Objective:To explore the predictive value of the change rate of parathyroid hormone (PTH) after total thyroidectomy (TT) for hypoparathyroid function.Methods:A total of 182 patients with thyroid tumor who underwent TT from Jan. 2018 to Jun. 2023 in the Department of Otolaryngology, Head and Neck Surgery, Second Hospital of Shanxi Medical University were retrospectively selected as the study objects. The clinical and surgical data of the patients were collected, and the key factors associated with postoperative hypoparathyroidism were screened by multi-factor analysis. The change rate of serum PTH was calculated during perioperative period (before operation, at the end of operation, 1 and 3 days after operation). Receiver operator curve (ROC) was used to analyze the predictive value of PTH change rate in all patients.Results:Whether temporary hypoparathyroidism (THP) or permanent hypoparathyroidism (PHP), both were closely related to TT+ bilateral central lymph node dissection ( χ2=33.764, 9.235, P < 0.05) and parathyroid resection ( χ2=6.512, 58.999, P < 0.05). The change rate of PTH in HP patients was significantly higher than that in normal patients ( F=15.993, 16.830, 19.024, P < 0.05), and on the first and third day after surgery, the change rate of PTH in PHP patients was significantly higher than that in THP patients ( t=7.955, 9.023, P < 0.05). The predicted area under curve (AUC) of THP or PHP in different patient populations is different with the change rate of PTH in different periods. For patients with TT+ bilateral central lymph node dissection and parathyroidectomy, the change rate of PTH at the end of surgery was significantly higher than the change rate of PTH at 3 days after surgery for the AUC with PHP ( Z=5.433, 4.923, P < 0.05) . Conclusion:Perioperative PTH has good predictive value for THP and PHP in TT patients, especially in TT+ bilateral central lymph node dissection and parathyroidectomy.

Objective:To explore the clinical characteristics of children with Streptococcus pneumoniae cellulitis. Methods:The bacterial culture information management system in 18 children′s hospitals from January 2012 to December 2017 were reviewed.Among 1 138 children diagnosed with invasive pneumococcal disease(IPD), 7 cases were hospitalized with cellulitis.Clinical information was collected and analyzed.Results:Seven cases of Streptococcus pneumoniae cellulitis accounted for 0.6%(7/1 138 cases) of 1 138 IPD cases in 18 hospitals.There were 5 males and 2 females.The onset age was from 1 month to 6 years old, and the median age was 2 years old.There were 4 cases in rural areas and 3 cases in urban areas.Langerhans cell histiocytosis (LCH) was found in 1 case.Clinical manifestations: fever, local swelling and pain with infection.The focus of cellulitis: orbital cellulitis in 2 cases, buccal infection in 2 cases, upper extremity, head and buttock infection in 1 case, respectively.At the beginning of the disease: 2 cases of orbital cellulitis were accompanied by nasosinusitis and suppurative otitis media, 1 case was treated with acute periapical inflammation, 1 case was 10 months after chemotherapy.Type of infection: 6 cases were complicated with bloodstream infection, 2 cases with bacterial meningitis and 1 case with pneumonia.Other culture results: 6 cases of Streptococcus pneumoniae were cultured in peripheral blood, 2 cases were positive in local pus culture.Drug sensitivity test: 6 cases were sensitive to Penicillin and Cephalosporin (Cefotaxime/Ceftriaxone), 1 case was resistant.Treatment: 3 patients were treated with Cephalosporins alone, 2 cases with Cephalosporins and Penicillins, 2 cases with Vancomycin and Meropenem for meningitis, 3 cases with local abscess by incision and drainage, 2 cases with meningitis in Intensive Care Unit, and 1 case with endotracheal intubation and ventilator assisted ventilation.The average length of stay was 14.3 days(5-41 days). Discharge outcome: 6 cases improved and 1 case died. Conclusions:Cellulitis is a rare type of infection in children with IPD.It is mainly found in the head, face and around the orbit.It may be accompanied by bloodstream infection or bacterial meningitis.Most of them have a good prognosis.

