OBJECTIVE: To investigate the feasibility of salvage surgery of thyroid carcinoma in advanced stage with common carotid artery involvement. METHODS: Reviewed 4 cases of advanced-stage thyroid carcinoma treated in the Department of Otolaryngology, West China hospital from July 2006 to September 2009. CT revealed that the common carotid artery entrapped in the tumor without obvious anatomical space. 2 cases were proved to be low-differentiated squamous carcinoma pathologically and the rest 2 cases were papillary carcinoma. Total thyroidectomy, total laryngectomy and bilateral neck dissection were performed in 3 cases while in one case, total thyroidectomy, bilateral neck dissection and partial tracheal resection being performed. Adjacent prepared cervico-pectoral flap was used to reconstruct the defect of cervico-thoracic trachea. Rupture of common carotid artery in one case took place and was repaired by mere suture. One case of low differentiated squamous carcinoma was given postoperative chemotherapy and radiotherapy while the rest 3 cases given no adjuvant chemotherapy and radiotherapy. The follow-up time lasted from half a year to 2 years. RESULTS: Half a year postoperatively, the low-differentiated squamous carcinoma patient not receiving postoperative chemoradiotherapy suffered from lumber spinal metastasis, one year after operation he was still alive and half a year later lost follow-up, the other 3 patients were alive from half a year to 2 years postoperatively without any obvious clue of recurrence or remote metastasis. CONCLUSION Salvage surgery is still feasible in thyroid carcinoma in advanced stage with common carotid artery involvement. The larynx and trachea should be kept intact as possible but the reconstruction of the trachea defect is recommended to be less prior in the situation when carotid artery is involved in.
Adult ; Carcinoma, Papillary ; pathology ; surgery ; Carcinoma, Squamous Cell ; pathology ; surgery ; Carotid Artery, Common ; pathology ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Salvage Therapy ; Thyroid Neoplasms ; pathology ; surgery

Objective:To investigate the effects of three monomer components stilbene glycoside, emodin, catechin of Polygonum multiflorum on damages of liver tissue and cell.Methods:A total of 48 rats were randomly divided into four groups of stilbene glycoside, emodin, catechin-and normal saline(control)-treated groups(n=12, each). Rats were gavaged with the same dose of 1 g/kg for stilbene glycoside, emodin, catechin groups and normal saline for control group for 28 days.During the administration, the general state of rat was observed.After the last administration, serum biochemical indexes related to liver function were detected.Pathological morphological changes of liver tissue were observed by hatmatoxylin-Eosin(HE)staining.The expression levels of apoptosis-related proteins in liver tissue were determined by Western blot.Cells of human normal liver cell line LO2 divided into the stilbene glycoside-, emodin-, catechin-treated cells groups were cultured with 7 different concentrations of interfering agents for 24 h and 48 h respectively, and cultured with normal saline in the control group for the same time.Cell proliferation was observed using the cholecystokinin octapeptide(CCK8), and the mRNA expressions of apoptosis-related factors were detected using PCR.Results:After 28 days of feeding, there was no significant difference in body weight and food intake among the four groups( P>0.05). Pathological liver damage and abnormal liver biochemical indexes were observed in rat liver tissues in the emodin and catechin groups( P<0.05). Compared with the control group, the expression levels of anti-apoptotic proteins Bcl-2 were decreased(0.34±0.03, 0.41±0.07 vs.0.45±0.04, P<0.05), the expression levels of apoptotic proteins Caspase-3 and Bax were increased(0.76±0.03, 0.27±0.06 vs.0.03±0.00; 0.44±0.03, 0.15±0.04 vs.0.02±0.00, P<0.01), and those in the stilbene glycoside group were normal.Compared with the control group, emodin and catechin-treated cell groups showed the concentration-and time-dependent proliferation inhibition in LO2 normal hepatocytes( P<0.05)after treatment.And the mRNA expression of hepatocyte apoptosis factors Bax and Caspase-3 were increased(1.74±0.05, 1.29±0.01 vs.0.89±0.12, 1.21±0.07, 1.25±0.01 vs.0.97±0.07, P<0.01), and that of anti-apoptotic proteins Bcl-2 was decreased(0.06±0.06, 0.56±0.11 vs.1.39±0.18, P<0.01). Compared with the control group, the survival rate had no significant difference in the stilbene glycoside treated-cell group( P>0.05), while its mRNA expression of hepatocyte apoptosis factors was reduced( P<0.05). Conclusions:No obvious liver damage is found in rats treated with the stilbene glycoside of Polygonum multiflorum, but the emodin and catechin cause damages of liver tissue and cell in vivo and in vitro.

Objective To observe the optimal target areas for shear wave velocity(SWV)evaluation on stages of chronic kidney disease(CKD)in different sides(left,right),different parts(upper pole,middle part and lower pole)and different tissue(renal cortex,renal medulla,renal sinus)of kidney.Methods Sixty-five CKD patients(130 kidneys)were retrospectively collected.SWV were compared between different sides,among different parts and tissue of kidney.The optimal regions for evaluating CKD stages were screened.Results No significant difference of SWV was found between left and right kidneys in same parts for same tissue(all P＞0.05),while significant differences of SWV of the same tissue were noticed among upper pole,middle part and lower part of kidney on the same side(all P＜0.05),i.e at upper pole＞at middle part＞at lower pole.Significant differences of SWV were also observed among renal cortex,medulla and sinus of kidney in the same side and parts(all P＜0.05),and the sinus had the highest SWV.Intraclass correlation coefficient analysis showed that the repeatability of the measurements of SWV was the best at the middle part of kidney.Besides,significant differences of SWV were found between renal cortex and medulla at the middle part of kidney among patients with stages 1,2,3 and 4-5 CKD(all P＜0.05),while the highest SWV were observed in patients with 4-5 stage CKD(all P＜0.05).SWV of renal cortex and medulla at middle part were positively correlated with CKD stages(both P＜0.01),the area under the curve of them for evaluating stage of CKD was 0.802 and 0.774,respectively.Conclusion The optimal target areas for SWV evaluation on stages of CKD were renal cortex and medulla at middle part of kidney.

