Volume 25,Issue 11,2016 Table of Contents

1 Intraoperative neuromonitoring in thyroid surgery: development, clinical application and future directions

SUN Hui , LIU Xiaoli

2016, 25(11):1525-1530. DOI: 10.3978/j.issn.1005-6947.2016.11.001

[Abstract](263) [HTML](0) [PDF 1.31 M](1061)

Abstract:
The use of intraoperative neuromonitoring in thyroid surgery has been available for more than 40 years and widely applied in Europe and America. In China, this technique is still at an early stage since it was introduced in 2008, but it has gradually been accepted by surgeons, and become an important assistant method for protecting recurrent laryngeal nerve during thyroid surgery. It is expected in China that the intraoperative neuromonitoring technique will further reduce the complications associated with recurrent laryngeal nerve injury, and bring thyroid surgery into the precision era, under the standardized training and application and scientific development.

2 Endoscopic thyroid surgery: the creation and maintenance of surgical space

WANG Ping , YAN Haichao

2016, 25(11):1531-1535. DOI: 10.3978/j.issn.1005-6947.2016.11.002

[Abstract](381) [HTML](0) [PDF 1.97 M](999)

Abstract:
The creation and maintenance of surgical space is the first step of endoscopic thyroid surgery (ETS), which is important for subsequent operation and an initial challenge to beginners. The three main methods of maintaining the surgical space are gasless suspension, CO2 insufflation and hybrid technique. In this article, the authors summarize the common approaches of ETS, and with special emphasis on the anterior chest approach, describe the methods for surgical space creation and maintenance as well as precautions and major complications.

3 Dynamic risk stratification of differentiated thyroid cancer: a new concept that arose from the view of disease characteristics

GUAN Haixia , LIANG Nan

2016, 25(11):1536-1543. DOI: 10.3978/j.issn.1005-6947.2016.11.003

[Abstract](265) [HTML](0) [PDF 1.29 M](931)

Abstract:
Conducting the dynamic risk assessment in patients with differentiated thyroid cancer (DTC) during follow-up period is a newly proposed concept that is closely linked to the characteristics of the disease, and it is a critical and solid step towards individualized and precise management. The present review is to comprehensively illustrate the dynamic risk assessment of DTC from the aspects of the development process, the standpoint of the guidelines, and the follow-up recommendations according to the assessment results, as well as the limitations and prospects of the current risk stratification.

4 Recovery and management of hypoparathyroidism following thyroid surgery

LI Xinying , PENG Yao

2016, 25(11):1544-1549. DOI: 10.3978/j.issn.1005-6947.2016.11.004

[Abstract](757) [HTML](0) [PDF 1.21 M](1174)

Abstract:
Hypoparathyroidism-induced hypocalcemia is a common complication following thyroid surgery, which considerably impairs the patient’s quality of life. Surgery-related factors and postoperative management as well as patient- and disease-related factors, are closely associated with the occurrence of postoperative hypocalcemia. Accelerating the recovery of postoperative function of the parathyroid glands has significant importance in prevention of permanent hypoparathyroidism. Supplementary calcium and vitamin D intake is the main treatment method for hypoparathyroidism, but at the same time, the complications related to long-term use of calcium supplements should be prevented and treated accordingly. Parathyroid hormone replacement therapy promises to be an important treatment of hypocalcium after thyroidectomy.

5 Clinical comparison of complete areolar approach and chest/breast approach for endoscopic thyroidectomy of papillary thyroid microcarcinoma

GAO Xinbao , JIA Gaolei , TIAN Zhilong , XI Hailin , FENG Su , WANG Xiaokai

2016, 25(11):1550-1556. DOI: 10.3978/j.issn.1005-6947.2016.11.005

[Abstract](214) [HTML](0) [PDF 1.39 M](811)

