Objective To observe the effectiveness and safety of DiaSphere embolized microsphere TACE for treating primary hepatocellular carcinoma(HCC).Methods Totally 188 patients with HCC were prospectively enrolled and randomly assigned to research group(n=93)and control group(n=95),who underwent TACE with DiaSphere embolized microspheres and Embosphere embolized microspheres,respectively.The incidence of TACE-related adverse events were recorded.The therapeutic efficacy 1 month after the first TACE,also 1 and 3 months after the last TACE,and liver functions 1 month after the first and last TACE were compared between groups.Results In research group,there were 69 cases underwent 1 time TACE,22 cases underwent 2 times and 2 cases underwent 3 times TACE,while in control group,there were 82 cases underwent 1 time and 13 cases underwent 2 times TACE,respectively.No statistical difference of the incidence of adverse events was found between groups(77.42%[72/93]vs.76.84%[73/95],P=1.000).One month after the first TACE,7 cases in research group and 11 cases in control group were lost to follow-up,respectively.One month after the last TACE,12 cases were lost to follow-up in both groups,and 3 months after the last TACE,28 cases were lost to follow-up in both groups.No significant difference of objective response rate nor disease control rate was found between groups at the above time points(all P＞0.05).One month after the first and last TACE,liver function indicators were not different between groups(all P＞0.05).Conclusion Both the short-term efficacy and safety of TACE with DiaSphere embolized microspheres for treating HCC were good.

Objective To observe the effectiveness and safety of DiaSphere embolized microsphere TACE for treating primary hepatocellular carcinoma(HCC).Methods Totally 188 patients with HCC were prospectively enrolled and randomly assigned to research group(n=93)and control group(n=95),who underwent TACE with DiaSphere embolized microspheres and Embosphere embolized microspheres,respectively.The incidence of TACE-related adverse events were recorded.The therapeutic efficacy 1 month after the first TACE,also 1 and 3 months after the last TACE,and liver functions 1 month after the first and last TACE were compared between groups.Results In research group,there were 69 cases underwent 1 time TACE,22 cases underwent 2 times and 2 cases underwent 3 times TACE,while in control group,there were 82 cases underwent 1 time and 13 cases underwent 2 times TACE,respectively.No statistical difference of the incidence of adverse events was found between groups(77.42%[72/93]vs.76.84%[73/95],P=1.000).One month after the first TACE,7 cases in research group and 11 cases in control group were lost to follow-up,respectively.One month after the last TACE,12 cases were lost to follow-up in both groups,and 3 months after the last TACE,28 cases were lost to follow-up in both groups.No significant difference of objective response rate nor disease control rate was found between groups at the above time points(all P＞0.05).One month after the first and last TACE,liver function indicators were not different between groups(all P＞0.05).Conclusion Both the short-term efficacy and safety of TACE with DiaSphere embolized microspheres for treating HCC were good.

BACKGROUND: SMARCA4-deficient non-small cell lung cancer (SMARCA4-dNSCLC) is a rare primary lung malignancy. These diseases are not listed separately in the 2021 World Health Organization (WHO) classification of lung neoplasms, but they have special morphological, immunophenotypic and molecular genetic characteristics. This study aims to improve understanding of SMARCA4-dNSCLC by discussing the clinicopathological features, diagonosis and differential diagnosis of the disease. METHODS: The clinical and imaging data of 9 cases of SMARCA4-dNSCLC diagnosed in Shanghai Changhai Hospital from January 2020 to March 2022 were collected. The clinicopathological features were analyzed by histological and immunohistochemical staining, and the literature was reviewed. RESULTS: The median age of 9 patients was 65 years old. Six men were smokers. The average maximum diameter of tumor was 3.3 cm. Six cases had been metastasized. The imaging showed that it was an infiltrating mass with unclear boundary and 3 cases invaded the pleura. Nine cases were diagnosed as SMARCA4-dNSCLC, which mainly showed three pathological forms including classic lung adenocarcinoma, mucinous adenocarcinoma and poorly differentiated carcinoma. Poorly differentiated tumor cells are epithelioid, syncytial or rhabdomyoid, the cytoplasm was rich, the cytoplasm could be completely transparent to eosinophilic, eosinophilic globules or small abscesses could be seen, showing solid flakes, with more inflammatory cells and flake necrosis in the stroma. Immunohistochemistry showed that SMARCA4 was negative in all cases and eight cases demonstrated cytokeratin 5.2 (CAM5.2) and cytokeratin 7 (CK7) was diffusely strongly positive, p40 was negative, thyroid transcription factor-1 (TTF-1) was negative in 6 cases, partially positive in 2 cases and diffusely positive in 1 case. CONCLUSIONS SMARCA4-dNSCLC is a rare subtype of lung cancer with complex and diverse pathological morphology. The characteristic of immunohistochemical phenotype can assist in the diagnosis.
Biomarkers, Tumor/genetics* ; Carcinoma, Non-Small-Cell Lung/genetics* ; China ; DNA Helicases/genetics* ; Humans ; Lung Neoplasms/pathology* ; Nuclear Proteins/genetics* ; Transcription Factors/genetics*