Objective:To investigate the role of serum hepatitis B virus RNA (HBV RNA) in predicting HBeAg serological conversion in children with chronic hepatitis B.Methods:175 children aged 1~17 years with chronic hepatitis B who received interferon α (IFNα) for 48 weeks were selected. Patients were divided into HBeAg seroconversion and non-conversion based on whether HBeAg seroconversion occurred at 48 weeks of treatment.T-test and Mann-Whitney U test were used to compare between groups; chisquare test or Fisher exact probability method was used to compare the frequency between groups of classified variables; and Pearson correlation was used to analyze the correlation between indicators. Univariate and multivariate logistic regression analyses were used to identify influencing factors associated with HBeAg serological conversion. The predictive effect of HBV RNA, HBV DNA, and HBsAg on HBeAg serological conversion was compared and analyzed by the receiver operating characteristic curve (ROC).Results:The seroconversion rate of HBeAg at 48 weeks was 36.0% (63/175). The reduction in HBVRNA levels from baseline to the 12th, 24th, 36th, and 48th weeks of antiviral therapy was significantly greater in the HBeAg serological conversion group than that in the non-conversion group, and the difference was statistically significant between the two groups (P < 0.05). Univariate and multivariate regression analyses showed that age and a decline in HBV RNA levels at week 12 were independent predictors of HBeAg serological conversion. The area under the ROC curve (AUROC) of HBV RNA decline at week 12 was 0.677(95% CI∶0.549-0.806, P = 0.012), which was significantly better than the same period of AUROC of HBV DNA (0.657, 95% CI∶0.527-0.788, P = 0.025) and HBsAg (0.660, 95% CI∶0.526-0.795, P = 0.023) decline. HBV RNA levels decreased (>1.385 log10 copies/ml) at week 12, with a positive predictive value of 53.2%, a negative predictive value of 72.2%, a sensitivity of 77.4%, and a specificity of 57.9% for HBeAg seroconversion. Conclusion:HBV RNA level lowering during the 12th week of antiviral therapy can serve as an early predictor marker for HBeAg serological conversion in children with chronic hepatitis B.

Objective:To investigate the clinical value of multiparameteric quantitative ultrasound combined with a non-invasive prediction model for assessing high-risk steatohepatitis.Methods:One hundred and ninety-four cases with metabolic-associated fatty liver disease (MAFLD) who underwent liver biopsy in Huashan Hospital, Fudan University, from June 2021 to September 2022 were selected. Shear wave elastography (SWE), shear wave dispersion (SWD) imaging, and attenuation imaging (ATI) examinations were conducted in all patients before biopsy. High-risk steatohepatitis was defined as a total activity score of ≥4 in patients with steatohepatitis, hepatocellular ballooning, and liver lobular inflammation based on pathological hepatic steatosis, inflammatory activity, and fibrosis scoring system (SAF), and fibrosis stage≥F2. Binary logistic regression analysis was used to identify the factors influencing high-risk steatohepatitis. A predictive model for diagnosing high-risk steatohepatitis was constructed using R language. The DeLong test was used to compare the area under the curve between groups. Measurement data was compared between groups using the t-test or rank-sum test, and count data were compared between groups using the χ2 test. Results:There were 46 cases (23.7%) with high-risk steatohepatitis. The quantitative ultrasound parameters included elastic modulus ( OR=2.958, 95% CI: 1.889-4.883, P<0.001), dispersion coefficient ( OR=1.786, 95% CI: 1.424-2.292, P<0.001) and attenuation coefficient ( OR=42.642, 95% CI: 3.463-640.451, P=0.004). Serological indexes of fasting blood glucose ( OR=1.196, 95% CI: 1.048-1.392, P=0.011), alanine aminotransferase ( OR=1.012, 95% CI: 1.006-1.019, P<0.001), aspartate aminotransferase ( OR=1.027, 95% CI: 1.014-1.042, P<0.001), γ-glutamyl transferase ( OR=1.008, 95% CI: 1.001-1.017, P=0.041) and HDL cholesterol ( OR=0.087, 95% CI: 0.016-0.404, P=0.003) were the factors influencing its progression. The AUCs of elastic modulus, dispersion coefficient, attenuation coefficient, multiparametric ultrasound model, serological index model, and ultrasound combined with serology model for the diagnosis of high-risk steatohepatitis were 0.764, 0.758, 0.634, 0.786, 0.773 and 0.825, respectively. The results of the DeLong test showed that the ultrasound combined with the serological model was significantly better than the serological index model and the elastic modulus, dispersion coefficient, and attenuation coefficient alone ( P=0.024, 0.027, 0.038 and <0.001). Conclusion:The combination of multiparametric quantitative ultrasound is helpful for the non-invasive diagnosis of high-risk steatohepatitis and possesses great clinical significance.