Objective To investigate the methods and clinical significances of preserving the pectoral nerve(PN) and intercosto-brachial nerve(IBN) in modified radical mastectomy. Methods Eighty-seven patients suffering from breast cancer in stage Ⅰ and Ⅱ were randomly divided into 2 groups. Transpectoral anterior approach was used on patients in group A(n=52),with axillary lymph node dissection, preservation of the pectoralis minor muscles, PNS and IBNS. Patients in group B(n=35) were operated on through transpectoral posterior approach, with dissection of pectoralis minor muscles, sections of PNS and IBNS. Results No case in group A and 28 cases(80%) in group B suffered from postoperative atrophy of pectoralis major muscles(P

Objective To summarize the therapeutic effect of recombinant human growth hormone and early enteral nutrition in severely burned patients. Methods 35 cases were randomly divided into group EN and group PN.Group EN was treated with early enteral nutrition(EEN) and recombiant human growth hormone(rhGH) ,while group PN was given parenteral nutrition. The plasma levels of pre-albumin (PA), C-reactive protein (CRP) , tunmor necrosis factor α(TNFα) ,fasting blood glucose(FBG) were measured after burn injury. Comparision was made in length of hospital stay, wound healing time,incidence of burn sepsis, gastrointestinal stress ulcer bleeding and enteral nutrition intoleranc. Results Incidence of burn sepsis,gastrointestinal stress ulcer bleeding and enteral nutrition intoleranc in group EN were significantly lower than those of group PN(P ＜ 0.05). The serum levels of CRP、TNFα、FBG in group EN were significantly lower than those of group PN (P ＜ 0.05). The serum PA was decreased at all times in two periods and was markedly decreased in group EN(P ＜0.05). Length of hospital stay and the healing time of donor site, deep partial thickness burn wound, skin transplantion area were significantly shortened in group EN compared with group PN. Conclusion Early enteral nutrition was beneficial for the improving of nutrition state of the burn patients,and the reduction of the incidence of burn sepsis and the hospitalization time.

Objective To summarize the imaging features of computed tomography (CT)and magnetic resonance imaging (MRI) combined with multi-technology imaging and compare its effects in the preoperative evaluation of malignant perihilar biliary obstruction.Methods The clinical data of 20 patients receiving CT and MRI who were diagnosed with malignant perihilar biliary obstruction by pathological examination at the Wuxi Second People's Hospital between January 2008 and April 2014 were retrospectively analyzed.Patients receiving CT combined with negative-contrast CT cholangiopancreatography (nCTCP) and computed tomography angiography (CTA) were allocated into the CT group,and patients receiving MRI combined with magnetic resonance cholangiopancreatography (MRCP) and magnetic resonance angiography (MRA) were allocated into the MRI group.The images of the 2 groups were analyzed by 2 independent reviewers.The classification of malignant perihilar biliary obstruction,hepatic artery and portal vein invasions and lymph node and organ metastases were evaluated respectively,and then the results of evaluation were compared with the results of surgery and pathological examinations.The comparison between the accuracy of imaging examination in the 2 groups and accuracy of perihilar biliary obstruction classification were analyzed by the chi-square test.The comparison of evaluating accuracy (sensitivity and specificity) among vascular invasion and lymph node and organ metastases were done by the receiver operating characteristic (ROC) curve analysis,and the comparison of its accuracy were done by the z-score test.Results The imagings of bile duct involvement of the 2 groups showed that there were irregular thickening bile duct wall combined with retrograde intrahepatic bile duct dilatation.The symptoms of vascular invasion included the stricture and occlusion of blood vessels or more than half of vascular contact surface with tumor.The symptoms of lymph node metastasis included the enlarging short-axis or round-like circular enhanced lesions.The symptoms of organ involvement included the unclear boundary of lesions or low-density necrotic foci within organ.All the 20 patients underwent the surgical treatment,including 13 patients with hilar cholangiocarcinoma and 7 patients with gallbladder carcinoma.Hepatic artery invasions were detected in 5 patients,portal vein invasions in 10 patients,lymph node metastases in 10 patients and organ metastases in 4 patients.The cases of classification of perihilar biliary obstruction,hepatic artery invasion,portal vein invasion,lymph node metastasis and organ metastasis which were evaluated respectively by reviewer 1 and 2 were 18/18,19/18,18/18,17/16 and 18/19 in the CT group and 17/16,14/13,17/16,15/14 and 19/18 in the MRI group.The imaging of the 2 groups were compared with the evaluating accuracies of classification of malignant hilar biliary obstruction,hepatic artery and portal vein invasions,lymph node and organ metastases in the 2 groups,showing no significant differences (x2=12.593,8.889,z=1.823,1.956,0.462,0.817,0.977,0.751,0.233,1.403,P＞0.05).Conclusion CT and MRI for malignant hilar biliary obstruction had the same imaging features,meanwhile,they can provide an equivalent performance in the classification of malignant hilar biliary obstruction,hepatic artery and portal vein invasions and lymph node and organ metastases.

