Abstract:

Objective: To compare the incidence of recurrent laryngeal nerve (RLN) injury of precise thyroid lobectomy and subtotal thyroidectomy， and to assess the safety of precise thyroid lobectomy.
Methods: The clinical data of 249 patients with 438 affected  thyroid sides undergoing precise thyroid lobectomy or subtotal thyroidectomy from January 2010 to June 2011 were retrospectively analyzed.
Results: Six cases of the whole group of patients had transient unilateral RLN palsy. The incidence of RLN injury of precise thyroid lobectomy and subtotal thyroidectomy was 1.38% (3/216 affected sides) and 1.35% (3/222 affected sides)， respectively， and there was no statistical difference between the two procedures (P>0.05). No bilateral or permanent RLN injury occurred in any of the patients.
Conclusions: Precise thyroid lobectomy after improvements in technique， is as safe as subtotal thyroidectomy in terms of avoiding RLN injury.

Abstract:

Objective: To investigate the efficacy of recurrent laryngeal nerve (RLN) exposure in preventing RLN injury during thyroid surgery.
Methods: Using a prospective， randomized， controlled design， 373 patients scheduled to undergo thyroid surgery and met the inclusion criteria were randomly divided into observation group and control group. The patients of the observation group (173 cases) underwent thyroid surgery with RLN exposure， while the patients of the control group (200 cases) underwent thyroid surgery without RLN exposure. The RLN injury rate and outcome of the two groups were compared.
Results: A total of 198 RLNs were exposed in observation group with the RLN injury rate of 0.5% (1/198)， and the nerve injury recovered within 6 months. The RLN injury rate of the control group was 6.0% (12/200). Of the patients with RLN injury， 4 cases partially recovered within 6 months and 8 cases were permanent injury. There were significant differences of RLN injury between the two groups (P＜0.05).
Conclusions: The routine exposure of RLN pathway during thyroid surgery can effectively reduce the incidence of RLN injury.

Abstract:

Objective: To assess the value of laryngeal recurrent nerve (RLN) dissection during primary surgery for benign thyroid diseases.
Methods: Two hundred and forty-one patients with benign thyroid disease who underwent surgery performed by the same surgeon were retrospectively analyzed. Of the patients， 159 cases had unilateral total lobectomy and 82 cases had bilateral total lobectomy. The patients were divided into dissection group (145 cases) and non-dissection group (96 cases) as to whether or not they had RLN dissection. The incidences of RLN injury of the two groups were counted according to the number of RLN at risk of injury during surgery， and the difference in temporary and permanent RLN injury rates between the two groups was analyzed.
Results: The incidence rate of temporary and permanent RLN injury was 4.1% and 0 in the dissection group， and was 5.4 and 3.8% in the non-dissection group， respectively. The incidence rate of temporary RLN injury had no statistical difference between the two groups (P＞0.05). The incidence rate of permanent RLN injury of the dissection group was lower than that of the non-dissection group， and this had statistical difference (P＜0.05).
Conclusions: RLN dissection during the operation for benign thyroid disease can reduce the risk of permanent RLN injury. Total lobectomy with routine RLN dissection is recommended as a basic procedure in surgery for benign thyroid diseases.

Abstract:

Objective: To assess the value of medial approach for recurrent laryngeal nerve (RLN) dissection during thyroid surgery.
Methods: The data of 368 patients undergoing thyroid surgery with RLN dissection through medial approach were retrospectively analyzed to assess the incidence of RLN injury after the procedure.
Results: Of the patients， 2 cases (0.54%) had transient RLN injury and no permanent RLN injury occurred.
Conclusions: Medial approach for RLN dissection can decrease the incidence of RLN injury， and is an effective method to prevent RLN injury in thyroid surgery.

