OBJECTIVE: To investigate the clinical application of carbon nanoparticles staining in cervical lymph node dissection on clinical neck lymph nodes the negative (cN0 period) thyroid papillary thyroid carcinoma (PTC). METHOD: This retrospective analysis comprised 100 papillary thyroid cancer patients who met inclusion criteria,and they were randomly divided into the nano-carbon group (50 cases) and control group (50 cases). They underwent lobectomy, subtotal thyroidectomy or total thyroidectomies and were given elective central compartment neck dissection (CCND). The number of detected lymph nodes in each group was summed, and pathological examination was conducted. The number of lymph nodes (dyedor not dyed) and the location of metastatic nodes were recorded separately. RESULT: In the nano-carbon group the average number of eliminated lymph nodes is significantly more than that of the control group(P<0.05). The metastasis lymph nodes in the nano-carbon group was higher than that in the control group(P<0.01). Among 100 cases, 2% had temporary vocal cord palsy, and 8% had temporary hypoparat hyroidism. No case of permanent vocal cord palsy or permanent hypocalcemia was observed. CONCLUSION The dyed lymph nodes can be easily identified and can be used as a guide for lymphnodes dissection in papillary thyroid carcinoma operation.
Carbon ; Carcinoma ; pathology ; surgery ; Carcinoma, Papillary ; Coloring Agents ; Humans ; Lymph Node Excision ; Lymph Nodes ; Lymphatic Metastasis ; diagnosis ; Nanoparticles ; Neck ; Neck Dissection ; Radiopharmaceuticals ; Retrospective Studies ; Thyroid Cancer, Papillary ; Thyroid Neoplasms ; pathology ; surgery ; Thyroidectomy ; Vocal Cord Paralysis

OBJECTIVE: To explore the diagnostic value of the proposed thyroid imaging reporting and data system (TI-RADS) classification in thyroid nodules, and to investigate interobserver variability among different observers using TI-RADS classification for ultrasound. METHOD: We reviewed 667 thyroid nodules conventional ultrasound image data from 532 patients who were confirmed by Pathological diagnosis. Those ultrasound images were reviewed by 4 experienced sonographers who can independently assessed the sonographic characteristics and analyzed according to the TI-RADS classification. It is to assess the diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the TI-RADS classification. The multirater kappa statistics were used to assess the interobserver agreement among different observers. RESULT: The overall sensitivity, specificity, negative predictive value (NPV) and Accuracy were 94%, 79%, 97% and 81%, respectively. Positive predictive values (PPVs) for categories 4 and 5 were 55% and 92%. There was substantial interobserver agreement for categories 3, 4B and 5 (Kappa = 0.62, 95% CI, 0.58-0.65), and was moderate agreement for category 4A (Kappa = 0.57) and 4B(Kappa = 0.60). CONCLUSION The diagnostic criteria of TI-RADS for differentiating between benign and malignant thyroid nodules have a high diagnostic value. There was substantial interobserver agreement in different experienced sonographers. The TI-RADS diagnostic criteria have a high diagnostic value and has great practical value in making a proper and further treatment plan.
Humans ; Observer Variation ; Predictive Value of Tests ; Sensitivity and Specificity ; Thyroid Nodule ; classification ; diagnostic imaging ; Ultrasonography

