Mechanical Properties of High Temperature Vulcanized Silicone Rubber Aged in the Natural Environment.

Composite insulators operate in harsh field environments all year round. Their various properties and states of aging require attention. It is important to study the performance changes of composite insulator sheds after aging to evaluate the life of insulators operating on grids. For this reason, 22 composite insulator sheds from different factories, with different voltage levels and different ages years were selected to conduct mechanical properties testing. The mechanical properties include hardness, tensile strength, and elongation at break, and were investigated by thermogravimetric (TGA) testing, surface morphology, and nuclear magnetic resonance (NMR) characterization. The changes in mechanical properties of high temperature vulcanization (HTV) composite insulator silicone rubber aged in the natural environment were analyzed, including the reasons for these changes. The results showed that the transverse relaxation time T2 of the sample was closely related to its aging state. The more serious the silicone rubber's aging, the smaller was the T2. The state of the composite insulator can be evaluated by using T2 and aging years simultaneously. With the actual degree of aging in the silicone rubber intensified, its tensile strength and elongation at break generally showed a downward trend.

Analysis and prediction model of ferroptosis related genes in breast cancer.

Background: The prognosis of patients with breast cancer (BRCA) is difficult to predict because of the high degree of heterogeneity and complex etiological factors. Ferroptosis, an iron-dependent, new form of cell death, plays an important role in regulation of tumor growth and progression. The aim of this study was to clarify the predictive value of ferroptosis-related genes in the overall survival of patients with BRCA. Methods: The messenger RNA expression profile and clinical information of patients with BRCA were collected from The Cancer Genome Atlas (TCGA) database. The differences between BRCA and adjacent normal tissues were analyzed, and candidates with differentially expressed ferroptosis-related genes were identified. Through Cox and LASSO analyses, the prognostic genetic characteristics of ferroptosis-related genes were established. Lastly, according to the median risk score, the patients were divided into high-risk and low-risk groups, a nomogram was constructed, and the prediction accuracy was tested. Results: It was determined that the four ferroptosis related genes had a significant difference in survival in BRCA (P<0.05); a prognostic model was constructed based on the four ferroptosis related genes, and the overall survival of patients in the high-risk group was significantly worse (P<0.05). The four-gene nomogram can quantify the contribution of each index to survival, and the calibration chart shows high prediction accuracy. Conclusions: This study constructed four ferroptosis related gene characteristics and nomogram, which can effectively predict the prognosis of BRCA patients and provide new insights for future anti-cancer treatments based on ferroptosis targets.

[Retracted] MicroRNA­766 inhibits papillary thyroid cancer progression by directly targeting insulin receptor substrate 2 and regulating the PI3K/Akt pathway.

Following the publication of this paper, it was drawn to the Editors' attention by a concerned reader that various panels showing the data from flow cytometry experiments in Figs. 2D, 4D and 5D, and certain of the tumor images featured in Fig. 7A, were strikingly similar to data appearing in different form in other articles by different authors. Furthermore, overlapping data panels were identified within this paper comparing the cell migration assay images between Figs. 2C and 4F. Owing to the fact that the contentious data in the above article had already been published elsewhere, or were already under consideration for publication, prior to its submission to International Journal of Oncology, the Editor has decided that this paper should be retracted from the Journal. The authors were asked for an explanation to account for these concerns, but the Editorial Office did not receive a reply. The Editor apologizes to the readership for any inconvenience caused. [the original article was published in International Journal of Oncology 54: 315­325, 2019; DOI: 10.3892/ijo.2018.4615].

Plasma-Tuned nitrogen vacancy graphitic carbon nitride sphere for efficient photocatalytic H2O2 production.

