Surgery is the major treatment option for malignant tumors and some benign neoplasms of the thyroid, most of which are differentiated thyroid carcinoma. Despite the progresses that have been made in surgical techniques, iatrogenic injuries of the parathy-roid and laryngeal nerves, including superior and recurrent laryngeal nerves, could not be completely avoided in the surgical manage-ment of thyroid tumors. In this review, the causes of intraoperative injuries of parathyroid and laryngeal nerves are systematically ana-lyzed with respect to types and extents of surgical operations, changes in topical anatomy, and secondary thyroid surgeries. The princi-ples and strategies for protecting and restoring injuries of the parathyroid and laryngeal nerves are also elucidated for the effective prevention and adequate treatment of these major complications in the thyroid surgery.

Overexpression of the epidermal growth factor receptor (EGFR) is a common characteristic of head and neck squamous cell carcinomas (HNSCC) , and initiates important signal transduction pathways in carcinogenesis. Now the EGFR is a validated target for cancer therapies in HNSCC. However, the effect of EGFR-targeted therapies is only modest because of primary and/or acquired resistance. Therefore, an improved understanding of the molecular mechanisms of resistance to EGFR inhibitors may establish new treatment options to overcome resistance. In this review, the molecular mechanisms of resistance and the strategies to overcome it were summarized.
Antineoplastic Agents ; Carcinoma, Squamous Cell ; drug therapy ; Drug Resistance, Neoplasm ; ErbB Receptors ; Head and Neck Neoplasms ; drug therapy ; Humans ; Signal Transduction ; Squamous Cell Carcinoma of Head and Neck

OBJECTIVE: To-evaluate the role and clinical value of cetuximab in the treatment of head and neck squamous cell carcinoma (HNSCC), and figure out its effectiveness and application, so as to develop evidence-based recommendations for treatment. METHOD: We comprehensively searched the CBM, Pubmed, EMBASE, and the Cochrane databases to identify published studies on the effect of cetuximab in HNSCC patients. Primary outcomes included overall survival (OS), progression-free survival(PFS) and overall response rate(ORR). Secondary outcomes included serious adverse events, such as neutropenia, anemia, thrombocytopenia, skin reactions, hypokalemia, vomiting, asthenia, hypomagnesemia, dyspnea and sepsis. Results were dispalyed as risk ratio (RR), odds ratio (OR), mean difference (MD) and 95% CI. RESULT: A Meta-analysis was conducted on 4 randomized controlled trials, including 2 trials comprising 1,319 patients with locally advanced HNSCC and 2 trails comprising 559 patients with recurrent or metastatic HNSCC. For locally advanced HNSCC, the 2 year PFS and OS showed no significant differences in patients received cetuximab or not (PFS fixed effect: RR=1.02, 95%CI 0.92-1.12, P>0.05; OS fixed effect: RR=1.06, 95%CI 1.00-1.13, P>0.05, respectively). Grade 3-4 dysphagia was also similar in patients treated with cetuximab or no cetuximab (dysphagia: fixed effect: RR = 0.92; 95% CI 0.84-1.02, P>0. 05). Only grade 3-4 mucositis and skin reaction showed statistical significance between patients treated with cetuximab and patients with no cetuximab (mucositis: fixed effect: RR=1.21; 95%CI 1.07-1. 36, P<0. 05; skin reaction: fixed effect: RR=1.99; 95%CI 1.39-2.85, P<0.05, respectively). For recurrent or metastatic HNSCC, the OS overall mean difference was 2.41 (95% CI 0.96-3.86, P<0.05), the PFS overall mean difference was 2. 06 (95% CI 1.34 - 2.77, P<0.05), and the ORR overall Odds ratio was 2.38 (95% CI 1.60-3.54,P<0.05), suggesting significant effect of cetuximab in improving the prognosis of R/M HNSCC. Owing to small number of trials it was not possible to assess the presence of publication bias. Of note, the 1 year survival overall Odds ratio was 1.39 (95% CI 0.98-1.97, P>0.05). The grade 3 or 4 adverse effects were described in 83. 4% of patients in cetuximab group and 75. 5% of patients in no cetuximab group. The overall side effects risk ratio suggested statistically significant difference between patients treated with cetuximab and pa- tients with no cetuximab (RR=1.11, 95% CI 1.01-1.20, P<0.05, P =47%). CONCLUSION The 2 year progression-free survival and overall survival were similar between cetuximab group and no cetuximab group in patients with locally advanced head and neck squamous cell cancer. Data are limited and the benefits of cetuximab on this outcome remain uncertain. Impact of grade 3-4 dysphagia was similar in both groups, however, the incidence of grade 3-4 mucositis and skin reaction were lower in patients treated with cetuximab. Existing randomized controlled trials provided a scientific evidence for the use of cetuximab in R/M HNSCC. The conclusion of the study is based on limited number of RCT, so further investigation is still needed before firm recommendations of cetuximab can be made in the treatment of HNSCC.
Antibodies, Monoclonal, Humanized ; therapeutic use ; Antineoplastic Agents ; therapeutic use ; Carcinoma, Squamous Cell ; drug therapy ; Cetuximab ; Disease-Free Survival ; Head and Neck Neoplasms ; drug therapy ; Humans ; Squamous Cell Carcinoma of Head and Neck