Abstract:

Objective:  To investigate the surgical complications of total thyroidectomy (TT) and their associated risk factors.
Methods: The clinical data of 172 patients who underwent TT under surgical loupes from January 2007 to December 2009 in our hospital were retrospectively reviewed. The intraoperative and postoperative complications were recorded and the possible factors responsible for surgical complications of TT were analyzed.
Results:  Of the whole group， the exposure rate of the parathyroid glands and the recurrent laryngeal nerves was 96.5% and 98.3%， respectively. The exposure rate of the parathyroid glands of the patients undergoing primary surgery was higher than that of the patients undergoing secondary surgery (98.7% vs. 77.7%) (P＜0.05). The average serum calcium level after surgery decreased significantly compared with that before surgery ［(2.057±0.016) mmol/L vs. (2.347±0.009) mmol/L］ (P＜0.01). In the whole group， the incidence of transient and permanent hypoparathyroidism was 16.9% and 1.2%， respectively. The incidence of permanent hypoparathyroidism in the patients undergoing secondary surgery was significantly higher than that in the patients undergoing primary surgery (11.1% vs. 0) (P＜0.01). The permanent recurrent laryngeal nerve palsy occurred in one case (0.6%).
Conclusions: TT is a safe procedure with low complication rate under the condition of meticulous dissection with the aid of surgical loupes， and is recommended for use in clinical practice.

Abstract:

Objective: To assess the clinical value of multislice spiral CT (MSCT) in diagnosis of thyroid papillary cancer (PTC) with cervical lymph node metastases.
Methods: The preoperative MSCT examination findings of 38 PTC patients undergoing functional neck dissection were retrospectively analyzed， and were also compared with the results of pathological diagnosis after surgery.
Results: In the 38 patients， the positive rate of lymph node metastasis by MSCT examination was 84.2% (32/38)， and most of the lymph node metastatic lesions had characteristic imaging changes. The central cervical lymph nodes had the maximum metastatic rate that reached 52.6% (20/38)， but the small lymph node metastases were difficult to be detected by MSCT in this region， which was responsible for the six false-negative cases.
Conclusions: MSCT has high accuracy in diagnosis of PTC with cervical lymph node metastases. Routine central neck dissection is recommended for PTC patients undergoing primary surgery. 

Abstract:

Objective: To investigate the efficacy and toxicity of capecitabine (Xeloda) -based combination chemotherapy for metastatic breast cancer (MBC).
Methods: Of the 42 MBC patients， 23 cases who had failed previous anthracycline-based chemotherapy received a regimen of Xeloda plus navelbine (treatment schedule: navelbine 25 mg/m2 iv. on day 1 and day 8， Xeloda 2000 mg/m2 po. twice daily from day 1 to day 14 every 3 weeks); the other 19 cases who had no prior anthracycline-based chemotherapy received Xeloda plus pirarubicin (treatment schedule: pirarubicin 35 mg/m2 iv. on day 1 and day 8， Xeloda with the same dosage regimen and treatment course as above-mentioned). The efficacy was assessed after at least 6 cycles of chemotherapy in all patients.
Results: Of the patients who received Xeloda plus navelbine， complete response (CR) was achieved in 5 cases， partial response (PR) in 12 cases and stable disease (SD) in 4 patients， and progressive disease (PD) was observed in 2 patients; the response rate was 73.91% (17/23); the median time to progression (TTP) was 8.4 months， and median survival time (MST) was 18.1 months. Of the patients who received Xeloda plus pirarubicin， the cases of CR， PR， SD and PD were 5， 7， 2 and 5， respectively; the response rate was 63.16% (12/19); TTP and MST was 7.8 and 17.5 months， respectively. The effective rate between the two sets of schedules showed no significant difference (P＞0.05). The major toxicity and adverse events for all the patients were leukopenia (Grade III-IV in 52.4% patients) and hand-foot syndrome (Grade II-III in 19.0% patients).
Conclusions: Capecitabine-based combination chemotherapy has substantial efficacy for MBC with tolerable toxicity profiles.

