BACKGROUND In recently diagnosed patients with thyroid cancer,papillary thyroid cancer(PTC),as the most common histological subtype,accounts for 90%of all cases.Although PTC is known as a relatively adolescent maligna...BACKGROUND In recently diagnosed patients with thyroid cancer,papillary thyroid cancer(PTC),as the most common histological subtype,accounts for 90%of all cases.Although PTC is known as a relatively adolescent malignant disease,there still is a high possibility of recurrence in PTC patients with a poor prognosis.Therefore,new biomarkers are necessary to guide more effective stratification of PTC patients and personalize therapy to avoid overtreatment or inadequate treatment.Accumulating evidence demonstrates that microRNAs(miRNAs)have broad application prospects as diagnostic biomarkers in cancer.AIM To explore novel markers consisting of miRNA-associated signatures for PTC prognostication.METHODS We obtained and analyzed the data of 497 PTC patients from The Cancer Genome Atlas.The patients were randomly assigned to either a training or testing cohort.RESULTS We discovered 237 differentially expressed miRNAs in tumorous thyroid tissues compared with normal tissues,which contained 172 up-regulated and 65 downregulated miRNAs.The evaluation of differently expressed miRNAs was conducted using our risk score model.We then successfully generated a fourmiRNA potential prognostic signature[risk score=(-0.001×hsa-miR-181a-2-3p)+(0.003×hsa-miR-138-5p)+(-0.018×hsa-miR-424-3p)+(0.284×hsa-miR-612)],which reliably distinguished patients from high and low risk with a significant difference in the overall survival(P<0.01)and was effective in predicting the five-year disease survival rate with the area under the receiver operating characteristic curve of 0.937 and 0.812 in the training and testing cohorts,respectively.Additionally,there was a trend indicated that high-risk patients had shorter relapse-free survival,although statistical significance was not reached(P=0.082)in our sequencing cohort.CONCLUSION Our results indicated a four-miRNA signature that has a robust predictive effect on the prognosis of PTC.Accordingly,we would recommend more radical therapy and closer follow-ups for highrisk groups.展开更多
BACKGROUND Papillary thyroid cancer(PTC)is one of the well-differentiated thyroid tumors.Cutaneous metastasis from differentiated thyroid cancers occurs in<1%of primary thyroid carcinomas but produces the worst sur...BACKGROUND Papillary thyroid cancer(PTC)is one of the well-differentiated thyroid tumors.Cutaneous metastasis from differentiated thyroid cancers occurs in<1%of primary thyroid carcinomas but produces the worst survival prognosis.The multi-targeting tyrosine kinase inhibitor anlotinib has been approved to treat refractory advanced non-small-cell lung cancer as well as advanced soft-tissue and clear cell sarcomas in China.CASE SUMMARY In a patient with scalp metastasis caused by PTC,thyroid and skull metastasis tumor sizes were significantly reduced after a trial of neoadjuvant anlotinib therapy for 3 cycles.Anlotinib maintenance medication after thyroidectomy further reduced the metastatic skull tumor size thereby preventing the requirement for craniotomy.CONCLUSION The outcome of the present trial confirmed the potential of anlotinib therapy to treat scalp metastasis induced by PTC and point the way for the treatment of similar diseases in the future.展开更多
BACKGROUND Thyroglobulin(Tg)is one of the markers of thyroid cancer,and its concentration may be elevated in patients with malignant thyroid tumors.Thyroid-stimulating hormone(TSH)is secreted by the pituitary gland,wh...BACKGROUND Thyroglobulin(Tg)is one of the markers of thyroid cancer,and its concentration may be elevated in patients with malignant thyroid tumors.Thyroid-stimulating hormone(TSH)is secreted by the pituitary gland,which has a significant impact on thyroid gland function.Excessively high or low TSH levels may be associated with an increased risk of thyroid cancer.Thus,in-depth studies on the association of serum Tg and TSH levels with thyroid cancer risk in patients with thyroid nodules are warranted.This can help determine whether Tg and TSH levels can predict the degree of malignancy of thyroid nodules,which can in turn guide doctors in making accurate diagnoses and treatment decisions.Furthermore,such studies can provide more accurate diagnostic methods for thyroid nodules and help patients become aware of the presence of thyroid cancer as early as possible,thereby improving the success rate of treatment and prognosis.AIM To investigate the association of serum Tg and TSH levels with the risk of thyroid cancer in patients undergoing thyroid nodule surgery.METHODS The clinical data and laboratory examination results of 130 patients who underwent thyroid nodule surgery were retrospectively analyzed.Furthermore,their preoperative serum Tg and TSH levels were recorded.Histopathological examination conducted during follow-up revealed the presence of thyroid cancer.Correlation analysis were used to analyze the association of Tg and TSH levels with the risk of thyroid cancer.RESULTS Of the 130 patients,60 were diagnosed with thyroid cancer.Statistical analysis revealed a significant positive correlation between serum Tg levels and the risk of thyroid cancer(P<0.05).This suggests that high serum Tg levels are associated with an increased risk of thyroid cancer.However,no significant correlation was observed between serum TSH levels and the risk of thyroid cancer(P>0.05).CONCLUSION In patients who underwent thyroid nodule surgery,serum Tg levels exhibited a significant correlation with the risk of thyroid cancer but serum TSH levels did not.These findings suggest that serum Tg can serve as an important biomarker for assessing the risk of thyroid cancer in these patients.展开更多
BACKGROUND Patients rarely develop complicated infections in thyroid cysts.Here,we describe a patient with chronic infected unilateral giant thyroid cyst related to diabetes mellitus(DM).CASE SUMMARY A 66-year-old mal...BACKGROUND Patients rarely develop complicated infections in thyroid cysts.Here,we describe a patient with chronic infected unilateral giant thyroid cyst related to diabetes mellitus(DM).CASE SUMMARY A 66-year-old male was admitted due to an evident neck lump for 5 d after approximately 40 years of gradually progressive neck mass and 7 years of DM.Doppler ultrasound and computed tomography scan showed a giant lump in the left thyroid gland lobe.He was diagnosed with a large thyroid nodule complicated by tracheal dislocation and had surgical indications.Surgical exploration revealed evident inflammatory edema and exudation between the left anterior neck muscles,the nodule and glandular tissue.Fortunately,inflammatory lesions did not affect major neck vessels.Finally,a left partial thyroidectomy was performed.Macroscopic observation showed that the cystic thyroid mass consisted of extensive cystic wall calcification and was rich in massive rough sand-like calculi content and purulent matter.Postoperative pathology confirmed benign thyroid cyst with chronic infection.CONCLUSION The progression of this chronic infectious unilateral giant thyroid cyst may have been related to DM,and identifying blood vessels involvement can prevent serious complications during operation.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)is a prevalent malignancy,and transcatheter arterial embolization(TAE)has emerged as a pivotal therapeutic modality.How-ever,TAE may induce symptom distress and fatigue,adversel...BACKGROUND Hepatocellular carcinoma(HCC)is a prevalent malignancy,and transcatheter arterial embolization(TAE)has emerged as a pivotal therapeutic modality.How-ever,TAE may induce symptom distress and fatigue,adversely affecting the quality of life of patients.AIM To investigate symptom distress,fatigue,and associated factors in HCC patients undergoing TAE.METHODS We used a cross-sectional design and purposive sampling to enroll HCC patients who underwent TAE at our institution from January to December 2022.Question-naires were utilized to collect data on symptom distress and fatigue scores from the first to the third day after TAE.RESULTS Our study revealed a significant reduction in fatigue and symptom distress among patients after TAE.Pain,fatigue,insomnia,fever and abdominal dis-tension were the most common symptoms troubling patients during the first 3 d post-TAE.Marital status,presence of family support,physical functional status,age,and symptom distress were identified as predictors of fatigue in patients.CONCLUSION Healthcare professionals should educate HCC patients on symptom distress and INTRODUCTION Hepatocellular carcinoma(HCC)ranks as the fifth most prevalent cancer and the third leading cause of cancer-related mortality globally.Surgical intervention remains the cornerstone of HCC treatment;however,due to the challenges associated with early diagnosis and the lack of specific diagnostic markers,a considerable proportion of patients are diagnosed at advanced stages,rendering them ineligible for surgical interventions.Transcatheter arterial embolization(TAE)is an interventional therapeutic approach involving the insertion of a fine catheter via the femoral artery to reach the vasculature near the tumor site.TAE aims to obstruct the arterial supply to the tumor by deploying embolic agents,thereby inducing necrosis in cancer cells.This procedure is suitable for patients with good liver function and overall health,particularly those with large HCCs that have not invaded the portal vein[1,2].Nonetheless,following TAE,hepatocytes incur variable degrees of damage,leading to the development of a constel-lation of symptoms reminiscent of acute hepatitis.These symptoms include fatigue and systemic discomfort,such as nausea,vomiting,fever,abdominal pain,as well as transient elevations in aspartate aminotransferase(AST)and alanine aminotransferase(ALT),collectively referred to as postembolization syndrome[3,4].These symptoms may arise due to ischemia of the liver and gallbladder,temporary liver enlargement,and peritoneal irritation.While many studies have explored fatigue and symptom distress in cancer patients both nationally and internationally,with some focusing on symptom distress following transcatheter arterial chemoembolization,there has been limited in-depth investigation into the fatigue and symptom distress resulting from TAE treatment[5-8].Fatigue and pain are both subjective experiences,typically arising from the gradual depletion of energy reserves during the course of illness[9].Fatigue is particularly prevalent among cancer patients,with rates soaring as high as 90%.Despite extensive research exploring cancer-related fatigue and its influencing factors,a unanimous consensus remains elusive.Hence,the primary objective of this study was to investigate the symptom distress and fatigue experienced by liver cancer patients following TAE treatment and to analyze potential contributing factors.展开更多
