Objective To evaluate the clinical application of endoscopic thyroidectomy via the breast areolae.Methods From Aug.2010 to Nov.2011,90 patients with benign thyroid nodules(＜6 cm)received endoscopic thyroidectomy in our department.Three trocars were used during the surgery.Small incisions were made at the points 1.2 cm away from the breast cleavage,1 cm or 0.5 cm away from the left and right breast areola to place the trocars.Ultrasonic harmonic scalpel was used to remove the thyroid nodules.Results 89 patients were treated successfully by endoscopy and 1 case was converted to open surgery because of thyroid cancer with central lymph node metastasis diagnosed by intraoperative rapid pathological assessment.The medium operation time was 100 minutes,ranging from 90 to 240 minutes.The average intraoperative blood loss was 20 ml,ranging from 10 to 120 ml.The mean postoperative hospitalization stay was 6 days(ranging from 3 to 12 days).85 cases were followed up from 3 to 13 months with 6 months as the average,during which no recurrence happened and no patient developed scars at the breast areolae.Conclusion Endoscopic thyroidectomy via the breast areolae is feasible and safe with excellent cosmetic effects.

Objective To explore the relationship between calcium-sensing receptor's expression and papillary thyroid carcinoma.Methods Seventy cases of postoperative papillary thyroid carcinoma were selected.Immunohistochemical technique was used to detect expression of calcium-sensing receptor in papillary thyroid carcinoma,thyroid benign lesions,and normal thyroid tissue,respectively.SPSS 17.0 statistical analysis was used with non parametric test,P＜0.05 indicated significant difference.Results The expression of calcium-sensing receptor in papillary thyroid carcinoma,benign thyroid,and normal thyroid were significantly different (90％,40％,0％,respectively; P ＜ 0.05).The expression of the calcium-sensing receptor in the group of papillary thyroid carcinoma with calcification was significantly higher than that in thyroid cancer without calcification (P ＜ 0.05).Conclusions This study suggests that the calcium-sensing receptor may be associated with papillary thyroid carcinoma and may play a key role in the calcification of the carcinoma.

Objective To investigate the therapeutic efficacy and side effects of arsenic trioxide (As2O3) with ATRA on newly-diagnosed patients with acute promyelocytic leukemia (APL). Methods 35 patients of newly-diagnosed APL received As2O3 with ATRA treatment. The therapeutic effects were compared with As2O3 treatment on 33 patients. The dose were adjusted according with As2O3 0.16 mg·kg-2·d-1 and ATRA 25 mg·m-2·d-1 until complete remission (CR). The CR rate, period to CR, the incidence of early death and side effects were observed in two groups. Results There was no significant difference in CR rate, in which 94.3 % for As2O3 with ATRA group and 90.9 % for As2O3 group (P >0.05). Significant difference was observed in the period to CR, in which the medium time to CR was 26.1 days for As2O3 with ATRA group and 30.5 days for As2O3 group (P <0.05). No significant differences was detected in APL associated syndrome, the occurrence of cytoxic responses and the incidence of early death. The death rate was higher in high WBC group than that in middle and low WBC group, with statistical difference (P <0.05), but there was no obvious difference between lower WBC and middle WBC group (P >0.05). Conclusion The treatment combined with As2O3 and ATRA could lessen the time of reaching CR. The WBC count > 10×l09/L was one of the main causes of therapy associated death and the APL differentiation syndrome should be detected and given attention immediately.

Objective To explore the correlation of the myeloid antigen expression and clinical characteristics of acute lymphoblastic leukemia (ALL) in children.Methods The clinical data of 77 newly diagnosed ALL patients in Department of Hematology,the People's Hospital of Zhengzhou University from Jan.2010 to Dec.2013 were analyzed.The patients included 53 boys and 24 girls with a median age of 7.73 (2.00-15.00) years old.Based on flow cytometry (FCM) analysis of bone marrow,these patients were divided into 2 groups:one group included 26 patients with positive myeloid antigen expression (MyAg + ALL) and the other group included 51 patients with negative myeloid antigen expressions (MyAg-ALL).The correlation among myeloid antigen expression,clinical features,prednisone experiment,myelogram on the 15th day was analyzed through induction chemotherapy and minimal residual disease (MRD) on the 33rd day,and the rate of disease-free survival (DFS) was compared between the 2 groups.Results There were 26 cases with myeloid antigen expression among 77 patients (33.77％),CD13 + accounting for 19.48％ (15/77 cases),CD33 + 10.39％ (8/77 cases),and CD117 + 5.19％ (4/77 cases).Among these patients,there were 2 patients expressing both CD13 + and CD33 +,and 1 patient expressing both CD33 + and CD117 +.There was no difference between the MyAg + ALL group and MyAg-ALL group in gender (x2 =0.217,P =0.641),age (≥ 10 years old,x2 =0.011,P =0.918),white blood count(≥50 × 109/L,x2 =1.198,P =0.274),lactate dehydrogenase (LDH) (≥500 U/L,x2 =0.317,P =0.573),genetic abnormality (x2 =0.377,P =0.539),immunophenotype (B-ALL/T-ALL,x2 =0.397,P =0.529),and risk stratification (low-risk group,middle-risk group and high-risk group,x2 =0.260,P =0.878).Univariate Logistic regression showed that the reaction rate of prednisone experiment (P =0.023,OR =3.422) and positive rate of MRD (P =0.001,OR =0.133) of MyAg + ALL group were obviously higher than those in MyAg-ALL group.Multivariate Logistic regression showed that positive rate of MRD in CD13 + ALL group was obviously higher than that of CD13-ALL group (P =0.034,OR =120.765).The DFS rate of CD13 + ALL group and CD13-ALL group were (50.4 ± 13.8)％ and (77.4 ±6.7)％ respectively,and there was a significant difference between the 2 groups (x2 =3.928,P =0.047).Conclusions There is no significant correlation between myeloid antigen expression and clinical characteristics of children patients with ALL.For the patients with myeloid antigens,the early reaction of induction chemotherapy is bad,and for patients with CD13,the prognosis is not good.

Objective To explore the expression of lymphoid-associated antigens in acute myloid leukemia and its clinical significance.Methods 84 patients with de nove (untreated) AML were classified by FAB classification and immunophenotype,of which 53 cases were analyzed by karyotype according to WHO standards.Patients were divided into 2 groups according to whether lymphoid antigen (Ly) was expressed or not.After all patients were treated with a standard remission-induction regimen for 1 course,bone marrow in 63 cases were re examined.Results 49 cases (58.3％) were classified into lymphoid surface antigen-positive acute myeloid leukemia (Ly+ AML) group,35 cases (42.7％) into lymphoid surface antigen-negative acute myeloid leukemia (Ly-AML) group.The incidences of hepatosplenomegaly and lymphadenopathy had significant differences between Ly+AML and Ly AML groups [55.1％ (27 cases) vs.22.9％ (8 cases),t=3.412,P=0.003].There were no significant differences in other indicators between the two groups.On the basis of equal intensity of chemotherapy,complete remission (CR) had no significant difference(x2 =1.995,P=0.158),the disease-free survival (DFS) in Ly + AML group was shorter than in Ly-AML group(t=2.427,P=0.019),the recurrence rate was higher in Ly + AML group than in Ly-AML group(x2 =4.132,P=0.044).Conclusions The expression of lymphoid associated antigens in acute myeloid leukemia is complex.Patients with Ly+AML show poor response to chemotherapy,and have poor prognosis.We should explore new chemotherapy for acute myeloid leukemia.