Abstract:

Objective: To determine the risk factors of brain metastases of patients with  breast cancer.
Methods: Follow-up surveys were carried out in the patients with breast cancer who were treated at our hospital from 1997 to 2007. Of the patients， 133 cases having brain metastasis were considered as the study group and the other 145 cases without brain metastasis served as the control group. The factors related to brain metastasis were comparatively analyzed.
Results: The likelihood of brain metastasis of patients with breast cancer was increased in the conditions of histological grade 3， tumor diameter more than 5 cm， estrogen receptor (ER) negative and human epidermal growth factor receptor 2 (HER-2) positive. Other factors， including tumor stage， histological classification， progesterone receptor (PR) status， presence or absence of axillary lymph node metastases and menopausat status， were not obviously related to brain metastasis.
Conclusions: Histological grade， tumor size and HER-2 status are independent risk factors for breast cancer brain metastasis， while ER may be an independent protective factor against breast cancer brain metastasis.

Abstract:

Objective: To assess the protective effect of goserelin on the ovarian function of premenopausal patients with breast cancer during chemotherapy.
Methods: The clinical data of premenopausal patients with breast cancer treated in the recent two-year period were retrospectively analyzed. The patients were divided into study group (goserelin plus conventional chemotherapy) and control group (conventional chemotherapy) with 40 cases in each group. The menstrual status and the hormone levels during chemotherapy and first year follow-up after chemotherapy between the two groups were observed. 
Results: All the 80 patients completed their chemotherapy treatment and all of them developed menstrual disorders. The menstrual recovery rate of the observation group and the control group was 85% and 55%， respectively， and the difference between the two groups had statistical significance (P=0.007). In the observation group， the serum oestradiol (E2) decreased to postmenopausal level， and the serum levels of follicle stimulating hormone (FSH) were also significantly decreased during combination treatment (goserelin plus conventional chemotherapy). In the control group， the E2 levels decreased gradually while FSH and LH level increased significantly during chemotherapy.
Conclusions: Goserelin administration during chemotherapy can effectively prevent the ovarian function injury caused by chemotherapy， and can help maintain normal menstruation and fertility for the young and middle-aged patients.

Abstract:

Objective: To investigate the value of color Doppler ultrasonography (CDU) and full-field digital mammography (FFDM) in diagnosis and differential diagnosis of benign and malignant breast lesions.
Methods: Retrospective analysis was performed on the clinical data of 107 patients with benign breast lesions and 100 patients with breast cancer， which were confirmed by surgical and pathological findings. The results of CDU and FFDM examination of the patients before operation were compared with the final diagnoses to assess the accuracy of the two methods and the diagnostic efficacy of their combination.
Results: All the patients underwent both CDU and FFDM examinations. The sensitivity and specificity was 88% and 82.84% for CDU， 89% and 75.7% for FFDM， and 97% and 88.78% for combination of CDU and FFDM， respectively. Based on a receiver-operating characteristics (ROC) curve analysis， the overall accuracy for breast cancer detection was the combination of CDU and FFDM>CDU>FFDM， successively. The detection rate of CDU and FFDM for breast mass was 95% and 70%， respectively and the difference had statistical significance (P＜0.01). The detection rate of breast cancer in pre- and post-menopausal patients by CDU was 93.5% and 83.3% (P＞0.05)， and by FFDM was 80.4% and 96.3% (P＜0.05)， respectively. No significant difference was noted in the detection rate of breast cancer in the pre-menopausal patients between CDU and FFDM (P＞0.05)， while FFDM had higher detection rate of breast cancer than that of CDU in the post-menopausal patients (P＜0.05).
Conclusions: CDU has a high sensitivity to breast mass and FFDM has high detection rate of breast cancer in post-menopause patients. The combination of the two examinations can enhance the overall diagnostic accuracy for malignant breast lesions and decrease the missed diagnosis and misdiagnosis rate.

