OBJECTIVE:To study the effects of mifepristone on related indexes of patients with myomectomy. METHODS:The information of 100 patients with uterine fibroids were analyzed retrospectively,and they were divided into observation group and control group according to therapy method,with 50 cases in each group. Control group only received myomectomy. Observa-tion group was given Mifepristone tablets 10 mg orally,qd,for consecutive 3 months,and then received myomectomy within 2 d after drug withdrawal;they were given Mifepristone tablets 10 mg/d orally after surgery,for consecutive 3 months. The 2 groups were followed up for 6 months. The maximual volume of uterine fibroids and the volume of uterus were compared between 2 groups as well as related operation indicator,levels of serun reproductive hormones,sex hormones of uterine myoma tissure and re-lated growth factors of uterus myomas. The recurrence and occurrence of ADR was recorded during treatment. RESULTS:Before surgery,the maximual volume of uterine fibroids and the volume of uterus in observation group were significantly lower than control group,with statistical significance(P<0.05). The operation time,vaginal bleeding time and hospital stay of observation group were significantly shorter than those of control group,the intraoperative blood loss and the recurrence rate were significantly lower than those of control group,with statistical significance (P<0.05). Six months after surgery,ER,PR,EGFR,TGF-β1R and IGF-1R of uterus myomas in observation group were significantly lower than those of control group,with statistical significance (P<0.05). There was no statistical significance in the levels of FSH、E2 and P level of uterus myomas between 2 groups in first di-agnosis and 6 months after surgery(P>0.05). No obvious ADR was found in 2 groups during treatment. CONCLUSIONS:Mife-pristone helps to reduce operative time,intraoperative blood loss,vaginal bleeding time and hospital stay of patients with myomecto-my,and may be related to the regulation of ER and PR levels and related growth factor receptors.

Objective To investigate the clinical features and prognosis of recurrent gastric cancer. Methods The clinical data of 147 patients with recurrent gastric cancer was reviewed. Risk factors correlated with tumor recurrence and recurrent intervals were studied by logistic regression analysis. Survival analyses and comparisons were performed using Kaplan-Meier plots, the log rank test and the Cox proportional hazards model. Results Patients were divided into an early recurrence group consisting of 86 patients (recurred within one year after surgery) and a late recurrence group of 61 patients (recurred one year or more after surgery). There were significant difference in size of primary tumor, Borrmann stage, type of gastrectomy, T stage, N stage, TNM stage between the two groups(P ＜0.05). Multivariate analysis showed that the TNM stage and N stage independently influenced the recurrent time ( P ＜ 0. 05 ). In univariate survival analysis, post-gastrectomy chemotherapy(P ＜0. 05) , T stage (P ＜0. 05) , N stage(P ＜0.01) , TNM stage ( P ＜ 0. 01) , recurrence-free interval (P ＜ 0. 01) and reoperation (P ＜ 0.01) were significantly correlated with the prognosis. In multivariable analysis, TNM stage(P ＜0. 01) , recurrence-free interval ( P ＜ 0. 05 ) and reoperation ( P ＜ 0. 05 ) were independent factors predicting recurrence. Conclusions The TNM stage and N stage were the important factors predicting the time of recurrence after curative resection for gastric cancer. Patients with recurrent gastric cancer have poor prognosis and reoperation was associated with an improved survival in patients with recurrent gastric cancer.

Objective:To evaluate the role of Tg in diagnosis of lateral cervical lymph node recurrence in papillary thyoid cancer(PTC)after radioactive iodine(RAI) therapy.Methods:From Jan 2012 to Aug 2018, 22 PTC patients who received RAI therapy after operation were reoperated for lateral cervical lymph node recurrence. The clinical data was retrospectively analyzed.Results:The median recurrence time was 30.5 (5-86) months. All 22 patients received RAI therapy after the first operation, and the median dose of RAI was 250mCi(100-700 mCi) and the episode of RAI therapy ranged from 1 to 4. All 22 PTC patients underwent neck reoperation, among which 20 cases were identified to have lymph node metastasis. The median number of lymph nodes dissected was 31 (8-83) and median number of metastatic lymph nodes was 4 (1-19) . The diagnostic accuracy of ultrasonography in detecting lymph node metastasis was 90.9%. Before reoperation, the median Tg was 1.305 (0.10-99.51) μg/L, with the cutoff value of Tg being 0.2 μg/L, and its sensitivity and specificity were 80.0% and 100%, respectively. The median stimulated Tg was 5.89 (0.14-255.80) μg/L in the 10 patients, with the cutoff value of stimulated Tg of 2 μg/L, and its sensitivity and specificity were 88.9% and 100%, respectively.Conclusions:The serum Tg level is helpful for monitoring the recurence of PTC, but recurrence cannot be completely ruled out for those with low Tg.

