnosis and treatment characteristics of breast surgery. 
Results: Thirty-seven patients received surgical treatment after the exclusion of the risk of COVID-19. The mean operative time was (152.23±46.19) min, the average intraoperative blood loss was (85.23±23.47) mL, and no intraoperative blood transfusion was required in any of the patients. Among the 37 breast cancer patients, 19 cases underwent 6 to 8 cycles of preoperative neoadjuvant therapy, of whom, complete pathological remission was obtained in 7 cases after surgery. Prolonged fever occurred in 2 patients after operation, which returned to normal after isolation, body temperature monitoring and symptomatic treatment, and COVID-19 was excluded by nucleic acid testing for SARS?CoV?2. After follow-up, no suspected COVID-19 symptoms such as fever, cough and fatigue were noted in any of the patients or their accompanying relatives, and also no suspected cases were observed among the relevant medical staff. 
Conclusion: During the epidemic period, on the premise of scientific prevention and control, and full avoidance of COVID-19 infection in both doctors and patients, aggressive treatment can be provided to breast cancer patients according to the local epidemic situation. The principles of "scientific decision-making, and humanistic service" should be continuously followed, and the various prevention and control guidelines and management norms issued by superiors should be strictly obeyed, and the necessary elements such as prehospital screening, preoperative preparation, intraoperative protection and postoperative recovery of the breast cancer patients should be completed according to the actual situation. Rigorous compliance with the protection measures against epidemic in all aspects of the pre-admission and perioperative period of the patients, and coordinated relations of the epidemic prevention and control with the specialized treatment, may maximally ensure the safe completion of breast surgery and protect the health of the patients and medical personnel. 

Abstract:Background and Aims: A great number of studies have demonstrated that long non-coding RNAs (lncRNAs) play important roles in the occurrence and development of cancers in recent years. lncRNA RP1-85F18.6 is a newly discovered non-coding RNA, which is overexpressed in colon cancer tissues and cells, and can promote the proliferation and invasion, inhibit the apoptosis and regulate the cell cycle of the cancer cells. However, there are no reports of studies about the lncRNA RP1-85F18.6 in breast cancer so far. So, this study was conducted to preliminarily investigate the expression of lncRNA RP1-85F18.6 in breast cancer cells and its effect on proliferation and cell cycle.   
Methods: The expressions of lncRNA RP1-85F18.6 in breast cancer cell lines MDA-MB-231, MBA-MD-468, MCF-7 and normal mammary cell line MCF-10A were detected by qRT-PCR. MDA-MB-231 cells were transfected with RP1-85F18.6 silencing sequence (silencing group) and negative control sequence (negative control group), respectively, using the untreated MDA-MB-231 cells as blank control group. In the three groups of cells, the proliferation abilities were measured by MTT assay, the cell-cycle distributions were examined by PI staining flow cytometry, and protein expressions of Ki67, proliferating cell nuclear antigen (PCNA), cyclin A1 and p21c1p1 were determined by Western blot analysis. 
Results: The relative expression levels of lncRNA RP1-85F18.6 in MDA-MB-231, MBA-MD-468 and MCF-7 were all significantly higher than that in the normal mammary cell line MCF-10A (all P<0.05). The OD490 nm values at 24, 48, 72 and 96 h after transfection in silencing group were all significantly lower than those in blank control group (all P<0.05). In silencing group compared with blank control group, the proportion of G1/G0 phase cells showed no significant change (P>0.05), but the proportion of S phase cells was significantly increased, and the proportion of G2/M phase cells were significantly decreased (both P<0.05); the expression levels of Ki67, PCNA and cyclin A1 proteins were significantly down-regulated, while the expression of p21C1P1 protein was significantly up-regulated (all P<0.05). No statistical differences were noted in all above indexes between negative control group and blank control group (all P>0.05). 
Conclusion: LncRNA RP1-85F18.6 is highly expressed in breast cancer cells, which may participate the occurrence and development of breast cancer through regulating the expressions of proliferation-promoting and cell-cycle-controlling proteins. Intervention of lncRNA RP1-85F18.6 and its target genes may be a new therapeutic  approach for the treatment of breast cancer.

Abstract:Background and Aims: The aberrant expressions of microRNAs (miRNAs) have been demonstrated to be closely associated with the occurrence and development of malignant tumors. The expressions of some miRNAs have clear correlations with the invasive clinicopathologic characteristics of papillary thyroid carcinoma (PTC). This study was conducted to investigate the expression of miR-221 in PTC and its influence on the biological behaviors of PTC cells.  