Graphitic carbon nitride (CN) is a promising photocatalyst for sustainable energy conversion. Meanwhile, N vacancies are useful for H2O2 generation; however, they are hard to control. In this study, the N vacancy CN sphere (NVCNS) is synthesized by H2 plasma treatment to tune the NV. The as-synthesized NVCNS exhibits an efficient and stable photocatalytic H2O2 yield of 4413.1 µmol gcat-1h-1, which is 2.5 and 4.6 times higher than that of CNS (1766.4 µmol gcat-1h-1) and bulk CN (956.6 µmol gcat-1h-1), respectively, using a Xe lamp with an intensity of 100 mWcm-2. In particular, the charges recombination rate is remarkably reduced by introducing N defect state, promoting electron accumulation and O2 adsorption, through theoretical calculation and experiments. Furthermore, the NV creates abundant unsaturated sites and induces strong interlayer interactions, leading to effective electronic excitation and the promotion of charge transport.

Analysis of Circulating Tumor DNA to Predict Neoadjuvant Therapy Effectiveness and Breast Cancer Recurrence.

PURPOSE: Real-time detection and intervention can be used as potential measures to markedly decrease breast cancer mortality. Assessment of circulating tumor DNA (ctDNA) may offer great benefits for the management of breast cancer over time. However, the use of ctDNA to predict the effectiveness of neoadjuvant treatment and recurrence of breast cancer has rarely been studied. METHODS: We prospectively recruited 31 breast cancer patients with 4 subtypes. Three time points were set in this study, including before any therapy (C1), during surgery (T), and six months after surgery (C2). We collected peripheral blood samples from all 31 patients at C1, tumor tissue from all 31 patients at T, and peripheral blood samples from 25 patients at C2. Targeted 727-gene panel sequencing was performed on ctDNA from all blood samples and tissue DNA from all tissue samples. Somatic mutations were detected and analyzed using a reference standard pipeline. Statistical analysis was performed to identify possible associations between ctDNA profiles and clinical outcomes. RESULTS: In total, we detected 159, 271, and 70 somatic mutations in 30 C1 samples, 31 T samples, and 12 C2 samples, respectively. We identified specific genes, such as PIK3CA, TP53, and KMT2C, which were highly mutated in the tissue samples. Furthermore, mutated KMT2C observed in ctDNA of the C2 samples may be an indicator of breast cancer recurrence. CONCLUSION: Our study highlights the potential of ctDNA analysis at different timepoints for assessing tumor progression and treatment effectiveness, as well as prediction of breast cancer recurrence.

Whole Exome Sequencing in the Male Breast Cancer with Prolactinoma: A Case Report and Literature Review.

Male breast cancer (MBC) is rare and accounts for approximately 1% of all breast cancer cases worldwide. Previous studies have suggested that several factors significantly increase the risk of MBC. Prolactinoma has the highest incidence rate among patients with functional pituitary tumors. However, whether prolactinoma is involved in the onset and progression of breast cancer remains unclear. To date, there are only five case reports globally on MBC with concurrent prolactinoma. We hereby describe the first case of MBC with prolactinoma in China. We also explored the patient's genetic profile using whole exome sequencing. Our findings may help advance our understanding of the molecular pathogenesis of MBC. Further molecular analyses of such cases are warranted to improve auxiliary molecular diagnostic methods and targeted therapy for MBC.

MicroRNA­766 inhibits papillary thyroid cancer progression by directly targeting insulin receptor substrate 2 and regulating the PI3K/Akt pathway.