Chronic kidney disease,especially in patients with end-stage renal disease (ESRD),is prone to causing secondary hyperparathyroidism,and part of refractory secondary hyperparathyroidism patients require treatment with parathyroidectomy.Parathyroidectomy makes the thyroid inevitably subject to mechanical stimulation,leading to transient mechanical thyroiditis,hyperthyroxinemia and postoperative transient thyrotoxicosis,causing dysfunction in multiple systems of the body,and even inducing or aggravating water and electrolyte disorders (such as hyperkalemia),arrhythmia and cardiovascular events.However,this complication has not yet received sufficient clinical attention.This article will discuss the prevention and treatment of thyrotoxicosis or hyperthyroidism,one of the postoperative complications,in secondary hyperparathyroidism patients with ESRD,based on the relevant documents and our own clinical practice.

Objective To investigate the clinical application value of stathmin, p16 and Ki-67 in the cervical intractable cases. Methods Immunohistochemical method was used to detect the expressions of stathmin, p16 and Ki-67 in surgical specimens of 288 cervical intractable cases, including 30 cases of cervical benign changes, 70 cases of cervical intraepithelial neoplasia (CIN)Ⅰ, 78 cases of CINⅡ, 85 cases of CINⅢand 25 cases of squamous cell carcinoma (SCC, as control group). The application value of stathmin, p16 and Ki-67 in the cervical cases were analyzed. Results The positive expression rates of Ki-67 of cervical benign changes and CINⅠwere 20.0 % (6/30) and 54.3 % (38/70) (χ2 = 3.29, P> 0.05). The expression rates of Ki-67 in CINⅡ, CINⅢ and SCC were all 100.0 %, and compared with the cervix benign changes, the differences were statistically significant (χ2= 112, P< 0.05). The expression rates of p16 in cervical benign changes and CINⅠwere 6.7 % (2/30) and 91.4 % (64/70), and there was significantly statistical difference (χ2=50.64, P<0.05). However, the expression rates of p16 in CINⅡ, CINⅢand SCC were all 100.0%, and compared with the cervix benign changes, the differences were statistically significant (χ2= 7.18, P< 0.01). The expression rates of stathmin in cervical benign changes, CINⅠ, CIN Ⅱ, CINⅢ and SCC were 3.3 %(1/30), 5.7 % (4/70), 23.1 % (18/78), 77.0 % (67/87) and 100.0 % (25/25), respectively, and there was no statistic difference in cervical benign changes, CINⅠand CINⅡ (χ2=0.68, P>0.05), but the expression rates in CINⅢ and SCC were higher than those in cervical benign change, CINⅠand CIN Ⅱ(P< 0.01). The positive expressions of stathmin, p16 and Ki-67 in each group of CIN were positively correlated (r= 0.412, P< 0.05). Conclusions Combined detection of p16 and Ki-67 can assist in the differential diagnosis of cervical intractable cases, and provide objective indicators for the classification and accurate diagnosis of CIN. Combined detection of p16 and stathmin may help to identify high-grade, low-grade CIN and cervix benign changes for the reduction of over-treatment.