This editorial discusses the article written by Zheng et al that was published in the latest edition of the World Journal of Gastrointestinal Surgery.Our primary focus is on the causes,location,diagnosis,histological ...This editorial discusses the article written by Zheng et al that was published in the latest edition of the World Journal of Gastrointestinal Surgery.Our primary focus is on the causes,location,diagnosis,histological classification,and therapy of ectopic pancreas.Ectopic pancreas refers to the presence of pancreatic tissue that is situated in a location outside its usual anatomical placement,and is not connected to the normal pancreas in terms of blood supply or anatomical struc-ture.Currently,the embryological origin of ectopic pancreas remains uncertain.The most prevalent form of ectopic pancreatic is gastric ectopic pancreas.Endoscopic ultrasonography examination can visualize the morphological charac-teristics of the ectopic pancreatic lesion and pinpoint its anatomical location.The histological categorization of ectopic pancreas evolves.Endoscopic treatment has been widely advocated in ectopic pancreas.展开更多
Liver transplantation is the primary therapeutic intervention for end-stage liver disease.However,vascular complications,particularly those involving the hepatic artery,pose significant risks to patients.The clinical ...Liver transplantation is the primary therapeutic intervention for end-stage liver disease.However,vascular complications,particularly those involving the hepatic artery,pose significant risks to patients.The clinical manifestations associated with early arterial complications following liver transplantation are often non-specific.Without timely intervention,these complications can result in graft fai-lure or patient mortality.Therefore,early diagnosis and the formulation of an op-timal treatment plan are imperative.Ultrasound examination remains the pre-dominant imaging modality for detecting complications post liver transplan-tation.This article comprehensively reviews common causes and clinical present-ations of early hepatic artery complications in the post-transplantation period and delineates abnormal sonographic findings for accurate diagnosis of these con-ditions.Overall,ultrasound offers the advantages of convenience,safety,effect-iveness,and non-invasiveness.It enables real-time,dynamic,and precise evalua-tion,making it the preferred diagnostic method for post-liver transplantation assessments.INTRODUCTION Liver transplantation stands as the primary therapeutic approach for end-stage liver disease.Continuous advancements in surgical techniques and the application of novel immunosuppressive agents contribute to ongoing improvements in the success rate and overall survival in patients undergoing liver transplantation procedures.Despite these advan-cements,vascular complications,particularly those involving the hepatic artery,pose significant risks to patients.During the early stages following liver transplantation(within the first 30 d),proper hepatic artery function is crucial for hepatic arterial blood flow.During later stages,collateral circulation,including arteries such as the phrenic artery,right gastric artery,and gastroduodenal artery,becomes important for maintaining hepatic blood supply.It is now understood that the establishment of effective collateral circulation is pivotal for determining the prognosis of hepatic artery complic-ations.The clinical manifestations of these complications are closely linked to factors such as timing,severity,and the specific type of onset.Insufficient hepatic arterial blood flow can lead to abnormal liver function,hepatic infarction,and the formation of hepatic abscesses.Additionally,since the hepatic artery is the sole blood supply to the biliary tract,hepatic artery-related ischemia may result in biliary stricture,obstruction,and the formation of bile ducts.Ultrasound examination remains the primary imaging modality for diagnosing complications post liver transplantation.This article comprehensively reviews common causes and clinical presentations of early hepatic artery complications in the post-transplantation period and outlines abnormal sonographic findings for accurately diagnosing these conditions.NORMAL HEPATIC ARTERY During the intraoperative phase,an ultrasound examination is typically conducted to evaluate the hepatic artery anas-tomosis.The normal internal diameter of the hepatic artery typically ranges from 2 to 5 mm.Two strong echo points are typically identified near the anastomosis.To assess blood flow dynamics,peak systolic velocity,end-diastolic velocity,and resistance index are measured at the donor and recipient sides of the anastomosis following angle correction.Anastomotic stenosis presence and severity can be evaluated by comparing the velocity at the anastomotic site with that at the recipient side.Postoperatively,direct visualization of the anastomosis site through gray ultrasound scans is often challenging.The surgical approach has a significant impact on the proper hepatic artery’s position,resulting in a lower overall success rate of continuous visualization.Color Doppler ultrasound is primarily employed to trace the artery’s path,and spectral measurements are taken at the brightest position of the Color Doppler blood flow signal,primarily used to identify the presence of high-speed turbulence.Hepatic artery spectrum examination plays a crucial role,as a favorable arterial spectral waveform and appropriate hepatic artery flow velocity typically indicate a successful anastomosis,even in cases where the hepatic artery anastomosis cannot be directly visualized by ultrasound.The hepatic artery runs alongside the portal vein,often selected as a reference due to its larger inner diameter.A normal hepatic artery spectrum displays a regular pulsation pattern with a rapid rise in systole and a slow decline in diastole.Parameters for assessing hepatic artery resistance include a resistance index between 0.5 to 0.8 and an artery systolic acceleration of less than 80 ms.Instantaneous increases in the resistance index(RI>0.8)often occur within 2 d after surgery,followed by a subsequent return to normal hepatic arterial parameters.It has been established that the maximum blood flow velocity during systole in the hepatic artery should not exceed 200 cm/s[1].展开更多
Objective: To study the sonographic features of the primary site of papillary thyroid microcarcinoma(PTMC) for the prediction of cervical lymph node metastasis during preoperative diagnosis.Methods: A total of 710 PTM...Objective: To study the sonographic features of the primary site of papillary thyroid microcarcinoma(PTMC) for the prediction of cervical lymph node metastasis during preoperative diagnosis.Methods: A total of 710 PTMC patients between 2013 and 2016 with a diagnosis of cervical lymph node metastases were reviewed.We analyzed the sonographic features of the PTMC primary site to predict ipsilateral or central lymph node metastases in univariate and multivariate models.The ratio of abutment/perimeter of the PTMC primary site was utilized to evaluate cervical lymph node status.Results: Regarding clinical characteristics, multifocality and extrathyroidal extension were associated with cervical lymph node involvement.In the multivariate regression model, calcification and the abutment/perimeter ratio of lesions were evaluated as independent factors in level Ⅵ, ipsilateral or skip cervical lymph node metastases.The cut-off value of the ratio of abutment/perimeter of the PTMC primary site(25%) was significantly correlated with cervical lymph node metastases(P = 0.000).Conclusions: Independent sonographic features, including lesion size, lesion location, calcification, and the ratio of abutment/perimeter of the primary site, were associated with cervical lymph node metastases in PTMC patients.展开更多