MicroRNAs (miRNAs/miRs) are widely dysregulated in papillary thyroid cancer (PTC). Dysregulated miRNAs, together with their target genes, comprise a complex network that has been implicated in the regulation of PTC pathogenesis. Further knowledge of the functional roles of aberrantly expressed miRNAs in PTC, and the underlying molecular mechanisms, may assist in the identification of novel therapeutic targets. miR­766 has been well studied in human cancer; however, the expression status, specific roles and regulatory mechanisms of miR­766 in PTC remain unclear. The present study aimed to detect miR­766 expression in PTC tissues and cell lines, to explore the biological roles of miR­766 in the malignant biological behaviors of PTC cells, and to determine the underlying mechanism of action of miR­766 in PTC cells. The results revealed that miR­766 was downregulated in PTC tissues and cell lines, and its downregulation was strongly associated with TNM stage and lymph node metastasis. Overexpression of miR­766 inhibited PTC cell proliferation, colony formation, migration and invasion, promoted cell apoptosis and reduced tumor growth in vivo. Mechanistically, insulin receptor substrate 2 (IRS2) was identified as a direct target of miR­766 in PTC cells. IRS2 was upregulated in PTC tissues, and this was inversely correlated with miR­766 expression. Inhibition of IRS2 simulated the tumor suppressor activity of miR­766 in PTC cells. Restoration of IRS2 expression negated the tumor­suppressing effects of miR­766 overexpression on PTC cells. Notably, miR­766 directly targeted IRS2 to inhibit activation of the phosphoinositide 3­kinase (PI3K)/protein kinase B (Akt) pathway in PTC cells in vitro and in vivo. Overall, these findings indicated that miR­766 may inhibit the malignant biological behaviors of PTC cells by directly targeting IRS2 and regulating the PI3K/Akt pathway, thus suggesting that this miRNA may be a promising therapeutic target for PTC.

Lobaplatin inhibits breast cancer progression, cell proliferation while it induces cell apoptosis by downregulating MTDH expression.

OBJECTIVE: Lobaplatin shows antitumor activity against a wide range of tumors, including metastatic breast cancer (BCa). The overexpression of metadherin (MTDH) is associated with poor prognosis of BCa patients. This study was designed to investigate the effect of lobaplatin on MCF-7 cell proliferation and its association with MTDH expression. PATIENTS AND METHODS: Clinical treatment for BCa using lobaplatin, in combination with other general chemotherapy drugs, was administered to 32 BCa patients. The safety, effectiveness, and prognosis in lobaplatin-treated BCa patients were compared with those in controls (n=32). In vitro experiments were performed in MCF-7 cells to investigate the effect of lobaplatin on cell proliferation, apoptosis, and MTDH expression. RESULTS: We found the intraoperative local chemotherapy using lobaplatin was safe and effective for BCa treatment, in comparison with the patients administered general chemotherapy drugs. Treatment of MCF-7 cell cultures with lobaplatin significantly reduced cell proliferation and increased cell apoptotic percentage. The expression of MTDH and Bcl-2 was inhibited by lobaplatin and that of Bax was increased by lobaplatin. Moreover, we observed the inhibition of MTDH by shRNA reduced cell proliferation and enhanced cell apoptosis. CONCLUSION: Lobaplatin was a safe and effective adjuvant chemotherapy for BCa. The effect of lobaplatin on inhibiting MCF-7 cell proliferation and inducing cell apoptosis might be, as least in part, mediated by suppressing the expression of oncogene MTDH.

Steroid receptor coactivator-1 interacts with NF-κB to increase VEGFC levels in human thyroid cancer.

Thyroid cancer is the most common endocrine cancer, and has a high incidence of lymphatic metastasis. Vascular endothelial growth factor C (VEGFC) is essential for development of lymphatic vessels and lymphatic metastases during carcinogenesis. Steroid receptor coactivator-1 (SRC-1) interacts with nuclear receptors and transcription factors to promote tumor proliferation and metastasis. However, the correlation between SRC-1 and VEGFC levels in the lymphatic metastases of thyroid cancer remains unclear. We analyzed 20-paired specimens of thyroid cancer tissue and normal thyroid tissue and found increased levels of SRC-1 and VEGFC proteins in 13/20 and 15/20 thyroid cancer specimens, respectively, when compared with those levels in specimens of normal thyroid tissue. A high level of SRC-1 expression was positively correlated with VEGFC and lymphatic endothelial cell marker LYVE-1 expression. Papillary thyroid carcinoma cell line TPC-1 displayed high levels of SRC-1 and VEGFC expression and was selected for stable knockdown of SRC-1 in vitro Inhibition of SRC-1 significantly reduced the VEGFC levels in TPC-1 cells. We found that SRC-1 binds to transcription factor NF-kB (p50/p65), and that this coactivation complex directly promoted VEGFC transcription, which could be abrogated by SRC-1 knockdown. Up-regulated NF-kB signaling was also confirmed in thyroid cancer tissues. In vivo studies showed that SRC-1 knockdown restricted tumor growth, reduced the numbers of LYVE-1-positive lymphatic vessels, and decreased the levels of VEGFC in tumor tissues. These results suggest a tumorigenic role for SRC-1 in thyroid cancer via its ability to regulate VEGFC expression.

