OBJECTIVE To investigate the expression and clinical significance of epidermal growth factor receptor (EGFR), the mutations of gene EGFR, KRAS and BRAF in sinonasal intestinal-type adenocarcinomas. METHODS We investigated the EGFR protein expression by immunohistochemistry method with antibodies targeting the extracellular domain, the intracellular domain, and the phosphorylated isoform in a series of 11sinonasal intestinal-type adenocarcinomas tissues. EGFR, KRAS, and BRAF mutational status were detected by DNA direct sequencing and Melt curve method.RESULTS The findings were analyzed with respect to clinical data, histological typing, and outcome of the patients. EGFR was expressed in 72.7% tumors with a focal distribution with both extracellular domain and intracellular domain, which showed a significantly correlation. p-EGFR was expressed in 9.1% tumors. 9.1% tumors had the mutation of EGFR gene in exon 19, 9.1% tumors had the mutation in exon 2 and exon 15 of gene KRAS and BRAF respectively. There was no association between these molecular features and the survival period of the patients. CONCLUSION The current study revealed various EGFR expression patterns in sinonasal intestinal-type adenocarcinomas, that indicated the tumor heterogeneity. Sinonasal intestinal-type adenocarcinomas share common alterations of the EGFR pathway as the mutation of EGFR, KRAS and BRAF genes, but with a lower frequency.

[ABSTRACT]OBJECTIVETo explore the efficacy and safety of localization for parathyroid glands with intravenous low dosage of methylene blue in thyroidectomy. METHODSWe retrospectively reviewed the clinical data of 41 patients who suffered from thyroid papillary carcinoma between Aug, 2014 and Jan, 2015 (9 males and 32 females, with a median age of 46 years). Thirty eight patients underwent primary thyroidectomy and 3 patients underwent second operation. A variety of thyroidectomy was performed in all patients, and who also underwent intravenous (3-4) mg/kg methylene blue in operation. RESULTSEighty four parathyroid glands were stained. Among 39 patients who's parathyroid glands were stained, the mean dyeing time was (31.27±9.41) min. Dyeing rates and dyeing time were not significantly different between 3 mg/kg group and 4 mg/kg group (t=0.24 and 0.20, all P>0.05). None of patients had the hypoparathyroidism problem such as peri-oral numbness, tingling, muscle aches and spasms. According to postoperative monitoring of parathyroid hormone, all of patients had no permanent hypofunction of the parathyroid gland. Neurotoxic effects and other serious side effects were not observed in all patients. CONCLUSIONIntravenous low-dose methylene blue in thyroidectomy is a safe, easy, and effective technique that facilitates rapid identification of parathyroid gland.

Objective To acknowledge the quality of life (QOL) in patients after lung transplantation and to explore related factors. Methods A cross- sectional study design and a convenience sampling were performed in this research. Totally 30 patients after lung transplantation were investigated. The questionnaires which used to explore the quality of life were Short Form 36 Health Survey Questionnaires (SF-36) and Revised Airways Questionnaires 20 (AQ20-R). Related state were surveyed by questionnaires consisted of demographic questionnaires, Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS) and Medical Coping Mode Questionnaires (MCMQ). Statistical analysis was performed by SPSS 20.0 software. Correlation analysis and multivariate analysis were performed using Pearson linear correlation analysis and multi-linear regression. Results The scores among the 8 dimensions of SF-36 were(34.48±16.73)-( 71.63±22.83), lower than those of norms(Z=-9.684--2.817, P<0.05 or 0.01). Somatic pain scored the highest (71.63±22.83), while physiological function scored the lowest (34.48±16.73). The mean score of AQ20-R was 7.93±5.21. The major two problems that manifested QOL were: uncomfortable feeling of lung caused by strong scent, smog or perfume, exhausted feeling after having a cold. The mean scores of SAS and SDS were 44.33±9.33,48.05±9.80, higher than those of norms, which were 33.80 ± 5.90, 41.88 ± 10.57 (t=6.1833, 3.4458, P < 0.01). The scores among the 3 dimensions of MCMQ were 8.93 ± 2.08, 16.10 ± 2.28, 3.63 ± 1.33 and the differences were significant in 3 dimensions compared with those norms, which were 19.48±3.81, 14.44±2.97, 8.81±3.17(t=-27.7281, 3.9885,-21.3878, P<0.01). Conclusions In SF-36, role-physical of patients after lung transplantation was the worst dimension, while bodily pain was the best dimension of QOL. The QOL of patients after lung transplantation were almost worse than normal people. The related factors of QOL in patients after lung transplantation maybe:anxiety, depression and medical coping style.

Objective To analyse the mutation of K17 gene in a pedigree with steatocystoma multi-plex. Methods Blood samples were obtained from 3 affected and 3 normal individuals in a family with steatocystoma multiplex, as well as from 50 unrelated healthy individuals. Mutation scanning was carried out by PCR and direct sequencing. Results A heterozygous nucleotide transition (C→T) at position 428 in exon 1 of KI7 gene, which leads to the substitution of CGC (arginine) by TGC (histidine) at codon 94, was detected in the affected individuals, but not in normal family members or the 50 unrelated individuals. Conclusion A missense mutation (428C→T) in KI7 gene has been detected in affected individuals of this family, which seems to be a molecular basis of pathogenesis of steatocystoma multiplex.

