[Modified gasless trans-subclavian approach endoscopic lateral neck dissection for treatment of papillary thyroid carcinoma: a series of 31 cases].

Objective: To examine the feasibility of the modified gasless trans-subclavian approach endoscopic thyroidectomy for lateral neck dissection (LND) in papillary thyroid carcinoma (PTC). Methods: The clinical data of 31 patients with PTC who underwent modified gasless trans-subclavian approach endoscopic LND in the Department of Head and Neck Surgery, Run Run Shaw Hospital, from January to October 2022 were retrospectively analyzed. There were 2 males and 29 females, aged (32.6±8.3) years (range: 17 to 55 years). The maximum diameter of the primary thyroid lesion (M(IQR)) was 1.06 (1.16) cm (range: 0.53 to 2.44 cm), and the maximum diameter of the metastatic lymph node was (1.04±0.37) cm (range: 0.44 to 1.88 cm). Operation time, postoperative hospital stay, number of lymph nodes dissected, and postoperative complications were recorded. Outpatient follow-up was conducted until November 30, 2022. Results: All operations were successfully completed with the endoscopy approach without conversion to open surgery. The operation time was 160 (20) minutes (range: 100 to 215 minutes), and the postoperative hospital stay was 4 (2) days (range: 2 to 14 days). The number of lymph nodes obtained by dissection in the central and lateral compartment of the neck was 11 (12) (range: 0 to 37) and 34.7±14.8 (range: 15 to 69), respectively. Temporary hypoparathyroidism occurred in 4 cases and all recovered within 1 month after the operation. One case suffered from recurrent laryngeal nerve injury (continuing followed up to assess whether it is a temporary injury). The complication of LND included 1 case of chylous leakage that was recovered with conservative treatment, 1 case of Horner syndrome returned to normal 3 months after surgery. During follow-up, there was no residual tumor or recurrence. Conclusion: The modified gasless trans-subclavian approach endoscopic LND for PTC is feasible, with a thorough dissection and concealed incision.

[Gasless submental-transoral combined appoach endoscopic thyroidectomy for papillary thyroid carcinoma: a series of 41 cases].

Objective: To examine the safety and feasibility of gasless submental-transoral combined appoach endoscopic thyroidectomy for papillary thyroid carcinoma (PTC). Methods: A retrospective analysis of the clinical data of 41 patients with PTC who underwent the gasless submental-transoral combined appoach endoscopic thyroidectomy at the Department of Head and Neck Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from November 2020 to April 2021. There were 5 males and 36 females with the age of (35.0±8.7) years (range: 19 to 58 years). A horizontal incision with a length of 2.0 cm is made under the chin as an observation hole, a 10 mm Trocar and a self-developed retractor are inserted, and two 5 mm longitudinal incisions are made on the labial side in the vestibule of the oral cavity as an operation hole, each inserting a 5 mm Trocar, the operation direction is from the cranial side to the caudal side. The sensation of the lower lip and chin was measured on the first day and one month postoperative. The operation time, hospital stay, the number of lymph nodes dissected and postoperative complications were recorded. Results: Surgical procedures in all cases were successfully completed under endoscopic approach without transfering to open surgery. The operation time was (99±34) minutes (range: 50 to 180 minutes) and the postoperative hospital stay was (3.4±2.2) days (range: 2 to 16 days). The maximum diameter of PTC was (7.6±5.8) mm (range: 2 to 30 mm), and the number of lymph nodes of the central compartment dissection was 6(5) (M(IQR)) (range: 1 to 25). The duration of follow-up is 1 month after operation, and the follow-up method is adopted in outpatient clinic. Postoperation complications included 2 cases of transient hypoparathyroidism, One case of recurrent laryngeal nerve injury (continue to follow up to assess whether it is a temporary injury). Postoperative minor chyle leak, seroma, and local redness and swelling in 1 case each were cured after conservative treatment. 1 case of transient minor numbness of the lower lip was observed. No permanent hypoparathyroidism, postoperative bleeding and numbness of the chin was observed. Conclusion: The gasless submental-transoral combined appoach endoscopic thyroidectomy is a feasible approach in selected PTC patients and has clinical application value.