BACKGROUND Surgery for thyroid carcinoma offers a good prognosis;however,cervical lymph node metastasis may occur in the early stage.An effective diagnostic method can accurately guide clinical surgical planning and t...BACKGROUND Surgery for thyroid carcinoma offers a good prognosis;however,cervical lymph node metastasis may occur in the early stage.An effective diagnostic method can accurately guide clinical surgical planning and the scope of lymph node dissection,ultimately improving patient prognosis.AIM To explore the diagnostic value of fine-needle aspiration of thyroglobulin(FNATg)combined with ultrasound(US)-guided fine-needle aspiration cytology for cervical lymph node metastasis in thyroid carcinoma.METHODS We enrolled 209 pathologically confirmed thyroid carcinoma patients who visited our hospital between Jan 2017 and Dec 2020.Patients were tentatively diagnosed with cervical lymph node enlargement using preoperative US.They underwent US-guided fine-needle aspiration cytology and FNA-Tg.The value of single and combined application of the two methods for the diagnosis of cervical lymph node metastasis was calculated.The factors affecting FNA-Tg for diagnosis were analyzed using univariate and multivariate methods.RESULTS FNA-Tg values were significantly higher among patients with positive cervical lymph node metastasis.The sensitivity and specificity of US-guided fine-needle aspiration cytology,FNA-Tg,and US-guided fine-needle aspiration cytology+FNA-Tg were 85.48%and 90.59%,83.06%and 87.06%,and 96.77%and 91.76%,respectively.The area under the receiver operating characteristic curve for USguided fine-needle aspiration cytology,FNA-Tg,and the two combined,was 0.880,0.851,and 0.943,respectively.A long diameter/short diameter ratio<2,an insufficient number of acquired cells,a low serum thyroglobulin level,and an absence of typical metastatic US features increased the risk of cervical lymph node metastasis in thyroid carcinoma patients misdiagnosed using FNA-Tg.CONCLUSION The diagnostic value of FNA-Tg for detecting cervical lymph node metastasis is not high;however,combined with US-guided fine-needle aspiration cytology,it is significantly improved.展开更多
The incidence of papillary thyroid carcinoma(PTC)has exponentially increased in recent years.Papillary thyroid microcarcinoma(PTMC)accounts for the majority of the reported cases of PTC.The debates and crucial issues ...The incidence of papillary thyroid carcinoma(PTC)has exponentially increased in recent years.Papillary thyroid microcarcinoma(PTMC)accounts for the majority of the reported cases of PTC.The debates and crucial issues in PTMC management have received researchers'attention.To further improve the clinical management of PTMC in China,展开更多
In recent years, the clinical incidence of thyroid cancer has been increasing year by year, and its risk assessment and clinical management methods have also been accordingly modified and constantly improved. There ar...In recent years, the clinical incidence of thyroid cancer has been increasing year by year, and its risk assessment and clinical management methods have also been accordingly modified and constantly improved. There are great differences between the clinical diagnostic and therapeutic modes and disease management of thyroid cancer employed by various medical institutions in China, particularly with regard to the clinical application of serum marker of thyroid cancer. To this end, the China Anti-Cancer Association Thyroid Cancer Specialized Committee Chinese Association of Thyroid Oncology organized this compilation of ExpertConsensus on Clinical Application of Serum Marker of Thyroid Cancer to help and impel relevant clinical institutions and professionals to standardize clinical diagnosis, treatment, and long-term management of thyroid cancer, and to properly utilize the serum marker for scientific auxiliary clinical diagnosis and assessment of thyroid cancer before and after operation.展开更多
BACKGROUND Lymph node metastasis(LNM) of papillary thyroid carcinoma(PTC) has a certain regularity and occurs first to the central lymph node and then to the lateral lymph node. The pathway of PTC LNM can guide surgic...BACKGROUND Lymph node metastasis(LNM) of papillary thyroid carcinoma(PTC) has a certain regularity and occurs first to the central lymph node and then to the lateral lymph node. The pathway of PTC LNM can guide surgical prophylactic lymph node dissection(LND) for clinical surgeons.AIM To investigate the relationship between subgroups of central LNM and lateral LNM in unilateral clinically node-negative PTC(cN0-PTC).METHODS Data were collected for 1089 PTC patients who underwent surgical treatment at the Department of Endocrine and Breast Surgery of the First Hospital of Chongqing Medical University from January 2016 to December 2017. A total of 388 unilateral cN0-PTC patients met the inclusion criteria and were enrolled in this study. The clinical and pathological data for these 388 patients who underwent total thyroidectomy + central LND + lateral LND were retrospectively analyzed. The relationship between the central LNM and lateral LNM subgroups was investigated.RESULTS The coincidence rate of cN0-PTC was only 30.0%.Optimal scaling regression analysis showed that sex(57.1% vs 42.9%, P = 0.026), primary tumor size(68.8% vs 31.2%, P = 0.008), tumor location(59.7% vs 40.3%, P = 0.007), extrathyroid extension(ETE)(50.6% vs 49.9%, P = 0.046), and prelaryngeal LNM(57.1% vs 42.9%, P = 0.004) were significantly associated with ipsilateral level-II LNM. Their importance levels were 0.122, 0.213, 0.172, 0.110, and 0.227, respectively. Primary tumor size(74.6% vs 30.2%, P = 0.016), pretracheal LNM(67.5% vs 32.5%, P < 0.001), and paratracheal LNM(71.4% vs 28.6%, P < 0.001) were significantly associated with ipsilateral level-Ⅲ LNM. Their importance levels were 0.120, 0.408, and 0.351, respectively. Primary tumor size(72.1% vs 27.9%, P = 0.003), ETE(70.4% vs 29.6%, P = 0.016), pretracheal LNM(68.3% vs 31.7%, P=0.001), and paratracheal LNM(80.8% vs 19.2%, P < 0.001) were significantly associated with ipsilateral level-IV LNM. Their importance levels were 0.164, 0.146, 0.216, and 0.472, respectively.CONCLUSION The LNM pathway of thyroid cancer has a certain regularity. For unilateral cN0-PTC patients with a tumor diameter > 2 cm and pretracheal or ipsilateral paratracheal LNM, LND at ipsilateral level Ⅲ and level IV must be considered. When there is a tumor in the upper third of the thyroid with prelaryngeal LNM, LND at level II, level Ⅲ and level IV must be considered.展开更多
<strong>Background:</strong> We aimed to investigate the ability of carbon nanoparticles to identify parathyroid glands with vasculature during thyroid surgery. <strong>Material and methods:</stro...<strong>Background:</strong> We aimed to investigate the ability of carbon nanoparticles to identify parathyroid glands with vasculature during thyroid surgery. <strong>Material and methods:</strong> Totally 42 patients with various thyroid diseases were selected for the prospective research of carbon nanoparticle injection used in thyroidectomy. Another 42 patients without receiving carbon nanoparticle injection were selected as the control group. All cases underwent total or subtotal bilateral thyroidectomy. Before the ligation of the superior and inferior poles of the thyriod lobes, 0.1 mL of a carbon nanoparticle suspension was injected into the two poles. Important tissues such as the recurrent laryngeal nerve, parathyroid gland with blood supply and the inferior thyroid artery were identified and protected. <strong>Results:</strong> The parathyroid glands with vasculature were not stained and thus remained the primary color in all cases, while abnormal thyroid tissues were stained black. After 5 minutes, thyroid lobes were injected with the carbon nanoparticle suspension and the original color of parathyroid glands was unchanged. Even the parathyroids with blood supply can be identified and protected. The number of parathyroid glands for autotransplantation was one in the test group and six in the control group. At one day after the thyroid surgery, hypocalcemia became detectable in four patients of the test group and in five of the control group. Twenty-four instances of hypoparathyroidism occurred at 1 day after surgery in the control group, while ten instances in the test group. <strong>Conclusion:</strong> Intraoperatvie carbon nanoparticle suspension injection is an effective and safe technique for guiding thyroid surgery. The carbon nanoparticle suspension plays an important role in identifying the vasculatural parathyroid glands, while protecting the physiologic function of the parathyroid glands during surgery.展开更多