Objective To comprehensively analyze of risk factors for the incidence of pulmonary embolism,and provide the basis for the prevention of clinical decision-making.Methods Using Meta-analysis to find out the domestic risk factors of pulmonary embolism with a comprehensive analysis of the quantitative method,and RevMan 5.2 and Stata 12.0 software were used for statistical analysis.Results A total of 11 research literature was included,with a total sample size of 1 459 cases,including DVT,cancer,operation history within 6 weeks,long-term bedridden ≥ 7 d and COPD which were associated with pulmonary embolism,the pooled odd rate (95％ CI) were 10.41 (4.54,23.87),6.79 (2.37,19.43),2.63 (1.12,6.19),3.48 (1.15,10.58),2.36 (1.45,3.84).It could not be certain that past history of thrombosis and smoking history were related to pulmonary embolism,their pooled OR (95％ CI) were 2.06 (0.80,5.33),1.57 (0.87,2.82).Conclusions Bedridden ≥ 7 d,cancer,DVT,operation history within 6 weeks and COPD are major risk factors for incidence of pulmonary embolism.Pulmonary embolism in high-risk groups should be dealt with early intervention.

OBJECTIVE To investigate the diagnostic and prognostic value of molecular biological detection of DTC in peripheral blood. METHODS 32 cases of laryngeal or laryngopharyngeal carcinoma were investigated. DTC in peripheral blood was detected by nested reverse transcription polymerase chain reaction,using CK19mRNA as the marker. RESULTS In the RT-PCR study,15 of 32 cases (46.9 %) showed a positive result. Ten of the 25 cases (40 %) of laryngeal carcinoma were positive. Fix of the remaining 7 cases (71.4 %) of laryngopharyngeal carcinoma were positive. All controls were negative. Of the 20 cases without lymph node metastasis,6 were positive; of the 12 cases with lymph node metastasis,9 were positive. The positive rate of the group with lymph node metastasis was higher than that of the group without lymph node involvement(P

Objective To investigate the possibility of chest approach gasless endoscopic surgery for the parathy-roid tumor. Methods Through a 2 cm incision on the surface of chest bone, a gasless procedure was developed to management of parathyroid tumor in our department. There were 2 cases of the parathyroid cyst-adenoma were dis-sected. Results 2 cases were successfully performed, and there were no paralyze of the revers laryngeal nerve and hypofunction of parathyroid could be observed. The cosmic and mini-invasive results were obtained. Conclusion Chest approach gasless endoscopic surgery for parathyroid tumor is a safe, mini-invasive, and cosmic procedure for selected patients.

OBJECTIVE To explore the strategy of diagnosis and therapy of lingual ectopic thyroid(LET). METHODS We retrospectively reviewed the clinical data of6 cases of LET, and figured out the clinical features, imaging characteristics, therapy and prognosis.RESULTS 6 lingual ectopic thyroids were diagnosed by the Tc-99m thyroid static imaging; 3 cases accepted surgery, one only took oral levothyroxine, and one selected watch and see. 3 cases of lingual ectopic thyroid accepted the ectopic thyroid transposition and took oral levothyroxine postoperatively. Pharynx foreign body sensation and sleep snoring disappeared one month later. The lingual ectopic thyroid carcinoma resection was performed by direct laryngoscope in one case which was lost to follow up.CONCLUSION The thyroid static imaging is specific to the diagnosis of the LET. The indications of the surgery were obvious symptoms such as airway obstruction, snoring and pharyngeal foreign body sensation, and mass hemorrhage, cystic degeneration and carcinogenesis. The principle of therapy is to retain thyroid function as far as possible and comprehensive use of surgery, thyroid hormone replacement and iodine radiotherapy to improve symptoms, prevention and treatment of hypothyroidism.

OBJECTIVE To explore t he significance of reducing the incidence rate of airway burn of CO2 laser laryngeal surgery by spreading the idea of grading prevention st rateg y. M ETHODS We retrospectively reviewed the data of laryngeal lesions treated by the endoscopic CO2 laser surgery from Feburary 1992 to December 2016. The period was divided into two stages, the first one is from Feburary 1992 to December 2008, and the second one is from January 2009 to December 2016. We will distinguish the difference of airway burn between the two stages. RESULTS Four cases of airway burn were found in the first stage including 3 cases of glottic cancer and 1 case of vocal cord polyp with Reink's edema. But no airway burn happened in the second stage. Two cases of endotracheal intubation cuff broken by laser were found promptly, but with FiO2 decreasing from 70% to 30%, wet gauze filling subglottic region and the endotracheal tube reserved, the laser surgery proceeded till airway burn happened. The endotracheal intubation cuffs of the remaining two cases kept intact intraoperatively, the FiO2 was 70% when airway burn happened. One case had the cervical tracheal stenosis with long-term tracheotomy, The other 3 cases had no postoperative complications. CONCLUSION The grading prevention strategy is helpful for reducing airway burn during the CO2 laser surgery of larynx.

[ABSTRACT]OBJECTIVETo observe the short term effects and adverse effects of induction chemotherapy with Paclitaxel,Cisplatin and Fluorouracil(TPF) in locally advanced squamous cell cancer of hypopharynx. METHODS78 cases locally advanced squamous-cell cancer of hypopharynx form jan 2011 to oct 2013 for the first time treated by TPF scheme,after 2 cycles,to recheck CT scan and evaluate therapeutic effective.RESULTSAll 78 cases patients achieved 156 cycles chemotherapy,CR was 4 cases (5.1%),PR 55 cases (70.5%),SD 17 cases (21.8%), PD 2 cases (2.6%). Total effective rate (CR+PR) was 75.6%,and with low incidence ofⅢ/Ⅳ grade side effect. Logistic regression analysis shows that there is a significant correlation between effective rate and low differentiation cancer.CONCLUSIONFor locally advanced squamous-cell cancer of hypopharynx patients,the TPF chemotherapy scheme showed good therapeutic effective and safety,could be a choice for the induction chemotherapy treatment in locally advanced squamouscell cancer of hypopharynx. The patients with low differentiation cancer may have benefit from the induction chemotherapy.