Objective To investigate the treatment and prognosis of metastatic ovarian carcinoma from gastrointestinal tract. Methods The clinical data of 110 patients with metastatic ovarian carcinoma were reviewed. Results The median age of 110 patients was 45 years old.Metastatic ovarian carcinomas were from stomach (74.5%),and colon and rectum (25.5%).The median overall survival time of 110 patients was 16.3 months,and the median progression-free survival time of 110 patients was 8.2 months.Survival rates of 1-,3-and 5-year were 68.4% 、15.4% and 2.5%,respectively.In univariate survival analysis,different origins(P ＜ 0.01),extent of recurrent disease (P ＜ 0.01),cytoreductive surgery (P ＜0.01),intraperitoneal chemotherapy (P ＜ 0.05) and pathologic type of metastatic ovarian carcinoma (P ＜0.05) were correlated with the prognosis.Age,menstrual history,ascites,and chemotherapy have less effect on prognosis (P ＞ 0.05).In multivariable analysis,different origins (P ＜ 0.01),extent of recurrent disease(P ＜ 0.05) and cytoreductive surgery (P ＜ 0.01) were confirmed to be independent factor. Conclusion Patients with metastatic ovarian carcinomas have poor prognosis.Optimal cytoreduction significantly prolongs overall survival in patients with metastatic ovarian carcinoma from gastrointestinal tract.

Objective:To investigate the BRAF(V600E)gene mutation of pediatric papillary thyroid carcinoma (PTC) and refine their clinicopathological correlates. Methods:Tumor tissue samples of pediatric PTCs (≤18 years old) were collected from tumor tissue bank of Tianjin Medical University Cancer Institute and Hospital from January 2012 to December 2016.The medical records of 22 patients with pediatric PTC were reviewed retrospectively.The frequencies of BRAF(V600E) mutation were evaluated and the correlation between BRAF(V600E) mutation and clinical characteristics were analyzed. Results:BRAF(V600E) mutations were present in 45.5% of cases (10 cases). BRAF(V600E) mutation in pediatric PTC was obviously lower than that in adults PTC(77.7%) ( χ2=11.250, P=0.001). BRAF(V600E) mutation in>12-year-old group (66.7%) was remarkably higher than that in ≤12-year-old group (20.0%) ( P<0.05). BRAF(V600E) mutation in female (69.2%) was greatly higher than that in male (11.1%) ( P<0.05). There was no significant correlation with BRAF(V600E) mutation and multiple tumor, tumor size, highly invasive subtype, extrathyroidal extension, lymph node metastasis and radiological history of infants (all P>0.05). The median follow-up time was 45 months.No patients died and BRAF(V600E) mutation was not associated with the increase of recurrence rate ( P>0.05). Conclusions:BRAF(V600E)gene mutation in pediatric PTC is lower than that in adults. BRAF(V600E) mutation does not portend a more aggressive clinical biological behavior in pediatric PTC.

Objective:To discuss the causes and effective measures of prevention and treatment of chylous fistula after central lymph node dissection (CLND) of thyroid cancer. Methods:A total of 6 127 patients who underwent CLND of thyroid cancer in the Tianjin Medical University Cancer Institute and Hospital between July 2013 and June 2015 were analyzed;of which, 14 patients acquired the complication of postoperative chylous fistula. The following conservative treatments were initially performed:systemic therapy, local pressure bandaging, normal pressure drainage, 50%glucose injection, or pingyangmycin injection through a drainage tube. Surgical op-eration was then conducted when the efficacy of the treatment was poor. Results:After the conservative treatment of the 14 patients, the drainage volume gradually decreased in 12 patients, and surgery was performed on the remaining two patients. Conclusion:The CLND of thyroid cancer must be carefully conducted to prevent postoperative chylous fistula. An active conservative treatment must be the first option when chylous fistula occurs. Surgery must only be performed if the treatment is invalid.

BACKGROUNDAbnormal neuronal differentiation plays an important role in central nervous system (CNS) development abnormalities such as Down syndrome (DS), a disorder that results directly from overexpression of genes in trisomic cells. Receptor-interacting protein 140 (RIP140) is significantly upregulated in DS brains, suggesting its involvement in DS CNS development abnormalities. However, the role of RIP140 in neuronal differentiation is still not clear. The current study aimed to investigate the effect of RIP140 overexpression on the differentiation of neuro-2a (N2a) neuroblastoma cells, in vitro.

METHODSStably RIP140-overexpressing N2a (N2a-RIP140) cells were used as a neurodevelopmental model, and were constructed by lipofection and overexpression validated by real-time polymerase chain reaction and Western blot. Retinoic acid (RA) was used to stimulate N2a differentiation. Combining the expression of Tuj1 at the mRNA and protein levels, the percentage of cells baring neurites, and the number of neurites per cell body was semi-quantified to determine the effect of RIP140 on differentiation of N2a cells. Furthermore, western blot and the ERK1/2 inhibitor U0126 were used to identify the specific signaling pathway by which RIP140 induces differentiation of N2a cells. Statistical significance of the differences between groups was determined by one-way analysis of variance followed by the Dunnett test.