Objective:To investigate the expression of human epidermal growth factor receptor 2 (HER2) in pancreatic ductal adenocarcinoma(PDAC) and its relationship with the prognosis of patients with PDAC.Methods:From January 2001 to December 2012, 109 paraffin embedded PDAC tissue samples and 27 normal pancreatic tissue samples were collected from the Department of Pathology, Huadong Hospital Affiliated to Fudan University. The expression of HER2 protein in pancreatic tissue was detected by immunohistochemical Envision two-step method. HER2 expression was evaluated according to Hercept test, and its relationship with clinicopathological features and survival time was analyzed.Results:The expression of HER2 protein was negative (-) in 29.4% of PDAC tissues, weakly positive (+ ) in 35.8%, positive (+ + ) in 25.7% and strongly positive (+ + + ) in 9.2%, respectively, and the overexpression rate (+ + , + + + ) was 34.9%; the negative (-) and weakly positive (+ ) expression of HER2 protein in normal pancreatic tissues accounted for 88.9% and 11.1% respectively. There was no expression with positive (+ + ) or strongly positive (+ + + ), therefore, the overexpression rate was 0. The overexpression rate of HER2 protein in PDAC and normal pancreatic tissues was significantly different ( P=0.000). The expression of HER2 protein was significantly correlated with age, and the expression of HER2 protein in patients with PDAC over 65 years old was significantly higher than that in patients with PDAC under 65 years old ( P=0.043), but not with gender, tumor location, tumor grade, T stage, N stage and nerve invasion (all P>0.05). Univariate Cox proportional hazards analysis showed that HER2 expression was associated with postoperative survival time of patients with PDAC ( P=0.032). Multivariate Cox proportional hazards analysis showed that HER2 expression was an independent prognostic factor for survival of patients with PDAC ( P=0.040). The median survival period of patients with HER2 expression + + + was significantly longer than that of patients with HER2 expression -~+ + (128.4 months vs 21.5 months), and the difference was statistically significant ( P=0.038). Conclusions:The overexpression of HER2 in PDAC tissue was related to the age of patients. The survival time of patients with HER2 strongly positive PDAC was significantly longer. HER2 can be considered as an index to evaluate the biological behavior and prognosis of PDAC.

ObjectiveTo analyze the development mechanism and investigate the more effective therapeutic method of the multiple system organs failure (MSOF) after severe craniocerebral injury.MethodsThe clinical data of 21 MSOF cases after severe craniocerebral injury was analyzed retrospectively.ResultsOf all 21 cases, 2 cured, 7 mended and 12 died with death rate 57% and deformity rate 33.3%.ConclusionTo severe craniocerebral injury, comprehensive, timely and effective therapeutic method is the key to reduce the occurrence of MSOF and the rate of death and deformity.

Objective To investigate the expressions of HBXIP and GRIM-19 in hepatocellular carcinoma tissues and their clinic significance. Methods Hepatocellular carcinoma tissue (n=42) and normal liver tissue (n=28) were collected from Tianjin First Central Hospital,immunohistochemistry was used to detect the expressions of HBXIP and GRIM-19 in these two groups. Results Rate of cells with positive expressions of HBXIP in hepatocellular carcinoma and normal liver tissues were 80.95%(34/42)and 42.86%(12/28)respectively;Rate of cells with positive expression of GRIM-19 in hepato?cellular carcinoma tissues and normal liver tissues was 40.48%(17/42)and 75.00%(21/28)respectively, and the difference between these two groups was statistically significant(P<0.05);The expression of HBXIP was higher but the expression of GRIM-19 was lower in poor differentiated and stageⅢ-IV cells than those in well and moderate differentiated cells and in stage I-II, cells. What′s more, the expression of GRIM-19 is higher in tissue without portal thrombosis than that in tissue with portal thrombosis. The expression of HBXIP was negatively correlated with GRIM-19 expression(rS=-0.400,P<0.01). Conclusion The abnormal expressions of HBXIP and GRIM-19 may play important roles in the process of development and metastasis of hepatocellular carcinoma.