Low expression of long non-coding RNA GAS5 is associated with poor prognosis of patients with thyroid cancer.

The study aims to investigate the role of long non-coding RNA (lncRNA) GAS5 in the diagnosis and prognosis of patients suffering from thyroid cancer (TC). A total of 212 patients with TC and 61 patients with benign thyroid tumor were enrolled in the study. Quantitative real-time polymerase chain reaction (qRT-PCR) was applied to detect the lncRNA GAS5 expression in TC and benign tumor tissues. All TC patients were categorized into high-risk and low-risk groups according to the MACIS, AGES and AMES prognostic scoring system. A 5-year follow-up was conducted in order to determine the disease free survival (DFS) rates and overall survival (OS) rates. The associations between lncRNA GAS5 expression and prognosis of TC patients were analyzed by The Kaplan-Meier survival curves and the Cox regression models. There was a decrease in the lncRNA GAS5 expression in TC tissues in comparison to benign tumor tissues. Expression of lncRNA GAS5 showed significant association with tumor node metastasis (TNM) staging, lymph node metastasis and the multiple cancer foci of TC. AMES high-risk patients showed a decreased expression of lncRNA GAS5 expression than the AMES low-risk patients. The AGES and MACIS high-risk patients showed lower lncRNA GAS5 expression than low-risk patients. The survival rate of TC patients with high lncRNA GAS5 expression was higher than that of TC patients with low lncRNA GAS5 expression during the DFS and OS periods. Cox regression analysis indicated that lncRNA GAS5 expression, TNM staging, lymph node metastasis and multiple cancer foci were independent risk factors for poor prognosis in TC patients. LncRNA GAS5 may be closely related to the diagnosis and prognosis of TC.

Does dual HER-2 blockade treatment increase the risk of severe toxicities of special interests in breast cancer patients: A meta-analysis of randomized controlled trials.

Although dual HER-2 blockade treatment could offer greater clinical efficacy in breast cancer, the risk of severe toxicities of special interest related to this combined regimen in breast cancer remained unknown. We systematically searched public databases (MEDLINE, EMBASE, Cochrane library) to identify relevant studies that comparing anti-HER2 monotherapy (lapatinib or trastuzumab or pertuzumab) with dual HER-2 blockade treatment (pertuzumab plus trastuzumab or trastuzumab plus lapatinib) in breast cancer. A total of 11,941 breast cancer patients from 9 trials were included for analysis. Meta-analysis showed that dual HER2 blockade treatment significantly increased the risk of severe diarrhea (OR 2.52, p<0.001) and treatment discontinuation (OR 1.52, p=0.014), but not for severe rash (OR 1.06, p=0.81), liver toxicities (OR 1.16, p=0.28), CHF (OR 1.46, p=0.09), LVEF decline (OR 1.09, p=0.40) and FAEs (OR 0.97, p=0.91). Similar results were observed in sub-group analysis according to anti-HER2 regimens in terms of severe diarrhea and treatment discontinuation. Additionally, trastuzumab plus lapatinib significantly increased the risk of LVEF decline in comparison with lapatinib alone (OR 1.48, p=0.002). Our analysis indicated that dual anti-HER2 blockade treatment significantly increased the risk of developing severe diarrhea and treatment discontinuation in comparison with anti-HER2 monotherapy. These were no evidence of an increased risk of fatal adverse events with dual-HER2 blockade treatment.