Abstract:

Objective: To identify the clinicopathological features of triple-negative breast cancer (TNBC).
Methods: There were 38 TNBC patients with complete records available who were admitted to our hospital over a 4-year period. Their clinical data that included the general conditions， pathological features， molecular markers， recurrence and metastasis were retrospectively analyzed and were compared with those of non-TNBC patients admitted during the same period.
Results: In the TNBC and non-TNBC patients， the cases less than 35 years old accounted for 21.05% and 5.14%， respectively (P＜0.05). The patients with lymph nodes metastases accounted for 60.53% (23/38) of the TNBC patients， which was higher than that of the non-TNBC patients (43.49%， 127/292) (P＜0.05). Tumors of histological grade III were found in 52.63% (20/38) of the TNBC patients， which was higher than that of the non-TNBC patients (35.27%， 103/292) (P＜0.05). Peritumoral vascular invasion occurred in 31.58% (12/38) of TNBC patients， which was higher than that of the non-TNBC patients (15.41%， 45/292) (P＜0.05). The positive rate of epidermal growth factor receptor (EGFR) and vascular endothelial growth factor (VEGF)， and the abnormal expression rate of E-cadherin were 81.58% (31/38)， 78.95% (30/38) and 65.79% (25/38)， respectively， in the TNBC patients， all which were higher than those in the non-TNBC patients ［39.73% (116/292)， 61.30% (179/292) and 48.29% (141/292)］ (all P＜0.05). The distant metastasis rate was 23.68% (9/38) in the TNBC patients and 11.99% (35/292) in the non-TNBC patients， respectively， and that was statistically different (P＜0.05).
Conclusions: TNBC usually occurs in young people， and has a higher metastasis rate and poor prognosis.

Abstract:

Objective:  To investigate the expression of the p16/p38MAPK/p53/Wip1 pathway in patients with papillary thyroid cancer (PTC) and its clinical significance.
Methods: The protein expressions of Wip1， p53， p38MAPK and p16 in 70 cases of PTC tissues and 20 cases of normal thyroid tissues were detected by immunohistochemical staining. The correlations of Wip1 protein high-expression with p53， p38MAPK and p16 protein expression were analyzed.
Results: The high-expression rate of Wip1 protein in the PTC tissue was 64.3% (45/70)， which was significantly different than that in normal thyroid tissue (0/20) (P＜0.01). There were no significant differences between the paired groups in terms of age， gender， tumor size and lymph node metastasis (all P＞0.05). The Wip1 protein high-expression was negatively correlated with the expression of p38MAPK， p53 and p16 (r value was -0.620， 0.356 and 0.550， respectively， and all P＜0.01).
Conclusions: The p16/p38MAPK/p53/Wip1 pathway is abnormal in PTC， and this abnormality may possibly be associated with the aberrantly up-regulated Wip1， which can induce inhibition of p38MAPK， p53 and p16. Wip1 may potentially become a therapeutic target for thyroid cancer.

Abstract:

Objective: To investigate the expressions of D2-40， CK19， galectin-3， VEGF and EGFR in papillary thyroid carcinoma and their clinical significances.
Methods: The expressions of D2-40， CK19， galectin-3， VEGF and EGFR in 38 cases of papillary thyroid carcinoma and 12 cases of thyroid papillary hyperplasia were detected by immunohistochemical staining.
Results: The positive expression rates of D2-40， CK19， Galectin-3， VEGF and EGFR in patients with papillary thyroid carcinoma were all significantly higher than those in patients with thyroid papillary hyperplasia (all P＜0.05). The expressions of D2-40， VEGF and EGFR in papillary thyroid carcinoma with lymph node metastasis were significantly higher than those without lymph node metastasis (P＜0.05). The expressions of CK19 and galectin-3 showed no significant differences between the papillary thyroid carcinomas with and without lymph node metastasis (P＞0.05).
Conclusions: The detection of D2-40， CK19， galectin-3， VEGF and EGFR is helpful to diagnosis and differential diagnosis of papillary thyroid carcinoma and thyroid papillary hyperplasia. The expressions of D2-40， VEGF and EGFR are associated with lymph node metastasis of papillary thyroid carcinoma， which may be useful for predicting whether or not there is cancer  metastasis. 