Objective: To explore the clinical features, the serotype distribution and drug resistance of the isolates in patient with invasive pneumococcal disease (IPD). Methods: By retrieving the laboratory information system in 18 children′s hospitals from 2012 to 2017, the children with IPD were enrolled. Streptococcus pneumoniae (Spn) must be isolated from the sterile sites (blood, cerebrospinal fluid, hydrothorax and joint effusion etc.). The clinical characteristics, serotype, drug resistance, treatment and prognosis were reviewed and analyzed. According to the telephone follow up results, the patients were divided into death group and recovered group. The index as an independent risk factor of mortality was demonstrated by multivariate logistic regression analysis. Results: There were 1 138 children with IPD, including 684 male and 454 female. The proportion of male to female was 1.5∶1. The age ranged from one day to 16 years. The median age was 1 year 3 month. The majority was under 5 years of age (89.3%, n= 1 016), especially under 2 years of age (61.9%, n=704). In all cases, 88.2% (n=1 004) were community acquired infection. The infections included meningitis (n=446, 39.2%), pneumonia with bacteremia (n=339, 29.8%), and bacteremia without focus (n=232, 20.4%). Underlying diseases were found in 242 cases (21.3%). Co-infections were determined in 62 cases (5.4%) with mycoplasma, 27 cases (2.4%) with adenovirus and 34 cases with influenza virus (3.0%). The penicillin insensitivity (PNSP) rates in meningitis and non-meningitis isolates were 69.5% (276/397) and 35.9% (221/615), respectively. There were 81 strains serotyped, in which 93.8% (76/81) were covered by 13-valent protein-polysaccharide conjugate vaccine (PCV13). In the 965 patients who were followed up by phone call, 156 cases (16.2%) were confirmed dead. The independent risk factors for the death were under 2 years of age (OR=2.143, 95%CI 1.284-3.577, P=0.004), meningitis (OR=3.066, 95%CI 1.852-5.074, P<0.01), underlying disease (OR=4.801, 95%CI 2.953-7.804, P<0.01), septic shock(OR=3.542, 95%CI 1.829-6.859, P<0.01), disseminated intravascular coagulation (DIC) (OR=4.150, 95%CI 1.468-11.733, P=0.007), multiple organ failure (OR=12.693, 95%CI 6.623-24.325, P<0.01) and complications of central nervous system (OR=1.975, 95%CI 1.144-3.410, P=0.015). Conclusions Most children with IPD were under 5 years of age, having underlying diseases and acquired the infection in community. The independent risk factors for death were under two years old, meningitis, underlying diseases and multiple organ failure. The problem of drug resistance was severe. The universal immunization of PCV13 would be effective to prevent IPD in Chinese children.

OBJECTIVETo assess the safety, feasibility and clinical outcome of laparoscopic radical resection for low rectal cancer with telescopic anastomosis or with colostomy by stapler through transanal resection without abdominal incisions.

METHODSFrom January 2010 to September 2014, 37 patients underwent laparoscopic radical resection for low rectal cancer through transanal resection without abdominal incisions. The tumors were 4-7 cm above the anal verge. On preoperative assessment, 26 cases were T1N0M0 and 11 were T2N0M0.

RESULTSFor all cases, successful surgery was performed. In telescopic anastomosis group, the mean operative time was (178±21) min, with average blood loss of (76±11) ml and (13±7) lymph nodes harvested. Return of bowel function was (3.0±1.2) d and the hospital stay was (12.0±4.2) d without postoperative complications. Patients were followed up for 3-45 months. Twelve months after surgery, 94.6%(35/37) patients achieved anal function Kirwan grade 1, indicating that their anal function returned to normal.

CONCLUSIONSLaparoscopic radical resection for low rectal cancer with telescopic anastomosis or colostomy by stapler through transanal resection without abdominal incisions is safe and feasible. Satisfactory clinical outcome can be achieved mini-invasively.