Carcinoma, Squamous Cell ; surgery ; Head and Neck Neoplasms ; surgery ; Humans ; Nose Neoplasms ; surgery ; Paranasal Sinus Neoplasms ; surgery ; Reconstructive Surgical Procedures

Objective:To provide reference for the pharmaceutical care for aged acute cerebral infarction with various complica-tions. Methods:Clinical pharmacists participated in the treatment for an elder patient with acute cerebral infarction complicated with gastrointestinal bleeding, liver dysfunction and pulmonary infection through providing drug therapy information, analyzing the effect and safety of drug therapy and adjusting the pharmaceutical care plan according to the drug efficacy in time. Results:Taking use of phar-maceutical knowledge, clinical pharmacists provided whole-course pharmaceutical care for the treatment of the patient and coordinated with doctors to make the drug therapy, which guaranteed the effectiveness and safety of therapy. Conclusion:The old are with high in-cidence of cerebral infarction, and complications are common. Due to their physiological dysfunction and the other reasons, high safety risk exists in their drug therapy. Clinical pharmacists can use their professional knowledge to provide whole-course pharmaceutical care for the patients in order to improve the therapeutic effect and promote the rational drug use.

Head and Neck Neoplasms ; therapy ; Humans ; Palliative Care

Genetic Therapy ; Head and Neck Neoplasms ; therapy ; Humans

Humans ; Thyroid Diseases ; diagnosis ; surgery

Objective To report arthroscopic reconstruction of anterior cruciate ligament (ACL) with iliotibial tract autograft and gracilis tendon by Moriya s method and to evaluate its clinical results. Methods The iliotibial tract autograft of about one third length was dissected with the tibial attachment kept. Then the trimmed gracilis tendon was wrapped in the iliotibial tract to reconstruct ACL. 16 patients (12 males and 4 females) were treated in this way. The anterior drawer test and the Lachman s test were all positive before operation, indicating that anteromedial and posterolateral bundles of ACL were totally broken, which was proved by arthroscopy. Results All patients were followed up for 4 to 17 months (mean 9 months). According to the criteria for knee ligament function evaluation set up by Japanese Association of Orthopaedics( JOA) , 10 patients scored ≥ 90 points, 5 patients 80 to 90 points, and 1 patient ≤ 80 points.The excellent and good rate was 93.75% . Conclusion Iliotibial tract autograft transfer with gracilis tendon to reconstruct ACL under arthroscopy boasts convenience in harvesting grafts, simplicity in performance and excellent results, without evidence of damaging extension and flexion tendons of the knee or causing patellofemoral pain. [

Objective:To evaluate the significance of expression of laminin (LN) and vascular endothelial growth factor(VEGF) in adenoid cystic carcinoma of salivary glands. Methods:Ultrasensitive immunohistochemical staining(S-P) was used to examine LN and VEGF expression in specimens from 34 patients with adenoid cystic carcinoma of salivary glands.Results:Higher LN expression was found in adenoid or tubular type of the cases (P0.05). Higher VEGF expression was found in stage Ⅲ-Ⅳ of the tumor (P0.05). Conclusion: LN and VEGF expression may be served as one of the predictors for the biological behavior of adenoid cystic carcinoma of salivary glands.