RESULTSCompared to untransfected N2a cells RIPl40 expression in N2a-RIP140 cells was remarkably upregulated at both the mRNA and protein levels. N2a-RIP140 cells had a significantly increased percentage of cells baring neurites, and numbers of neurites per cell, as compared to N2a cells, in the absence and presence of RA (P < 0.05). In addition, Tuj1, a neuronal biomarker, was strongly upregulated in N2a-RIP140 cells (P < 0.05) and phosphorylated ERK1/2 (p-ERK1/2) levels in N2a-RIP140 cells were dramatically increased, while differentiation was inhibited by the ERK1/2-specific inhibitor U0126.

CONCLUSIONSRIP140 overexpression promotes N2a cell neuronal differentiation by activating the ERK1/2 pathway.

Blotting, Western ; Cell Differentiation ; physiology ; Cell Line ; Humans ; Mitogen-Activated Protein Kinase 1 ; metabolism ; Mitogen-Activated Protein Kinase 3 ; metabolism ; Neurons ; cytology ; metabolism ; Nuclear Receptor Co-Repressor 1 ; metabolism ; Signal Transduction ; physiology

Clinical data from 11 previously diagnosed and treated patients with hyperthyroidism(Graves′ disease) complicated by liver failure were collected. Among them, 4 cases were drug-induced liver injury leading to liver failure, 1 case had a history of schistosomal liver cirrhosis combined with hyperthyroidism, and 6 cases had hyperthyroidism-induced liver injury(HILI) leading to liver failure. During hospitalization, all patients received supportive therapy and symptomatic treatment with β-blockers. Nine patients were treated with glucocorticoids and artificial liver support therapy. Among the 11 patients, 2 died, 8 patients achieved normal thyroid and liver function within 1-12 months after treatment, and 1 patient with liver cirrhosis had stable liver function in the later stage. After improvement in liver function, 7 patients received isotope therapy, 1 patient underwent total thyroidectomy, and 1 patient received medication. These results indicate that the clinical characteristics differ for drug-induced liver injury and HILI-related liver failure. Early initiation of artificial liver support therapy, in addition to β-blockers and glucocorticoids, is important in alleviating thyroid toxicity and liver damage, thus creating an opportunity for subsequent radioactive iodine or surgical treatment.

Objective:To investigate the difference of clinicopathological characteristics between mixed medullary and papillary carcinoma of thyroid and medullary carcinoma coexistent with papillary carcinoma.Method:The clinicopathological data of 3 MMPTC cases and 9 MTC-PTC cases treated at Tianjin Medical University Cancer Institute & Hospital during the past ten years were retrospectively analyzed. The differences in clinical characteristics, pathological characteristics, immunohistochemistry results, treatment and prognosis of the two groups were compared.Results:In the MMPTC group, the median onset-age was 59 years old. 3 patients were all medullary carcinoma colliding with micropapillary carcinoma. The immunohistochemistry results showed that medullary carcinoma and papillary carcinoma showed their distinctive immunohistochemical characteristics. The lymph node metastasis rate was 66.7% (2/3). In MTC-PTC group, the median onset-age was 55; 8 out of 9 patients had an increased preoperative calcitonin level. Medullary carcinoma and papillary carcinoma showed their distinctive immunohistochemical characteristics. Four out of the 9 cases had lymph node metastasis.Conclusion:Compared with MTC-PTC, MMPTC is more common in middle-aged and elder patients, with higher lymph node metastasis rate. The pathogenesis of MTC-PTC is similar to papillary thyroid carcinoma, and the treatment should be individualized. The prognosis of these two groups of patients is fair.

Objective:To examine the expression of MHC class Ⅱ in medullary thyroid carcinoma(MTC) and analyze its clinical significance.Methods:98 MTC patients treated at Tumor Hospital of Tianjin Medical University from Jan 2010 to Dec 2018 were included for the study. Immunohistochemistry was used to detect the expression of MHC class Ⅱ molecule .Results:The high expression of MHC class Ⅱ was not correlated with age (χ 2=0.900, P=0.410), multifocal (χ 2=0.295, P=0.672), bilateral (χ 2=2.957, P=0.127), T stage (χ 2=0.554, P=0.457), but correlated with gender (χ 2=5.227, P=0.025), preoperative calcitonin level (χ 2=6.663, P=0.019), lymph node metastasis (χ 2=21.651, P<0.001) and AJCC stage (χ 2=19.522, P<0.001). Overall survival rate of patients with high expression of MHC class Ⅱ was 97.4%.It was significantly higher than that of patients with low expression 66.1% ( P=0.016 3). COX regression model showed that age >55 years old ( HR=4.129, P=0.009), T stage ( HR=3.265, P=0.024) were independent risk factors for the prognosis of MTC patients. High expression of MHC class Ⅱ molecules ( HR=0.103, P=0.030) was a protective factor for the prognosis of MTC patients. Conclusion:The MTC patients with high expression of MHC class Ⅱ have a better prognosis.