Adipocytokines are polypeptides or proteins that are secreted by fat cells with a wide range of biological activities. Adiponectin is a fatty cytokine with insulin sensitization. It possesses the function of anti- diabetes, atherosclerosis and anti-inflammation. Adiponectin may participate in regulating the development of cognitive impairment, which is considered as a new regulatory factor for cognitive impairment.
Adiponectin ; Cognitive Dysfunction ; Diabetes Mellitus ; Humans ; Insulin ; Insulin Resistance

Objective To explore the feasibility of biplane-transesophageal echocardiography (Bip-TEE) in measuring the aortic annulus dimension (AAD).Methods Totally 24 patients underwent transcatheter aortic valve implantation (TAVI) were collected,and their AAD was measured by two-dimensional transthoracic echocardiography (2D-TTE),two-dimensional transesophageal echocardiography (2D-TEE),Bip-TEE and three-dimensional transesophageal echocardiography (3D-TEE) respectively.These four methods were compared with each other.The correlation between 3D-TEE measures and other three methods were analyzed.Results The AAD measured by 2D-TTE,2DTEE,Bip-TEE and 3D-TEE were (22.02±2.21)mm,(23.34±2.34)mm,(23.89±2.37)mm,(24.21±2.78)mm,respectively.The differences among 4 groups was significant (F=3.88,P=0.01).No statistically significant differences were found between Bip-TEE and 3D-TEE,2D-TEE and 3DTEE,Bip TEE and 2D-TEE (all P＞0.05).There were significant differences between 2D-TTE and 2D-TEE,2D-TTE and Bip-TEE,2D-TTE and 3D-TEE (all P＜0.05).The AAD measured by 3D-TEE were positively correlated with that of 2D-TTE,2D-TEE,Bip-TE (r=0.79,0.88,0.94,all P＜0.05).Conclusion Bip-TEE is a feasible method to measure the AAD rapidly and can provide reliable measurements for the prosthetic valve size in TAVI.

Objective: To investigate the value of jugulo-omohyoid lymph nodes (JOHLN) in predicting occult lateral cervical lymph node metastasis in patients with papillary thyroid carcinoma (PTC). Methods: The clinicopathological data of 136 out of 2 100 PTC patients, who had a high risk of lateral neck lymph node metastasis and treated by us from January 2010 to December 2015, were retrospectively analyzed. Super selective neck dissection (SSND, level Ⅲ and Ⅳ)was performed and JOHLNs were sent for frozen section in all the 136 cases. The clinicopathological data was analyzed and the significance of JOHLN in predicting lateral cervical LNM was calculated using the SPSS software package. Results: Of the 136 patients, total thyroidectomy was performed in 76 cases (55.9%) and unilateral lobectomy plus isthmus was performed in the other 60 cases (44.1%). SSND was performed in 72 patients (52.9%), level Ⅱ-Ⅳ dissection in 15 (11.0%), and level Ⅱ-Ⅴ dissection in 49 (36.0%). According to the pathological results, 38 patients were pN0(27.9%), 18 (13.2%) were pN1a and 80 (58.8%) were pN1b. The lymph node metastasis(LNM) rates at level Ⅱ-Ⅵ were 19.9%, 43.4%, 42.6%, 2.9%, and 59.6%, respectively. The sensitivity, specificity and accuracy of JOHLN in predicting lateral neck metastasis were 58.8%, 62.9%, and 76.7%, respectively. The rates for predicting level Ⅱ metastasis were 81.5%, 43.2%, and 59.4%, respectively. None of the patients died in the follow-up. Only 1 recurrence was found in level Ⅱ and regional control was achieved after level Ⅱ and Ⅴ dissection. Conclusions JOHLN has a high accuracy for predicting lateral cervical lymph node metastasis and high sensitivity for level Ⅱ metastasis. For patients with high risk of lateral cervival metastasis, super-selective neck dissection including level Ⅲ and Ⅳ can confirm the stage and reduce the risk of reoperation. Dissection for level Ⅱ, Ⅲ, and Ⅳ is recommended.

Objective: To analyze the incidences of complications after central compartment reoperation for recurrent/persistent differentiated thyroid cancer, and to investigate the safety and feasiblity of central compartment reoperation. Methord: A total of 109 patients who underwent central compartment reoperation for recurrent/persistent differentiated thyroid cancer from January 1, 2011 to March 31, 2016 in Cancer Hospital, Chinese Academy of Medical Sciences was analysed retrospectively, and the incidences of reoperation-related complications were evaluated. Results: Among 109 patients, only 10 (9.2%) patients were treated initially in our hospital and remaining patients (90.8%) treated initially in the other hospitals. Surgical approaches for thyroid beds: 61 patients (56.0%) underwent supplemented total thyroidectomy, 3 patients (2.8%) for removal of recurrent thyroid cancer, 2 patients (1.8%) with supplemented total thyroidectomy and removal of recurrent thyroid cancer, and 12 cases (11.0%) had bilateral thyroid lobectomy. Central compartment lymph node dissection: 66 patients (60.6%) underwent bilateral central neck dissection, 40 patients (36.7%) with unilateral central neck dissection. A total of 16 patients (14.7%) had complications. Transient and permanent vocal fold paralysis developed in 9(8.3%) and 2(1.8 %) patients, respectively. Transient and permanent hypoparathyroidism occurred in 2(1.8%) patients and 11 patients (10.1%), respectively. Postoperative bleeding happened in 1 patient (0.9%). with follow-up from 7 to 61 month, median follow-up was 17.2 months. All patients survived, with recurrence in 3 (2.8%) patients. Conclusions It seems the incidences of complications for thyroid carcinoma reoperation in central compartment is low for the experienced surgeon. The reoperation was safe and feasible.