ObjectiveToevaluatethefeasibilityandresultsof transorallaparoscopic thyroidectomy. MethodThyroidectomy was attempted in 5 cases,including 4 females and 1 male with the average age of 42 years( range 35 -60 years).All patients was diagnosed as single nodule of the thyroid gland confirmed by B-mode ultrasound examination before the operation.The average diameter of nodule was 2.5 cm (range 2 - 3.4 cm). ResultTransoral laparoscopic thyroidectomy was perfoormed successfully in all 5 patients.The operation time was 120 - 210 min,averaging 170 min,blood loss during the operation was 15-60 ml,the postoperative hospitalization was 4 days. There was no conversion to open surgery,no recurrent laryngeal nerve injury,nor parathyroid glands dysfunction. ConclusionsTransoral laparoscopic thyroidectomy is feasible and safe,giving excellent cosmetic results.

Objective To evaluate the feasibility and results of laparoscopic thyroidectomy by oral and breast approach for the treatment of papillary throid carcinoma.Methods Thyoidectomy was performed in 26 cases,including 24 females and 2 males with the average age of 34 years (range 20-53 years).All patients were diagnosed throid carcinoma confirmed by FNA or B-mode ultrasound examination,a thyroid lobe or total thyroidectomy and central compartment dissection was performed by breast approach,then additional dissection of central compartment was completed through oral approach.Results Laparoscopic thyroidectomy via oral in combination with brest approach was performed successfully in all 26 cases.The mean operative time was (164 ± 13) min,including average time of oral approach of (40 ± 7) min.The mean number of lymph node dissection in central compartment was 7.42 ± 4.88,oral approach achieved additional 1.23 ± 2.21,with metastatic lymph nodes diseccted by oral approach in 3 cases.Conclusions Laparoscopic thyroidectomy via oral in combination with breast approach for the treament of papillary throid carcinoma is better than breast approach alone in central compartment dissection.

Trans-oral laporascopic thyroidectomy is a innovative technique that incoporated the concept of natural orifice transluminal endoscopic surgery.Compare to other endoscopic thyroidectomy,transoral laporascopic thyroidectomy is characterised with no scar in the body surface,better cosmetic results and conforms to the concept of minimally invasive surgery.At present,trans-oral laporascopic thyroidectomy is still in the initial stages of clinical application and gains a great deal of attention from surgeons all over the world.It mainly includes oral bottom approach and oral vestibular approach.Proponents and researchers in this field have been attempting to use this technique for treatment of thyroid cancer and combine it with the robotics assisted surgical system.In the future,the indications and contraindications of trans-oral laporascopic thyroidectomy need to be further studied and evaluated.Complications and surgical procedures still have many issues need to be solved.