MicroRNA-107 is downregulated and having tumor suppressive effect in breast cancer by negatively regulating brain-derived neurotrophic factor.

BACKGROUND: In the present study, we investigated the possible tumor suppressive effect of microRNA-107 (miR-107) in human breast cancer. METHODS: Gene expression of miR-107 in breast cancer cell lines and clinical breast tissues was evaluated by a quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR). MiR-107 was stably overexpressed in MCF-7 and MDA-MB-231 cells via lentiviral transduction. Its role in regulating in vitro cancer proliferation, cell cycle, invasion and in vivo tumor growth was evaluated by MTT, flow cytometry, transwell and in vivo tumorigenicity assays, respectively. Association of miR-107 and its downstream target, brain-derived neurotrophic factor (BDNF), was evaluated by luciferase assay and qRT-PCR. BDNF was further upregulated in miR-107-overexpressed MCF-7 and MDA-MB-231 cells to evaluate its role in regulating breast cancer with respect to in vitro proliferation, cell cycle and invasion. RESULTS: MiR-107 was markedly downregulated in both breast cancer cell lines and breast tumors. MiR-107 overexpression was markedly suppressed with respect to in vitro breast cancer proliferation, cell cycle progression and invasion, as well as with respect to in vivo development of breast cancer xenograft. BDNF was found to be the downstream target of miR-107 in breast cancer. BDNF upregulation functionally facilitated in vitro proliferation, cell cycle progression and invasion in miR-107-overexpressed breast cancer cells. CONCLUSIONS: MiR-107 is downregulated and has a tumor suppressive effect in breast cancer, likely through regulation via its inverted downstream target of BDNF.

PTEN/PI3K/AKT protein expression is related to clinicopathological features and prognosis in breast cancer with axillary lymph node metastases.

We explored the relations between PTEN/PI3K/AKT expression and clinicopathological characteristics and prognosis in breast cancer patients with and without axillary lymph node metastasis (LNM). Tissues and follow-up data from 142 patients with (LNM group) and 154 without (non-LNM group) metastases were collected. Expression of PTEN/PI3K/AKT was detected using immunohistochemistry staining. With axillary LNM, the positive rate of PTEN was reduced, whereas that of PI3K and AKT was increased. Expression of AKT was negatively correlated with PTEN expression but positively correlated with PI3K expression. Apparent correlations were detected between AKT and axillary LNM with a tumor size of 2 cm or less; between PTEN, PI3K, and AKT and axillary LNM in stage T1 or T2 breast cancer and invasive carcinoma of a nonspecial type; and between PTEN and AKT and axillary LNM of histologic grade I or II tumors and non-triple-negative breast cancer (all P<.05). In the LNM group, the 5-year survival rate of patients with PTEN-positive tumors was higher than that of patients with PTEN-negative lesions; whereas in the non-LNM group, the 5-year survival rate of patients with AKT-positive tumors was lower than that of patients with AKT-negative lesions (both P<.05). Cox regression analysis showed that PTEN expression was an independent prognostic factor for patients with LNM; AKT expression, tumor diameter, pathologic grade, and pathologic type were independent prognostic factors for patients without LNM. In conclusion, TEN/PI3K/AKT proteins are related to the clinicopathological features and prognosis of breast cancer with axillary LNM.

Long non-coding RNA ANRIL promotes the invasion and metastasis of thyroid cancer cells through TGF-ß/Smad signaling pathway.