BACKGROUND In recent years,studies have found that the occurrence and development of diabetic cardiomyopathy(DCM)is closely related to an increase in polyadenosine diphosphate-ribose polymerase-1(PARP-1)activity.PARP-...BACKGROUND In recent years,studies have found that the occurrence and development of diabetic cardiomyopathy(DCM)is closely related to an increase in polyadenosine diphosphate-ribose polymerase-1(PARP-1)activity.PARP-1 activation could be involved in the pathophysiological process of DCM by promoting oxidative stress,the inflammatory response,apoptosis and myocardial fibrosis.AIM To investigate the mechanism of liraglutide in improving myocardial injury in type 2 diabetic rats,further clarified the protective effect of liraglutide on the heart,and provided a new option for the treatment of DCM.METHODS Forty healthy male SD rats aged 6 wk were randomly divided into two groups,a normal control group(n=10)and a model group(n=30),which were fed an ordinary diet and a high-sugar and high-fat diet,respectively.After successful modeling,the rats in the model group were fed a high-glucose and high-fat diet for 4 wk and randomly divided into a model group and an intervention group(further divided into a high-dose group and a low-dose group).The rats were fed a high-glucose and high-fat diet for 8 wk and then started drug intervention.Blood samples were collected from the abdominal aorta to detect fasting blood glucose and lipid profiles.Intact heart tissue was dissected,and its weight was used to calculate the heart weight index.Haematoxylin and eosin staining was used to observe the pathological changes in the myocardium and the expression of PARP-1 in the heart by immunohistochemistry.RESULTS The body weight and heart weight index of rats in the model group were significantly increased compared with those in the normal control group,and those in the intervention group were decreased compared with those in the model group,with a more obvious decrease observed in the high-dose group(P<0.05).In the model group,myocardial fibers were disordered,and inflammatory cells and interstitial fibrosis were observed.The cardiomyopathy of rats in the intervention group was improved to different degrees,the myocardial fibers were arranged neatly,and the myocardial cells were clearly striated;the improvement was more obvious in the high-dose group.Compared with the normal control group,the expression of PARP-1 in myocardial tissue of the model group was increased,and the difference was statistically significant(P<0.05).After liraglutide intervention,compared with the model group,the expression of PARP-1 in myocardial tissue was decreased,and the reduction was more obvious in the high-dose group(P<0.05)but still higher than that in the normal control group.CONCLUSION Liraglutide may improve myocardial injury in type 2 diabetic rats by inhibiting the expression of myocardial PARP-1 in a dose-dependent manner.展开更多
BACKGROUND Multiple endocrine neoplasia type 1(MEN1)is a rare hereditary tumor syndrome inherited in an autosomal dominant manner and presents mostly as parathyroid,endocrine pancreas(such as gastrinoma)and anterior p...BACKGROUND Multiple endocrine neoplasia type 1(MEN1)is a rare hereditary tumor syndrome inherited in an autosomal dominant manner and presents mostly as parathyroid,endocrine pancreas(such as gastrinoma)and anterior pituitary tumors.At present,papillary thyroid carcinoma(PTC)and nodular goiter are not regarded as components of MEN1.CASE SUMMARY A 35-year-old woman presented with MEN1 accompanied by coinstantaneous PTC and nodular goiter.The pathological diagnosis was PTC with cervical lymph node metastasis,nodular goiter,parathyroid cyst and adenomatoid hyperplasia.Genetic testing was performed and a MEN1 gene mutation was detected.The patient underwent unilateral lobectomy of the thyroid gland and surgical removal of the parathyroid tumors.At 18 mo of follow-up,ultrasonic examination of the neck showed no abnormality.Serum calcium and parathyroid hormone levels were normal.No new MEN1-associated tumors were detected.CONCLUSION The role of inactivating mutations of MEN1 gene in tumorigenesis of PTC and/or nodular goiter remains to be determined by more case reports and further research.展开更多
BACKGROUND Esophageal cancer is one of the most common causes of cancer-related death.Some patients with esophageal cancer have distant metastases at the time of diagnosis,but metastasis to the thyroid gland(MTG)and m...BACKGROUND Esophageal cancer is one of the most common causes of cancer-related death.Some patients with esophageal cancer have distant metastases at the time of diagnosis,but metastasis to the thyroid gland(MTG)and multifocal thyroid lesions alone are extremely rare.CASE SUMMARY In this case report,we present a case of a 69-year-old male with esophageal MTG.The patient visited our hospital for a routine body check-up,which revealed multifocal nodules in his thyroid lobes and enlarged cervical lymph nodes.A fine needle aspiration biopsy showed malignancies in both thyroid lesions and lymph nodes.The patient was initially diagnosed with primary bilateral thyroid cancer that spread to his lymph nodes,and a total thyroidectomy was performed.The histology showed MTG and therefore,a diagnostic work-up was implemented to determine the primary tumor.A fluorine-18-deoxyglucose positron emission tomography scan showed that the lower part of the esophagus and the lymph nodes in the neck,chest,and abdomen were involved.An esophagogastroscopy and corresponding pathology revealed distal esophageal squamous cell carcinoma.The esophageal MTG diagnosis was confirmed with pathological immunohistochemistry.CONCLUSION This case report highlights the difficulty in diagnosing esophageal MTG.Patients may have no malignancy history and be asymptomatic.Further diagnostic procedures are necessary after MTG is confirmed by cytology or histology,and the final diagnosis should be made according to the identification of the primary malignancy combined with pathological immunohistochemistry findings.展开更多
Radioiodine ablation(RIA) therapy is one of the most important treatments for papillary thyroid carcinoma(PTC), but some patients who received 131 I have radioiodine-refractory disease caused by the decreased expressi...Radioiodine ablation(RIA) therapy is one of the most important treatments for papillary thyroid carcinoma(PTC), but some patients who received 131 I have radioiodine-refractory disease caused by the decreased expression of the Na^+/I^- symporter(NIS). BRAF^(V600E) E mutation is one possible risk factor that can disturb the NIS expression, but the roles are unclear in clinical practice. This research discussed the association of BRAF^(V600E) E mutation and NIS expression in PTC tissue and the clinical implications in RIA therapy. 134 PTC samples were collected between June 2013 and June 2014 from Tongji Hospital affiliated to Tongji Medical College, and their clinical characteristics were analyzed. RT-PCR was used to detect the BRAF^(V600E) E mutation from formalin-fixed paraffin-embedded samples, and immunohistochemistry was applied to detect the NIS expression. IPP software was used to calculate the relative expression quantity of NIS. We found that there was no significant correlation between the absorbance(A) values of NIS and clinicopathologic features in these cases, even thyroid stimulating hormone. BRAF^(V600E) E mutation showed inhibitory effect on the NIS expression without statistically significant difference in all PTC cases(β=–0.0195, P=0.085), but in the subgroup without hashimoto's thyroiditis(HT), BRAF^(V600E) E mutation could significantly inhibit the NIS expression(β=–0.0257, P=0.046). The results indicate that BRAF^(V600E) E mutation is correlated with a lower expression of NIS in PTCs without HT, suggesting the radioiodine-refractory effects during RIA therapy in these patients.展开更多
BACKGROUND Parathyroid adenoma(PA) sometimes recurs after surgery,how to improve the surgical success rate of PA is the key to the treatment of this disease.AIM To investigate the clinical features,diagnosis,and surgi...BACKGROUND Parathyroid adenoma(PA) sometimes recurs after surgery,how to improve the surgical success rate of PA is the key to the treatment of this disease.AIM To investigate the clinical features,diagnosis,and surgical treatment of patients with PA.METHODS Patients who were pathologically confirmed with PA and had undergone surgery for the first time between January 2010 and December 2017 at the Beijing Shijitan Hospital affiliated to Capital Medical University were included in the study.The clinical features,localization diagnosis,and surgical treatment of these patients were analyzed.RESULTS Of the 140 patients,32 were male and 108 were female;132 cases had one adenoma,and 8 had two adenomas.In addition,114 cases had clinical symptoms,among which 51,28,23,8,and 4 had urinary system,skeletal system,digestive system,neuromuscular system,and neuropsychiatric symptoms,respectively,while 26 cases had no obvious symptoms.The median level of preoperative parathyroid hormone(PTH) was 201.0 pg/m L.The positive detection rate of technetium-99m sestamibi(Tc-99m MIBI) single-photon emission computed tomography/computed tomography(SPECT/CT),ultrasound examination,and the combined use of Tc-99m MIBI SPECT/CT and ultrasound examination was 92.9%,85.5%,and 96.4%,respectively.Open surgery was performed in all patients,and PTH was monitored during surgery.The success rate of surgery was 98.6%.After surgery,21 cases developed hypocalcemia,1 case developed temporary hoarseness,and 19 cases had transient hypoparathyroidism but there was no permanent hypoparathyroidism,postoperative hemorrhage,or hematoma in the surgical area.CONCLUSION For patients with clinically unexplained skeletal system,urinary system,and neuropsychiatric symptoms,the possibility of PA should be considered.Imaging examinations such as ultrasound and Tc-99m MIBI SPECT/CT could be integrated before surgery to obtain accurate localization diagnosis.Precise preoperative localization,intraoperative PTH monitoring,and delicate surgery to protect the integrity of the PA capsule ensure a minimally invasive and successful surgery.展开更多