Objective: To analyse the postoperative metastasis or recurrence of cervical lymph nodes in individual neck levels for papillary thyroid carcinoma and to evaluate the outcomes and complications of re-surgery. Methods: A retrospective cohort study of 259 patients who underwent lymph node dissection for PTC relapse from January 2010 to June 2011. Lymph node metastases in each of neck levels were detected, postoperative complications were evaluated, and the patients were followed up with examining thyroglobulin levels to assess the therapeutic effect.Continuous variables were compared with t test.Categorical variables were compared with Fisher′s exact test. Results: Lymph node metastasis was found in 259 cases and lymph node metastasis rates in levels Ⅱ, Ⅲ, Ⅳ, Ⅴ and Ⅵ were 43.2%, 50.2%, 45.6%, 8.1% and 59.1% respectively. In 44 cases received the neck dissection of level Ⅱ, the metastasis rates in the levels Ⅱa and Ⅱb were respectively (52.3% vs 18.2%, P=0.887). Recurrence in unilateral lateral neck was more common than that in bilateral lateral neck (73.1% vs 20.6%, P<0.001). The lymph nodes in lateral neck were more likely to metastasize than those in central region (80.7% vs 59.1%, P<0.001). There were 47 cases (18.1%) had postoperative complications, including 10 cases with permanent hypocalcemia. Conclusions The scope of re-operation for neck metastasis or recurrence in papillary thyroid carcinoma should include the dissection of levels Ⅱ-Ⅳ and Ⅵ. The incidence of postoperative complications for re-surgery is high, and re-surgery should be performed by experienced surgeon.

Objective: To discuss the strategy of therapeutic management of T3 supraglottic carcinoma. Methods: A retrospective analysis of 459 patients with T3 supraglottic carcinoma treated in our hospital was performed. We evaluated the results of different managements, including surgery alone, preoperative radiotherapy, postoperative radiotherapy and radiotherapy alone. The extent of the lesion was also put into analysis. Statistical analysis of the overall survival (OS), cause-specific survival (CSS), local control (LC), regional control(RC), function-conservation (FC) were performed with the statistical package from SPSS. Results: In all patients, the rates of 5-year OS, CSS, LC, RC and FC were 64.2%, 71.2%, 87.8%, 78.8% and 64.5% respectively. The OS, LC and FC of the patients treated by surgery alone, preoperative radiotherapy and postoperative radiotherapy had no significant difference, and were remarkably better than that of patients treated by radiotherapy alone (P<0.001). In 412 patients treated by surgery, 300 patients received function-conservation laryngectomy. 209 patients (50.7%, 209/412) survived and maintained well-function of larynx for 5 years, which was significantly better than those in the radiotherapy alone group (27.7%, 13/47). The patients with the lesion invading the pre-epiglottic space but limited in supraglottic area had better OS (70.2%), LC (93.5%) and FC (85.1%). The rate of 5-year neck lymphatic metastasis was 56.2%(258/459), and the 5-year OS of patients with N0, N1, N2 and N3 stage were 76.0%, 66.2%, 50.5% and 13.0% respectively. Conclusions Surgical treatment was the best therapeutic approach for T3 supraglottic laryngeal carcinoma. Most patients with T3 lesions are suitable for function-conservation laryngectomy. Surgical procedure was determined by tumor invaded location and extension. The combined therapy of surgery and radiotherapy had no significant advantage.