OBJECTIVE: To investigate the effect of antisense non-coding RNA in the INK4 locus (ANRIL) on invasion and metastasis of thyroid cancer (TC). RESULTS: ANRIL expression was significantly up-regulated in TC tissues and cells (P < 0.001), and ANRIL expression was significantly different regarding histological grade and LNM (both P < 0.01). The siRNA-mediated ANRIL silencing inhibits proliferation, invasion, and metastasis of TPC-1 and SW579 cells, and lung metastasis, which can be reversed by TGF-ß1 siRNA. The mRNA levels of p15INK4b, p14ARF and p16INK4a in TPC-1 and SW579 cells increased significantly after silencing ANRIL (all P < 0.001), and TGF-ß1 siRNA could reverse the ANRIL siRNA induced increase of p15INK4b; expressions of TGF-ß1 and p-Smad2/3 were increased after silencing ANRIL (both P < 0.05). MATERIALS AND METHODS: TC and adjacent normal tissues were collected from 105 TC patients. LncRNA ANRIL expressions were detected by qRT-PCR. The siRNA ANRIL and siRNA TGF-ß1 were constructed for TPC-1 and SW579 cell line transfection: si-ANRIL group, si-TGF-ß1 group, si-ANRIL + si-TGF-ß1 group, negative control group and blank group. Effects of ANRIL silencing on proliferation, invasion and metastasis of TC cells was detected by MTT assay, Transwell assay and tail vein injection of nude mice in vitro and in vivo. TGF-ß1 and p-Smad2/3 expressions in TGF-ß/Smad signaling pathway were detected by western blot. CONCLUSIONS: ANRIL may reduce p15INK4B expression through inhibiting TGF-ß/Smad signaling pathway, promoting invasion and metastasis of TC cells, and the silencing of ANRIL inhibits the invasion and metastasis of TPC-1 cells.

Application of carbon nanoparticles for parathyroid protection in reoperation of thyroid diseases.

OBJECTIVE: To explore a new identification and protection method of the parathyroid gland in reoperation for thyroid diseases. METHOD: 54 patients receiving reoperation for thyroid diseases were selected. The experiment group intraoperatively adopted carbon nanoparticles suspension for negative development of the parathyroid gland, whereas the control group did not use carbon nanoparticles suspension. RESULTS: At 48 h after surgery, the parathyroid hormone level was lower than the normal state in 9 patients (33.30%) of the control group and 1 patient (3.70%) of the experiment group; meanwhile, 6 months after surgery, 8 patients of the control group (29.63%) and 1 patient of the experiment group (3.70%) showed a lower level than the normal state with statistical differences. The serum calcium level in 10 patients of the control group (37.04%) and 2 patients of the experiment group (7.41%) was lower than the normal state at 48 h after surgery, while a lower level than the normal state was also shown in 8 patients of the control group (29.63%) and 1 patient of the experiment group (3.70%) 6 months after surgery with statistically significant between the two groups. A total of 10 (37.04%) and 1 parathyroid gland (3.70%) were detected with a statistical difference in both groups. CONCLUSION: By adopting carbon nanoparticles in reoperation for the thyroid diseases and negative development of the parathyroid gland for identification and protection of the parathyroid gland, the incidence of hypoparathyroidism is reduced effectively, thus improving the postoperative quality of life of the patients.

Application of nano-carbon in lymph node dissection for thyroid cancer and protection of parathyroid glands.

BACKGROUND: The aim of this study was to explore a new method to identify and protect parathyroid glands in neck lymph node dissection for patients with thyroid cancer. MATERIAL AND METHODS: One hundred patients with thyroid cancer underwent total thyroidectomy combined with central neck lymph node dissection. During the operation, 50 patients receiving nano-carbon suspension were included in the experiment group, and 50 patients without nano-carbon suspension were included in the control group. We compared changes in parathyroid hormone levels before surgery and at 48 h after surgery between the 2 groups and of serum Ca^2+ level within 48 h after surgery, as well as postoperative parathyroid pathological and lymph node dissection results. RESULTS: Eight and 1 parathyroid glands were detected pathologically in the control and experimental group, respectively. Decrease in parathyroid hormone level at 48 h occurred in 7 patients in the control group and 1 patient in the experimental group. Hypocalcemia was found at 48 h after surgery in 10 patients in the control group and 2 patients in the experimental group. CONCLUSIONS: Nano-carbon suspension can cause development of the thyroid gland and the central lymph node and a negative development of parathyroid glands. Careful identification and removal of black-stained lymphatic tissues in the process of total thyroidectomy with neck lymph node dissection can ensure a complete lymph node dissection and prevent parathyroid damage, thus effectively reducing the incidence of hypoparathyroidism.