BACKGROUND The bone is the second most common site of thyroid cancer metastasis,after the lung.Treatment options for bone metastasis of thyroid cancer include surgery,radioiodine therapy(RAIT),external radiation thera...BACKGROUND The bone is the second most common site of thyroid cancer metastasis,after the lung.Treatment options for bone metastasis of thyroid cancer include surgery,radioiodine therapy(RAIT),external radiation therapy,thyroid-stimulating hormone(TSH)inhibition,bisphosphonates,and small-molecule targeted therapies.In most cases,thyroid carcinoma is found in the thyroid tissue;reports of follicular thyroid carcinoma with a single metastasis to the lumbar spine are rare.CASE SUMMARY We report a case of bone metastasis as the only clinical manifestation of thyroid cancer.The patient was a 67-year-old woman with lumbar pain for 7 years and aggravation with intermittent claudication who had previously undergone partial thyroidectomy of a benign thyroid lesion.No abnormal nodules were found in the bilateral thyroid glands.However,imaging studies were consistent with a spinal tumor,and the lesion was diagnosed as a metastatic follicular carcinoma of thyroid origin.We adopted a multidisciplinary collaboration and comprehensive treatment approach.The patient underwent lumbar spine surgery,total resection of the thyroid,postoperative TSH suppression therapy,and RAIT.There were no complications associated with the operation,and the patient had good postoperative recovery.She has experienced no recurrence.CONCLUSION Follicular thyroid carcinoma is associated with early hematogenous metastasis,and the bone is a typical site of metastasis.Single bone metastasis is not a contraindication to medical procedures,and providing the appropriate therapy can result in better outcomes and quality of life for these patients.展开更多
BACKGROUND Although papillary thyroid microcarcinoma(PTMC)is not considered a threatening tumor,in some cases,it can be aggressive.Metastatic thrombosis of papillary thyroid carcinoma,follicular thyroid carcinoma,H...BACKGROUND Although papillary thyroid microcarcinoma(PTMC)is not considered a threatening tumor,in some cases,it can be aggressive.Metastatic thrombosis of papillary thyroid carcinoma,follicular thyroid carcinoma,Hürthle cell carcinoma,poorly differentiated thyroid carcinoma and anaplastic thyroid carcinoma have been reported in the literature,but there have been no reports about PTMC.CASE SUMMARY A 45-year-old woman presented with a thyroid mass and thrombosis in a middle thyroid vein during a physical examination.She had no symptoms,and the physical examination showed no positive signs.Subsequent ultrasonographyguided fine-needle aspiration biopsy results indicated an atypical lesion of ambiguous significance,with some actively growing cells(TBSRTCⅢ)and the BRAFV600E mutation not present.This patient underwent left thyroidectomy,isthmus lobectomy,prophylactic central lymph node dissection and thromboembolectomy.Postoperative pathology showed papillary microcarcinoma of the left thyroid,and the thrombus in the middle thyroid vein was a tumor thrombus.CONCLUSION Middle thyroid vein tumor thrombus is an extremely rare condition in PTMC,but it does exist.Lobectomy and thromboembolectomy may be an option for patients with thrombi in the middle vein of the thyroid,and we strongly suggest close follow-up of these patients.展开更多
基金Supported by the Foundation of Wenzhou Municipal Science and Technology Bureau,No.Y20190209 and No.Y2020739the Hospital Research Incubation Program,No.FHY2019075。
文摘BACKGROUND In recently diagnosed patients with thyroid cancer,papillary thyroid cancer(PTC),as the most common histological subtype,accounts for 90%of all cases.Although PTC is known as a relatively adolescent malignant disease,there still is a high possibility of recurrence in PTC patients with a poor prognosis.Therefore,new biomarkers are necessary to guide more effective stratification of PTC patients and personalize therapy to avoid overtreatment or inadequate treatment.Accumulating evidence demonstrates that microRNAs(miRNAs)have broad application prospects as diagnostic biomarkers in cancer.AIM To explore novel markers consisting of miRNA-associated signatures for PTC prognostication.METHODS We obtained and analyzed the data of 497 PTC patients from The Cancer Genome Atlas.The patients were randomly assigned to either a training or testing cohort.RESULTS We discovered 237 differentially expressed miRNAs in tumorous thyroid tissues compared with normal tissues,which contained 172 up-regulated and 65 downregulated miRNAs.The evaluation of differently expressed miRNAs was conducted using our risk score model.We then successfully generated a fourmiRNA potential prognostic signature[risk score=(-0.001×hsa-miR-181a-2-3p)+(0.003×hsa-miR-138-5p)+(-0.018×hsa-miR-424-3p)+(0.284×hsa-miR-612)],which reliably distinguished patients from high and low risk with a significant difference in the overall survival(P<0.01)and was effective in predicting the five-year disease survival rate with the area under the receiver operating characteristic curve of 0.937 and 0.812 in the training and testing cohorts,respectively.Additionally,there was a trend indicated that high-risk patients had shorter relapse-free survival,although statistical significance was not reached(P=0.082)in our sequencing cohort.CONCLUSION Our results indicated a four-miRNA signature that has a robust predictive effect on the prognosis of PTC.Accordingly,we would recommend more radical therapy and closer follow-ups for highrisk groups.
文摘BACKGROUND Papillary thyroid cancer(PTC)is one of the well-differentiated thyroid tumors.Cutaneous metastasis from differentiated thyroid cancers occurs in<1%of primary thyroid carcinomas but produces the worst survival prognosis.The multi-targeting tyrosine kinase inhibitor anlotinib has been approved to treat refractory advanced non-small-cell lung cancer as well as advanced soft-tissue and clear cell sarcomas in China.CASE SUMMARY In a patient with scalp metastasis caused by PTC,thyroid and skull metastasis tumor sizes were significantly reduced after a trial of neoadjuvant anlotinib therapy for 3 cycles.Anlotinib maintenance medication after thyroidectomy further reduced the metastatic skull tumor size thereby preventing the requirement for craniotomy.CONCLUSION The outcome of the present trial confirmed the potential of anlotinib therapy to treat scalp metastasis induced by PTC and point the way for the treatment of similar diseases in the future.
文摘BACKGROUND Thyroglobulin(Tg)is one of the markers of thyroid cancer,and its concentration may be elevated in patients with malignant thyroid tumors.Thyroid-stimulating hormone(TSH)is secreted by the pituitary gland,which has a significant impact on thyroid gland function.Excessively high or low TSH levels may be associated with an increased risk of thyroid cancer.Thus,in-depth studies on the association of serum Tg and TSH levels with thyroid cancer risk in patients with thyroid nodules are warranted.This can help determine whether Tg and TSH levels can predict the degree of malignancy of thyroid nodules,which can in turn guide doctors in making accurate diagnoses and treatment decisions.Furthermore,such studies can provide more accurate diagnostic methods for thyroid nodules and help patients become aware of the presence of thyroid cancer as early as possible,thereby improving the success rate of treatment and prognosis.AIM To investigate the association of serum Tg and TSH levels with the risk of thyroid cancer in patients undergoing thyroid nodule surgery.METHODS The clinical data and laboratory examination results of 130 patients who underwent thyroid nodule surgery were retrospectively analyzed.Furthermore,their preoperative serum Tg and TSH levels were recorded.Histopathological examination conducted during follow-up revealed the presence of thyroid cancer.Correlation analysis were used to analyze the association of Tg and TSH levels with the risk of thyroid cancer.RESULTS Of the 130 patients,60 were diagnosed with thyroid cancer.Statistical analysis revealed a significant positive correlation between serum Tg levels and the risk of thyroid cancer(P<0.05).This suggests that high serum Tg levels are associated with an increased risk of thyroid cancer.However,no significant correlation was observed between serum TSH levels and the risk of thyroid cancer(P>0.05).CONCLUSION In patients who underwent thyroid nodule surgery,serum Tg levels exhibited a significant correlation with the risk of thyroid cancer but serum TSH levels did not.These findings suggest that serum Tg can serve as an important biomarker for assessing the risk of thyroid cancer in these patients.
文摘BACKGROUND Patients rarely develop complicated infections in thyroid cysts.Here,we describe a patient with chronic infected unilateral giant thyroid cyst related to diabetes mellitus(DM).CASE SUMMARY A 66-year-old male was admitted due to an evident neck lump for 5 d after approximately 40 years of gradually progressive neck mass and 7 years of DM.Doppler ultrasound and computed tomography scan showed a giant lump in the left thyroid gland lobe.He was diagnosed with a large thyroid nodule complicated by tracheal dislocation and had surgical indications.Surgical exploration revealed evident inflammatory edema and exudation between the left anterior neck muscles,the nodule and glandular tissue.Fortunately,inflammatory lesions did not affect major neck vessels.Finally,a left partial thyroidectomy was performed.Macroscopic observation showed that the cystic thyroid mass consisted of extensive cystic wall calcification and was rich in massive rough sand-like calculi content and purulent matter.Postoperative pathology confirmed benign thyroid cyst with chronic infection.CONCLUSION The progression of this chronic infectious unilateral giant thyroid cyst may have been related to DM,and identifying blood vessels involvement can prevent serious complications during operation.
基金The study was reviewed and approved by the Shanghai Fourth People’s Hospital Institutional Review Board(approval No.2022108-001).