Methods: The expressions of miR-221 in 51 paired samples of PTC and adjacent tissue were detected by qPCR. In PTC K1 cells after transfection with miRNA random sequence (negative control group) or miR-221 inhibitor (miR-221 inhibitor group) with the untreated K1 cells as blank control, the proliferation was detected by MTT colorimetry, apoptosis and cell cycle were analyzed by flow cytometry, and invasion ability were determined by Transwell chamber.
Results: The relative expression level of miR-221 in PTC tissue was significantly higher than that in the adjacent tissue (P<0.05). In K1 cells of miR-221 inhibitor group compared with blank control group, the proliferative ability was significantly reduced; the apoptosis rate was significantly increased and the proportion of G0/G1 phase was increased while the proportion of G2/M phase decreased significantly; the invasion capability was significantly decreased, and all the differences had statistically significance (all P<0.05). there were no significant differences in above studied indexes between negative control group and blank control group (all P>0.05).
Conclusion: The expression of miR-221 is increased in PTC, which may probably affect the proliferation and invasion capability of PTC cells through regulating the cell cycle and apoptosis. So, miR-221 has a potential application value as a biomarker for early diagnosis and treatment of PTC. 

Abstract:Background and Aims: Thyroid cancer (TC) is not only one of the most common endocrine malignancies, but also has become the fastest growing cancer at present time. Diabetes mellitus (DM) is also currently one of the major global public health problems, and studies have demonstrated that DM is associated with the occurrence and development of various malignant tumors. This study was to investigate the clinicopathologic characteristics of patients with comorbid TC and DM by comparison with the clinicopathologic data and results of the thyroid B ultrasound of patients with TC alone, so as to provide reference for the treatment decision-making in patients with such condition. 
Methods: A total of 1 064 patients undergoing surgical treatment for TC from January 2016 to October 2019 in Xiangya Hospital of Central South University were enrolled. Of the patients, 245 cases had concomitant TC and DM (TC+DM group) and 819 cases had lone TC (TC group). And 604 subjects undergoing health maintenance examination during the same period in Xiangya Hospital of Central South University were also recruited (healthy control group). The differences in general features and biochemical parameters (DM-related indexes, thyroid function indexes and tumor markers) among TC+DM group, TC group and healthy control group were analyzed. The differences in clinicopathologic factors and thyroid ultrasound findings (TI-RADS) between TC+DM group and TC group as well as between groups with different glycated hemoglobin (HbA1c) levels in patients with comorbid TC and DM were compared.
Results: Compared with healthy control group, the female proportion, average age, and the levels of thyroid stimulating hormone and neuron-specific enolase in both TC+DM group and TC were significantly increased, and the increasing amplitudes in TC+DM group were significantly greater than those in TC group (all P<0.05); the BMI and DM-related indexes (fasting plasma glucose, 2-hour post-meal blood glucose and HbA1c) were significantly elevated in TC+DM group (all P<0.05), but showed no significant changes in TC group (all P>0.05). The proportions of large tumor diameter, lymph node metastasis, distant metastasis, and TI-RADS 4c and 5 nodules and multiple thyroid nodules in TC+DM group were significantly higher than those in TC group (all P<0.05); among patients with comorbid TC and DM, the proportions of distant metastasis and multiple nodules in high HbA1c group (HbA1c≥7%) were significantly higher than those in low HbA1c group (HbA1c<7%) (both P<0.05). In the 1 064 patients, 1 056 cases (99.2%) were papillary thyroid carcinoma (PTC), and all cases with comorbid TC and DM were PTC.
Conclusion: Comorbid TC and DM mostly occurs in older females, and this kind of patients have a higher TI-RADS classification, and are likely to develop multiple nodules, lymph node metastasis and distant metastasis. In patients with combined TC and DM, those with poor glucose control may have a high incidence of distant metastasis and multiple nodules. Therefore, older female DM patients with thyroid nodules should be vigilant to the occurrence of TC, and the nodules should be observed dynamically, along with tight blood sugar control.

Abstract:Background and Aims: Non-surgical active surveillance is an option for patients with papillary thyroid microcarcinoma (PTMC). However, the long-term clinical outcomes after delayed surgery remain unclear. Therefore, this study was conducted to investigate the influence of the time interval from diagnosis to surgery on the long-term clinical outcomes of PTMC patients by comparing the clinical outcomes of PTMC patients with different intervals from initial diagnosis to surgery.  