[Inhibitory effect of DAPT on Notch signaling pathway in curcumin mediated photodynamic therapy for cervical cancer xenografts in nude mice].

Objective: Curcumin was used as photosensitizers in photodynamic therapy on cervical cancer xenografts in nude mice.Analysis the expression changes of Notch and downstream gene as NF-κB and VEGF before and after DAPT inhibition of Notch signaling pathway in vivo experiments.Our aim was to investigate the possible mechanism of Notch signaling pathway in the treatment of cervical cancer with PDT. Methods: A cervical cancer model of nude mice was established by subcutaneous inoculation of human cervical cancer Me180 cells 200 µl.After the success of the model, the experimental animals were divided into 4 groups (model group, curcumin PDT group, simple DAPT group, curcumin-PDT+ DAPT group), each group was 12.Tumor volume changes were analyzed and HE staining was observed in each group.MRNA and protein expression of Notch1 and its downstream NF-κB, VEGF were detected by RT-PCR, immunohistochemistry and Western blot before and after inhibition of Notch signaling pathway by DAPT. Results: Except the control group, the tumor volume of the other three groups remained unchanged or slightly reduced after 1-7 days of treatment.The difference was significant (P<0.05). HE staining showed the most obvious necrosis of curcumin-PDT group with DAPT.Both DAPT and curcumin-PDT could reduce the expression level of Notch1 in mRNA.The inhibition rates were 42.17% and 40.54%, respectively.And the inhibitory effect of curcumin-PDT with DAPT on Notch-1 was the strongest (79.22%) (P<0.01), and two of them had synergistic effect after combination with curcumin-PDT.But the expression of Notch-2 has no obvious inhibitory effect (P>0.05). Both DAPT and curcumin-PDT can inhibit the protein expression of Notch1, NF-κB and VEGF, and two of them have synergistic effect after combined use. Conclusions: DAPT can effectively block the Notch signaling pathway and inhibit the proliferation of cervical cancer cell line Me180.The application of DAPT to inhibit Notch signaling pathway after photodynamic therapy can achieve synergistic effect, which is mainly related to the down-regulation of the expression of Notch1 and NF-κB.Notch signaling pathway may be one of the targets of curcumin-PDT photodynamic therapy.

[Modified minimally invasive video-assisted lateral neck dissection for papillary thyroid carcinoma: a series of 130 cases].

Objective: To discuss the feasibility, safety and oncologic completeness of modified minimally invasive video-assisted lateral neck dissection (MIVALND) for papillary thyroid carcinoma. Methods: Data of 130 patients from Department of Head and Neck Surgery, Sir Run Run Shaw Hospital, Medical School, Zhejiang University undergoing MIVALND from January 2013 to September 2015 were reviewed retrospectively. There were 31 male and 99 female patients with the mean age of (39±11) years. The thyroidectomy and central compartment dissection were performed under a direct visual field or video-assisted (VA) approach, lateral neck dissection was performed via the VA approach. Serum thyroglobulin and thyroglobulin antibody levels were measured every 6 months after surgery. Ulrasonography was performed to assess the thyroid bed and lateral neck compartment every 6 months after surgery. The mean operation time for MIVALND, mean postoperative hospital stay, size of primary tumor, number of retrieved lymph nodes, complication rates, and postoperative serum thyroglobulin levels were analyzed retrospectively. The patients were followed up by outpatient review and until March 2016. Results: Beside 1 case was converted to open procedure, 129 (99.2%) patients successfully underwent MIVALND. The mean operative time was (74±17) min (ranging from 40 to 120 min) for MIVALND. The mean postoperative hospital stay was (4.9±2.1) days (range 2 to 14 days). The mean size of primary tumor was (1.3±0.7) cm (range 0.3 to 4.0 cm). The mean number of lymph nodes removed was 42±13 (range 15 to 79) in lateral compartment. Postoperative complications included 19 transient hypoparathyroidism, 7 transient recurrent laryngeal nerve (RLN) palsy and 3 permanent RLN palsy (tumor invasion and the RLN was resected en bloc with the tumor in 2 cases), 2 (1.5%) transient palsy of spinal accessory nerve, 1 (0.8%) transient palsy of marginal mandibular branch of the facial nerve, 1 (0.8%) seroma, and 4 (3.1%) minor chyle leak. The mean follow-up period was (19±10) months (ranged 6 to 36 months). The mean serum thyroglobulin level was 0.10 µg/L during follow-up. No evidence of local residual or recurrent disease was observed at postoperative follow-up. Conclusion: The modified MIVALND is a safe and feasible approach in selected papillary thyroid carcinoma patients.