Anal Canal ; Anastomosis, Surgical ; Colostomy ; Humans ; Laparoscopy ; Lymph Nodes ; Operative Time ; Postoperative Complications ; Rectal Neoplasms ; Safety

Objective To assess the safety, feasibility and clinical outcome of laparoscopic radical resection for low rectal cancer with telescopic anastomosis or with colostomy by stapler through transanal resection without abdominal incisions. Methods From January 2010 to September 2014, 37 patients underwent laparoscopic radical resection for low rectal cancer through transanal resection without abdominal incisions. The tumors were 4-7 cm above the anal verge. On preoperative assessment , 26 cases were T1N0M0 and 11 were T2N0M0. Results For all cases, successful surgery was performed. In telescopic anastomosis group, the mean operative time was (178±21) min, with average blood loss of (76±11) ml and (13±7) lymph nodes harvested. Return of bowel function was (3.0±1.2) d and the hospital stay was (12.0±4.2) d without postoperative complications. Patients were followed up for 3-45 months. Twelve months after surgery, 94.6%(35/37) patients achieved anal function Kirwan grade 1, indicating that their anal function returned to normal. Conclusions Laparoscopic radical resection for low rectal cancer with telescopic anastomosis or colostomy by stapler through transanal resection without abdominal incisions is safe and feasible. Satisfactory clinical outcome can be achieved mini-invasively.

Objective To assess the safety, feasibility and clinical outcome of laparoscopic radical resection for low rectal cancer with telescopic anastomosis or with colostomy by stapler through transanal resection without abdominal incisions. Methods From January 2010 to September 2014, 37 patients underwent laparoscopic radical resection for low rectal cancer through transanal resection without abdominal incisions. The tumors were 4-7 cm above the anal verge. On preoperative assessment , 26 cases were T1N0M0 and 11 were T2N0M0. Results For all cases, successful surgery was performed. In telescopic anastomosis group, the mean operative time was (178±21) min, with average blood loss of (76±11) ml and (13±7) lymph nodes harvested. Return of bowel function was (3.0±1.2) d and the hospital stay was (12.0±4.2) d without postoperative complications. Patients were followed up for 3-45 months. Twelve months after surgery, 94.6%(35/37) patients achieved anal function Kirwan grade 1, indicating that their anal function returned to normal. Conclusions Laparoscopic radical resection for low rectal cancer with telescopic anastomosis or colostomy by stapler through transanal resection without abdominal incisions is safe and feasible. Satisfactory clinical outcome can be achieved mini-invasively.

Objective:To evaluate the efficacy and safety of pegaspargase plus GEMOX (pegaspargase, gemcitabine, oxaliplatin) regimen in the initial treatment of nasal NK/T-cell lymphoma. Methods: Twelve preliminarily diagnosed nasal NK/T-cell lymphoma patients in Tianjin Medical University Cancer Institute and Hospital from June 2011 to March 2012 were analyzed. All patients took the pegaspargase plus GEMOX regimen (gemcitabine 800-1 000 mg/m2 on days 1 and 8, oxaliplatin 130 mg/m2 on day 1, and pegaspargase 2 500 IU/m2 on day 2), every three weeks for one cycle. The efficacy and toxicity of the regimen were evaluated in the follow-up treat-ment. Results:After two cycle treatments, 1 patient dropped out of treatment because of acute pancreatitis;the remaining 11 patients had response, in which 1 achieved complete response , 7 had partial response, 2 had stable disease, and 1 had progressive disease. The objective response rate was 72.7%, and the disease control rate was 90.9%. The 2-year overall survival rate was 90.9%. With median 6-cycle P-GEMOX regimen treatment, 81.8% of 11 patients presented side effects, primarily myelosuppression and hepatic dysfunc-tion. Conclusion:Pegaspargase plus GEMOX regimen showed high efficacy on the initial treatment of nasal NK/T-cell lymphoma pa-tients, but the incidence of adverse effect was still high.

Objective To study the clinical efficacy of anus-preserving rectectomy by using telescopic anastomosis of colon and rectal mucosa for the middle and lower rectal cancer. Methods A retrospective analysis was carried out in 402 cases with middle and lower rectal cancer undergoing telescopic anastomosis for anus-preserving procedure, including 241 males and 161 females, age ranging from 21 to 99 years, averaging at 55. 7 years. The distal margins of the tumors were within 6 - 9 cm to anal verge. According to TNM staging, there were 123 cases in Stage Ⅰ , 244 cases in Stage Ⅱ , 31 cases in Stage Ⅲ,and 4 cases in Stage Ⅳ. Results 345(345/402, 85. 8% ) cases were followed up, the median time of the follow-up was 6. 1 years. Postoperative complications included 17(4.2%) cases of stomal leakage, 11(2.7% ) cases of stomal stenosis. All patients recovered normal defecating function 12-24 weeks post operation. Local recurrence rate was 6. 3% (22/345). Hepatic and lung metastasis was 13. 6% (47/345) and 2. 6% (9/345)respectively. The five year survival rate was 68. 7% (112/163). Conclusions Anuspreserving rectectomy by using telescopic anastomosis is safe and effective procedure to treat middle and lower rectal cancer, with the preservation of anal function and without the increasing rate of local recurrence.