Methods: The clinical data of PTMC patients undergoing delayed thyroid surgery from January to December 2015 were retrospectively analyzed. According to the interval from diagnosis to surgery, the patients were classified into short-interval group (<6 months), mid-interval group (6-12 months) and long-interval group (>12 months). Then, the patients were matched according to clinical variables such as age, sex, surgical scope, initial tumor diameter measured by ultrasound (US), extrathyroidal invasion, multifocal tumors, and central cervical lymph node metastasis. The dynamic risk stratifications (DRS) and patient structural relapse/disease persistence among the groups of patients were compared.
Results: A total of 426 patients were enrolled according to the inclusion and exclusion criteria. Of the patients, 331 cases were females and 95 cases were males; the average age was (48.9±10.1) years; the average tumor size of the initial US determination was (0.65±0.12) cm; 214 cases received thyroid lobectomy and the remaining cases were subjected to total thyroidectomy. There were 290 cases in short-interval group, 106 cases in mid-interval group and 30 cases in long-interval group, and the clinicopathologic features showed significant differences among the three groups, in which, the age was old, the proportions of male sex and cases receiving lateral lobectomy were high, tumor size was small and the incidence of extrathyroidal invasion was high in long-interval group (all P<0.05). Then, 147 patients were included for analysis after the clinicopathologic variables of the three groups of patients were matched with a in a 3:3:1 ratio, where there were 63 cases each in short-interval group and mid-interval group, and 21 cases in long-interval group. Of the patients after matching, 120 cases were females and 27 cases were males; the average age was (50.0±8.2) years; the average tumor size at the initial US was (0.63±0.14) cm; no significant differences were noted in clinicopathologic variables among groups (all P>0.05); the DRS classification showed no significant difference among the three groups (P=0.07). During the average (2.8±0.6) years of follow-up, there were no significant differences in the development of structural recurrent/persistent disease (P=0.34) and disease-free survival rates (P=0.25) among the three groups. The results of analysis of risk factors for structural recurrent/persistent disease in the PTMC patients showed that male sex (HR=2.43. 95% CI=1.21–4.91, P=0.013) and multifocal tumors (HR=2.45, 95% CI=1.24–4.83, P=0.010) are risk factors, and the period of delay of thyroid surgery is irrelevant to structural recurrent/persistent disease in the PTMC patients.
Conclusion: In PTMC patients, delayed surgery is not associated with increased risk of structural recurrent/persistent disease. The surgical treatment can be safely delayed in PTMC patients with under active surveillance.

Abstract:Background and Aims: Parathyroidectomy (PTX) is an important treatment method for the refractory renal secondary hyperparathyroidism (SHPT) not controlled by drugs. However, permanent hypoparathyroidism, adynamic bone disease or refractory osteomalacia may probably occur after PTX, and the studies regarding its long-term efficacy are still limited in our country. Therefore, this study was designated to further evaluate the safety as well as the short- and long-term therapeutic effect of PTX on refractory renal SHPT. 
Methods: One-hundred and thirty-nine patients with refractory renal SHPT depend on long-term dialysis who received PTX in the Second Affiliated Hospital of Anhui Medical University from January 2011 to December 2014 were recruited. The clinical data and blood parameters that included intact parathyroid hormone (iPTH), calcium, phosphorus, hemoglobin (Hb) and hematocrit (Hct) were collected before operation and 3 d, 6 months, 1 year, 2 years and 3 years after operation. Meanwhile, the degree of symptom relief, postoperative complications and follow-up conditions were observed and recorded.
