OBJECTIVE: To investigate the possibility of thyroidectomy/lobectomy without drainage after surgery. METHOD: Eighty-eight consecutive cases with thyroid mass have been underwent operations including: lobectomy group(42 cases), thyroid lobectomy with contralateral partial thyroidectomy group (17 cases) and total thyroidectomy group (29 cases) from 2013. 06 to 2014. 06 in Nanjing Tongren Hospital. FIfteen patients with thyroid operation in other hospital were collected from 2014. 01 to 2014. 06, the recovery of postoperative incision were compared. RESULTS: Eighty-four cases were smoothly discharged from hospital except 4 thyroidectomy cases suffered from a small amount of effusion in surgical cavity. Our postoperative wound recovery were more in line with the principle of cosmetology compared with other hospital operation group. CONCLUSION Drainage following thyroidectomy is not essential, if the thyroid surgery is meticulous in each step of the surgery, and can increase the effect of beauty.
Drainage ; methods ; Humans ; Postoperative Period ; Thyroid Diseases ; Thyroidectomy

Objective To establish the mice model of immunological tolerance,and investigate the significance of haploidentical allogeneic lymphocytes infusion in induction of graft versus host disease and graft versus tumor in mice.Methods Sixty-four BALB/C female mice were randomly divided into 4 groups with 16 mice in each group.Control group:no special treatment was given after inoculation of tumor cells at the 4th day (CT26 colorectal cancer cell lines with mixture of 1 × 107/mL tumor cells suspension was inoculated to the right subcutaneous axillary of mice) ; Chemotherapy group:chemotherapy was applied at the 7th day after inoculation of tumor cells at the 4th day; DLI group:tumor cells were inoculated at the 4th day,and then haploid donor cells were infused at the 13th,15th and 17th day; Chemotherapy + DLI group:tumor cells were inoculated at the 4th day,chemotherapy was applied at the 7th day,and haploid donor cells were infused at the 13th,15th and 17th day.The pretreatment scheme included haploidentical allogeneic lymphocyte + ring ling amide + haploidentical allogeneic lymphocyte,and the chemotherapy regimen included peritoneal infusion of cyclophosphamide at the 3rd day after inoculation of tumor cells in mice.The time from the first day after vaccination to the day of death of mice and the mass of the tumors were detected to calculate the tumor inhibition rate.The clinical indexes of GVHD were observed,and clinical evaluation was made.The numbers of T lymphocytes in peripheral blood were detected by flow cytometry.Three mice were sacrificed in each group at the 15th day to make the tissue specimens,and they were observed under light microscope after HE staining.All data were analyzed using the analysis of variance or LSD-t test.Results The symptoms of GVHD of mice in the chemotherapy + DLI group were milder than those in other groups.The GVHD scores of the control group,chemotherapy group and the chemotherapy + DLI group were 2.3 ±0.6,1.5 ± 1.1,6.7 ±0.9 and 3.4 ±0.5,respectively,with significant difference between the 4 groups (F =148.68,P ＜ 0.05).The tumor masses of the control group,chemotherapy group,DLI group and the chemotherapy + DLI group were (3.40 ± 0.20) g,(0.80 ± 0.10) g,(2.20 ± 0.20) g and (0.50 ± 0.30) g,respectively,with significant difference between the 4 groups (F =149.17,P ＜ 0.05).The tumor inhibition rates of the control group,chemotherapy group,DLI group and the chemotherapy + DLI group were 0,77％ ± 9％,35％ ± 3％,85％ ± 44％.The levels of CD3 + of the control group,chemotherapy group,DLI group and the chemotherapy + DLI group were 52.3％ ± 2.9％,44.8％ ± 3.1％,62.9％ ± 3.5％,65.9％ ± 3.3％,respectively,with significant difference between the 4 groups (F =28.04,P ＜ 0.05).The levels of CD3 + CD4 + of the control group,chemotherapy group,DLI group and the chemotherapy + DLI group were 32.1％ ± 2.6％,27.1％ ± 1.1％,42.6％ ± 1.8％ and 41.7％ ± 2.4％,respectively,with significant difference between the 4 groups (F =40.29,P ＜ 0.05).The levels of CD3 + CD8 + of the control group,chemotherapy group,DLI group and the chemotherapy + DLI group were 22.7％ ± 2.2％,20.7％ ± 1.8％,26.7％ ± 0.8 ％ and 26.1％ ± 0.7％,respectively,with significant difference between the 4 groups (F =10.74,P ＜ 0.05).The levels of CD3 + CD4 + CD25 + of the control group,chemotherapy group,DLI group and the chemotherapy + DLI group were 8.7％ ±0.6％,6.6％ ±0.6％,11.2％ ±0.4％ and 13.3％ ± 0.7％,respectively,with significant difference between the 4 groups (F =82.88,P ＜ 0.05).Necrosis and bleeding of the tumor tissues were observed in all the 4 groups.Necrosis,shrinking of the tumor cells,inflammatory infiltration were observed in the DLI group and the chemotherapy + DLI group.Proliferation of lymphoid follicles was observed in the chemotherapy + DLI group.The survival time of mice in the control group,chemotherapy group,DLI group,chemotherapy + DLI group were (16.8 ± 2.5) days,(26.3 ± 2.9) days,(23.4 ± 2.5) days and (33.7 ± 4.6) days,respectively,with significant difference between the 4 groups (F =46.45,P ＜ 0.05).Conclusions (1) Pretreatment can induce specific immune tolerance in mice.(2) Haploidentical allogeneic lymphocyte infusion and chemotherapy have synergistic effects,joint application of haploidentical allogeneic lymphocyte infusion and chemotherapy can inhibit the proliferation of tumor cells and prolong the survival time of mice.(3) Chemotherapy can reduce the GVHD of haploidentical allogeneic lymphocyte infusion and enhance the GVT.(4) CD3 + CD4 + CD25 + T lymphocytes play important roles in decreasing GVHD.