Abstract:
Objective: To compare the clinical efficacy of complete areolar approach and chest/breast approach for endoscopic thyroidectomy of papillary thyroid microcarcinoma. Methods: The clinical data of 50 patients with papillary thyroid carcinoma undergoing endoscopic resection of the thyroid lobe and isthmus and central neck dissection from January 2014 to June 2015 were retrospectively analyzed. Endoscopic thyroid surgery was performed via complete areolar approach in 21 cases (complete areolar group) and via chest/breast approach in 29 cases (chest/breast group). The main clinical variables between the two groups of patients were compared. Results: There was no statistical difference in age and maximum diameter of tumor between the two groups of patients (both P>0.05). Endoscopic surgery was successfully completed in all patients. In complete areolar group versus chest/breast group, all the variables that included the average number of resected lymph nodes (5.90 vs. 6.07), operative time (99.95 min vs. 99.17 min), intraoperative blood loss (23.81 mL vs. 28.21 mL), length of hospital stay (5.19 d vs. 6.07 d), and postoperative pain score as well as incidence of postoperative complications had no statistical difference (all P>0.05), but the degree of patients’ satisfaction with surgical incision in complete areolar group was significantly higher than that in chest/breast group (8.81 vs. 6.59, P<0.0001). Conclusion: For papillary thyroid microcarcinoma, endoscopic thyroidectomy via complete areolar approach has equivalent clinical efficacy to that via chest/breast approach, but the former offers better cosmetic results, so it is a safe and favorable approach.

6 Thyroid microcarcinoma: a clinical analysis of 262 cases

WANG Zhijun , LI Yulong , PENG Defeng , DONG Huiming

2016, 25(11):1557-1562. DOI: 10.3978/j.issn.1005-6947.2016.11.006

[Abstract](186) [HTML](0) [PDF 1.10 M](834)

Abstract:
Objective: To investigate the clinical characteristics, diagnosis and surgical procedure for thyroid microcarcinoma (TMC). Methods: The clinical data of 262 TMC patients confirmed by surgical and pathological findings from January 2011 to June 2014 were reviewed, and were comparatively analyzed with the data of 90 patients with benign thyroid nodules (BTN) undergoing surgery during the same period. Results: Of the 262 TMC patients, 260 cases had papillary carcinoma, 1 case had follicular carcinoma, and 1 case had undifferentiated carcinoma; 246 cases (93.9%) were diagnosed as TMC by intraoperative frozen section; 126 cases (48.09%) were combined with nodular goiter, 18 cases (6.87%) with thyroid adenoma, 27 cases (10.30%) with chronic lymphocytic thyroiditis, and 3 cases (1.15%) with hyperthyroidism. The proportions of low echo, micro calcification, abundant blood flow signal, high TI-RADS grade shown by ultrasound examination in TMC patients were significantly higher than those in BTN patients (all P<0.05), and the sensitivity, specificity, positive predictive value and negative predictive value of high resolution ultrasound for diagnosis of TMC was 83.88%, 80.50%, 91.73% and 65.97% respectively. All TMC patients received surgical treatment that included ipsilateral thyroidectomy plus isthmectomy in 73 cases, subtotal thyroidectomy in 153 cases and total thyroidectomy in 36 cases. One hundred and seventy-two patients underwent lymph node dissection that included central lymph node dissection in 162 cases, and metastasis was found in 45 cases (27.78%) and was found in all the 10 cases who accepted additional functional neck dissection. The central cervical lymph node metastasis in TMC patients was significantly associated with tumor size and number of lesions (χ2=6.77 and 13.11, both P<0.05); the incidence of postoperative complications showed no statistical difference between patients with and without central lymph node dissection (χ2=0.09, P>0.05); no statistical difference was noted in postoperative recurrence rate among patients undergoing different surgical procedures (χ2=2.89, P>0.05). Conclusion: Papillary carcinoma is the main type of TMC and high-resolution ultrasonography is an important diagnostic method for TMC. In TMC patients, proper procedure of ipsilateral thyroidectomy plus isthmectomy or total/subtotal thyroidectomy should be selected according to tumor number and size, and routine ipsilateral central lymph node dissection should be performed, while additional functional neck dissection should be performed in those with highly suspicious or confirmed lateral cervical lymph node metastases.

7 Application of carbon nanoparticles in central neck dissection for papillary thyroid carcinoma

SONG Yuntao , ZHANG Naisong , WANG Tianxiao , XU Guohui , WEI Wei

2016, 25(11):1563-1567. DOI: 10.3978/j.issn.1005-6947.2016.11.007

[Abstract](283) [HTML](0) [PDF 1.09 M](850)