Results: The success rate of PTX in 139 patients was 95.7% (133/139). The total number of parathyroid glands removed during operation was 537, and the average number of the parathyroid glands removed per case was 3.86. Transient recurrent laryngeal nerve injury occurred in 12 patients (8.6%) after operation, including hoarseness in 9 cases (6.5%) and choking cough when drinking water in 3 cases (2.2%), which were all recovered spontaneously without treatment within 3 months. Postoperative hypocalcemia or vitamin D deficiency occurred in 120 patients (86.3%), which were effectively controlled after treatment with cinacalcet, calcium supplementation, and active vitamin D supplementation. No surgical complications such as wound infection, bleeding, asphyxia, and hypothyroidism occurred in the whole group of patients. The anemia parameters in all patients were improved by different degrees, and the values of Hb and Hct were increased significantly at 6 months after surgery and remained stable during the follow-up period; postoperative iPTH level was significantly reduced, and the blood levels of calcium, phosphorus and calcium-phosphorus product reached the lowest at 3 d after operation, which were still lower than those before operation during the follow-up for 3 years. and all the changes were statistically different from preoperative conditions (all P<0.05). No death occurred during the follow-up. The preoperative symptoms of the patients such as bone pain, intractable skin itching, insomnia, ectopic calcification, muscle weakness with atrophy were significantly relieved within 1 day after surgery; there were no progressive exacerbation in patients with height shrinkage or skeletal deformities during follow-up; the anorexia, and general nutritional status and self-care ability were improved to varying degrees within 3 months after surgery. Eleven patients (7.9%) showed sustained SHPT, of whom 4 cases (2.9%) had incomplete removal of the parathyroid glands during operation, and 1 case (0.7%) had a parathyroid small gland that failed to remove during operation and 6 cases (4.3%) had mediastinal ectopic parathyroid glands which were identified by postoperative examination. During the follow-up period, the iPTH levels in 5 patients (3.5%) with unremoved glands all were higher than 800 pg/mL, with obvious symptoms of muscle weakness and intractable skin itching, and PTX was performed again; 6 patients (4.3%) had ectopic parathyroid glands were given medical treatment, because they refused to be re-operated for the greater risk of surgery; recurrence occurred in 8 patients (5.8%) after operation, of whom 6 cases (4.3%) were caused by the recurrence of the forearm grafts, which were all resected under local anesthesia, and 2 cases (1.4%) were caused by the excessive hyperplasia of the residual glands in the neck, which were treated by second operation, and then the symptoms were improved. All patients undergoing second surgery had no obvious clinical symptoms or recurrence at the end of follow-up. 
Conclusion: PXT can improve the clinical symptoms, and the anemia parameters as well as the calcium and phosphorus metabolism in patients with refractory renal SHPT, with favorable short-term efficacy and long-term efficacy. So, it is a safe and effective method for the treatment of refractory renal SHPT.

Abstract:Background and Aims: The novel coronavirus (COVID-19), discovered in December 2019, has now spread throughout the world. Studies have shown that patients with cancer have a higher risk of COVID-19 and are more likely to develop severe symptoms and progress to exacerbation. Head and neck tumors, as the major disease entities to be encountered in a cancer-specialized hospital, have a large number of cases of complex disorders, and some of them are highly malignant with rapid progress, for which the treatment cannot be delayed. Moreover, the operations involving the mouth, throat and airway are unavoidable during the diagnosis and treatment process of head and neck tumors, which may increase the risk of COVID-19 infection between doctors and patients. Therefore, this study was conducted to mainly investigate the appropriate diagnosis and treatment of head and neck tumors and prevention and control strategies of COVID-19 in a cancer-specialized hospital amid the COVID-19 pandemic.  
Methods: The clinical data of 38 patients with head and neck malignant tumors admitted for therapy by scheduled appointment in Zhejiang Cancer Hospital from February 1th, 2020 to February 22rd, 2020 were retrospectively analyzed. In our center, the time-phased appointments were implemented, patients were appropriately diverted based on the diagnosis and treatment guidelines and clinical practice, and the hospitalization indications were rigorously adhered to. All admitted patients received surgery or chemotherapy on the premise of exclusion of COVID-19 by detailed epidemiological investigation, nucleic acid detection and chest CT scan. During hospitalization, the epidemic prevention and control measures were strictly implemented, the treatment process was carefully observed, and the temperature monitoring and management were paid particular attention. After discharge, the outcomes of patients were followed up and the patients received medical advice and post-discharge treatment through internet-based hospitals or other online channels. 
Results: Among the 38 patients with head and neck tumors, 17 cases were males and 21 were females, with an average age of 49 years. There were 21 cases of thyroid cancer, 6 cases of oral malignancies, 3 cases of salivary gland cancer, 2 cases of laryngeal cancer, 2 cases of hypopharyngeal cancer, and 1 case each of cervical esophageal cancer, lymphoma, nasopharyngeal cancer and of angiosarcoma. COVID-19 was excluded in all 38 patients upon admission. Thirty-one patients underwent surgical treatment and the other 7 patients were subjected to chemotherapy. Fever occurred in 3 patients during the process of treatment, which included fever associated with agranulocytosis in 1 case, fever caused by tumor necrosis and infection in 1 case and fever caused by wound infection in 1 case. Patients generally had an uneventful treatment course and recovered well. No COVID-19 infection was found in patients and medical staff during hospitalization and at the end of 2 weeks after discharge from hospital.
