Objective To analyze the clinical and pathological factors related to the metastasis of contralateral central lymph nodes (Cont-CLNs) in unilateral near isthmus papillary thyroid carcinoma (PTC), and to establish a prediction model of lymph node metastasis, so as to provide reference for the scope of lymph node dissection. Methods A total of 381 unilateral PTC patients from February 2012 to June 2022 were collected in our hospital, and according to the location of the cancer, they were divided into the isthmus group (n=152) and the unilateral glandular lobe group (n=229) , and the correlation analysis was performed on whether there was Cont-CLNs metastasis. One hundred and fifty-two patients in the unilateral isthmus PTC group were further divided into metastatic and non metastatic groups based on whether Cont-CLNs metastasis occurred. Univariate analysis was used to analyze the relationship between gender, age, distribution of glandular lobe, tumor size, tumor location, pathological subtype, capsule invasion, thyroid stimulating hormone (TSH) level, combine Hashimoto’s thyroiditis (HT), ipsilateral central lymph nodes（Ipsi-CLNs) metastasis and Cont-CLNs metastasis. According to the univariate analysis results of this study and the possible high-risk factors of contralateral central lymph node metastasis of unilateral thyroid papillary carcinoma in other literatures, they were included in logistic multivariate analysis to obtain independent risk factors and establish a prediction model. Results The incidence of Cont-CLNs metastasis in unilateral isthmus PTC patients was higher than that in nilateral glandular lobe group (24.3% vs. 14.4%, χ²=6.009, P=0.014). Univariate analysis showed that Cont-CLNs metastasis in patients with unilateral near isthmus PTC was correlated with age (P=0.02), tumor size (P＜0.01), capsule invasion (P＜0.01) and Ipsi-CLNs metastasis (P＜0.01), but not with gender, distribution of glandular lobe, tumor location, pathological subtype, TSH level and whether to merge HT (P＞0.05). Further logistic multivariate analysis suggested that capsule invasion and Ipsi-CLNs metastasis were independent risk factors for Cont-CLNs metastasis in patients with unilateral near isthmus PTC. Moreover, the above logistic multifactor prediction model is proved to be effective by the test of goodness of fit by Hosmer and Lemeshow. Conclusions Capsule invasion and Ipsi CLNs metastasis are high risk factors for Cont-CLNS metastasis in patients with unilateral near isthmus PTC. It is suggested that such patients should be cleaned up with prophylactic Cont-CLNs while cleaning up Ipsi-CLNs.
Currently,lung cancer (LC) has one of the highest incidence rates among various malignant tumors worldwide,and the annual mortality rate of LC has ranked first among all malignant tumors. About 80% of LC patients present to the hospital in a late advanced stage and lose the chance of surgical resection. Among all the patients who receive surgical treatment,the 5-year mortality rate of patients with early TNM stages is far lower than that of patients with advanced stage LC. With the advancement of medical equipment and more people who receive routine medical examination,more and more patients with small pulmonary nodules are discovered. Limited lung resection,including wedge resection and segmental resection,can be performed with minimally invasive video-assisted thoracoscopic surgery for these patients to acquire equivalent surgical outcomes as traditional lobectomy and a much better postoperative quality of life. LC screening increases the chances of early detection and diagnosis of LC patients,so these patients can receive reasonable diagnosis and treatment at an early stage. This strategy can greatly reduce treatment cost and mortality,and achieve maximal treatment benefits with minimal economic and medical cost. This review focuses on the necessity,high-risk groups,evaluation criteria and methods of LC screening with some LC screening guidelines and research studies in order to provide reasonable and feasible screening strategies and references for clinical LC screening.