Abstract:
Objective: To investigate the clinical value of intraoperative injection of carbon nanoparticles in central neck dissection for papillary thyroid carcinoma (PTC). Methods: The clinical and pathological data of 270 consecutive PTC patients were retrospectively analyzed. Of the patients, 70 cases (78 sides) underwent intraoperative injection of carbon nanoparticles (observation group), and the other 200 cases (215 sides) underwent conventional surgery without injection of carbon nanoparticles (control group). Routine pathological examination was performed in all resected specimens. Results: The basic clinicopathologic data showed no significant difference between the two groups of patients (all P>0.05), and were comparable. The total number of detected lymph nodes was 475 and 790 in observation group and control group, respectively. The average number of detected lymph nodes for each side in observation group was greater than that in control group (5.50 vs. 3.00, P<0.01), but that showed no significant difference between the two groups in patients with lymphocytic thyroiditis (6.00 vs. 4.50, P>0.05). The metastatic rate in the black-stained lymph nodes was less than that in those without staining in observation group (21.67% vs. 39.15%, χ2=17.250, P<0.01). Conclusion: Carbon nanoparticle injection can increase the number of lymph node detection during central neck dissection for papillary thyroid cancer, but the value is limited in patients with lymphocytic thyroiditis.

8 Clinical features of multifocal papillary thyroid microcarcinoma

YAN Li , LI Qinghuai , JI Hong , HAO Fang

2016, 25(11):1568-1572. DOI: 10.3978/j.issn.1005-6947.2016.11.008

[Abstract](273) [HTML](0) [PDF 1.04 M](822)

Abstract:
Objective: To investigate the clinical features of multifocal papillary thyroid microcarcinoma (PTMC). Methods: The clinical data of 297 patients undergoing surgical treatment and pathologically diagnosed as PTMC from May 2013 to April 2016 were retrospectively analyzed. Results: Among the 297 PTMC patients, 70 cases (23.6%) had multifocal PTMC. In patients with multifocal PTMC compared with those with unifocal PTMC, the tumor size was smaller (0.54 cm vs. 0.69 cm), but the incidence of capsular invasion (18.6% vs. 8.8%) and proportion of cases undergoing total thyroidectomy (87.1% vs. 41.4%) were increased, and all the differences had statistical significance (all P<0.05). In multifocal PTMC patients with ≥3 lesions compared with those with 2 lesions, the proportion of cases with bilateral involvement (88.2% vs. 44.4%) and central lymph node metastasis (47.1% vs. 22.2%) were increased, and both differences had statistical significance (both P<0.05). Conclusion: The lesion of multifocal PTMC is relatively small but prone to capsular invasion. The larger the number of lesions in multifocal PTMC patients, the higher is the risk of bilateral cancer involvement and central lymph node metastasis. Routine prophylactic central lymph node dissection is recommended for multifocal PTMC.

9 Analysis of risk factors for cervical lymph node metastases in papillary thyroid microcarcinoma

ZHAI Baowei , GAO Qingjun , ZHAO Daiwei

2016, 25(11):1573-1579. DOI: 10.3978/j.issn.1005-6947.2016.11.009

[Abstract](222) [HTML](0) [PDF 1.09 M](859)

Abstract:
Objective: To investigate the risk factors for cervical lymph node metastasis of papillary thyroid microcarcinoma (PTMC). Methods: The clinicopathologic data of 169 patients with PTMC treated in the Department of Thyroid Surgery of Affiliated Hospital of Guiyang Medical University from January 2014 to March 2016 were retrospectively analyzed. Results: All the 169 patients underwent prophylactic central neck dissection, of whom 54 cases (32.0%) had central lymph node metastases; univariate analysis showed that age greater than 45 years old, multiple lesions and extrathyroidal invasions were related to central cervical lymph node metastases and multivariate analysis identified that age, multiple lesions and extrathyroidal invasion were independent risk factors for central lymph nodes metastasis (all P<0.05). Thirty patients received central and lateral neck dissection and of them, 18 cases (10.7%) had lateral lymph node metastases (18/30); univariate analysis demonstrated that the maximal diameter of the tumor, extrathyroidal invasion, multiple lesions and central lymph node metastases were associated with lateral lymph node metastases, and multivariate analysis indicated that only extrathyroidal invasion was a dependent risk factor for lateral lymph node metastases (P<0.05); 11 of the 30 cases (6.5%) had both central and lateral lymph node metastases, and both univariate and multivariate analyses found that multiple lesions and extrathyroidal invasion were risk factors for concomitant central and lateral lymph node metastases (all P<0.05). The sensitivity and specificity of high frequency color Doppler ultrasonography for detection of central lymph nodes metastasis was 14.8% and 96.5%, for detection of lateral lymph nodes metastasis was 94.4% and 83.3%, respectively. Conclusion: Age greater than 45 years, multiple lesions and extrathyroidal invasion are risk factors for PTMC cervical lymph node metastasis. High frequency neck ultrasound examination can be used as a preoperative assessment approach of PTMC lymph node metastases.

