Objective To investigate the clinical features,diagnosis and treatment of medullary thyroid microcarcinoma (MTMC).Methods The clinical data of 14 patients with MTMC from Mar.2012 to Sep.2016 were retrospectively reviewed.All cases were treated with surgery and pathologically proved to be MTMC.Results All patients were sporadic MTMC.Calcitonin and CEA levels were measured before surgery in 11 patients.The median values were 81.61 (3.36-1187) pg/ml and 7.42 (0.81-90.75) ug/ml,respectively.All patients were followed up postoperatively.During a median follow-up of 24 months (8-63 months),no death happened.Regional lymph node metastasis occurred in 8 patients (57.14％),and lateral lymph node metastasis in 5 cases (35.71％).The rate of postoperative calcitonin abnormal was significantly higher in patients with lateral lymph node metastasis (P＜0.01).6 cases (42.86％) had abnormal postoperative calcitonin,among whom 5 cases had preoperative baseline calcitonin level higher than 100 pg/ml.Patients having abnormal postoperative calcitonin suffered from higher calcitonin and CEA baseline (P＜0.05).The tumor size was similar in two groups (P＞0.05).Conclusions For patients with thyroid nodules,preoperative screen of calcitonin can effectively detect MTC.Patients with elevated CEA also need to exclude the possibility of MTC.Compared with tumor size,calcitonin baseline is more important to surgical options and postoperative outcomes.Lateral lymph node metastasis,baseline calcitonin ＞100 pg/ml indicates abnormal postoperative calcitonin.

Objective To evaluate the role of cabon nanoparticles for dissecting lymph nodes and preserving parathyroid glans in patients with differentiated thyroid carcinoma undergoing total thyroidectomy plus bilateral central neck dissection.Metheds From Sep.2015 to Feb.2016,100 patients in Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine with thyroid carcinoma undergoing primarily total thyroidectomy plus bilateral central neck dissection were randomly divided into carbon nonoparticle group and the contol group.The numbers of total dissected lymph nodes,the lymph node posterior to fight recurrent laryngeal nerve,metastasized lymph nodes,inadvertent parathyroidectomy,the parathyroid hormone and serum total calcium were measured.Results The average counts of lymph nodes in carbon nonoparticle group (10.96±5.43)were more than those in the control group at (8.22±4.40)lymph nodes,(t＝2.78,P＝0.01).The average counts of lymph node posterior to fight recurrent laryngeal nerve in carbon nonoparticle group (1.62±1.95)were more than those in the control group at (0.76±1.21)lymph nodes,(t＝2.66,P＝0.01).The numbers of metastasized lymph nodes was 2.02±2.40 in carbon nonoparticle group and 1.84±2.61 in the control group.The difference had no statistical significance(t＝0.36,P＞0.05).The amount of PTH and the decrease of PTH discrepancy one day after surgery between the two groups had no statistical difference (t＝0.23,P＞0.05),(t＝l.04,P＞0.05).The carbon nonoparticle group had 2％(1/50)mistakenly parathyroid gland removed incidence,on contrary,the control group had 6％(3/50)mistakenly removed incidence.The difference had no statistical significance(x2＝0.26,P＞0.05).Conclusion Carbon nonoparticle can improve the central lymph node detection rate,but the protection of the parathyroid glands is more likey to depend on the experience of the operator and the vascular protection.