Objective To summarize the clinical characteristics of laparoscopic unexpected gallbladder cancer (UGC), and to explore the impact of TNM stage and secondary surgery timing on postoperative survival. Methods Clinical data of 70 UGC patients who treated in Xianyang Hospital of Yanan University and The First Affiliated Hospital of Xi’an Jiaotong University from January 2008 to January 2014 were retrospectively analyzed. The influencing of TNM staging and secondary surgery timing on the prognosis of UGC patients were analyzed by single factor analysis. Results Of the 70 patients before operation, 68 patients (97.2%) were diagnosed as calculus of gallbladder, 1 patient (1.4%) was diagnosed as gallbladder polyps, 1 patient (1.4%) was diagnosed as intrahepatic and extrahepatic bile duct stone. TNM staging: 2 patients (2.9%) in stage 0, 9 patients (12.9%) in stage Ⅰ, 50 patients (71.4%) in stage Ⅱ, 6 patients (8.6%) in stage Ⅲa, 1 patient (1.4%) in stage Ⅲb, 1 patient (1.4%) in stage Ⅳa, and 1 patient (1.4%) in stage Ⅳb. Fifty-five patients (78.6%) were confirmed by intraoperative frozen section examination, and 15 patients (21.4%) were confirmed after laparoscopic surgery. There were 66 patients were followed-up for 2-79 months, and the median follow-up time was 28-month, the 1-， 3-, and 5-year survival rates were 92.3%, 70.7%, and 53.7% respectively. The survival curves of stage 0, Ⅰ, Ⅱ, and Ⅲ+Ⅳ were differed significantly (P ＜0.01), the survival situation was best in patients in stage 0 and Ⅰ, but worst in patients in stage Ⅲ+Ⅳ. There was no statistical difference between the prognosis of patients underwent one-stage surgery and those underwent two-stage surgery (P=0.73). Conclusions A large proportion of UGC are in stage Ⅱ. For UGC patients, the prognosis is related with the clinical stage, so the surgical approach does not worsen the prognosis, regardless whether the tumor is detected during or after laparoscopic cholecystectomy.
ObjectiveTo investigate the application value of the Ilizarov technique for infection after the limb salvage operation of primary bone tumor. MethodsA retrospective analysis was made on the clinical data of 6 patients with infection treated with Ilizarov technique after limb salvage operation of primary bone tumor between July 2012 and April 2015. There were 4 males and 2 females, aged 18-40 years (mean, 28 years). Tumor types included 3 cases of osteosarcoma and 3 cases of giant cell tumor of bone. Tumor located at the left distal femur in 2 cases, at the right distal femur in 1 case, at the left proximal tibia in 1 case, and at the right proximal tibia in 2 cases. Six cases had recurring infection after debridement. The patients underwent operation 2 to 5 times (mean, 3.5 times). The time from tumor resection to visiting was 8-20 months (mean, 14.3 months). During operation, the internal implant was removed; infection and necrotic tissue was removed thoroughly; and the Ilizarov external fixator was installed. After operation, gentamycin normal saline was used for 2 to 3 weeks, and the sensitive antibiotic intravenous infusion was performed at the same time. After 1 week, the osteotomy lengthening was used. ResultsAll 6 patients were followed up for 6 to 18 months (mean, 12.2 months). Pin tract infection occurred in 1 case after operation; primary healing of incision was obtained in the other patients, and no related complications occurred. The external fixation time ranged from 6 to 16 months (mean, 11.5 months). The healing indexes ranged from 34 to 62 days/cm (mean, 52.0 days/cm). After removal of the external fixator, the knee range of motion ranged from 0 to 5° (mean, 3°) in extension, and from 120 to 130° (mean, 125°) in flexion. The American musculo-skeletal tumor society system (MSTS) function scoring was excellent in 3 patients, good in 2 patients, and fair in 1 patient, with an excellent and good rate of 83.3%. During follow-up period, there was no recurrence of infection; and no recurrence or metastasis was found in 3 patients with osteosarcoma. ConclusionInfection can be cured by Ilizarov technique after limb salvage operation of bone tumor.
Objective To investigate the clinical efficacy of combined therapy of Gankang Granule and Entecavir for patients with chronic hepatitis B. Methods A total of 118 patients with chronic hepatitis B treated between January 2012 and January 2013 were randomly divided into treatment group (n=59) and control group (n=59). Patients in the treatment group were treated with Gankang Granule and Entecavir, while those in the control group were treated with Entecavir alone. Results Before treatment, there was no significant difference between the two groups in such liver fibrosis evaluation indexes as hyaluronic acid (HA), laminin (LN), procollagenⅢ(PCⅢ), and collegen typeⅣ(CⅣ) (P > 0.05). After treatment, the two groups had significant differences in HA, LN, PCⅢ, and CⅣ(P < 0.05). After 48 weeks of treatment, the alanine aminotransferase recovery rate was significantly different between the two groups (P < 0.05); but there was no significant difference in hepatitis B virus DNA negative conversion rate, hepatitis B e antigen negative conversion rate and hepatitis B e antibody seroconversion rate (P > 0.05). Forty-eight weeks after treatment began, 45 patients underwent liver biopsy which showed that liver fibrosis alleviation was significantly better in the treatment group than the control group (P < 0.05). Conclusions Gankang granule combined with antiviral drug Entecavir for chronic hepatitis B is better in protecting the liver and alleviating hepatic fibrosis than the sole Entecavir. The combined method is worthy of being promoted.