10 Radiation damage effect of 131I therapy to parathyroid glands after surgery for differentiated thyroid carcinoma

WU Hongwei , SHEN Feng , SUN Shaohua , HU Hongsheng , ZHOU Wenbo

2016, 25(11):1580-1584. DOI: 10.3978/j.issn.1005-6947.2016.11.010

[Abstract](259) [HTML](0) [PDF 501.28 K](760)

Abstract:
Objective: To investigate the direct radiation damage to the parathyroid glands and impact on the function of parathyroid glands due to 131I therapy after surgery for differentiated thyroid carcinoma, as well as the timing for postoperative 131I therapy. Methods: The clinical data of 281 patients with differentiated thyroid carcinoma undergoing the first postoperative 131I thyroid remnant ablation from January 2013 to February 2015 were retrospectively analyzed. According to parathyroid hormone level before 131I treatment, 238 patients had normal function of parathyroid glands and 43 patients had mild hypoparathyroidism. The serum levels of calcium and parathyroid hormone of the patients on postoperative day (POD) 1 and 6, as well as before, 1 week and 3 months after 131I therapy were determined and analyzed. Results: All patients had no manifestations of hypocalcemia before 131I therapy. In patients with postoperative normal function of parathyroid glands, the overall difference in serum calcium level was statistically significant among different time points (F=6.912, P<0.05), and the serum calcium showed the lowest level on POD 1 (P<0.05), while it showed no statistical difference among the other 4 time points (P>0.05); the overall difference in serum parathyroid hormone level was statistically significant among different time points (F=16.808, P<0.05), and the parathyroid hormone reached the lowest level on POD 1, then increased before 131I therapy, and reduced again 1 week after 131I therapy, and then, increased again 3 months after 131I therapy. In patients with postoperative mild hypoparathyroidism, hypocalcemia occurred with different degrees on average POD 7.5 d after 131I therapy; the overall difference in serum calcium level was statistically significant among different time points (F=37.710, P<0.05), and the serum calcium showed the lowest level on POD 1 and 1 week after 131I therapy; the overall difference in serum parathyroid hormone level was statistically significant among different time points (F=29.082, P<0.05), the serum parathyroid hormone showed the lowest level on POD 1, then increased before 131I therapy, and reduced again one week after 131I therapy, which approached the level on POD1 (P>0.05), and rose again 3 months after 131I therapy, which averagely reached the normal range. Conclusion: 131I thyroid remnant ablation exerts direct radiation damage to parathyroid glands, may cause hypoparathyroidism and aggravate the existing hypoparathyroidism. For patients with hypoparathyroidism after surgery for differentiated thyroid carcinoma, 131I thyroid remnant ablation is recommended to be delayed until the parathyroid hormone has completely recovered to normal level.

11 Application of LigaSure vessel sealing system in surgery for benign thyroid diseases

WU Baoqiang , CHEN Weibo , JIANG Yong , SUN Donglin

2016, 25(11):1585-1589. DOI: 10.3978/j.issn.1005-6947.2016.11.011

[Abstract](258) [HTML](0) [PDF 1.10 M](705)

Abstract:
Objective: To investigate the application value of LigaSure vessel sealing system in surgery for benign thyroid diseases. Methods: The clinical data of 278 patients undergoing surgical treatment for benign thyroid disease from June 2012 to June 2014 were retrospectively analyzed. According to whether using LigaSure or not during surgery, the patients were divided into LigaSure group (130 cases) and traditional surgery group (148 cases). The main clinical variables between the two groups of patients were compared. Results: There was no statistical difference in preoperative general data between the two groups (all P>0.05). In LigaSure group compared with traditional surgery group, the scope of surgical resection showed no significant difference (P>0.05), the operative time was significantly shortened (55.2 min vs. 70.8 min, P<0.05), the intraoperative blood loss was significantly reduced (18.1 mL vs. 35.2 mL, P<0.05), and the incidence of main postoperative complications as well as length of hospitalization had no significant difference (all P>0.05). Conclusion: LigaSure can simplify the surgical procedure, and reduce the operative time and intraoperative bleeding in surgery for benign thyroid diseases. So, it is recommended to be used in clinical practice.