Trans-oral laporascopic thyroidectomy is a innovative technique that incoporated the concept of natural orifice transluminal endoscopic surgery.Compare to other endoscopic thyroidectomy,transoral laporascopic thyroidectomy is characterised with no scar in the body surface,better cosmetic results and conforms to the concept of minimally invasive surgery.At present,trans-oral laporascopic thyroidectomy is still in the initial stages of clinical application and gains a great deal of attention from surgeons all over the world.It mainly includes oral bottom approach and oral vestibular approach.Proponents and researchers in this field have been attempting to use this technique for treatment of thyroid cancer and combine it with the robotics assisted surgical system.In the future,the indications and contraindications of trans-oral laporascopic thyroidectomy need to be further studied and evaluated.Complications and surgical procedures still have many issues need to be solved.

Objective To investigate whether SIS3, a specific inhibitor of Smad3 phosphorylation, can reverse the stemness of multidrug?resistant ( MDR ) hepatocellular carcinoma cells. Methods MDR HCC Huh7. 5. 1/ADM cell lines were developed by exposing parental cells to stepwise increasing concentrations of ADM. CCK?8 assay was used to determine the cellular sensitivity of various anticancer drugs. Flow cytometry ( FCM) was used to analyze the expression level of cancer stem cell marker CD133. Clone formation assay and mouse subcutaneous xenograft tumors were used to investigate the tumorigenicity in vitro and in vivo. Western blotting ( WB) was used to analyze the changes of expressions of CD133, Smad3, Bcl?2, Bax and p?Smad3 in different conditions. Results ADM treatment of HCC cells in vitro resulted in a development of subline, Huh7. 5. 1/ADM cells, with CSC phenotypes: stable MDR phenotype ( besides ADMc Huh7.5.1/ADM cells were also more resistant to some other anticancer drugs including VCR, MMC and CTX ) (IC50:0.215±0.018 vs. 0.123± 0.004, 0.145±0.009 vs. 0.014±0.002, 1.021± 0.119 vs. 0.071± 0.006, 27.007±1.606 vs. 1.919±0.032)(unit: μg/ml)(P<0.05). Huh7.5.1/ADM cells enriched the cancer stem?like cell fraction (CD133?positive subpopulation) (76.06±2.948% vs. 25.38±4.349%)(P<0.05) , had stronger tumorigenicity in vivo and colony formation ability, and activated the Smad3 activity. Inhibition of Smad3 activity by SIS3 decreased stemness of the Huh7. 5. 1/ADM cells: CD133?positive subpopulation (48.49±2.304% vs. 76.06±2.948%)(P<0.05); ADM IC50: (0.112±0.019 vs. 0.215± 0.018), VCR IC50(0.065±0.013 vs. 0.145±0.009), MMC IC50(0.749±0.121 vs. 1.021±0.119), CTX IC50 (10.576±1.248 vs. 27.007±1.606)(unit:μg/ml)(P<0.05), and decreased tumorigenicity and colony formation ability. Conclusion SIS3 as a specific inhibitor of Smad3 signal is involved in the stemness of
multidrug resistant hepatocellular carcinoma cells.