Objective To research the effect of regulating systemic inflammatory response by using ulinastatin in elderly patients after sevoflurane inhalation of postoperation cognitive function. Methods 60 patients under went elective abdominal surgery, were randomly double-blinded divided into 2 groups. Every group had 30 patients.Group A accepted continuously intravenousiy infusion ulinastatin 2000 units · kg-1 · h-1 , while group B got equivalent continuously intravenous infusion 0.9% sodium chloride injection. The time point of opening eye, extubation, response and the mini-mental state examination(MMSE) score on different time points were observed. Meanwhile, the changes of concentration of hs-CRP, IL-6,IL-10 were measured. Results Compared with two groups,group A has shorter time on response(F =4.399,P = 0.040). Two both groups had decrease of MMSE score 1 hour after surgery compared with preoperation(t =7. 732,11. 916, both P ＜ 0.01), and the score were less than the preoperative value of more than 2 points which showed cognitive decline in patients. But group A's rate of decline in MMSE score was lower than group B(F = 7. 582 ,P =0.012). Both groups had the MMSE score decline 6h after surgery (t = 4. 606,8. 615, both P ＜ 0.05). Group A's score was less than the preoperative value for less than 2 points, group B's score was lower than the preoperative value for more than 2 points, but the difference between the two groups was not significant (P ＞0. 05). Both groups had higher concentrations of hs-CRP、IL-6 、IL-10 at postoperative 1 d ,3d ,7d (all P ＜ 0.01), peaked at postoperative 1 d, and hadn't come back to the preoperative level 7d*after surgery. In group A, the concentrations of hs-CRP, IL-6 increased (postoperative 1 d,3d), but the rate was lower than the group B (F = 14. 885, P = 0.000;F = 4. 405, P = 0. 040; F = 18. 204, P = 0.000; F = 8. 074, P = 0. 006); while the increased rate of concentration of IL-10 was higher than the group B(F=5.197,P=0.026;F= 12.236,P =0.000). Conclusion Ulinastatin could promote the elderly after sevoflurane inhalation rapid recovery of cognitive function, which may be related to the regulation of systemic inflammatory response.

Objective To investigate the effects of sevoflurane pretreatment on renal ischemia-reperfusion (I/R)-induced apoptosis in kidney in rats. Methods Thirty pathogen-free male SD rats weighing 220-260 g were randomized into 3 groups (n=10 each):group control (group C);group I/R and group sevoflurane(group S). Renal I/R was induced by clamping the left renal pedicle for 45 min in I/R and S groups. In group S inhalation of 2.2% sevoflurane in O2 was started at 30 min before operation and maintained throughout the experiment.Venous blood samples were taken at 3 h of reperfusion for determination of serum BUN and Cr concentrations. The animals were then sacrificed and the left kidneys were removed for microscopic examination, detection of apoptosis(by TUNEL)and determination of heme oxygenase-1(HO-1) mRNA and protein expression (by RT-PCR and Western blot).Results Renal I/R significantly increased serum BUN and Cr concentrations, apoptotic index(percentage of apoptotic cells) and the severity of necrosis of renal proximal convoluted tubules (0=normal,4=necrosis of whole segment of proximal convoluted tubules).Sevoflurane inhalation attenuated the I/R-induced changes mentioned above.HO-1 mRNA and protein expression was up-regulated by I/R and HO-1 mRNA expression was further up-regulated by sevoflurane inhalation.Conclusion Sevoflurane pretreatment can protect kidney against I/R injury by attenuating cell apoptosis.Up-regulation of HO-1 mRNA expression may be involved in the mechanism.