12 Expression and action of LncRNA SNHG15 in thyroid cancer cells

SHUAI Yongfeng , ZHAN Daqian , WANG Xiaojun , ZHANG Yizhong

2016, 25(11):1590-1595. DOI: 10.3978/j.issn.1005-6947.2016.11.012

[Abstract](221) [HTML](0) [PDF 1.26 M](747)

Abstract:
Objective: To investigate the expression and action of LncRNA SNHG15 in thyroid cancer cells. Methods: The LncRNA SNHG15 expressions in human undifferentiated thyroid carcinoma FRO cells, thyroid squamous cell carcinoma SW579 cells and human thyroid ductal carcinoma TT cells as well as normal thyroid HT-ori3 cells were determined by qRT-PCR. In FRO cells after transfection with SNHG15 siRNA or negative control siRNA sequences, the cell proliferation was tested by CCK8 assay and colony-forming assay, the cell apoptosis was measured by flow cytometry, and the expression levels of apoptosis-related protein were analyzed by Western blot, respectively. Results: The expression levels of LncRNA SNHG15 in FRO, SW579 and TT cells were all significantly higher than that in HT-ori3 cells, with the highest level in PRO cells (all P<0.05). In FRO cells transfected with SNHG15 siRNA compared with those transfected with negative control sequences, the proliferative and colony-forming abilities were significantly decreased, apoptosis rate was significantly increased, and the protein expressions of caspase-3 and Bax were up-regulated, while Bcl-2 protein expression was down-regulated significantly (all P<0.05). Conclusion: LncRNA SNHG15 expression is increased in thyroid cancer cells, and moreover, the poorer the differentiation of the cells, the higher is the expression of LncRNA SNHG15. LncRNA SNHG15 silencing can inhibit proliferation and promote apoptosis of thyroid cancer cells.

13 Expressions of EGFR and TGF-α in parathyroid gland tissue of patients with secondary hyperparathyroidism and their significance

ZHU Zhu , TAO Qingsong , JI Zhenling

2016, 25(11):1596-1601. DOI: 10.3978/j.issn.1005-6947.2016.11.013

[Abstract](228) [HTML](0) [PDF 3.70 M](777)

Abstract:
Objective: To investigate the expressions of transforming growth factor α (TGF-α) and epidermal growth factor receptor (EGFR) in the parathyroid gland tissue of patients with secondary hyperparathyroidism (SHPT) and their significance. Methods: The tissue specimens of parathyroid gland tissue from 36 SHPT patients and 7 healthy subjects were collected. The parathyroid gland tissues with diffuse hyperplasia or nodular hyperplasia were distinguished by HE staining, the protein expressions of TGF-α, EGFR and Ki-67 in all the parathyroid gland tissues were determined by immunohistochemical staining, and the relations of TGF-α and EGFR expressions with the clinicopathologic factors of SHPT patients were analyzed. Results: Of the 36 SHPT patients, the parathyroid gland presented diffuse hyperplasia in 17 cases and nodular hyperplasia in 19 cases. The types of hyperplasia showed no significant relation with the clinicopathologic factors that included age, gender, dialysis time, preoperative parathyroid hormone level, blood levels of calcium and phosphate, calcium-phosphate product, albumin, hemoglobin, blood urea nitrogen, creatinine and alkaline phosphatase of the patients (all P>0.05). All expressions of TGF-α, EGFR and Ki-67 were significantly elevated in an increasing order in normal, diffuse and nodular hyperplastic parathyroid gland tissue (all P<0.05). Conclusion: TGF-α and EGFR expressions are increased in the parathyroid gland tissue of SHPT patients, and are closely related with the type of the hyperplasia of the parathyroid of SHPT patients.

14 Relations of Foxp3+ regulatory T cells with lymph node metastasis and proliferation of breast cancer

ZENG Fanyu , LIU Wenhui , ZHOU Xinyi , ZHANG Qiujin , ZHANG Jie , LUO Naixiang

2016, 25(11):1602-1607. DOI: 10.3978/j.issn.1005-6947.2016.11.014

[Abstract](208) [HTML](0) [PDF 1.40 M](682)