文摘BACKGROUND Hepatocellular carcinoma(HCC)is a prevalent malignancy,and transcatheter arterial embolization(TAE)has emerged as a pivotal therapeutic modality.How-ever,TAE may induce symptom distress and fatigue,adversely affecting the quality of life of patients.AIM To investigate symptom distress,fatigue,and associated factors in HCC patients undergoing TAE.METHODS We used a cross-sectional design and purposive sampling to enroll HCC patients who underwent TAE at our institution from January to December 2022.Question-naires were utilized to collect data on symptom distress and fatigue scores from the first to the third day after TAE.RESULTS Our study revealed a significant reduction in fatigue and symptom distress among patients after TAE.Pain,fatigue,insomnia,fever and abdominal dis-tension were the most common symptoms troubling patients during the first 3 d post-TAE.Marital status,presence of family support,physical functional status,age,and symptom distress were identified as predictors of fatigue in patients.CONCLUSION Healthcare professionals should educate HCC patients on symptom distress and INTRODUCTION Hepatocellular carcinoma(HCC)ranks as the fifth most prevalent cancer and the third leading cause of cancer-related mortality globally.Surgical intervention remains the cornerstone of HCC treatment;however,due to the challenges associated with early diagnosis and the lack of specific diagnostic markers,a considerable proportion of patients are diagnosed at advanced stages,rendering them ineligible for surgical interventions.Transcatheter arterial embolization(TAE)is an interventional therapeutic approach involving the insertion of a fine catheter via the femoral artery to reach the vasculature near the tumor site.TAE aims to obstruct the arterial supply to the tumor by deploying embolic agents,thereby inducing necrosis in cancer cells.This procedure is suitable for patients with good liver function and overall health,particularly those with large HCCs that have not invaded the portal vein[1,2].Nonetheless,following TAE,hepatocytes incur variable degrees of damage,leading to the development of a constel-lation of symptoms reminiscent of acute hepatitis.These symptoms include fatigue and systemic discomfort,such as nausea,vomiting,fever,abdominal pain,as well as transient elevations in aspartate aminotransferase(AST)and alanine aminotransferase(ALT),collectively referred to as postembolization syndrome[3,4].These symptoms may arise due to ischemia of the liver and gallbladder,temporary liver enlargement,and peritoneal irritation.While many studies have explored fatigue and symptom distress in cancer patients both nationally and internationally,with some focusing on symptom distress following transcatheter arterial chemoembolization,there has been limited in-depth investigation into the fatigue and symptom distress resulting from TAE treatment[5-8].Fatigue and pain are both subjective experiences,typically arising from the gradual depletion of energy reserves during the course of illness[9].Fatigue is particularly prevalent among cancer patients,with rates soaring as high as 90%.Despite extensive research exploring cancer-related fatigue and its influencing factors,a unanimous consensus remains elusive.Hence,the primary objective of this study was to investigate the symptom distress and fatigue experienced by liver cancer patients following TAE treatment and to analyze potential contributing factors.
文摘This editorial discusses the article written by Zheng et al that was published in the latest edition of the World Journal of Gastrointestinal Surgery.Our primary focus is on the causes,location,diagnosis,histological classification,and therapy of ectopic pancreas.Ectopic pancreas refers to the presence of pancreatic tissue that is situated in a location outside its usual anatomical placement,and is not connected to the normal pancreas in terms of blood supply or anatomical struc-ture.Currently,the embryological origin of ectopic pancreas remains uncertain.The most prevalent form of ectopic pancreatic is gastric ectopic pancreas.Endoscopic ultrasonography examination can visualize the morphological charac-teristics of the ectopic pancreatic lesion and pinpoint its anatomical location.The histological categorization of ectopic pancreas evolves.Endoscopic treatment has been widely advocated in ectopic pancreas.
基金Supported by the Shenzhen Science and Technology R&D Fund,No.JCYJ20220530163011026and Shenzhen Third People’s Hospital,No.G2022008 and No.G2021008。
文摘Liver transplantation is the primary therapeutic intervention for end-stage liver disease.However,vascular complications,particularly those involving the hepatic artery,pose significant risks to patients.The clinical manifestations associated with early arterial complications following liver transplantation are often non-specific.Without timely intervention,these complications can result in graft fai-lure or patient mortality.Therefore,early diagnosis and the formulation of an op-timal treatment plan are imperative.Ultrasound examination remains the pre-dominant imaging modality for detecting complications post liver transplan-tation.This article comprehensively reviews common causes and clinical present-ations of early hepatic artery complications in the post-transplantation period and delineates abnormal sonographic findings for accurate diagnosis of these con-ditions.Overall,ultrasound offers the advantages of convenience,safety,effect-iveness,and non-invasiveness.It enables real-time,dynamic,and precise evalua-tion,making it the preferred diagnostic method for post-liver transplantation assessments.INTRODUCTION Liver transplantation stands as the primary therapeutic approach for end-stage liver disease.Continuous advancements in surgical techniques and the application of novel immunosuppressive agents contribute to ongoing improvements in the success rate and overall survival in patients undergoing liver transplantation procedures.Despite these advan-cements,vascular complications,particularly those involving the hepatic artery,pose significant risks to patients.During the early stages following liver transplantation(within the first 30 d),proper hepatic artery function is crucial for hepatic arterial blood flow.During later stages,collateral circulation,including arteries such as the phrenic artery,right gastric artery,and gastroduodenal artery,becomes important for maintaining hepatic blood supply.It is now understood that the establishment of effective collateral circulation is pivotal for determining the prognosis of hepatic artery complic-ations.The clinical manifestations of these complications are closely linked to factors such as timing,severity,and the specific type of onset.Insufficient hepatic arterial blood flow can lead to abnormal liver function,hepatic infarction,and the formation of hepatic abscesses.Additionally,since the hepatic artery is the sole blood supply to the biliary tract,hepatic artery-related ischemia may result in biliary stricture,obstruction,and the formation of bile ducts.Ultrasound examination remains the primary imaging modality for diagnosing complications post liver transplantation.This article comprehensively reviews common causes and clinical presentations of early hepatic artery complications in the post-transplantation period and outlines abnormal sonographic findings for accurately diagnosing these conditions.NORMAL HEPATIC ARTERY During the intraoperative phase,an ultrasound examination is typically conducted to evaluate the hepatic artery anas-tomosis.The normal internal diameter of the hepatic artery typically ranges from 2 to 5 mm.Two strong echo points are typically identified near the anastomosis.To assess blood flow dynamics,peak systolic velocity,end-diastolic velocity,and resistance index are measured at the donor and recipient sides of the anastomosis following angle correction.Anastomotic stenosis presence and severity can be evaluated by comparing the velocity at the anastomotic site with that at the recipient side.Postoperatively,direct visualization of the anastomosis site through gray ultrasound scans is often challenging.The surgical approach has a significant impact on the proper hepatic artery’s position,resulting in a lower overall success rate of continuous visualization.Color Doppler ultrasound is primarily employed to trace the artery’s path,and spectral measurements are taken at the brightest position of the Color Doppler blood flow signal,primarily used to identify the presence of high-speed turbulence.Hepatic artery spectrum examination plays a crucial role,as a favorable arterial spectral waveform and appropriate hepatic artery flow velocity typically indicate a successful anastomosis,even in cases where the hepatic artery anastomosis cannot be directly visualized by ultrasound.The hepatic artery runs alongside the portal vein,often selected as a reference due to its larger inner diameter.A normal hepatic artery spectrum displays a regular pulsation pattern with a rapid rise in systole and a slow decline in diastole.Parameters for assessing hepatic artery resistance include a resistance index between 0.5 to 0.8 and an artery systolic acceleration of less than 80 ms.Instantaneous increases in the resistance index(RI>0.8)often occur within 2 d after surgery,followed by a subsequent return to normal hepatic arterial parameters.It has been established that the maximum blood flow velocity during systole in the hepatic artery should not exceed 200 cm/s[1].
基金supported by grants from the National Natural Science Foundation of China(Grant No.81771852)
文摘Objective: To study the sonographic features of the primary site of papillary thyroid microcarcinoma(PTMC) for the prediction of cervical lymph node metastasis during preoperative diagnosis.Methods: A total of 710 PTMC patients between 2013 and 2016 with a diagnosis of cervical lymph node metastases were reviewed.We analyzed the sonographic features of the PTMC primary site to predict ipsilateral or central lymph node metastases in univariate and multivariate models.The ratio of abutment/perimeter of the PTMC primary site was utilized to evaluate cervical lymph node status.Results: Regarding clinical characteristics, multifocality and extrathyroidal extension were associated with cervical lymph node involvement.In the multivariate regression model, calcification and the abutment/perimeter ratio of lesions were evaluated as independent factors in level Ⅵ, ipsilateral or skip cervical lymph node metastases.The cut-off value of the ratio of abutment/perimeter of the PTMC primary site(25%) was significantly correlated with cervical lymph node metastases(P = 0.000).Conclusions: Independent sonographic features, including lesion size, lesion location, calcification, and the ratio of abutment/perimeter of the primary site, were associated with cervical lymph node metastases in PTMC patients.
基金Supported by The Research and Development Project of Science and Technology of Chengde City,No.201706A046.
文摘BACKGROUND Surgery for thyroid carcinoma offers a good prognosis;however,cervical lymph node metastasis may occur in the early stage.An effective diagnostic method can accurately guide clinical surgical planning and the scope of lymph node dissection,ultimately improving patient prognosis.AIM To explore the diagnostic value of fine-needle aspiration of thyroglobulin(FNATg)combined with ultrasound(US)-guided fine-needle aspiration cytology for cervical lymph node metastasis in thyroid carcinoma.METHODS We enrolled 209 pathologically confirmed thyroid carcinoma patients who visited our hospital between Jan 2017 and Dec 2020.Patients were tentatively diagnosed with cervical lymph node enlargement using preoperative US.They underwent US-guided fine-needle aspiration cytology and FNA-Tg.The value of single and combined application of the two methods for the diagnosis of cervical lymph node metastasis was calculated.The factors affecting FNA-Tg for diagnosis were analyzed using univariate and multivariate methods.RESULTS FNA-Tg values were significantly higher among patients with positive cervical lymph node metastasis.The sensitivity and specificity of US-guided fine-needle aspiration cytology,FNA-Tg,and US-guided fine-needle aspiration cytology+FNA-Tg were 85.48%and 90.59%,83.06%and 87.06%,and 96.77%and 91.76%,respectively.The area under the receiver operating characteristic curve for USguided fine-needle aspiration cytology,FNA-Tg,and the two combined,was 0.880,0.851,and 0.943,respectively.A long diameter/short diameter ratio<2,an insufficient number of acquired cells,a low serum thyroglobulin level,and an absence of typical metastatic US features increased the risk of cervical lymph node metastasis in thyroid carcinoma patients misdiagnosed using FNA-Tg.CONCLUSION The diagnostic value of FNA-Tg for detecting cervical lymph node metastasis is not high;however,combined with US-guided fine-needle aspiration cytology,it is significantly improved.