Carcinoma ; Humans ; Parathyroid Neoplasms

Objective:To investigate the occurrence of carotid artery abnormalities in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients and the related risk factors affecting the occurrence of carotid artery abnormalities.Methods:A total of 169 regular follow-up outpatients with HIV/AIDS from April 2003 to December 2019 in Peking Union Medical College Hospital, whose carotid artery ultrasound examination were performed from July 2015 to December 2019 were included. The patients were divided into young (≤44 years old), middle-aged and elderly (≥45 years old) according to their ages, and the physical examination data of the included patients were collected.The statistical methods were logistic regression analysis and single sample t test. Results:Among the 169 HIV/AIDS patients, 40(23.7%) had abnormal carotid artery and 129(76.3%) had no abnormal carotid artery. Middle-aged and elderly people (odds ratio ( OR)=3.85, 95%confidence interval (95% CI) 1.54-9.65, P<0.01), hypertension ( OR=6.24, 95% CI 1.95-20.00, P<0.01), hyperlipidemia ( OR=2.44, 95% CI 1.00-5.93, P<0.05), and elevated human leucocyte antigen (HLA)-DR + CD8 + /CD8 + ( OR=1.03, 95% CI 1.01-1.06, P<0.05) were the risk factors for carotid artery abnormality. The common carotid artery inner medium film thickness (IMT) of patients in HIV/AIDS group Ⅰ (20 to 30 years old), group Ⅱ (31 to 40 years old), group Ⅲ (41 to 50 years old) were (0.061 0±0.001 2), (0.062 9±0.001 4) and (0.065 6±0.002 6) cm, respectively, which were thicker than the control groups ((0.051±0.003), (0.056±0.004) and (0.063±0.002) cm, respectively). The differences were all statistically significant ( t=5.119, 4.775 and 1.739, respectively, all P<0.05). The common carotid artery IMT of patients in HIV/AIDS group A (30 to 44 years old) and group B (45 to 59 years old) were (0.062 6±0.001 1) and (0.072 3±0.003 4) cm, respectively, which were thicker than the control groups ((0.052±0.011) and (0.064±0.015) cm, respectively), the differences were both statistically significant ( t=9.520 and 3.012, respectively, both P<0.01). Conclusion:Younger HIV-positive people have a higher probability of abnormal carotid arteries and may be at greater risk of cardiovascular disease than HIV-negative people of the same age, suggesting that HIV-positive people, especially young people, should be examined early with ultrasound of the neck arteries to detect abnormalities and intervene as soon as possible.

Objective To evaluate the risk factors for postoperative hypoparathyroidism.Methods Tolally 200 patients with thyroid diseases undergoing total thyroidectomy at Department of General Surgery,Ruijin Hospital from Sep 2012 to Oct 2015 were followed up.The related risk factors were analyzed.x2 test and Fisher's exact test were used to analyze the correlation between hypoparathyroidism after total thyroidectomy and the other clinical factors.Multiple logistic regression analysis was performed to identify these risk factors.We analyzed the receiver operating characteristic (ROC) curve and calculated the area under the curve (AUC).The highest accuracy cutoff levels of intact parathyroid hormone (iPTH) level at 1 day after thyroidectomy (iPTH 1 d) and ％ iPTH decline were determined from the ROC curves.Results Of the 200 patients,66.5％ developed hypoparathyroidism on the first day,6.5％developed hypoparathyroidism in 6 months after surgery.That was 3.5％ in 1 year.The femaleness(OR =2.966,95％ CI:1.480-5.945,P =0.002),age (OR =0.972,95％ CI:0.946-0.999,P =0.039),and bilateral center lymph node dissection (OR =5.508,95％ CI:1.693-17.923,P =0.005) were independently correlated with postoperative hypoparathyroidism.The parathyroid hormone concentration on postoperative day 1 (OR =0.738,95％ CI:0.556-0.979,P =0.035) and 131I remnant ablation therapy (OR =12.887,95％ CI:3.434-48.367,P =0.000) were independent risk factors for postoperative hypoparathyroidism in 6 month.Both iPTH ＜ 3.05 pg/ml and ＞ 92.5％ iPTH decline on post-op dl could accurately predict significant hypoparathyroidism postoperative 6 month with accuracy of 82.1％ and 78.2％.Conclusions Bilateral center lymph node dissection and 131I remnant ablation therapy are risk factors for postoperative hypoparathyroidism,the iPTH1 d and ％ iPTH decline can predict hypoparathyroidism in postoperative 6 month.