Objective To report our experience in reconstruction with free jejunal flap for circumferential defect following resection of hypopharygeal and cervical esophageal carcinoma.Methods A retrospective analysis was conducted to evaluate the outcomes of reconstruction with free jejunal flaps for circumferential defects in 103 patients treated from Aug 2008 to Mar 2015.Among them,84 were hypopharyngeal carcinoma and 19 were cervical esophageal carcinoma;31 patients had total pharyngolaryngectomy,70 had total pharyngolaryngectomy and cervical esophagectomy and 2 had laryngeal preservation.All patients underwent bilateral neck dissection and 84 underwent retropharyngeal lymph node dissection.Results The 3 year overall survival rate was 51.6％ and disease-specific survival rate was 50％ The 5 year overall survival rate was 39.1％.No in-hospital death,one patient had unsalvageable flap failure and underwent second reconstruction with free jejunal flap.The success rate for the free jejunal flaps was 99％ (102/103).Pharyngocutanous fistula occurred in 3 patients and all healed with conservative treatment.Satisfactory oral intake was achieved in all patients.Conclusions Oncological and functional outcomes of reconstruction with free jejunal flap for circumferential defects of hypopharynx and cervical esophagus were satisfying.Multidisciplinary cooperation is helpful to improve surgical success rate.Free jejunal flap is an ideal method for reconstruction of circumferential hypopharyngeal and cervical esophageal defects after removal of tumor.

Objective To investigate the efficacy of surgery followed by adjuvant radiotherapy and the prognostic factors affecting the results of treatment in hypopharyngeal carcinoma.Methods A retrospective review of 149 patients with hypopharyngeal carcinoma that received surgical treatment from Jun 2003 to Jun 2010 was accomplished.In the 149 patients,the site of origin were pyriform sinus (n =121),posterior pharyngeal wall (n =21) and postcricoid (n =7).According to UICC 2002 criteria,there were 3 in stage Ⅰ,15 in stage Ⅱ,29 in stage Ⅲ and 102 in stage Ⅳ.Surgical methods for primary tumor were:pyriform sinus resection or posterior pharyngeal wall resection in 22 cases,partial pharyngectomy and partial laryngectomy in 29 cases,partial pharyngectomy and total laryngectomy in 67 cases,total pharyngectomy and total laryngectomy in 16 cases,total pharyngolaryngectomy and partial esophagus resection in 12 cases,and total esophagus resection in 3 cases.All the patients received elective and/or radical neck dissection.Unilateral or bilateral thyroid lobectomy was performed in 98 cases.Eighty-seven patients received intensity modulation radiated therapy (IMRT) postoperatively in the cancer center of Provincial Hospital Affiliated to Shandong University.Individualized adjustment of the radiation field was made according to the surgical condition.Forty-nine cases received radiotherapy in other hospitals (dose 50-70 Gy).Laryngeal function was restored in 51 patients (34.2％).The risk clinicopathological factors of survival and the causes of death were analyzed.Results The survival rate was calculated with Kaplan-Meier method.The overall 3-and 5-year survival rates were 47.7％ and 38.7％,respectively.There were no significant differences in 3-year survival between T1-2 and T3-4 groups,N0 and N + groups,stage Ⅰ-Ⅱ and Ⅲ-Ⅳ groups,laryngeal function preserved and unpreserved groups.The overall 3 years survival rate of patients received surgery and adjuvant radiotherapy was higher than those just received surgery alone (x2 =6.851,P ＜ 0.05).The 3-year survival rate in patients treated in comprehensive treatment group has showed a good trend,although still no statistical significance (x2 =0.176,P ＞ 0.05).The cause of death in 86 patients,including regional lymph nodes recurrence in 25 cases (29.1％).Of them,one was stoma recurrence and 9 were retropharyngeal lymph nodes metastasis; distant metastasis in 19 cases (22.1％) ; local recurrence in 13 cases,local or regional recurrence with distant metastasis in 8 cases (9.3％),and second primary cancer in 6 cases (7.0％).Conclusions The overall prognosis of hypopharyngeal carcinoma was poor and dismal.In accordance with specific conditions of surgery,active adjustment of the personalized protocol of IMRT was the key of improving the efficacy of hypopharyngeal carcinoma.