Conclusion: In the situation of COVID-19 pandemic, rational distribution of patients as well as scientific prevention and control based on the diagnosis and treatment guidelines and clinical practice, making full use of the advantages of "internet + medical service", to protect cancer patients from virus while engage in the fight against the epidemic, providing psychological support to the patients, and minimizing the impact of the epidemic on treatment and ensuring the continuity of treatment are feasible strategies for the clinical treatment of head and neck tumors.

Abstract:Background and Aims: Radiofrequency ablation (RFA) and laparoscopic hepatectomy are important treatment modalities for small hepatocellular carcinoma (HCC), and both method have their indications, advantages and limitations, which also are the main themes addressed by existing literature. However, there are relatively scarce data regarding the short-term efficacy especially the health economic costs of the two methods. Therefore, this study was conducted to determine the differences in short-term efficacy outcomes and medical costs between percutaneous RFA and laparoscopic hepatectomy in treatment of small HCC, so as to provide help for the selection of treatment options for small HCC in clinical practice.  
Methods: The clinical data of 80 patients with small HCC (tumor diameter ≤5 cm) treated from August 2017 to July 2019 were retrospectively analyzed. Of the patients, 40 cases underwent percutaneous RFA (RFA group) and the other 40 cases underwent laparoscopic hepatectomy (laparoscopic group). The main clinical variables and medical costs were compared between the two groups of patients. 
Results: There were no signi?cant differences in preoperative baseline data and levels of liver function parameters and α-fetoprotein (AFP) between the two groups (all P>0.05). The liver function parameters were initially increased and then decreased in RFA group, and were continuously declined laparoscopic group after operation. The liver fuction parameters on postopertive 3 d were significantly higher in RFA group than those in laparoscopic group[ALT: (65.72±25.61) U/L vs. (45.26±23.36) U/L, AST: (77.27±12.51) U/L vs. (53.29±11.24) U/L, TBIL: (25.12±6.06) μmol/L vs. (22.26±4.39) μmol/L, all P<0.05] , but showed no significant differences on postoperative one month between the two groups (all P>0.05). The AFP levels were gradually reduced in both groups after operation, which showed no signi?cant differences between the two groups in the same time points (both P>0.05). The operative time, intraoperative blood loss, length of hospital stay and incidence of postoperative complications in RFA group were signi?cantly less than those in laparoscopic group[(62.6±11.7) min vs. (155.2±27.5) min, (5.2±0.5) mL vs. (76.2±11.3) mL, (4.3±1.2) d vs. (6.3±1.8) d, 5.0% vs. 17.5%, all P<0.05] . The tumor removal rates were 100% in both groups. In the direct medical cost components, the costs for surgery-related care, medications and hospitalization in RFA group were significantly lower than those in laparoscopic group[(11 526.46±941.08) yuan vs. (14 277.25±938.46) yuan, (1 825.33±179.5) yuan vs. (2 614.19±222.4) yuan, (476.30±67.71) yuan vs. (712.03±87.52) yuan, allP<0.05] , but no significant differences were noted in the testing and examination and other costs between the two groups (both P>0.05); the direct and indirect medical costs as well as the total medical costs in RFA group were significant lower than those in laparoscopic group[(17 446.78±1 465.24) yuan vs. (21 270.62±1 612.38) yuan, (782.23±66.80) yuan vs. (1 654.67±120.47) yuan, (18 228.01±1 539.72) yuan vs. (22 924.35±1922.67) yuan, all P<0.05] .
Conclusion: RFA and laparoscopic hepatectomy have similar the short-term efficacy in treatment of small HCC. However, RFA is associated with shortened operative time and hospital stay as well as decreased incidence of postoperative complications, so the direct and total medical costs incurred by RFA are aslo lower than those by laparoscopic hepatectomy.