Objective: To analyze the hints role of surveillance cultures of Carbapenem-resistant Enterobacteriaceae (CRE) by perianal swabs in patients with hematological diseases, and seek risk factors of CRE bloodstream infection. Methods: The resistance of CRE from 2 914 patients with hematological diseases who cultured perianal swabs, CRE bloodstream infection and risk factors were analyzed during January 2016 to December 2017. Results: In this study, perianal swabs from 2 914 patients with hematological diseases were cultured, 74 patients were CRE positive, and bloodstream infection with CRE was found in 13 of these patients. A total of 87 CRE strains were isolated (The same patient only keep the first one for the same location), including 31 Klebsiella pheuminiae, 43 Escherichia coli, 8 Enterobacter cloacae and 6 other Enterobacteriaceae. The resistance rates to piperacillin / tazobactam, imipenem, meropenam, amikacin, levofloxacin, tigecycline were 91.9%, 74.4%, 98.8%, 17.6%, 74.4% and 8.0%, respectively. Resistance to carbapenem, aminoglycoside, quinolones and tegacycline were highly consistent between two sites from 13 patients, whose both perianal swabs and blood were positive in CRE cultures. Febrile neutropenic time, digestive tract symptoms and perianal infection were independent risk factors for bloodstream infection in patients with perianal swabs positive results, the odds ratios (OR) were 1.10 (P=0.029), 1.13 (P=0.005) and 1.23 (P=0.016), respectively. Conclusion Perianal swabs surveillance cultures of CRE can be hints for CRE bloodstream infection in patients with hematological diseases, and also can provide suggestions for antibiotics. Long time of febrile neutropenic, digestive tract symptoms and perianal infection can be the early warning for CRE bloodstream infections.

Objective:To investigate the expressions of glutathione S-transferases M1 (GSTM1) and glutathione S-transferases M2 (GSTM2) in follicular thyroid carcinoma (FTC) and their clinical significances.Methods:Gene expression profile of GSE82208 generated from 52 human thyroid samples, including 27 cases of FTC and 25 cases of follicular adenoma (FA) were collected from Gene Expression Omnibus (GEO) database. The gene matrix data were extracted and analyzed, and then differentially expressed genes (DEG) between FTC and FA were identified by using Limma package. Immunohistochemical SABC method was used to detect the expression levels of GSTM1 and GSTM2 proteins in FTC tissues and FA tissues collected from 56 FTC samples and 56 FA samples in Dandong First Hospital of Liaoning Province from January 2000 to December 2020. The relationship between GSTM1 and GSTM2 was analyzed; the association of expression levels of GSTM1 and GSTM2 with the clinicopathological factors of FTC patients was also analyzed.Results:Based on the GEO database, a total of 40 DEG were identified, including 9 up-regulated DEG (GSTM1, GSTM2, COL6A2, CUX2, CLUH, TSC2, OGDHL, ACADVL, SDHA) and 31 down-regulated DEG in FTC. The immunohistochemistry results of samples resected showed that the positive rates of GSTM1 and GSTM2 proteins in FTC tissues were higher than those in FA tissues [71.4% (40/56) vs. 23.2% (13/56), 80.4% (45/56) vs. 14.3% (8/56)], and differences were statistically significant ( χ2 values were 26.11 and 49.03, both P < 0.01). The expressions of GSTM1 and GSTM2 in FTC tissues were correlated with clinical staging, invasion degree and distant metastasis (all P < 0.05), but not with gender, age and tumor diameter (all P>0.05). There was a positive correlation between GSTM1 and GSTM2 proteins expressions in FTC ( r = 0.384, P = 0.004). Conclusions:The expression levels of GSTM1 and GSTM2 in FTC are increased. The interaction between GSTM1 and GSTM2 proteins can be involved in the development and progression of FTC.