Objective: To investigate the principles of diagnosis and treatment of breast cancer during pregnancy. Methods: Clinical data of patients with breast cancer during pregnancy admitted to Obstetrics and Gynecology Hospital of Fudan University between January 2012 to July 2017 were analyzed retrospectively. A total of 17 patients were diagnosed with breast cancer in pregnancy, the median age was 32 years (range from 25 to 45 years old), pathological staging revealed 2 patient with stage 0, 1 with stage Ⅱa, 7 with stage Ⅱb, 1 with stage Ⅲa, 2 with stage Ⅲc, 4 with stage Ⅳ. Results: Thirteen patients received surgical treatment in pregnancy, the gestational age at surgery was (27.7±4.6) weeks; 2 patients with ductal carcinoma in situ received mastectomy, 11 patients with breast cancer underwent modified radical mastectomy. In patients undergoing surgery during pregnancy, no prophylactic contractions were used in 4 patients who had been treated earlier, there were 2 patients with frequent contractions within 24 hours after operation in these patients. Follow-up 9 patients were given oral nifedipine to prevent contractions, no obvious contractions occurred after the operation. Seven patients received chemotherapy during pregnancy; the chemotherapy of 4 cases of triple negative breast cancer was weekly paclitaxel sequential epirubicin and cyclophosphamide, the chemotherapy of the other three patients was docetaxel sequential epirubicin and cyclophosphamide. Fifteen patients underwent cesarean section to terminate pregnancy, 2 patients underwent spontaneous labor. The gestational age of birth was (36.9 ±1.3) weeks. Less than 35 weeks of termination of pregnancy occurred in one patient, the fetus was delivered to the neonatal intensive care unit due to neonatal respiratory distress syndrome, and suffered from congenital dysaudia. The prognosis of the other 16 survived infants was good. The median follow-up time was 10 months (range from 4 to 27) months, in 13 patients of stage 0 to Ⅲc, one patient were diagnosed with bone metastasis at 12 months after surgery, the remaining 12 patients had no disease progression, the progression free survival rate was 12/13, the overall survival rate was 13/13. Among the 4 patients with stage Ⅳ, one died in 7 months after delivery, one had new liver metastasis in 8 months after delivery. The remaining 2 patients were in stable condition. Conclusions Breast cancer in pregnancy can be treated effectively, multidisciplinary cooperation and detailed assessment of maternal-fetal risks and benefits are necessary. Chemotherapy during pregnancy is safe for maternal-fetal, but it needed a large sample of clinical studies and long-term follow-up. The neonatal outcome was associated with gestational age, and therefore premature delivery was avoided as much as possible during treatment.