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Objective: To investigate the relations of Foxp3+ regulatory T cells (Tregs) with lymph node metastasis and proliferation of breast cancer. Methods: The CD4 (marker of regulatory T cells) and Foxp3 expressions in breast cancer tissues from 168 female patients were determined by immunohistochemical staining, using tissue specimens from 42 female patients with benign breast disease as control. The relations of Tregs with lymph node metastasis of breast cancer and the expression of nuclear proliferation-associated antigen Ki-67 were analyzed. Results: The numbers of both CD4+ T cells and Foxp3+ T cells (Tregs) in breast tissue was higher than those in breast tissue with benign disease, and both differences had statistical significance (both P<0.05); the numbers of both CD4+ T cells and Foxp3+ T cells in breast tissue with lymph node metastasis were higher than those in breast tissue without lymph node metastasis, but only the latter had statistical significance (P<0.05). The number of infiltrating Tregs showed no significant association with Ki-67 expression in breast cancer tissue (P>0.05). Conclusion: There is immunosuppression in microenvironment of breast cancer tissue, and the number of infiltrating Tregs is closely associated with lymph node metastasis, but irrelevant to tumor proliferation. It suggests that Tregs can be used as a new indicator for estimating presence or absence of lymph node metastasis in breast cancer patients.

15 Therapeutic efficacy of paclitaxel plus trastuzumab chemotherapy in nude mice transplanted with human breast cancer SKBR-3 cells

GAO Yuzhe , Ni Qing , JIA Qi , SU Shiqiong , HU Shihang

2016, 25(11):1608-1614. DOI: 10.3978/j.issn.1005-6947.2016.11.015

[Abstract](462) [HTML](0) [PDF 1.37 M](825)

Abstract:
Objective: To observe the therapeutic effect of paclitaxel plus trastuzumab chemotherapy on nude mice transplanted with human breast cancer SKBR-3 cells and its influence on the expressions of apoptosis-inducing factor programmed cell death 5 (PDCD5) and anti-apoptosis factor X-linked inhibitor of apoptosis protein (XIAP) in the tumor. Methods: The subcutaneous xenograft model in nude mice was established by using Her-2-overexpression human breast cancer SKBR-3 cells. After tumor formation, the mice were randomly grouped and treated with paclitaxel plus trastuzumab (combined treatment group), paclitaxel alone (paclitaxel group), trastuzumab alone (trastuzumab group), and normal saline (control group), respectively. The drugs were administered once weekly and after 6 times of administration, the mice were sacrificed, their tumors were harvested and weighed, and the gene and protein expressions of PDCD5 and XIAP in the tumors were determined by qPCR and Western blot analysis respectively. Results: In each treatment group compared with control group, the tumor weight was significantly reduced, the relative expression levels of both PDCD5 mRNA and protein were significantly increased, and the relative expression levels of both XIAP mRNA and protein were significantly decreased, moreover, all above changes were more evident in combined treatment group than those in either single drug treatment group (all P<0.05). Comparison between the two single drug treatment groups showed that the reducing effects of XIAP mRNA and protein were greater in paclitaxel group than those in trastuzumab group (both P<0.05), but no significant difference was noted in other parameters (all P>0.05). Conclusion: Paclitaxel plus trastuzumab chemotherapy can effectively inhibit the growth of Her-2-positive human breast cancer in nude mice, and this action may be associated with its up-regulating PDCD5 expression and meanwhile down-regulating XIAP expression.

16 Targeted regulation of miR-204 on TFAM and their influence on growth and proliferation in breast cancer cells

XIAO Shunchong , LUO Hanchuan , QIN Junshi

2016, 25(11):1615-1621. DOI: 10.3978/j.issn.1005-6947.2016.11.016

[Abstract](172) [HTML](0) [PDF 1.28 M](765)

Abstract:
Objective: To investigate the targeted regulation of miR-204 on mitochondrial transcription factor A (TFAM) in breast cancer cells and their relations with cell growth and proliferation. Methods: Human breast cancer MDA-MB-231 cells were transfected with miR-204 mimics or inhibitors, and then, the miR-204 and TFAM protein expressions were determined by real-time PCR and Western blot, respectively. The luciferase reporter plasmids (mut-TFAM/wt-TFAM) were constructed and co-transfected with miR-204 mimics or inhibitors into MDA-MB-231 cells, and then, changes in luciferase activities were detected. The pcDNA3.1/TFAM plasmids were constructed and transfected alone or co-transfected with miR-204 mimics into MDA-MB-231 cells, and then, the TFAM protein expressions were measured, and cell growth and proliferation were analyzed by TTC and BrdU assay. Results: The miR-204 mRNA expression was significantly increased, and TFAM protein expression was significantly decreased in MDA-MB-231 cells after transfection with miR-204 mimics, while, opposite directional changes were found after transfection with miR-204 inhibitors (all P<0.05). The luciferase activity was significantly decreased after transfection with miR-204 mimics, but was significantly increased after transfection with miR-204 inhibitors (both P<0.05). In MDA-MB-231 cells, both expressions of TFAM mRNA and protein were significantly up-regulated, and the growth and proliferation were significantly enhanced after transfection of pcDNA3.1/TFAM (all P<0.05), and the growth and proliferation were significantly impaired along with significant down-regulation of TFAM protein expression after transfection of miR-204 mimics, which were all partially abolished by co-transfection with pcDNA3.1/TFAM (all P<0.05). Conclusion: MiR-204 exerts targeted inhibition on TFAM expression in breast cancer cells, and thereby suppresses the growth and proliferation of breast cancer cells.