Objective To detect the changes of CD4 + CD25 + CD127low/-regulatory T (Treg) cells in peripheral blood in patients with portal hypertension and hepatitis B virus infection before and after splenectomy,and to study the effects of splenectomy on the immune function of patients with portal hypertension.Methods The clinical data of 20 patients with portal hypertension,hepatitis B virus infection and hypersplenism who were admitted to the Third Hospital of Hebei Medical University from May 2012 to May 2013 were retrospectively analyzed.The dynamic levels of CD4 + CD25 + CD127low/ Treg cells in the peripheral blood of the 20 patients (portal hypertension group) at 1 day before splenectomy and at postoperative week 1,month 1 and month 3 were detected by flow cytometry,and the dynamic levels of CD4 + CD25 + CD127low/ Treg cells in the peripheral blood of 10healthy individuals (control group) from the same hospital were also detected by flow cytometry.The effects of changes of Treg cells on the immune function were analyzed.All data were analyzed using the t test or repeated measures analysis of variance.Results The proportions of CD4 + CD25 + CD127low/-Treg cells before operation were 5.1％ ± 3.5％ in the portal hypertension group and 1.4％ ± 0.2％ in the control group,with significant difference between the 2 groups (t =2.573,P ＜ 0.05).The proportions of CD4 + CD25 + CD127low/ Treg cells in the portal hypertension group at postoperative week 1,month 1 and month 3 were 9.2％ ±2.7％,5.6％ ± 1.7％and 2.5％± 2.1％,respectively.There was significant difference in the proportion of CD4+ CD25 + CD127low/-Treg cells between postoperative week 1 and that before operation (F =9.814,P ＜ 0.05),while there was no significant difference in the proportion of CD4 + CD25 + CD127low/-Treg cells between postoperative month 3 and that before operation (F =2.364,P ＞ 0.05).Conclusion The proportion of Treg cells increases in a short period after splenectomy,and then it decreases as time passed by,which indicates that splenectomy has slight influence on the immune system from the perspective of Treg cells.

Objective Cervical radiculopathy treatment experts' consensus to establish radiculopathy type by using the modified Delphi method. Methods Use document retrieval method to review information and articles about the treatment guidelines and articles of cervical radiculopathy including domestic and international areas, established a protocol about clini?cal consensus of the treatments for cervical radiculopathy. This protocol included 23 questions (the effective proportion of non?operating therapy, neck immobilization, physiotherapy, pharmacologic treatment, surgical indications, contraindications, anteri?or surgical decompression, anterior surgical implants). We performed a modified Delphi survey in which current professional opinions from experienced experts, representing from almost all of the Chinese provinces, were gathered. And then we modi?fied the protocol according to those professional opinions. Three rounds were performed and finally we established consensus. Consensus was achieved with ≥70% agreement. Results The panel included 30 experienced experts. The recycling question?naire's quantity of three rounds were 30(100%), 24(80%) and 16(53.3%) respectively. After three expert assessments, there were 18 questions which achieved with≥70%agreement and these questions accounted for 64.3%(18/28) of all the questions. Consen?sus of the treatments for cervical radiculopathy was reached on 7 aspects, including:the effective proportion of non?operating thera?py (1 question), neck immobilization (1 question), physiotherapy (1 question), pharmacologic treatment (5 questions), surgical indi?cations (3 questions), contraindications (4 questions), surgery (3 questions). Conclusion This modified Delphi study had reached a consensus concerning several treatment issues on cervical radiculopathy which had strong representativeness of experts and good convergence of opinions. In the absence of high?level evidence, at present, these experts' opinion findings will guide health care providers to define appropriate treatment in their regions. Areas with no consensus provide excellent insight for future research.

ObjectiveTo investigate the surgical management of left renal vein entrapment syndrome.MethodsEight cases with left renal vein entrapment syndrome (5 males and 3 female ; mean age 26 years) with history of gross hematuria for 3 to 46 months were reviewed.Doppler ultrasound reports suggested compression of the left renal vein at mesenteric angle in all cases.And the dilated segment of the left vein was three-fold than the stricture segment in diameter.CT scan showed the abnormal angle between aorta and superior mesentery artery in all cases.Bleeding from the left ureteral orifice was detected by cystoscopy in 6 cases.We treated 8 patients by extravascular stent immobilization with laparoscope.ResultsThe operation was successful in the 8 cases without surgical complications.The average operation time was 63 min.The average blood loss was 14 ml,and the average hospital stay after operation was 6 days.Follow-up of 3 -20 months,there was no hematuria relapse since been relieved in 7 cases,one case remained microscopic hematuria.Color Doppler ultrasound examination in all 8 cases showed the narrowest inner diameter of left renal vein was 7.4 mm (6.5 - 8.7 mm),the blood flow was smooth.The angle between abdominal aorta and superior mesenteric artery become normal.Conclusions Laparoscopic left renal vein extravascular stenting could be a new surgical method to treat left renal vein entrapment syndrome.The method of putting artificial blood vessel around renal vein is simple,safe and effective.