Abstract:

Objective: To investigate the differences in the amount of cancer stem cells in different breast cancer subtypes.
Methods: The specimens of breast cancer tissues were divided into five groups: group A (luminal A type)， B (luminal B type)， C (HER2+ type)， D (basal-like type) and E (normal-like) according to their molecular subtypes. The cancer stem cell spheres in each group were measured through colony formation method， and then the relations of the amount of cancer stem cells with the subtypes of breast cancer were analyzed.
Results:  The numbers of cancer stem cell spheres in group A and B were (1.1±0.2)/1 000 cells and (1.3±0.1)/1 000 cells， respectively， and this had no significant difference (P＞0.05). The number of cancer stem cell spheres in group C was (8.6±1.0)/1 000 cells， which was significantly higher than that in group A and B (both P＜0.05). The numbers of cancer stem cell spheres in group D and E were (22.4±1.2)/1 000 cells and (17.7±2.0)/1 000 cells， respectively， and this was statistically similar (P＞0.05) but either was significantly higher than that in the other three groups (all P＜0.05).
Conclusions: Breast cancer tissues of different molecular subtypes contain varying amounts of cancer stem cells， and this may have certain significance for predicting the prognosis of breast cancer.

Abstract:

Objective: To investigate the value of CD10， p63 and calponin， the markers of breast myoepithelial cells， in differential diagnosis between benign and malignant epithelial lesions of the breast.
Methods: The expressions of CD10， p63 and calponin in usual ductal hyperplasia (UDH)， atypical ductal hyperplasia (ADH)， ductal carcinoma in situ (DCIS) and invasive ductal carcinoma (IDC) of the breast were detected by immunohistochemical staining， and their diagnostic roles in benign and malignant epithelial lesions of the breast were analyzed.
Results: All the three markers of breast myoepithelial cells were expressed in the tissues of UDH， ADH and DCIS groups to varying degrees， and were mainly expressed in the myoepithelial cells around the mammary duct. The expression level of calponin had no difference between the three groups， and the expression level of p63 was in the order of UDH group ＞ADH group ＞DCIS group (all P＜0.05). The expression levels of CD10 between UDH group and ADH group were similar， but both were higher than that of the DCIS group (both P＜0.05). There was almost no expression of CD10 and p63， and little expression of calponin in tumor stroma of the IDC group， and all of these had statistical differences compared with the above three groups (all P＜0.05).
Conclusions: Combination detection of CD10， p63 and calponin can be used for the differential diagnosis between benign and malignant breast lesions. Of these markers， CD10 and p63 have better specificity， while calponin has high sensitivity but less specificity.

Abstract:

Objective: To investigate glypican-3 expression in breast cancer tissue and its correlation with clinicopathological factors of breast cancer.
Methods: The glypican-3 gene expressions in the breast cancer tissues and adjacent normal tissues from 52 patients were detected with RT-PCR method， and then their positive rates were determined. The glypican-3 protein expressions in the breast cancer tissues and adjacent normal tissues were also detected by Western blot technique.
Results: The expression rate of glypican-3 mRNA of the breast cancer tissue was significantly lower than that of the adjacent normal tissue (P＜0.05)， and of the patients with lymph node metastasis was significantly lower than that of the patients without lymph node involvement (P＜0.05). Furthermore， the less differentiated the cancer， the lower the expression rate of glypican-3 mRNA (P＜0.05)， but the glypican-3 gene expression was unrelated to the age and tumor size of patients (P＞0.05). The expression level of glypican-3 protein of the breast cancer tissue was significantly lower than that of the adjacent normal tissue (P＜0.05)， and of the patients with lymph node metastasis was significantly lower than that of the patients without lymph node involvement (P＜0.05). A poorer differentiation of the cancer tissue was correlated with lower expression level of glypican-3 protein (P＜0.05).
Conclusions: The low expression state of glypican-3 may probably be associated with the occurrence and development， and as well as invasion or metastasis of breast cancer.