17 Efficacy analysis of adenomammectomy with preservation of nipple-areola sensation in treatment of gynecomastia

ZHANG Yanwu , LU Yidong , NIU Yaodong , YAN Wenjun , FENG Aiqiang

2016, 25(11):1622-1626. DOI: 10.3978/j.issn.1005-6947.2016.11.017

[Abstract](324) [HTML](0) [PDF 1.19 M](708)

Abstract:
Objective: To investigate the efficacy and complications of adenomammectomy with preservation of nipple and areolar sensation in treatment of gynecomastia. Methods: Fifty-eight patients with gynecomastia were randomly designated to observation group (28 cases) and control group (30 cases). Patients in observation group received liposuction and subtotal adenomammectomy with preservation of the superior lateral glandular flap, while those in control group underwent liposuction and adenomammectomy with only preservation of a small volume of glands behind the nipple-areola. All patients were followed up for 6 months after operation. The surgical efficacy and postoperative complications in the two groups of patients were observed and compared. Results: Operation was successfully completed in both groups of patients. The nipple-areola sensation and blood supply were significantly better in observation group than those in control group at 24 h after operation (χ2=9.946, P=0.007; χ2=4.913, P=0.026); the incidence of postoperative chest wall unevenness in observation group was significantly reduced compared with control group (χ2=4.392, P=0.036); no significant difference was found in incidence of either postoperative hematoma or seroma between the two groups (both P>0.05); the nipple-areola sensation was significantly better in observation group than that in control group at 6 months after operation (χ2=6.054, P=0.014). No recurrence was noted in either group during follow-up period. Conclusion: Compared with conventional liposuction and adenomammectomy, liposuction plus subtotal adenomammectomy with preservation of the superior lateral glandular flap offers advantage in postoperative appearance without increasing complications and especially, it can preserve the nipple-areola sensation and blood supply. So, it is recommended to be used in clinical practice.

18 Comparison of indocyanine green and carbon nanoparticles for detection of sentinel lymph nodes in breast cancer

ZOU Weiwei , BAI Yu , WANG Xilong , CHENG Kai , SUN Hongguang , WU Mengmeng , LI Gaofe

2016, 25(11):1627-1632. DOI: 10.3978/j.issn.1005-6947.2016.11.018

[Abstract](169) [HTML](0) [PDF 1.10 M](774)

Abstract:
Objective: To compare the efficacy of indocyanine green (IGG) with that of carbon nanoparticles suspension injection for detection of sentinel lymph nodes (SLNs) in breast cancer. Methods: One-hundred and thirty-six patients with early breast cancer undergoing sentinel lymph node biopsy (SLNB) from November 2013 to July 2016 were enrolled. Of the patients, IGG was used as a tracer in 60 cases (IGG group) and carbon nanoparticles suspension injection was used in the other 76 cases (nano-carbon group). The relevant variables between the two groups were compared. Results: The general clinical data showed no statistical di?erence between the two group of patients (all P>0.05). Between IGG group and nano-carbon group, all the parameters that included the detection rate of the SLNs (96.67% vs. 100%), sensitivity (89.47% vs. 95.83%), accuracy (93.33% vs. 98.68%) and false negative rate (10.53% vs. 4.17%) had no statistical difference (all P>0.05). The number of detected SLNs in ICG group was less than that in nano-carbon group (3.17 vs. 3.92, P=0.000), but the time for detection in IGG group was significantly shorter than that in nano-carbon group (25.72 min vs. 49.29 min, P=0.000). Age and body mass index (BMI) did not affect the detection rate of SLNs and accuracy of SLNB of the two methods (all P>0.05). Conclusion: IGG and carbon nanoparticles suspension injection have similar efficiency for detection of SLNs in breast cancer, and both are easy and convenient to use.