Objective: To investigate the value of secondary cervical lymph node dissection in papillary thyroid carcinoma (PTC). Methods: PTC patients with recurrence re-operated in a previously dissected area at our hospital during 2000-2016 were included in this analysis. Patients were divided according to the operative interval of 6 months. The level and number of lymph node metastasis and the number of lymph node dissection were analyzed to calculate the ratio of lymph node metastasis. Results: A total of 336 PTC patients received 360 side lateral cervical lymph nodes dissection. The ratio of recurrence in unilateral lateral neck is 92.9%(312/336). The ratio of recurrence in multiple levels (more than two regions) were 47.5% (171/360). The recurrence ratio of level Ⅱ, Ⅲ, Ⅳ and Ⅴ were 55.6%(200/360), 44.2%(159/360), 59.7%(215/360) and 10.3%(37/360), respectively. Lymph node metastases were inclined to level Ⅱ (33.6%) and Ⅳ (35.8%). The mean number of lymph node dissection and metastasis in the group of operative interval ≤ 6 months was 26.56 per case and 4.37 per case, respectively. The mean number of lymph node dissection and metastasis in the group of operative interval >6 months was 16.80 per case and 3.20 per case, respectively. The number of lymph node dissection and metastasis between these two groups were significantly different (P=0.001, P<0.001). Conclusions Lymph node metastasis of PTC patients with secondary cervical lymph node dissection are inclined to level Ⅱ and level Ⅳ. Moreover, multi-level metastasis is not rare. Level Ⅱ and level Ⅳ require more attention in the first operation. Most of the patients undergo reoperation because of residual lymph nodes from the previous treatment. Normalization and completeness of the initial dissection are particularly important to PTC patients.

Objective: To evaluate the efficacy and safety of the application of dye-tattooing under ultrasound guidance in preoperative localization of neck recurrences from thyroid cancer. Methods: Between October 2014 to September 2016, 25 patients with 34 lesions were enrolled. There were 22 cases of papillary thyroid carcinoma and three cases of medullary thyroid carcinoma, all of which could not be detected by computed tomography. Surgeons located the recurrent lesions using dye-tattooing under ultrasound guidance along with radiologist three days before the operation. Results: All lesions were successfully located (100%), 32 of which were located directly and two of which were located indirectly. Postoperative pathological examination confirmed 25 metastases of papillary thyroid carcinoma, two metastases of medullary thyroid carcinoma, and seven cases of false positives. The accuracy of ultrasound diagnosis was 79.4%. After 15 months of follow-up, neither tumor residual nor recurrences was detected according to imaging tests. Conclusions Dye-tattooing under ultrasound guidance represents a reliable and safe method for localization of neck recurrences from thyroid cancer. The cooperation between experienced surgeons and radiologists will be crucial to successful location.

Background and purpose:In recent years, energy-based instruments have been widely used in today’s open surgeries. Harmonic Focus? (HF) and Ligasure Small Jaw? (LSJ) are both custom-made for thyroid open surgery. This study aimed to explore the effcacy and safety of HF and LSJ in open thyroidectomy.Methods:The data from patients who undertook total thyroidectomy with central neck dissection by the same surgeon during last year in this hospital were reviewed. HF was used in 100 patients, and LSJ was used in 104 patients. The effectiveness was appraised by comparing operation time and postoperative volume of drainage on the ifrst postoperative day. The safety was appraised by comparing the incidence of postoperative complications.Results:The results of the effectiveness:the average duration of operation was (95.8±18.0) min for HF group, and (97.8±19.1) min for LSJ group, there was no statistical signiifcance (P=0.363). Postoperative volume of drainage on the ifrst postoperative day was (35.2±20.3) mL for HF group, and (36.3±23.8) mL for LSJ group, there was no statistical signiifcance (P=0.977). One patient (1.0%) had temporary vocal cord paralysis in HF and one had postoperative hematoma (1.0%) in LSJ group. Temporary hypo-parathyroidism was detected in 18 patients (18.0%) of HF group, and 16 patients (15.4%) of LSJ group. The decline of parathyroid hormone during the ifrst postoperative day was (12.3±12.8) pg/mL in HF group, and (13.9±13.4) pg/mL in LSJ group. The decline of serum calcium was (0.20±0.13) mg/dL in HF group, and (0.20±0.16) mg/dL in LSJ group. There were all no statistical signiifcances (P>0.05).Conclusion:Both HF and LSJ are safe and effective in open thy-roidectomy without similar operative complications.

OBJECTIVETo identify risk factors for bleeding after thyroid surgery, and discuss the potential relevance between the bleeding timing and sources.

METHODSA total of 2568 cases that underwent thyroid operation from June 2012 to June 2013 were collected and analysed retrospectively the risk factors for postoperative bleeding by Cox and the potential relevance between the bleeding timing and sources.

RESULTSAmong 2568 patients, 40 patients occurred postoperative bleeding Indentified risk factors were extent resection (P=0.0435) and surgeon (P=0.0071). Thyroid bed and strap muscles/sternocleidomastoid were the most common sources of bleeding after surgery within 6 hours; while thyroid bed was the most common source of bleeding after surgery between 6 and 8 h; wound errhysis was the most common source during 8-24 h after the operation; thyroid bed and strap muscles/sternocleidomastoid were the most common sources within 24 h after thgroid surgery.

CONCLUSIONSBleeding after thyroid surgery is a rare but potentially life-threatening complication, and the extent of resection and the surgeon are risk factors. Thyroid bed and strap muscles/sternocleidomastoid are the most common sources of bleeding after surgery within 24 hours.