文摘The incidence of papillary thyroid carcinoma(PTC)has exponentially increased in recent years.Papillary thyroid microcarcinoma(PTMC)accounts for the majority of the reported cases of PTC.The debates and crucial issues in PTMC management have received researchers'attention.To further improve the clinical management of PTMC in China,
文摘In recent years, the clinical incidence of thyroid cancer has been increasing year by year, and its risk assessment and clinical management methods have also been accordingly modified and constantly improved. There are great differences between the clinical diagnostic and therapeutic modes and disease management of thyroid cancer employed by various medical institutions in China, particularly with regard to the clinical application of serum marker of thyroid cancer. To this end, the China Anti-Cancer Association Thyroid Cancer Specialized Committee Chinese Association of Thyroid Oncology organized this compilation of ExpertConsensus on Clinical Application of Serum Marker of Thyroid Cancer to help and impel relevant clinical institutions and professionals to standardize clinical diagnosis, treatment, and long-term management of thyroid cancer, and to properly utilize the serum marker for scientific auxiliary clinical diagnosis and assessment of thyroid cancer before and after operation.
文摘BACKGROUND Lymph node metastasis(LNM) of papillary thyroid carcinoma(PTC) has a certain regularity and occurs first to the central lymph node and then to the lateral lymph node. The pathway of PTC LNM can guide surgical prophylactic lymph node dissection(LND) for clinical surgeons.AIM To investigate the relationship between subgroups of central LNM and lateral LNM in unilateral clinically node-negative PTC(cN0-PTC).METHODS Data were collected for 1089 PTC patients who underwent surgical treatment at the Department of Endocrine and Breast Surgery of the First Hospital of Chongqing Medical University from January 2016 to December 2017. A total of 388 unilateral cN0-PTC patients met the inclusion criteria and were enrolled in this study. The clinical and pathological data for these 388 patients who underwent total thyroidectomy + central LND + lateral LND were retrospectively analyzed. The relationship between the central LNM and lateral LNM subgroups was investigated.RESULTS The coincidence rate of cN0-PTC was only 30.0%.Optimal scaling regression analysis showed that sex(57.1% vs 42.9%, P = 0.026), primary tumor size(68.8% vs 31.2%, P = 0.008), tumor location(59.7% vs 40.3%, P = 0.007), extrathyroid extension(ETE)(50.6% vs 49.9%, P = 0.046), and prelaryngeal LNM(57.1% vs 42.9%, P = 0.004) were significantly associated with ipsilateral level-II LNM. Their importance levels were 0.122, 0.213, 0.172, 0.110, and 0.227, respectively. Primary tumor size(74.6% vs 30.2%, P = 0.016), pretracheal LNM(67.5% vs 32.5%, P < 0.001), and paratracheal LNM(71.4% vs 28.6%, P < 0.001) were significantly associated with ipsilateral level-Ⅲ LNM. Their importance levels were 0.120, 0.408, and 0.351, respectively. Primary tumor size(72.1% vs 27.9%, P = 0.003), ETE(70.4% vs 29.6%, P = 0.016), pretracheal LNM(68.3% vs 31.7%, P=0.001), and paratracheal LNM(80.8% vs 19.2%, P < 0.001) were significantly associated with ipsilateral level-IV LNM. Their importance levels were 0.164, 0.146, 0.216, and 0.472, respectively.CONCLUSION The LNM pathway of thyroid cancer has a certain regularity. For unilateral cN0-PTC patients with a tumor diameter > 2 cm and pretracheal or ipsilateral paratracheal LNM, LND at ipsilateral level Ⅲ and level IV must be considered. When there is a tumor in the upper third of the thyroid with prelaryngeal LNM, LND at level II, level Ⅲ and level IV must be considered.
文摘<strong>Background:</strong> We aimed to investigate the ability of carbon nanoparticles to identify parathyroid glands with vasculature during thyroid surgery. <strong>Material and methods:</strong> Totally 42 patients with various thyroid diseases were selected for the prospective research of carbon nanoparticle injection used in thyroidectomy. Another 42 patients without receiving carbon nanoparticle injection were selected as the control group. All cases underwent total or subtotal bilateral thyroidectomy. Before the ligation of the superior and inferior poles of the thyriod lobes, 0.1 mL of a carbon nanoparticle suspension was injected into the two poles. Important tissues such as the recurrent laryngeal nerve, parathyroid gland with blood supply and the inferior thyroid artery were identified and protected. <strong>Results:</strong> The parathyroid glands with vasculature were not stained and thus remained the primary color in all cases, while abnormal thyroid tissues were stained black. After 5 minutes, thyroid lobes were injected with the carbon nanoparticle suspension and the original color of parathyroid glands was unchanged. Even the parathyroids with blood supply can be identified and protected. The number of parathyroid glands for autotransplantation was one in the test group and six in the control group. At one day after the thyroid surgery, hypocalcemia became detectable in four patients of the test group and in five of the control group. Twenty-four instances of hypoparathyroidism occurred at 1 day after surgery in the control group, while ten instances in the test group. <strong>Conclusion:</strong> Intraoperatvie carbon nanoparticle suspension injection is an effective and safe technique for guiding thyroid surgery. The carbon nanoparticle suspension plays an important role in identifying the vasculatural parathyroid glands, while protecting the physiologic function of the parathyroid glands during surgery.
基金Supported by Shanxi Provincial Natural Science Foundation,No.201701D121159Shanxi Provincial Health and Family Planning Commission,No.2014016Health Commission of Shanxi Province,No.2019020.
文摘BACKGROUND In recent years,studies have found that the occurrence and development of diabetic cardiomyopathy(DCM)is closely related to an increase in polyadenosine diphosphate-ribose polymerase-1(PARP-1)activity.PARP-1 activation could be involved in the pathophysiological process of DCM by promoting oxidative stress,the inflammatory response,apoptosis and myocardial fibrosis.AIM To investigate the mechanism of liraglutide in improving myocardial injury in type 2 diabetic rats,further clarified the protective effect of liraglutide on the heart,and provided a new option for the treatment of DCM.METHODS Forty healthy male SD rats aged 6 wk were randomly divided into two groups,a normal control group(n=10)and a model group(n=30),which were fed an ordinary diet and a high-sugar and high-fat diet,respectively.After successful modeling,the rats in the model group were fed a high-glucose and high-fat diet for 4 wk and randomly divided into a model group and an intervention group(further divided into a high-dose group and a low-dose group).The rats were fed a high-glucose and high-fat diet for 8 wk and then started drug intervention.Blood samples were collected from the abdominal aorta to detect fasting blood glucose and lipid profiles.Intact heart tissue was dissected,and its weight was used to calculate the heart weight index.Haematoxylin and eosin staining was used to observe the pathological changes in the myocardium and the expression of PARP-1 in the heart by immunohistochemistry.RESULTS The body weight and heart weight index of rats in the model group were significantly increased compared with those in the normal control group,and those in the intervention group were decreased compared with those in the model group,with a more obvious decrease observed in the high-dose group(P<0.05).In the model group,myocardial fibers were disordered,and inflammatory cells and interstitial fibrosis were observed.The cardiomyopathy of rats in the intervention group was improved to different degrees,the myocardial fibers were arranged neatly,and the myocardial cells were clearly striated;the improvement was more obvious in the high-dose group.Compared with the normal control group,the expression of PARP-1 in myocardial tissue of the model group was increased,and the difference was statistically significant(P<0.05).After liraglutide intervention,compared with the model group,the expression of PARP-1 in myocardial tissue was decreased,and the reduction was more obvious in the high-dose group(P<0.05)but still higher than that in the normal control group.CONCLUSION Liraglutide may improve myocardial injury in type 2 diabetic rats by inhibiting the expression of myocardial PARP-1 in a dose-dependent manner.
