Efficacy and safety of LigaSure™ small jaw instrument in thyroidectomy: a 1-year prospective observational study.

PURPOSE: To compare the efficacy and safety profiles of LigaSure™ small jaw instrument (LSJI) versus conventional technique in patients undergoing open thyroidectomy. METHODS: This single-center, prospective, observational study conducted in Zhejiang Provincial Cancer Hospital enrolled patients who underwent thyroidectomy between September 2013 and September 2014. The primary study outcomes included determination of blood loss, operative duration, length of hospital stay, and drainage volume. The secondary outcomes included evaluation of recurrent laryngeal nerve palsy, postoperative bleeding, and hypoparathyroidism. RESULTS: A total of 842 patients undergoing thyroidectomy either with conventional method (n = 440) or with LSJI (n = 402) were enrolled. A significantly reduced operative time and intraoperative blood loss were noted in the LSJI group (p < .001) compared with the conventional group. Further, the LSJI group also demonstrated a significantly lower postoperative drainage (p < .05) compared with the conventional group. Length of hospital stay and incidence of postoperative complications were similar in both the LSJI and conventional groups. CONCLUSION: LigaSure hemostasis in thyroidectomy appears to result in significantly reduced operative time, intraoperative blood loss, and postoperative drainage compared with the conventional method in Chinese patients.

Familial and genetic researches on three Chinese families with von Hippel-Lindau disease.

OBJECTIVE: Hemangioblastoma of the central nervous system (CNS) occur as sporadic tumors or as a part of von Hippel-Lindau (VHL) disease, an autosomal dominant hereditary tumor syndrome caused by germline mutation of the VHL tumor suppressor gene. This study shows the clinical characteristics of three large Chinese families with VHL disease and evaluates the consequence of the genetic test for the diagnosis of VHL disease and clinical screening of the family members. METHODS: DNA is extracted from peripheral blood in 43 members from three large families with VHL disease and amplified by PCR to three exons of the VHL gene. The PCR products were directly sequenced and the mutations compared with the Human Gene Mutation Database. RESULTS: The ages of the patients who are given the initial diagnosis ranged from 16 to 47 years (mean: 31 years), and the mean time was 17.3 months (2-30 months) from the emergence of the symptom to patients' first visit. Furthermore, the gender distribution was 20% female (4) and 80% male (16). Twenty VHL disease patients in the three families have the most common manifestation of CNS hemangioblastoma. The cytosine replaced the 716th guanine on four patients and three carriers of virulence gene from the first family, which made the 168th serine replaced by threonine. And no mutation was found on the 22 members of the second family. Meanwhile, it was also found that the guanine replaced the 559th cytosine on one patient and two carriers from the third family, which made the 116th leucine replaced by valine. CONCLUSION: The DNA analysis of VHL germline mutations is clearly superior to clinical information to diagnose VHL disease. The CNS hemangioblastoma is the early manifestation in VHL disease. It is recommended that every patient with CNS hemangioblastoma should be screened for VHL gene mutation. The test for the VHL gene plays a key role in the discovery of asymptomatic patients and the carriers of virulence gene.

[The influence of pressure on the cell survival and axonal growing in rat retinal ganglion cells in vitro].

OBJECTIVE: To evaluate the effect of pressures on the changes of purified cultivation of SD suckling rats' retinal ganglion cells (RGC) by a hyperbaric cell culture model and on the expression of neurofilament protein-H (NF-H) in vitro. METHODS: It was a control experimental study. RGC were purified from twenty SD neonatal rats (postnatal 1 - 3 days) using Thy1.1 antibody and cultured under the pressures of 0, 20, 40, 60, and 80 mm Hg (1 mm Hg = 0.133 kPa) respectively. The growth and survival times of RGC were observed, the numbers of processes of RGC were counted, and the processes measured under the different pressures after 48 h under phase-contrast microscope. The expression of NF-H and its distribution in primary purified RGC was investigated by an immunohistochemical technique and by semi-quantitative statistics analysis using microscopic image-analysis technique. The data was analyzed with SPSS 13.0 software. Difference among groups with One-way ANOVA and ambi-groups with SNK (q test), statistical significance was confirmed as P < 0.05. RESULTS: The purification rate of RGC reached 96.24% after cultured for 12 hours. Compared with the control group, the growth and survival times of RGC were similar (P = 0.595, 0.147) under the pressure of 20 mm Hg cultured for 48 hours, the expression of NF-H in RGC was not different (P = 0.227); but the growth and survival times of RGC were significantly different (P = 0.001, 0.000, 0.000 and 0.000, 0.000, 0.000) under the pressures of 40, 60, and 80 mm Hg, respectively. The expression of NF-H in RGC were significantly (P = 0.000, 0.000, 0.000) reduced under the pressures of 40, 60, and 80 mm Hg for 48 hours respectively. CONCLUSIONS: The growth and survival times of cultured RGC in vitro are affected by the pressure > 40 mm Hg leading to a decreased expression of NF-H indicating a pressure caused mechanism of RGC damage in glaucoma. Down-regulation of NF-H may influence the process growth of RGC.

Clinical characteristics and treatment of thyroid cancer in children and adolescents: a retrospective analysis of 83 patients.

OBJECTIVE: To study the clinical characteristics, treatment, and prognosis of thyroid cancer in children and adolescents. METHODS: We performed a retrospective analysis of clinical data from 83 cases of thyroid cancer in children and adolescents from January 1990 to December 2010. We compared extra-thyroid extension, lymph node metastasis, distant metastasis, and prognosis between pediatric patients ≤12 years of age (27 cases) and those >12 years of age (56 cases). All the patients agreed to undergo thyroidectomy and endocrine therapy, and the consent was obtained from parents or guardians. RESULTS: Histopathology included papillary carcinoma in 67 cases, papillary carcinoma with partial follicular growth pattern in 1 case, papillary carcinoma with squamous metaplasia in 4 cases, follicular carcinoma in 7 cases, medullary carcinoma in 3 cases, and poorly differentiated carcinoma in 1 case. The total lymph node metastasis rate was 78.31%. Patients ≤12 years of age showed a higher rate of lymph node metastasis than the older group (92.59% vs. 71.43%, P=0.028). The incidence rate in females in the older group was higher than that in the younger group (80.36% vs. 59.26%, P=0.041). There were no significant differences in extra-thyroid extension, distant metastasis, survival rate, or recurrent disease between the two groups. CONCLUSIONS: The lymph node metastasis of thyroid cancer is higher in patients ≤12 years of age than in those >12 years of age; the incidence rate is higher in females than in males. Childhood thyroid cancer has a good prognosis, surgery being the most effective treatment. Choosing a reasonable surgery method and comprehensive postoperative treatment can achieve a cure and satisfactory survival rate.