Abstract:

Objective: To investigate the expression of CD34 and α-SMA in stromal fibroblasts of benign and malignant breast lesions and their clinical significances.
Methods: The expression of CD34 and α-SMA in stromal fibroblasts of tissues from 100 cases of benign breast lesions， 32 cases of ductal carcinoma in situ (DCIS) and 150 cases of breast cancer were detected by immunohistochemical staining. The correlation of CD34 with α-SMA was analyzed.
Results: The positive rate of CD34 and α-SMA of stromal fibroblasts was 90% (90/100) and 49% (49/100) in benign breast lesion， 91% (29/32) and 81% (26/32) in DCIS， and 4% (6/150) and 99% (148/150) in cancer， respectively. Among the three tissues studied， the expression of CD34 in breast cancer was significantly lower than that of benign breast lesion and DCIS (both P<0.05)， and had no difference between benign breast lesion and DCIS (P>0.05). The expression of α-SMA was all significantly different among the three tissues (P<0.05). No correlation was noted between the expression of CD34 and α-SMA in the three tissues studied (P>0.05).
Conclusions: CD34 and α-SMA are sensitive indexes for stromal fibroblasts variations in breast gland， and their combination detection might be helpful for assessing the properties of breast lesions.

Abstract:

Objective: To investigate the correlations of aldehyde dehydrogenase 1 (ALDH1) expression with the molecular subtypes and ATP-binding cassette subfamily G member 2 (ABCG2) of breast cancer.
Methods:  The specimens from 179 cases of breast cancer were divided into five molecular subtypes according to the immunological markers (ER， PR， HER2 and CK5/6)， which were luminal A， luminal B， Her2-enriched， basal-like and breast-like subtype， respectively. The expressions of ALDH1 and ABCG2 of the specimens were detected with immunohistochemical staining， and the relationship between them as well as their relations with the clinicopathological factors of breast cancer was analyzed.
Results: Of the 179 cases of breast cancer， ALDH1 positive expression was present in 43 cases (24.0%). The ALDH1 expression rate had significant difference among the different molecular subtypes of breast cancer (P=0.003). The positive expression rate of ALDH1 was 16.7% (17/102) in luminal A subtype， 21.4% (3/14) in luminal B subtype， 54.5% (13/22) in Her2-enriched subtype， 33.3% (8/24) in basal-like subtype and 17.6% (3/17) in breast-like subtype， respectively. The positive expression of ALDH1 had no significant relation with the ABCG2 expression (P=0.052). Both ALDH1 and ABCG2 expression were related to the administration of preoperative chemotherapy (P=0.027 and P=0.033) and ALDH1 expression was related to the HER2 expression (P=0.006).
Conclusions: A small number of breast cancer cases have positive ALDHI expression and the ALDH1 expression rate varies among the molecular subtypes of breast cancer. The expression of ALDH1 has no obvious relation with ABCG2.

Abstract:

Objective: To investigate the efficacy of paclitaxel-loaded carbon nanoparticles (PA-CNP)，  the targeted chemotherapeutic drug，  on apoptosis of tumor cells in lymph nodes of gastric cancer and its mechanism.
Methods: Thirty patients with gastric cancer were selected to participate in this study. The patients were assigned into observation group and control group with 15 cases in each group. The patients of the observation group were intraoperatively given lymphatic targeting chemotherapy of paclitaxel-loaded carbon before surgical resection， while the patients of the control group underwent surgery for gastric cancer directly. The regional lymph nodes of gastric cancer underwent pathological examination after surgery. The apoptosis in the metastatic nodes confirmed by pathology were detected with TUNEL assay， and the positive expression of Bcl-2 and p16 were determined by immunohistochemical staining.
Results: The apoptotic index of lymphocytes of the observation group ［(28.6±5.2)%］ was significantly higher than that of the control group ［(7.0±1.9)%］ (P＜0.05). The positive expression rate of Bcl-2 and p16 of lymphocytes between the first and the second station lymph nodes had no difference in either the observation group or control group (both P>0.05). The positive expression rate of Bcl-2 of lymphocytes in the observation group (16.7%) was significantly lower than that in the control group (56.7%) (P＜0.05)， while the positive expression rate of p16 of lymphocytes in the observation group (63.3%) was significantly higher than that in the control group (23.3%) (P＜0.05).
Conclusions: The paclitaxel-loaded carbon nanoparticles suspension can target the metastatic nodes of gastric cancer to decrease Bcl-2 and increase p16 expression， and thereby promote apoptosis.