Objective To investigate whether SIS3, a specific inhibitor of Smad3 phosphorylation, can reverse the stemness of multidrug?resistant ( MDR ) hepatocellular carcinoma cells. Methods MDR HCC Huh7. 5. 1/ADM cell lines were developed by exposing parental cells to stepwise increasing concentrations of ADM. CCK?8 assay was used to determine the cellular sensitivity of various anticancer drugs. Flow cytometry ( FCM) was used to analyze the expression level of cancer stem cell marker CD133. Clone formation assay and mouse subcutaneous xenograft tumors were used to investigate the tumorigenicity in vitro and in vivo. Western blotting ( WB) was used to analyze the changes of expressions of CD133, Smad3, Bcl?2, Bax and p?Smad3 in different conditions. Results ADM treatment of HCC cells in vitro resulted in a development of subline, Huh7. 5. 1/ADM cells, with CSC phenotypes: stable MDR phenotype ( besides ADMc Huh7.5.1/ADM cells were also more resistant to some other anticancer drugs including VCR, MMC and CTX ) (IC50:0.215±0.018 vs. 0.123± 0.004, 0.145±0.009 vs. 0.014±0.002, 1.021± 0.119 vs. 0.071± 0.006, 27.007±1.606 vs. 1.919±0.032)(unit: μg/ml)(P<0.05). Huh7.5.1/ADM cells enriched the cancer stem?like cell fraction (CD133?positive subpopulation) (76.06±2.948% vs. 25.38±4.349%)(P<0.05) , had stronger tumorigenicity in vivo and colony formation ability, and activated the Smad3 activity. Inhibition of Smad3 activity by SIS3 decreased stemness of the Huh7. 5. 1/ADM cells: CD133?positive subpopulation (48.49±2.304% vs. 76.06±2.948%)(P<0.05); ADM IC50: (0.112±0.019 vs. 0.215± 0.018), VCR IC50(0.065±0.013 vs. 0.145±0.009), MMC IC50(0.749±0.121 vs. 1.021±0.119), CTX IC50 (10.576±1.248 vs. 27.007±1.606)(unit:μg/ml)(P<0.05), and decreased tumorigenicity and colony formation ability. Conclusion SIS3 as a specific inhibitor of Smad3 signal is involved in the stemness of
multidrug resistant hepatocellular carcinoma cells.

Objective:To summarize the clinical experience in transoral endoscopic thyroidectomy via sublingual and vestibular approach (TOETSLVA).Methods:We retrospectively reviewed the medical record of patients who underwent TOETSLVA in our department from November 2011 to May 2020, including 3 males and 95 females, aged from 18 to 57 years old. Initial 81 cases were categorized in "Period A (November 2011-November 2015)" and subsequent 17 cases in "Period B (August 2019-May 2020)" . Data about demographics, operation time and complications were collected. SPSS 22.0 software was used for statistical analysis.Results:In Period A, the average age of patients was (34.2±9.4) years old; the mean tumor diameter was (2.33±0.80) cm; postoperative pathology showed benign nodules in 76 cases and malignant carcinoma in 5 cases; there were 65 cases of unilateral subtotal thyroid lobectomy, 6 cases of isthmus lobectomy, and 5 cases of bilateral subtotal thyroid lobectomy, with the mean operation time of (132.70±47.22) min; in 5 cases of unilateral thyroid lobectomy with central lymph node dissection, the mean operation time was (185.4±31.40) min; postoperative neck infections occurred in 6 cases; temporary vocal cord paralysis occurred in 1 case, which it recovered within two months; and CO 2 gas embolism occurred in 2 cases. In Period B, the average age of patients was (35.1±8.5) years old; mean tumor diameter was (1.32±0.67) cm; postoperative pathology indicated malignant nodules in 15 cases and benign nodules in 2 cases; in 2 cases of unilateral thyroid lobectomy, the mean operation time was (153.5±34.64) min; in 15 cases of unilateral thyroid lobectomy with central lymph node dissection, the mean operation time was (123.73±14.26) min; and none of patients developed postoperative neck infections or CO 2 gas embolism. All patients had different degree of cutaneous numbness in the submandibular region after surgery, which recovered within 1-2 weeks. There were no complications such as postoperative secondary hemorrhage, permanent vocal cord paralysis, hypoparathyroidism in both the periods. The median follow-up time was 86 months (57-105 months) in Peroid A and 5 months (3-12 months) in Peroid B. During the follow-up periods, there were no obvious abnormalities in swallowing, chewing, oral sensory function and neck activity, and also no tumor recurrence or metastasis. Conclusions:TOETSLVA is a safe and feasible surgery method, with a good cosmetic result. This approach will not lead to a postoperative cutaneous numbness of the submandibular region for a long time.