Objective To systematically evaluate the clinical effect of surgery combined with adjuvant therapy (postoperative chemoradiotherapy or chemotherapy) and single surgery for resectable pancreatic cancers.Methods Literatures were researched using PubMed,Embase,Science Citation Index Expanded,Cochrane Central Register of Controlled Trials and China Biology Medicine disc with the key words including "pancreatic cancer,adjuvant therapy,chemoradiotherapy,radiochemotherapy,chemotherapy,radiotherapy,胰腺癌,辅助治疗,化学治疗and放射治疗”from the time of database building to October 2016.Two reviewers independently screened literatures,extracted data and assessed the risk of bias.All the patients undergoing surgery combined with adjuvant chemoradiotherapy,surgery combined with adjuvant chemotherapy and single surgery were respectively allocated into the first treatment group,second treatment group and control group.The inverse variance was used for mergering hazard ratio (HR) and related statistic data.HR and 95％ confidence interval (CI) were used for assessing the overall survival time and disease-free survival time.The median survival time and 1-,2-,5-year survival rates were evaluated by the relative risk (RR) and 95％CI.The heterogeneity of the studies was analyzed using the I2 test.Results Eleven randomized controlled trials (RCTs) of 9 literatures were retrieved,and the total sample size was 1 482 patients,including 238 patients in the first treatment group,545 in the second treatment group and 699 in the control group.Results of Meta analysis:① overall survival time:there was no significant difference in overall survival time between the first treatment group and control group (HR =0.87,95％ CI:0.56-1.17,P＞ 0.05).There was a significant difference in overall survival time between the second treatment group and control group (HR =0.68,95 ％ CI:0.55-0.80,P＜ 0.05).② Disease-free survival time:there was no significant difference in disease-free survival time between the first treatment group and control group (HR=0.78,95％CI:0.53-1.03,P＞0.05).There was a significant difference in disease-free survival time between the second treatment group and control group (HR=0.56,95％CI:0.45-0.67,P＜0.05).③ Median survival time:there were significant differences in median survival time between the first treatment group and control group (RR=1.82,95％CI:1.35-2.45,P＜0.05) between the second group and control group (RR=1.32,95％CI:1.07-1.62,P＜0.05).④ One-,2-,5-year survival rates:there was no significant difference in 1-,2-,5-year survival rates between the first treatment group and control group (RR=1.24,2.47,1.15,95％ CI:0.72-2.12,0.82-7.41,0.71-1.84,P＞0.05).One-year survival rate in the second treatment group was compared with that in the control group,with no significant difference (RR=1.15,95％CI:0.99-1.34,P＞0.05).There were significant differences in 2-and 5-year survival rates between the second treatment group and control group (RR=1.24,1.73,95％CI:1.01-1.50,1.32-2.27,P＜0.05).Conclusions Compared with single surgery,surgery combined with postoperative chemoradiotherapy cannot significantly improve the overall survival time and disease-free survival time of patients.However,surgery combined with adjuvant chemotherapy can prolong the overall survival time and disease-free survival time of patients.

Objective:To explore the surgical intervention strategy for metastatic cervical lymph nodes surrounding the carotid artery in head and neck squamous cell carcinoma.Methods:A total of 62 patients with advanced head and neck tumors and carotid wrap by disease treated in Department of Otorhinolaryngology and Head and Neck Surgery, the Affiliated BenQ Hospital of Nanjing Medical University between June 2019 and December 2023 were reviewed, of whom 9 patients presented with metastatic squamous cell carcinoma in cervical lymph nodes of unknown primary or with no recurrence of primary lesion and all the 9 patients were males, aged from 48 to 79 years old, with≤level 2 of Eastern Cooperative Oncology Group-Performance Status (ECOG-PS). Radiographically common carotid artery (CCA) and/or internal carotid artery (ICA) were surrounded by≥270° with tumor. All the 9 patients received implantation of covered stent in carotid artery and radical resection of metastatic cervical lymph nodes. The success rate, complications, surgery-related complications, local recurrence rate, quality of life (QOL) and overall survival (OS) were analyzed. The QOL of patients was compared by paired rank sum test, and P<0.05 indicated statistically significant difference. The OS was analyzed by Kaplan-Meier. Results:The success rate of stent implantation was 100%, with no implantation-related complications. R0 resection was performed in 8 cases and R1 resection in 1 case. The QOL of patients after surgery was improved, and the improvements in "pain", "mood" and "anxiety" were statistically significant( Z values were -2.236, -2.460 and -2.200, respectively, and all P values were<0.05). Follow-up was 1-18 months, with a median of 7 months, and 1 case was lost to follow-up. Local recurrence occurred in 3 patients with an incidence of 37.5% (3/8). OS was 59.9% at 12 months after surgery. Conclusion:Implantation of covered stent in carotid artery combined with radical resection is an effective method for the treatment of cervical lymph node metastasis.

Objective To investigate the protection of the parathyroid in the total thyroidectomy to avoid the postoperative permanent hypoparathyroidism.Methods Forty-three consecutive cases underwent total thyroidectomy from June 2013 to June 2014 in Nanjing Tongren Hospital were reviewed.Of them 26 cases with malignant and 17 cases with benign thyroid diseases.Results Intraoperatively,all 4 parathyroid glands were identified in 27 cases,3 parathyroids in 10 cases and 2 parathyroids in 6 cases.Intraoperative parathyroid transplantation was performed in 6 cases,including 5 cases with 1 parathyroid transplantation and 1 case with 2 parathyroid transplantation.With the follow-up of 1-3 months after surgery,10 cases presented with transient hypocalcemia,8 cases with temporary hypoparathyroidism and no case with permanent hypoparathyroidism.Conclusion Accurate identification and conservation in situ or auto-transplantation in total thyroidectomy could be effective for prevention of postoperative permanent hypoparathyroidism.