Objective Objective To explore the reasons of lung hypervolemia after liver transplantation and the corresponding treatment strategies.Method 291 patients received liver transplantation,in which 35 cases underwent pulmonary edema at early stage (pulmonary hypervolemia group),and the rest without pulmonary hypervolemia served as control group.Average central venous pressure (CVP) was recorded pre-,intra-and post-operatively.Total intake,total discharge and fluid balance were also recorded intraoperatively and 3 days post-operatively.Result In pulmonary hypervolemia group,CVP was (12.33 ± 5.08),(14.33 ± 3.03) and (16.50 ± 4.57) mmHg pre-,intra-and post-operatively,significantly higher than that in control group (P＜0.05 for all).Total intake,total discharge and fluid balance in pulmonary hypervolemia group were significantly higher than those in control group intraoperatively and 3 days post-operatively (P＜0.05 for all).After diuretic therapy and hemodialysis,30 cases in pulmonary hypervolemia group recurred,and 5 cases died of infection.Conclusion Pulmonary hypervolemia at early stage after liver transplantation is related to fluid balance.The reasonable control of total intake,total discharge and fluid balance is necessary.

OBJECTIVE: To study the prevalence of BRAF(V600E) mutations in small (≤ 2 cm) papillary thyroid carcinoma (PTC), explore the correlation with occult central nodal metastasis (CNM) of clinically-nodal negative (cN0) neck for small (≤ 2 cm) papillary thyroid carcinoma (PTC). METHOD: Primary tumor tissue (paraffin-embedded) from 72 patients with small (≤ 2 cm) cN0 PTC who underwent prophylactic central neck dissection (pCND) was tested for BRAF mutation. by nested PCR, the factors of lymph node metastasis such as clinicopathologic including tumor size, multifocality, extrathyroidal invasion, and BRAF mutations were analyzed. Prediction scores were generated using logistic regression models and BRAF was evaluated to see if it was a risk factor for CNM. RESULT: The prevalence of BRAF was 47.22% (34/72) while the rate of CNM was 36.11% (26/72). Univariate analysis showed that the risk factors of lymph node metastasis for cN0 PTC were significantly correlated with tumor size (P = 0.016), bilateral tumor (P = 0.010), multifocality (P = 0.026), extrathyroidal invasion (P = 0.024), and BRAF mutations (P = 0.041). Univariate analysis showed that tumor size (OR = 2.674, 95% CI = 1.702-3.997), multifocality (OR = 1.371, 95% CI = 1.065-2.087), extrathyroidal invasion (OR = 0.540, 95% CI = 0.396-0.794) and BRAF (OR = 1.647, 95% CI = 1.101-2.463) were risk predictors of CNM. CONCLUSION The incidence of central neck micrometastatic disease is 36.11% in patients with PTC deemed N0 preoperatively by clinical examination and ultrasound of the neck lymph nodes and intraoperatively by inspection of the central compartment. The factors of high risk of CNM included tumor size, multifocality, extrathyroidal invasion, BRAF mutations. When a patient has the risk factors of lymph node metastasis should be electived prophylactic CCND.
Axilla ; Carcinoma ; genetics ; Carcinoma, Papillary ; Humans ; Logistic Models ; Lymph Nodes ; Lymphatic Metastasis ; genetics ; Mutation ; Neck ; Neoplasm Micrometastasis ; diagnosis ; Neoplasm Staging ; Polymerase Chain Reaction ; Proto-Oncogene Proteins B-raf ; genetics ; Risk Factors ; Thyroid Cancer, Papillary ; Thyroid Neoplasms ; genetics