文摘BACKGROUND Multiple endocrine neoplasia type 1(MEN1)is a rare hereditary tumor syndrome inherited in an autosomal dominant manner and presents mostly as parathyroid,endocrine pancreas(such as gastrinoma)and anterior pituitary tumors.At present,papillary thyroid carcinoma(PTC)and nodular goiter are not regarded as components of MEN1.CASE SUMMARY A 35-year-old woman presented with MEN1 accompanied by coinstantaneous PTC and nodular goiter.The pathological diagnosis was PTC with cervical lymph node metastasis,nodular goiter,parathyroid cyst and adenomatoid hyperplasia.Genetic testing was performed and a MEN1 gene mutation was detected.The patient underwent unilateral lobectomy of the thyroid gland and surgical removal of the parathyroid tumors.At 18 mo of follow-up,ultrasonic examination of the neck showed no abnormality.Serum calcium and parathyroid hormone levels were normal.No new MEN1-associated tumors were detected.CONCLUSION The role of inactivating mutations of MEN1 gene in tumorigenesis of PTC and/or nodular goiter remains to be determined by more case reports and further research.
文摘BACKGROUND Esophageal cancer is one of the most common causes of cancer-related death.Some patients with esophageal cancer have distant metastases at the time of diagnosis,but metastasis to the thyroid gland(MTG)and multifocal thyroid lesions alone are extremely rare.CASE SUMMARY In this case report,we present a case of a 69-year-old male with esophageal MTG.The patient visited our hospital for a routine body check-up,which revealed multifocal nodules in his thyroid lobes and enlarged cervical lymph nodes.A fine needle aspiration biopsy showed malignancies in both thyroid lesions and lymph nodes.The patient was initially diagnosed with primary bilateral thyroid cancer that spread to his lymph nodes,and a total thyroidectomy was performed.The histology showed MTG and therefore,a diagnostic work-up was implemented to determine the primary tumor.A fluorine-18-deoxyglucose positron emission tomography scan showed that the lower part of the esophagus and the lymph nodes in the neck,chest,and abdomen were involved.An esophagogastroscopy and corresponding pathology revealed distal esophageal squamous cell carcinoma.The esophageal MTG diagnosis was confirmed with pathological immunohistochemistry.CONCLUSION This case report highlights the difficulty in diagnosing esophageal MTG.Patients may have no malignancy history and be asymptomatic.Further diagnostic procedures are necessary after MTG is confirmed by cytology or histology,and the final diagnosis should be made according to the identification of the primary malignancy combined with pathological immunohistochemistry findings.
基金supported by Hubei Natural Science Foundation of China(No.2014CKB519)
文摘Radioiodine ablation(RIA) therapy is one of the most important treatments for papillary thyroid carcinoma(PTC), but some patients who received 131 I have radioiodine-refractory disease caused by the decreased expression of the Na^+/I^- symporter(NIS). BRAF^(V600E) E mutation is one possible risk factor that can disturb the NIS expression, but the roles are unclear in clinical practice. This research discussed the association of BRAF^(V600E) E mutation and NIS expression in PTC tissue and the clinical implications in RIA therapy. 134 PTC samples were collected between June 2013 and June 2014 from Tongji Hospital affiliated to Tongji Medical College, and their clinical characteristics were analyzed. RT-PCR was used to detect the BRAF^(V600E) E mutation from formalin-fixed paraffin-embedded samples, and immunohistochemistry was applied to detect the NIS expression. IPP software was used to calculate the relative expression quantity of NIS. We found that there was no significant correlation between the absorbance(A) values of NIS and clinicopathologic features in these cases, even thyroid stimulating hormone. BRAF^(V600E) E mutation showed inhibitory effect on the NIS expression without statistically significant difference in all PTC cases(β=–0.0195, P=0.085), but in the subgroup without hashimoto's thyroiditis(HT), BRAF^(V600E) E mutation could significantly inhibit the NIS expression(β=–0.0257, P=0.046). The results indicate that BRAF^(V600E) E mutation is correlated with a lower expression of NIS in PTCs without HT, suggesting the radioiodine-refractory effects during RIA therapy in these patients.
文摘BACKGROUND Parathyroid adenoma(PA) sometimes recurs after surgery,how to improve the surgical success rate of PA is the key to the treatment of this disease.AIM To investigate the clinical features,diagnosis,and surgical treatment of patients with PA.METHODS Patients who were pathologically confirmed with PA and had undergone surgery for the first time between January 2010 and December 2017 at the Beijing Shijitan Hospital affiliated to Capital Medical University were included in the study.The clinical features,localization diagnosis,and surgical treatment of these patients were analyzed.RESULTS Of the 140 patients,32 were male and 108 were female;132 cases had one adenoma,and 8 had two adenomas.In addition,114 cases had clinical symptoms,among which 51,28,23,8,and 4 had urinary system,skeletal system,digestive system,neuromuscular system,and neuropsychiatric symptoms,respectively,while 26 cases had no obvious symptoms.The median level of preoperative parathyroid hormone(PTH) was 201.0 pg/m L.The positive detection rate of technetium-99m sestamibi(Tc-99m MIBI) single-photon emission computed tomography/computed tomography(SPECT/CT),ultrasound examination,and the combined use of Tc-99m MIBI SPECT/CT and ultrasound examination was 92.9%,85.5%,and 96.4%,respectively.Open surgery was performed in all patients,and PTH was monitored during surgery.The success rate of surgery was 98.6%.After surgery,21 cases developed hypocalcemia,1 case developed temporary hoarseness,and 19 cases had transient hypoparathyroidism but there was no permanent hypoparathyroidism,postoperative hemorrhage,or hematoma in the surgical area.CONCLUSION For patients with clinically unexplained skeletal system,urinary system,and neuropsychiatric symptoms,the possibility of PA should be considered.Imaging examinations such as ultrasound and Tc-99m MIBI SPECT/CT could be integrated before surgery to obtain accurate localization diagnosis.Precise preoperative localization,intraoperative PTH monitoring,and delicate surgery to protect the integrity of the PA capsule ensure a minimally invasive and successful surgery.
基金Supported by the Medical Scientific Research Foundation of Guangdong Province,China,No.A2021432 and B2021448the Shantou Medical Science and Technology Planning Project,No.210521236491457 and 210625106490696the Undergraduate Innovation Training Project of Shantou University,No.31/38/47/54。
文摘BACKGROUND The bone is the second most common site of thyroid cancer metastasis,after the lung.Treatment options for bone metastasis of thyroid cancer include surgery,radioiodine therapy(RAIT),external radiation therapy,thyroid-stimulating hormone(TSH)inhibition,bisphosphonates,and small-molecule targeted therapies.In most cases,thyroid carcinoma is found in the thyroid tissue;reports of follicular thyroid carcinoma with a single metastasis to the lumbar spine are rare.CASE SUMMARY We report a case of bone metastasis as the only clinical manifestation of thyroid cancer.The patient was a 67-year-old woman with lumbar pain for 7 years and aggravation with intermittent claudication who had previously undergone partial thyroidectomy of a benign thyroid lesion.No abnormal nodules were found in the bilateral thyroid glands.However,imaging studies were consistent with a spinal tumor,and the lesion was diagnosed as a metastatic follicular carcinoma of thyroid origin.We adopted a multidisciplinary collaboration and comprehensive treatment approach.The patient underwent lumbar spine surgery,total resection of the thyroid,postoperative TSH suppression therapy,and RAIT.There were no complications associated with the operation,and the patient had good postoperative recovery.She has experienced no recurrence.CONCLUSION Follicular thyroid carcinoma is associated with early hematogenous metastasis,and the bone is a typical site of metastasis.Single bone metastasis is not a contraindication to medical procedures,and providing the appropriate therapy can result in better outcomes and quality of life for these patients.
文摘BACKGROUND Although papillary thyroid microcarcinoma(PTMC)is not considered a threatening tumor,in some cases,it can be aggressive.Metastatic thrombosis of papillary thyroid carcinoma,follicular thyroid carcinoma,Hürthle cell carcinoma,poorly differentiated thyroid carcinoma and anaplastic thyroid carcinoma have been reported in the literature,but there have been no reports about PTMC.CASE SUMMARY A 45-year-old woman presented with a thyroid mass and thrombosis in a middle thyroid vein during a physical examination.She had no symptoms,and the physical examination showed no positive signs.Subsequent ultrasonographyguided fine-needle aspiration biopsy results indicated an atypical lesion of ambiguous significance,with some actively growing cells(TBSRTCⅢ)and the BRAFV600E mutation not present.This patient underwent left thyroidectomy,isthmus lobectomy,prophylactic central lymph node dissection and thromboembolectomy.Postoperative pathology showed papillary microcarcinoma of the left thyroid,and the thrombus in the middle thyroid vein was a tumor thrombus.CONCLUSION Middle thyroid vein tumor thrombus is an extremely rare condition in PTMC,but it does exist.Lobectomy and thromboembolectomy may be an option for patients with thrombi in the middle vein of the thyroid,and we strongly suggest close follow-up of these patients.
