Objective To evaluate the pattern of lateral cervical metastases and to investigate the risk factors for lateral cervical lymph node metastases in paoiuary thyroid carcinoma patients with clinical negative lateral neck lymph node.Methods 73 patients with paoiuary thyroid carcinoma who underwent prophylactic lateral neck dissections(level Ⅱ-Ⅵ or level Ⅱ-ⅣandⅥ) were reviewed retrospectively on their medical records paoiuary thyroid carcinoma.None of patients in this study had a clinically positive lymph node.Neck dissection specimens were obtained for histological analysis for node metastasis with respect to the individual neck levels.Results Occult metastases in lateral neck were observed in 12(16.4 ％)patients.9.6 ％,0,13.6 ％,9.6 ％,0,4.8 ％ and 42.4 ％ patients had histologically positive lymph nodes in levels Ⅱa,Ⅱb,Ⅲ,Ⅳ,Va,Vband Ⅵ respectively.In multivariate analysis,lymphatic metastases in level Ⅵ was associated with lateral neck metastasis(OR=7.3,P=0.020)in cN0 patients with paoiuary thyroid carcinoma.Conclusion Levels Ⅲ,Ⅱa and Ⅳwere the most common stages showing occult lymph node metastases.Prophylactic lateral neck dissections may be omitted in the treatment of cN0 PTC patients ff level Ⅵ lymphatic metastases are not found on histological exam.

Objective To evaluate if Ⅵ region lymph nodes metastasis status can be a reliable indicator in prediction of lateral lymph nodes metastasis in papillary thyroid carcinoma (PTC) with negative cervical lymph nodes (cN0).Methods Retrospectively reviewed the medical records from January 2003 to October 2011 of 73 patients with PTC who underwent prophylactic lateral neck dissection (Ⅱ-Ⅴ region or Ⅱ-Ⅳ region).The relationship between cervical lymph nodes metastasis and lateral lymph nodes metastasis was assessed.Results The rate of lateral lymph nodes metastasis was 16.4％(12/73).The rate of Ⅵ region lymph nodes metastasis was 42.5％(31/73).Multivariate analysis showed that Ⅵ region lymph nodes metastasis was the risk factor of lateral lymph nodes metastasis in cN0 patients with PTC(OR =7.3,P=0.020).Conclusion Ⅵ region lymph nodes metastasis status can be a reliable indicator of lateral lymph nodes metastasis in cN0 patients with PTC.

Objective To establish a method for the content determination of the free anthraquinones,garlic acid,berberine hydrochloride and palmatine hydrochloride in Shuangbai San,and to provide a reference for the quality control and chemical analysis of Shuangbai San.Methods HPLC with Eclipse XDB C18 column was used for the determination of the free anthraquinones.The chromatographic conditions were as follows:methanol-0.1 %phosphoric acid as a mobile phase in gradient mode and detection wavelength at 254 nm,flow rate at 1 mL?min-1,and column temperature at 30 ℃.The chromatographic conditions for the determination of gallic acid were as follows:Nucleodur C18 Gravity column,methanol-0.1 %phosphoric acid solution(2 ∶98) as mobone phase,detection wavelength at 273 nm,flow rate at 1 mL?min-1,and column temperature of 40 ℃.The chromatographic conditions for the determination of berbertine hydrochloride and palmatine hydrochloride were as follows.Nucleodur C18 Gravity,acetonitrile-0.1 %phosphoric acid(every 100 mL solution containing sodium dodecyl sulfonate 0.1 g)(39 ∶61) as mobile phase,detection wavelength at 345 nm,flow rate at 1 mL?min-1,and column temperature being 40 ℃.Results The calibration curves were linear(r≥0.999 7),and the average recoveries were all between 95 %～105 %.The total content of free anthraquinones was 5.1172～5.4933 mg?g-1,the content of gallic acid was 1.3376～2.0673 mg?g-1,and that of berbertine hydrochloride and palmatine hydrochloride were 1.2812～1.6855 mg?g-1.Conclusion This method is reliable and simple,which can provide a reference for the quality control and chemical analysis of Shuangbai San.

Objective To study the process conditions of purifying the total flavonoids from Cacumen Platycladi by AB-8 resin. Methods Spectrophotometric method was used to detect the total flavonoids,and HPLC was used to determine quercitrin and analyze the characteristic peaks of Fingerprint. Results The purification effect was satisfactory when the concentration of original solution of the extract of Cacumen Platycladi was 0.20 g?mL-1,the loading amount was 0.375 g of Cacumen Platycladi per 1 mL of wet AB-8 resin,the adsorption velocity was 1 mL?min-1,the eluant was 70 %alcohol being 4 times as much as the resin volume,and the elution velocity was 2 mL?min-1. AB-8 resin could be used for 3 times repeatedly after being reproduced by 95 %of ethanol and 1 moL?L-1 of natrium hydroxydatum (NaOH). The remaining rate of the total flavonoids and quercitrin was over 70 %and 95 %respectively,and the remaining rate of peaks 1～3 was over 90 %. After being purified by the B-8 resin,the contents of the total flavonoids and quercitrin were raised 2.48 times and 3.29 times more than those before purification respectively. Conclusion AB-8 resin is fit for separating and purifying the total flavonoids from Cacumen Platycladi.