Prevention and treatment of recurrent laryngeal nerve injury in thyroid surgery.

AIM: To summary the experience for prevention and treatment of recurrent laryngeal nerve (RLN) injury in thyroid surgery. METHODS: Clinical features of 623 patients who received thyroid surgery from January 2010 to December 2012 were analyzed retrospectively, and the features of RLN injury and intraoperative as well as postoperative treatments were reviewed. RESULTS: RLN injury occurred in 31 patients (4.98%), in which, unilateral RLN injury occurred in 27 patients and bilateral RLN injuries occurred in 4 patients (temporary injury in 28 patients and permanent injury in 3 patients). 6 patients underwent RLN anastomosis during surgery and exhibited transient hoarseness after surgery. RLN exploration and decompression was given in 1 patient and the patient got normal vocal cord motion 2 months after surgery. 1 patient with bilateral injuries received tracheotomy and CO2 laser resection of arytenoid cartilage and achieved recovery 1 year later. CONCLUSIONS: In order to prevent RLN injury, the anatomic variations of RLN should be mastered. Routine exposure of RLN can effectively prevent the injury in patients receiving the second or multiple surgeries. Early interventions for RLN injury include mainly early discovery, early exploration and early anastomosis, and the function of RLN in some patients can recover completely. Subsequent treatments mainly focus on the improvement of the voice, expansion of glottis and melioration of dyspnea.

Surgical treatment of large substernal thyroid goiter: analysis of 12 patients.

This study was carried out to evaluate the clinical presentation, surgical treatment, complications, and risk of malignancy for large substernal goiter. From March 2010 to December 2012, 12 patients with large substernal thyroid goiter who underwent surgery in our Department were enrolled in the study. Their medical records were retrospectively analyzed. Collar-shaped incision was adequate for resection of the lesions in 10 (83%) patients, while two (17%) patients required combined cervical-thoracic incision. In addition, one case was subjected to postoperative tracheotomy. Transient hypocalcaemia occurred in one case. The incidence of transient hoarseness, tracheomalacia and hypothyroidism was 8.3%. There was no perioperative bleeding, thyroid storm as well as other serious complications. All patients were clinically cured. Therefore, cervical collar incision is nearly always adequate for most cases of larger substernal goiter, and sternotomy can be avoided. Furthermore, the application of intraoperative ultrasonic knife can effectively reduce intraoperative and postoperative complications. Aggressive perioperative management is crucial for the successful removal of large substernal goiter.

Peri-operative treatment of giant nodular goiter.

OBJECTIVE: To summarize the experience in the peri-operative treatment of giant nodular goiter. METHODS: A total of 123 patients with giant nodular goiter sized 6~20 cm were admitted into our hospital from 1990 to 2011 and the clinical data were retrospectively analyzed. These patients underwent total or subtotal thyroidectomy. RESULTS: All patients underwent surgical intervention. Unilateral subtotal thyroidectomy was performed in 40 patients, unilateral total thyroidectomy in 1 patient, bilateral subtotal thyroidectomy in 79 patients, and unilateral total thyroidectomy, removal of entire isthmus and contralateral subtotal thyroidectomy in 3 patients. Nodular goiter was pathologically proven post-operatively. No short-term complications such as dyspnea or thyroid storm were found postoperatively. Post-operative follow up was done for 9 months to 6 years and no recurrence was observed. CONCLUSION: Comprehensive pre-operative preparation, pre-operative evaluation, complete exposure of the operative field, meticulous operation, effective control and prevention of hemorrhage and prevention against damage to superior and recurrent laryngeal nerves are crucial for the successful surgical intervention of giant nodular goiter.