Objective To investigate the necessity and feasibility of planned dissection of the retropharyngeal lymph nodes (RPLN) in advanced hypopharyngeal cancer.Methods Between February 2011 and December 2012,54 patients with advanced hypopharyngeal cancer accepted planned dissection of the RPLN during primary surgery.There were 45 cases of pyriform sinus carcinoma,5 cases of posterior pharyngeal wall carcinoma,and 4 cases of postcricoid carcinoma.All patients underwent surgery and postoperative adjuvant radiotherapy,meanwhile bilateral neck dissection and RPLN dissection were performed.All patients received preoperative CT scanning (with contrast).The results of the radiographic assessment were compared with the postoperative pathologic findings respectively.Results RPLN were confirmed positive by pathology in 13 cases,and negative in another 43 cases.For the entire treatment group,metastasis to the RPLN was confirmed hispathologically in 12 patients (22.2％).Eight patients were pyriform sinus carcinoma,4 were posterior pharyngeal wall carcinoma.Among them,seven patients were diagnosed as RPLN metastasis by CT imaging and another 5 patients were not confirmed.The overall accuracy for the radiologist's interpretation was 79.6％,the sensitivity was 58.3％,and the specificity was found to be 85.7％.Eleven patients were N2-3 and 6 patients were N2c.No RPLN metastasis or recurrence was found during more than one year follow-up period.Conclusions It is not rare for the RPLN metastasis in patients with advanced hypopharyngeal carcinoma.CT imaging is not effective in determining the early presence of RPLN metastasis.The planned dissection of the RPLN is highly recommended during the initial surgery of hypopharyngeal cancer,especially in posterior pharyngeal wall carcinoma,T3-4 pyriform sinus carcinoma and staged N2-3 cases.

Objective To study the feasibility and therapeutic effect of recurrent laryngeal nerve (RLN) decompression in the treatment of bilateral paralyzed RLN after thyroid surgery.Methods From March 2005 to June 2013,15 cases of bilateral RLN paralyses occurring within 3 months after thyroid surgery were treated with RLN decompression.Bilateral RLN paralyses were caused by revised thyroid surgery in 8 cases and by primary thyroid surgery in 7 cases.Results RLN injuries were found in 15 cases/ 22 side,including RLN-cut in 9 sides and RLN-ligated in 13 sides.RLN decompression was performed in the 10 cases/13 sides of ligated RLN.Vocal cord mobility was detected through electrolaryngoscope for evaluating the postoperative functional recovery of decompressed RLN.Of 8 patients with bilateral RLN paralyses due to the ligation of RLN after previous revised thyroid surgeries,functional adduction and abduction of the vocal cord was recovered completely in 4 patients and recovered basically with a slight weak abduction in one patient after RLN decompression,and the 5 patients were decannulated in 1-4 months postoperatively.For 7 patients with bilateral RLN paralyses resulted from previous primary surgeries,unilateral or bilateral RLN decompress was performed in 2 cases and in 3 cases respectively.The mobility of the paralyzed vocal cord restored in 1-6 months after RLN decompression,besides one case with relative deficient abduction and one case with slight limited abduction and adduction,and the 5 patients were decannulated successfully.Conclusion Exploration surgery could be performed as soon as possible in patients with bilateral RLN paralyses and RLN decompress is effective for the restoration of the function of the nerve.

Objective To establish new classification criteria for early rheumatoid arthritis (E-RA) based on large samples of early inflammatory arthritis patients and to evaluate the value of this criteria in China.Methods Patients who had arthritic complaints with disease duration less than one year were enrolled.They were divided into RA group and non-RA group according to the clinical diagnosis by experienced rheumatologists.The clinical and laboratory parameters were analyzed and those with high sensitivity or specificity were selected as the new classification criteria.Statistical analysis was carried out by using t test,x2 test and Logistic regression.Results ① A total of 803 patients with early inflammatory arthritis were included in this study.Five hundreds and fourteen patients were diagnosed as early RA and 251 were diagnosed as other rheumatic diseases,and the diagnosis of 38 patients remained unestablished by the end of follow-up.② New E-RA classification criteria were established based on the parameters with high sensitivity and/or specificity.The sensitivity of the new E-RA criteria was 84.4％,which was higher than 1987 ACR criteria (58.0％),while the corresponding specificities were similar,which were 87.4％ and 93.6％ respectively.③ Compared with the complex scoring system of 2010 ACR/EULAR criteria,the E-RA criteria was more simple and practical.The diagnostic sensitivity and specificity of E-RA criteria were higher than those of 2010 ACR/EULAR criteria reported in the literatures.④ New classification criteria based on scoring system using Logistic regression analysis was established.The sensitivity of this criteria was 86.4％,which was higher than 1987 ACR criteria (58.0％).Conclusion The diagnostic value of the E-RA criteria developed in this study for early RA is better than 1987 ACR criteria,and is more simple than 2010 ACR/EULAR criteria.It may be used as a new classification criteria for early RA diagnosis.