Objective To report the clinical results and the advantages/disadvantages of anterolateral thigh flap (ALT) and forearm flap (FAF) in reconstruction of head and neck defect after cancer ablation. Methods 20 FAFs and 12 ALTs were performed to repair the head and neck tumor ablation defects. Of the 20 FAFs, 7 were used for repair of the through and through buccal defects, 4 for circumferential bypopharyngeal defects, 2 for plate defects, 1 for parotid area skin defect, 4 for floor of the mouth defects, and 2 for defect, of the base of the tongue, while of the 12 ALTs, 3 were used for repair of the defects of the base of the tongue, 4 for plate defects, and 5 for the floor of the mouth and/or lower gum defects. Survival of the flaps, function of the recipient site, and impact to the donor site were compared between these two groups to analyze the advantages/disadvantsges and key technique details of these two flaps. Results 19 FAFs totally survived. Vascular crisis occurred in 2 cases of FAF, of which 1 flap survived after conservative treatment, while the other 1 developed partial necrosis. All the 12 ALTs survived, without vascular crisis. 2 of the 14 planed ALTs were abandoned and replaced by FAFs, of which 1 because of absence of the perforating branch and the other 1 because of injury of the perforating branch. Secondary defects of the ALTs could be closed primarily, while secondary defects of the FAFs should be closed with skin grafts. Conlusion Both ALT and FAF can be performed with high survival rate. Each has its own advantages. Selection of the donor site deponds on situation of the defect and purpose of the reconstruction.

ObjectiveTo compare the exposure, identification of parathyroid and postoperative complications between total thyroidectomy (TT) and subtotal/near total thyroidectomy (S/NT) for bilateral multiple thyroid nodules. MethodsA total of 278 cases were performed TT and S/NT randomly from Dec. 2006 to Dec.2009. The histology, identification of parathyroid and recurrent laryngeal nerves (RLN), and incidence of complications were compared between the 2 surgical procedures. The data were processed with t test or x2 test.Results227 cases were estimated to be benign preoperatively, among whom 28 cases ( 12.3％ ) were diagnosed as focal cancer by postoperative pathology. The identification rate of parathyroid was 96.5％ in TT group and 60.4％ in S/NT group (P＜0.05). The mean postoperative serum calcium level was 2.057 +0.016 mmol/L in TT group and 2. 15 + 0.019 mmol/L in S/NT group (P ＜ 0.05 ). The incidence rate of transient hypoparathyroidism (HPT) was 16.9％ in TT group and 5.7％ in S/NT group (P＜0.05). There was no statistical difference between the 2 groups in terms of the incidence rate of permanent HPT and transient recurrent laryngeal nerves (RLN) palsy ( P ＞ 0.05 ). The incidence rate of permanent HPT was higher in reoperation cases ( 11.1％ ) than in primary surgery cases (0.0％) in TT group ( P ＜0.05 ). ConclusionBased on the accurate technique under microscope field, TT is a safe surgical procedure for primary surgery with bilateral multiple thyroid nodules.

Objective To investigate the characteristics of the bone marrow mesenchymal stem cell(MSC)in children with aplastic anemia(AA)in vitro,and the expressions of tumor necrosis factor -α-induced protein -8 -like 2(TIPE2)in the bone marrow,and the correlation between the level of TIPE2 mRNA with γ-interferon(IFN -γ)and IL -6 in AA patients.Methods Bone marrow samples were collected from 1 8 children with AA(AA group)and 8 children with bone injury (control group)who were hospitalized in Jinan Children′s Hospital from January 201 2 to June 201 5.MSC were isolated and cultured.The morphology of MSC was observed and immune phenotype was detected.The TIPE2 mRNA was detected by using real -time fluorescence quantitative PCR,and the levels of IFN -γand IL -6 were detected by using enzyme linked immunosorbent assay.Results Different sizes had been presented in the primi-tive MSC of AA patients,but the third passage MSC until 80% confluence had manifested the uniform convergence with long spindle and swirl distribution.In the sixth passage,cells showed degenerative change.The primitive and first pa-ssage MSC in patients with AA was longer than that in the controls.CD73 ,CD1 05 ,CD44 and CD90 were expressed in MSC,while CD34 ,CD45 ,CD271 expressed rarely.The level of TIPE2 mRNA in AA patients (5.29 ±1 .56)was obviously lower than that of the control group(8.68 ±2.00),and the difference was significant(t =-4.48,P <0.01 ).The con-centration of IFN -γ[(5.48 ±1 .97)ng/L]and IL -6[(5.43 ±1 .92)ng/L]in AA patients were higher than those of the control group[(3.40 ±1 .24)ng/L,(3.79 ±0.92)ng/L],and the differences were significant (t =2.70, 2.26,all P <0.05).The level of TIPE2 mRNA in AA patients was negatively related with IFN -γand IL -6(r =-0.838,-0.658,all P <0.05),but there was no significant correlation between them in the control group (all P >0.05).Conclusions The proliferation of MSC is significantly reduced in patients with AA.TIPE2,as an important role to stabilize the immune system,plays an important role in the occurrence of AA by its low expression and up -regula-ting the expression of inflammatory factors.