Objective To study clinical therapeutic effects of anus-preserving operation with resecting anal intersphincter to treat ultra-low rectal cancer through abdominal cavity. Methods We retrospectively analyzed 52 cases of ultra-low rectal cancer, with the inferior border of the cancers within 2 cm to anocutaneous line or 5 cm to the edge of anus treated by anus-preserving operation with resecting archos internal sphincter muscles through abdominal cavity and anus. There were 29 males, and 23 females, with age 28 to 76 years old, averaging 56. 3 years old. The inferior border of the cancer were within 4 cm to the edge of anus in 18 cases, including 6 cases of adenoma cancerization, and 5 cm to the anus in 34 cases. Pathologic diagnosis was well-differentiated adenocarcinoma in 21 cases, moderately differentiated in 29 cases, low differentiated in 2 cases, there were 6 cases with adenoma cancerization. 28 cases were Dukes A stage, and 24 B stage. Results The follow-up rate was 88. 4% (46/52), and the median time was 5.9 years. 2 case developed stoma leak (3.8%), and 3 developed stoma stenosis(5.7% ) after operation. The anus could roughly control defecation in 6 ～ 12 mouths after operation. The local recurrence rate was 5.7%, and the 5-year-survival rate was 72.7%. Conclusion By anus-preserving operation with resecting archos internal sphincter muscles, defecation controlling was well reserved by anus, and the 5-year-survival rate was not cut down. This operation is one of the safe and effective operations of anus-preserving procedure.

OBJECTIVETo separate and detect membrane phospholipids and study the relationship of metabolism and signal transduction pathways of membrane phospholipids with genesis and hepatic metastasis of large intestinal carcinoma.

METHODSForty-eight cases of colorectal cancer were detected with high performance liquid chromatography. Membrane phospholipids of phosphatidylinosital (PI), phosphatidylserine (PS), phosphatidylethanolamine (PE) and phosphatidylcholine (PC) in primary foci, paratumor intestinal mucosa and hepatic metastasis of large intestine cancer were separated and analyzed.

RESULTSIn primary foci, paratumor intestinal mucosa, and hepatic metastasis of the 48 cases, the contents (mg/g) of PI were: 0.92 +/- 0.12, 1.57 +/- 0.14, 1.54 +/- 0.15 respectively, and PC 56.47 +/- 5.33, 108.57 +/- 6.37, 116.35 +/- 6.85. The contents of PI and PC were higher in primary foci and hepatic metastasis than in paratumor mucosa (F = 363.10, 870.10, P < 0.01). The contents of PE in the three tissues were 18.23 +/- 3.56, 42.02 +/- 4.33, 79.51 +/- 5.52, and in hepatic metastasis was the highest (F = 1 149.63, P < 0.01). PI and PC in primary foci of hepatic metastatic group and nonmetastasis group were not significantly different (t = 3.55, P > 0.05). But the PE content was higher in hepatic metastasis than in primary foci (t = 115.87, P < 0.01).

CONCLUSIONSMembrane phospholipids have obvious variations in genesis and hepatic metastasis of large intestine cancer. Rises of PI and PC were associated with genesis of large intestine carcinoma. The increase of PE content is closely related to invasion and hepatic metastasis of large intestine cancer.

Adult ; Aged ; Aged, 80 and over ; Chromatography, High Pressure Liquid ; Colorectal Neoplasms ; metabolism ; pathology ; Female ; Humans ; Intestinal Mucosa ; chemistry ; Liver Neoplasms ; secondary ; Male ; Membrane Lipids ; analysis ; Middle Aged ; Phospholipids ; analysis