Objective:To explore the risk factors and protective factors for esophageal cancer, and provide strategies for prevention, clinical treatment and later-stage intervention.Methods:A total of 150 patients with pathologically confirmed esophageal cancer admitted to Nanjing Liuhe District People′s Hospital from July 2020 to February 2023 were selected as the observation group, and 150 non-tumor patients hospitalized in the department of orthopedics during the same period were selected as the control group. A questionnaire survey was conducted to analyze the independent risk factors and independent protective factors for esophageal cancer.Results:Univariate Logistic regression analysis showed that smoking, alcohol consumption, drinking hot tea (hot drinking >65 ℃), eating hard food, frequency of consuming pickled food, frequency of consuming fruits, frequency of consuming vegetables, frequency of getting angry, economic income and frequency of consuming bread were factors affecting the incidence of esophageal cancer ( P<0.05). Multivariate Logistic regression analysis showed that smoking, consuming fruits ≤3 times per week, previously drinking alcohol but currently not drinking, and not eating hard food were factors affecting the incidence of esophageal cancer ( P<0.05). Conclusions:Smoking and consuming fruits ≤3 times per week are independent risk factors for esophageal cancer, while previously drinking alcohol but currently not drinking and not eating hard food are independent protective factors for esophageal cancer.

Objective To analyze the clinical and pathological features of papillary thyroid microcarcinoma(PTMC) of which the maximum diameter is less than 5 mm.Methods Clinical data of 487 PTMC (≤5 mm) patients who underwent primary surgery by the same team of doctors between March 2013 to March 2016 at Department of Surgery,Ruijin Hospital,School of Medicine,Shanghai Jiaotong University were analyzed retrospectively.Female patients accounted for 77.4％ (377/487).The age ranged from 22 to 80 years,with an average of (46± 11) years.x2 test and multivariate Logistic regression analysis were used to analyze risk factors.Results There were 93.6％ (456/487) of the patients with preoperative definite diagnosis.There were 92.6％ (452/487) of the patients underwent unilateral thyroid lobectomy with isthmectomy and ipsilateral central lymph node dissection.Multifocal carcinoma accounted for 20.3％ (99/487),Ⅲ to Ⅳ phase cases accounted for 12.3％ (60/487),patients with low risk of recurrence accounted for 67.6％ (329/487).The central lymph node metastasis rate was 34.9％ (170/487).Male (OR=2.149,95％CI:1.367 to 3.381),age＜45 years (OR=0.451,95％CI:0.303 to 0.672),multifocal carcinoma (OR=1.798,95％CI:1.116 to 2.898),and capsular invasion (OR=3.678,95％CI:1.406 to 9.622) were the independent risk factors for lymph node metastasis (P＜0.05).Conclusion Regardless of tumor size,PTMC still needs to be taken seriously,especially male,age ＜ 45 years,capsular invasion,or multifocal carcinoma patients.

Objective To analyze the clinical and pathological features of papillary thyroid microcarcinoma(PTMC) of which the maximum diameter is less than 5 mm.Methods Clinical data of 487 PTMC (≤5 mm) patients who underwent primary surgery by the same team of doctors between March 2013 to March 2016 at Department of Surgery,Ruijin Hospital,School of Medicine,Shanghai Jiaotong University were analyzed retrospectively.Female patients accounted for 77.4％ (377/487).The age ranged from 22 to 80 years,with an average of (46± 11) years.x2 test and multivariate Logistic regression analysis were used to analyze risk factors.Results There were 93.6％ (456/487) of the patients with preoperative definite diagnosis.There were 92.6％ (452/487) of the patients underwent unilateral thyroid lobectomy with isthmectomy and ipsilateral central lymph node dissection.Multifocal carcinoma accounted for 20.3％ (99/487),Ⅲ to Ⅳ phase cases accounted for 12.3％ (60/487),patients with low risk of recurrence accounted for 67.6％ (329/487).The central lymph node metastasis rate was 34.9％ (170/487).Male (OR=2.149,95％CI:1.367 to 3.381),age＜45 years (OR=0.451,95％CI:0.303 to 0.672),multifocal carcinoma (OR=1.798,95％CI:1.116 to 2.898),and capsular invasion (OR=3.678,95％CI:1.406 to 9.622) were the independent risk factors for lymph node metastasis (P＜0.05).Conclusion Regardless of tumor size,PTMC still needs to be taken seriously,especially male,age ＜ 45 years,capsular invasion,or multifocal carcinoma patients.