Abstract:Thyroid micropapillary carcinoma (PTMC) accounts for about 74.8% of newly diagnosed thyroid papillary carcinoma (PTC) in China. Although PTMC has an excellent prognosis, some PTMC patients will develop early lymph node metastasis or even distant metastasis. For instance, about 30.7% to 49.2% of patients with cN0 PTMC have central lymph node metastasis (CLNM). China’s guideline for differentiated thyroid cancer suggests that ipsilateral central lymph node dissection (CLND) should be performed for patients with cN0 PTMC on the premise of the effective technical guarantee. However, the latest guideline of the American Thyroid Association points out that prophylactic central lymph node dissection (pCLND) is ineffective in improving long-term survival, but may increase the incidence of complications. So, whether or not performing a pCLND for cN0 PTMC patients is still controversial. The supporters think that pCLND can reduce local recurrence, and the results of pathological examination can improve the accuracy of TNM staging, which may help make the individualized treatment plan for the patients after operation. The opponents argue against pCLND, as it does not improve the prognosis, but increases the risk of hypoparathyroidism and recurrent laryngeal nerve (RLN) injury. Right central lymph nodes are divided into lymph nodes superior to the RLN (VIa) and lymph nodes posterior to the RLN (VIb). The level VIb lymph nodes are locate in deep tissue, with a narrow anatomical space, and these anatomical characteristics make it difficult to predict the metastasis of them in preoperative assessment, and complete dissection of the lymphatic and adjacent adipose tissues in this area during surgery may cause various complications, such as RLN injury, pleural rupture, and chylous fistula. However, the incidence rates of CLNM and VIb level lymph node metastasis in cN0 PTMC patients reach 30.7% to 49.2%, which should not be ignored. Performing pCLND in cN0 PTMC patients with high-risk characteristics can avoid the repeated operation for tumor recurrence. The difficulty of reoperation is increased and the incidence of complications will also be greatly increased. Therefore, identification of the risk factors of VIb lymph node metastasis is of great significance. The risk factors for VIb lymph node metastasis in cN0 PTMC patients may include patient age <45 years, male sex, tumor diameter larger than 0.5 cm, multifocality, upper pole location, capsular invasion, extrathyroidal extension, concomitant nodular goiter and VIa lymph node metastasis, et al. Here, the authors address the metastasis and dissection of the VIb level lymph nodes in cN0 PTMC patients.

Abstract:Despite the great progress in surgical techniques, hypoparathyroidism is still one of the most common complications after total thyroidectomy. Either transient or permanent hypoparathyroidism after operation can cause severe hypocalcemia and affect the patient’s quality of life. Therefore, early diagnosis and prediction of hypocalcemia after thyroid surgery are of great clinical significance. Because parathyroid hormone (PTH) is secreted directly by the parathyroid glands, plus its short half-life, PTH can not only reflect the function of the parathyroid glands in real time, but also reflect the significance of rapid intraoperative PTH testing. Perioperative PTH monitoring for thyroid surgery has the advantages of practicability, effectiveness and economic efficiency in clinical practice. However, there are still some controversies and problems about the actual significance of clinical application of PTH monitoring during perioperative period of thyroid surgery at present, which needs to be verified by prospective studies of a large sample size. In conclusion, perioperative PTH monitoring may be helpful for early detection and prediction of the occurrence of hypocalcemia, optimization of clinical management strategies and methods, and appropriately guiding the postoperative calcium supplementation regimen. Here, the author addresses the methods and significance of perioperative PTH monitoring.

Abstract:Cancer-associated fibroblasts (CAFs) are one of the major stroma cells in tumor microenvironment. CAFs are usually derived from the normal fibroblasts by the actions of various platelet derived growth factor and fibroblast growth factor, interleukin 6 and hepatocyte growth factor, or from the mesenchymal stem cells, fat cells and other cells during the process of epithelial mesenchymal transformation (EMT), and some CAFs are transformed from cancer stem cells. Recent studies have demonstrated that the CAFs in breast cancer can promote the invasion and metastasis of breast cancer cells through secreting a variety of cytokines and exosomes, and participating in EMT and extracellular matrix remodeling, and also promote the growth and invasion of the breast cancer cells under the hypoxic tumor microenvironment through activating the relevant signaling pathways. Moreover, CAFs mediate the chemotherapy resistance, endocrine therapy resistance and multi-drug resistance in breast cancer through various ways such as elevating the apoptosis threshold, serving as a physical barrier against anti-tumor drugs, secreting glutamine for increasing the survival rate of breast cancer cells, activating the growth factor-associated signaling pathways or increasing mitochondrial function to produce anti-apoptotic effects. Here, the authors mainly address the research progress in sources of CAFs and its role in invasion/metastasis and treatment resistance of breast cancer.