The tumors of central nervous system refer to a group of benign and malignant diseases originating from tissues or structures within the central nervous system. Common tumors of central nervous system are sporadic, but a few have familial onset. Compared with sporadic brain tumors, the clinical symptoms, diagnostic ideas and follow-up review plans of familial brain tumors are more complicated. The multidisciplinary diagnosis and treatment (MDT) mode usually refers to a treatment mode in which a case involving multiple organs and systems is discussed, and the best treatment plan is formulated for the patient based on the comprehensive opinions of various disciplines. Because familial brain tumors often involve multiple organs, multiple disciplines and multiple systems, and their low incidence leads to less clinical experience for neurosurgeons, the MDT model is more conducive to efficient diagnosis, treatment and management of familial brain tumors. This review elaborates on the neurosurgeon-led MDT model, and introduces the latest research on the epidemiology, genetic characteristics, clinical manifestations, diagnostic ideas and multidisciplinary management of familial brain tumors.

Objective:To detect the infection and subtype status of human papilloma virus (HPV) for patients with head and neck squamous cell carcinoma (HNSCC) treated in a single center in Chaoshan area of Guangdong Province.Methods:The primary lesion samples from 167 HNSCC patients in Cancer Hospital of Shantou University Medical College between December 2014 and December 2016 were collected. The expression of p16 protein in tumor tissues was detected by using immunohistochemistry (IHC), and the positive rate of tumor cell p16 protein≥ 76% was used as a diagnostic standard to judge HPV in HNSCC; the relationship between p16 protein and the clinicopathological factors was analyzed. The status of HPV 16/18 DNA in tumor tissues was tested by using in situ hybridization(ISH). RNA scope was used to detect the RNA expression of 18 kinds of common high-risk HPV subtype (HPV HR 18), and the positive status of HPV HR 18 in tumor tissues with the positive cell proportion ≥ 50% of p16 protein was analyzed.Results:The strong expression rate of p16 protein was 7.2% (12/167). The strong expression rate of p16 protein in the younger group (< 50 years old) was higher than that in the older group (≥ 50 years old) [17.2% (5/29) vs. 5.1% (7/138), χ 2=5.321, P=0.021]. The strong expression rate of p16 protein in the oropharyngeal carcinoma group was higher than that in the non-oropharyngeal carcinoma group [29.4% (5/17) vs. 4.7% (7/150), χ 2=14.019, P < 0.01]. The strong expression rate of p16 protein in the gender, smoking and alcohol consumption, tumor staging and stratification among different patients was not statistically different (all P > 0.05). HPV 16/18 DNA was not found in all HNSCC primary lesions by using ISH, which showed the same result after repeated examination. RNAscope method showed that 3 cases (15.8%) out of the 19 patients with p16 protein positive rate≥50% were HPV HR 18 RNA positive. Conclusions:The positive rate of HPV for HNSCC patients in Chaoshan area is low, while the patients with oropharyngeal carcinoma have the highest rate and tend to be younger. The main carcinogenic viruses of HPV for HNSCC patients in Chaoshan area are other subtypes of HPV including HPV HR 18 rather than HPV 16/18.

Objective To conduct a network meta-analysis on the effectiveness of first-line immunotherapy on patients with brain metastases from advanced non-small cell lung cancer(NSCLC).Methods Two investigators conducted a computerized search of Pubmed,Embase,Cochrane,and other databases to screen the literature,extract the information,and assess the risk of bias of the included studies.The included clinical trials were statistically analyzed using R(4.1.3)software.For the study outcome indicators OS and PFS,the risk ratios(HRs),and the 95%confidence intervals(CIs)were extracted from the included studies and logarithmically transformed into effect analysis statistics.Results Six randomized controlled trials were finally included,including 327 patients with non-excludable NSCLC brain metastases.Network meta-analysis suggested that PD-1 inhibitor+CTLA-4 was more advantageous than the conventional chemotherapy for enhancing patients'OS(HR:0.13,95%CI:0.03-0.71),followed by PD-L1 inhibitor(HR:0.17,95%CI:0.04-0.74)and PD-1 inhibitor+chemotherapy(HR:0.36,95%CI:0.2-0.63).PD-1 inhibitor+CTLA-4 was also more advantageous(HR:0.37,95%CI:0.15-0.93)than the conventional chemotherapy for boosting patients'PFS,followed by PD-L1 inhibitor+chemotherapy(HR:0.44,95%CI:0.29-0.66)and PD-1 inhibitor(HR:0.48,95%CI:0.27-0.86).Conclusion Immune checkpoint inhibitor therapy improves the survival of patients with brain metastases from advanced NSCLC.In particular,the combination of PD-1 inhibitor and CTLA-4 inhibitor show excellent survival benefit.