19 Clinical application of combined localization of X-ray mammography and ultrasonography in biopsy of breast microcalcification

PENG You , LUO Zhongyao , DING Jinwang , NI JIe , WU Yuping , CUI Haidong , LU B

2016, 25(11):1633-1639. DOI: 10.3978/j.issn.1005-6947.2016.11.019

[Abstract](237) [HTML](0) [PDF 2.04 M](812)

Abstract:
Objective: To assess the clinical application value of the combined localization of X-ray mammography and ultrasonography in biopsy of breast microcalcification. Methods: Under X-ray mammography, three-dimensional lesion localization was performed with the placement of a double-hook localization needle that was fixedly positioned after it reached the lesion; a skin marker line was drawn after detection of the lesion site through searching the double-hook needle with ultrasonography, and a single-hook localization needle was inserted; a 3-cm incision was made over the skin marker line, the mammary tissue bearing lesions and the single-hook needle were exposed and fixed by using special retractor, and then the lesion region was excised by using a rotary cutting tool; the cylindrical specimen was placed on a scaled specimen holder to take radiographic images for verifying the complete removal of the calcification lesions and ascertaining the three-dimensional location of the lesions in the specimen so as to facilitate the following pathological works. Results: A total of 108 patients with breast microcalcification that was classified as BI-RADS 4A underwent above procedures. The average distance of the lesion from the double hook needle was 4.1 mm (less than those by conventional methods), the average weight of specimen was 8.5 g (lighter than those by conventional methods), and all lesions were precisely excised by one session. Of the 108 patients, 20 cases had positive lesions that included atypical ductal hyperplasia in 7 cases, ductal carcinoma in situ of breast in 7 cases, ductal carcinoma in situ with focal invasive carcinoma in 3 cases, and invasive ductal carcinoma in 3 cases, and 88 cases had negative lesions. Both location and shape of the microcalcification lesion showed no significant relation with the detection of breast cancer (both P>0.05). Conclusion: Combined localization of X-ray mammography and ultrasonography has the advantages of accurate lesion localization, proper biopsy method, and small volume of specimen, as well as providing precise position of lesions in the specimen for pathological examination. Further, it does not exert any influence on the breast appearance in patients with benign lesions.

20 Diagnosis and treatment of multifocal papillary thyroid carcinoma: recent progress

MENG Qingdong , BIAN Xuehai , SUN Hui

2016, 25(11):1640-1645. DOI: 10.3978/j.issn.1005-6947.2016.11.020

[Abstract](212) [HTML](0) [PDF 1.12 M](762)

Abstract:
Multiple foci are important clinical characteristics in papillary thyroid carcinoma (PTC). In recent years, with the increasing elaboration in diagnosis and treatment modalities for PTC, the diagnosis and treatment modalities will certainly be different between multiple focal PTC and the single focal PTC. To date, the investigations in multifocal PTC (MPTC) are still in progress at home and abroad. Here, the authors address MPTC in respects of the origin of disease, clinical characteristics, diagnosis and treatment.

21 Progress of using carbon nanoparticles in surgery for papillary thyroid carcinoma

LI Ziyi , TONG Liquan

2016, 25(11):1646-1651. DOI: 10.3978/j.issn.1005-6947.2016.11.021

[Abstract](241) [HTML](0) [PDF 1.10 M](847)

Abstract:
As a lymph node tracer, carbon nanoparticles suspension has the advantages of high dyeing rate, long dyeing time, clear tracing and low false negative rate as well as negative development of parathyroid glands, which may be helpful for thorough lymph node dissection and parathyroid gland protection during surgery. So, it has been increasingly applied in thyroid cancer surgery. Here, the authors address the progress of using carbon nanoparticles suspension in surgical resection for papillary thyroid carcinoma.

22 Progress of hypo-fractionated radiotherapy for breast cancer

HUANG Qingqing , CHEN Dongdong , TIAN Liping , JIANG Min

2016, 25(11):1652-1657. DOI: 10.3978/j.issn.1005-6947.2016.11.022

[Abstract](513) [HTML](0) [PDF 1.09 M](673)

Abstract:
Many large-scale clinical trials have confirmed that radiotherapy can significantly reduce the risk of local recurrence and mortality of breast cancer. Traditional radiotherapy has some disadvantages such as money- and time-consuming and traveling inconvenience, and the adverse reactions may cause the radiotherapy delay, which may impair the treatment effect. However, low energy hypo-fractionated radiotherapy offers solutions to those problems without impact on radiotherapy efficacy. The authors address the progress of hypo-fractionated radiotherapy for breast cancer.

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Volume 25,Issue 11,2016 Table of Contents

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