Multicenter randomized study on Me-CCNU, 5-FU and ADM vs ACNU, 5-FU and ADM for treatment of advanced gastric cancer.

AIM: To compare the efficacy of a combined chemotherapy regimen of 5-fluouracil (5-FU) and adriamycin (ADM) with nimustine hydrochloride (ACNU; brand name Nidran), a new nitrosourea agent, or with methyl-CCNU for advanced gastric cancer. METHODS: One-hundred-and-three cases of advanced gastric cancer were randomly allocated into Group A (Me-CCNU, 5-FU and ADM combination) and Group B (ACNU, 5-FU and ADM combination). The quality of life (QOL) questionnaire, composed of 11 ordinal categorical items, was used to collect data from these patients. RESULTS: Group A had no case of complete remission (CR) or partial remission (PR), while Group B had no CR but 8 PR (8/46 cases), for a response rate of 0% in Group A and 17.4% in Group B. The median survival time in Group A was 108 d and in Group B was 112 d. Both groups tolerated the treatment well and there were no serious adverse effects. QOL evaluations showed better psychological and physical feelings of tiredness for Group B than for Group A, and scores based on facial scaling showed a more pleasant inclination for the former. CONCLUSION: ACNU combination is superior to the Me-CCNU combination for advanced gastric cancer patients.

A phase II clinical trial of flutamide in the treatment of advanced breast cancer.

An antiandrogenic agent flutamide was used in the treatment of one male and 14 female postmenopausal breast cancer patients. Only a mild and transient response was seen in 2 female patients. Therefore, flutamide cannot be used solely in the treatment of female postmenopausal breast cancer.

[Short-term result of non-Hodgkin's lymphoma treated by the COMP regimen].

From March 1982 to November 1984, 31 patients with non-Hodgkin's lymphoma were treated by COMP regimen. 15 (48%) had stage III and IV lesions. This regimen consisted of cyclophosphamide 600 mg IV weekly, vincristine 2 mg IV weekly, methotrexate 20 mg IM weekly and prednisone 30 mg PO daily for 2-3 weeks. Then, there was an interval of 2 weeks and the same therapy was repeated. 27 patients had more than 3 cycles. Of the 31 patients, 22 gave objective response with an overall response rate of 71%. Among the 22 patients without prior treatment, 10 (45.5%) achieved complete remission (CR) and 8 (36.3%) partial remission (PR)--the overall response rate was 81.8%. 4 (44%) of 9 patients with prior chemotherapy responded to COMP regimen (1 CR and 3 PR). The treatment was well-tolerated. There were only 9 patients with leukocyte count below 4000 and none of them ever below 2000. One patient had a transient elevation of serum glutamic pyruvic transaminase, which dropped to normal very quickly after interruption of the treatment. COMP regimen was as effective as COPP (procarbazine replacing methotrexate) regimen in non-Hodgkin's lymphoma. Hence, it could be considered as a common regimen for advanced non-Hodgkin's lymphoma and used to treat the patients refractory to certain chemotherapeutic agents.