A retrospective study of the risk factors and the prognosis in patients with papillary thyroid carcinoma depending on the number of lymph node metastasis.

To retrospectively analyze the risk factors and the prognosis according to the number of lymph node metastases (LNMs) in different neck compartments in papillary thyroid carcinoma (PTC) patients. In total, 962 patients with PTC were enrolled in this study. According to the methods of the 2015 American Thyroid Association, the treatment response of the patients was divided into a good prognosis and a poor prognosis. First, their clinical characteristics were summarized. Then, according to whether they had LNMs and the number of LNMs in different neck compartments, their risk factors and their prognosis were analyzed. Male sex, younger (< 45 years), extrathyroid extension (ETE), T1 staging and higher stimulated thyroglobulin (sTg) levels were the risk factors for LNM. The cutoff for a poor prognosis of the number of LNMs was > 4. Male sex, younger age, higher sTg levels and ETE were correlated with LNM > 4. Furthermore, the cutoffs for a poor prognosis of central lymph node metastasis (CLNM), lateral lymph node metastasis (LLNM) and CLNM + LLNM were > 6, > 1 and > 5, respectively. Younger age and ETE were strongly correlated with CLNM > 6. Male sex, younger age, higher sTg levels and ETE were correlated with LLNM > 1. Younger age, ETE and higher sTg levels were correlated with CLNM + LLNM > 5. Further analysis revealed a positive correlation between CLNM and LLNM. We should pay more attention to LNMs in PTC patients who are male, are of a younger age, have ETE, T1 staging and have higher sTg levels. The neck regional LNMs should be correctly evaluated to guide the surgical options for the neck LNMs in PTC. When the number of LNMs in different neck compartments has exceeded the cutoff value, they can be considered as predictors of the outcome of 131I treatment.

Benzyl isothiocyanate induces protective autophagy in human lung cancer cells through an endoplasmic reticulum stress-mediated mechanism.

Isothiocyanates, such as allyl isothiocya¬nate (AITC), benzyl isothiocyanate (BITC), phenethyl isothio¬cyanate (PEITC) and sulforaphane (SFN), are natural compounds abundant in cruciferous vegetables, which have substantial chemopreventive activities against various human malignancies. However, the mechanisms underlying the inhibition of tumor cell growth by isothiocyanates are not fully understood. Since autophagy has dual functions in cancer, in the present study we investigated the effects of BITC on autophagy induction in human lung cancer cells in vitro and in vivo. BITC (1-100 µmol/L) dose-dependently inhibited the growth of 3 different human lung cancer cell lines A549 (adenocarcinoma), H661 (large cell carcinoma) and SK-MES-1 (squamous cell carcinoma) with IC50 values of 30.7±0.14, 15.9±0.22 and 23.4±0.11 µmol/L, respectively. BITC (10-40 µmol/L) induced autophagy in the lung cancer cells, evidenced by the formation of acidic vesicular organelles (AVOs), the accumulation of LC3-II, the punctate pattern of LC3, and the expression of Atg5. Pretreatment with the autophagy inhibitor 3-MA (5 mmol/L) significantly enhanced the BITC-caused growth inhibition in the lung cancer cells. Furthermore, BITC (20-40 µmol/L) activated ER stress, as shown by the increased cytosolic Ca2+ level and the phosphorylation of the ER stress marker proteins PERK and eIF2α in the lung cancer cells. Pretreatment with the ER stress inhibitor 4-PBA (5 mmol/L) attenuated the autophagy induction and potentiated the BITC-induced cell growth inhibition. In nude mice bearing A549 xenografts, administration of BITC (100 mg·kg-1·d-1, ip) for 8 weeks markedly suppressed the lung tumor growth, and significantly enhanced both autophagy and ER stress in the tumor tissues. Our results demonstrate that BITC inhibits human lung cancer cell growth in vitro and in vivo. In addition, BITC induces autophagy in the lung cancer cells, which protects the cancer cells against the inhibitory action of BITC; the autophagy induction is mediated by the ER stress response.

Comparison of Ligasure Versus Conventional Surgery for Curative Gastric Cancer Resection: a Meta-Analysis.

BACKGROUND: The LigaSure vessel sealing system has been proposed to save operation time and reduce intraoperative blood loss for various surgeries. However, its usage for gastric cancer is still controversial. The aim of the present meta-analysis was to compare the effectiveness of LigaSure with conventional surgery in gastrectomy. MATERIALS AND METHODS: Sources were retrieved from the Cochrane Library, MEDLINE, EMBASE, SCOPUS and Google Scholar until February, 2015. All randomized controlled trials comparing LigaSure with conventional surgery in curative gastric cancer resection were selected. After data extraction, statistics were performed by Review Manager 5.1 software. RESULTS: Three eligible randomized controlled trials were evaluated, with a total of 335 patients. The quality of the included trials was good, yet some methodological and clinical heterogeneity existed. There were no significant differences between the LigaSure and conventional groups in operative time (weighted mean difference [WMD], -22.95 minutes; 95% confidence interval [CI], [-59.75, 13.85]; P = 0.22), blood loss (WMD, -45.8 ml; 95% CI, [-134.5, 42.90]; P = 0.31), nor the incidence of surgical complications (odds ratio, 1.18; 95% CI, [0.68, 2.05]; P = 0.54). But there was a longer duration of hospital stay in LigaSure group (WMD, 1.41 days; 95% CI, [0.14, 2.68]; P = 0.03). CONCLUSIONS: All available randomized evidence has been summarized. LigaSure does not confer significant advantage over conventional surgery for curative gastric cancer resection. The usefulness of the device may be limited in gastrectomy. But, more trials are needed for further assessment of the LigaSure system for gastric cancer.

Apoptosis induced by benzyl isothiocyanate in gefitinib-resistant lung cancer cells is associated with Akt/MAPK pathways and generation of reactive oxygen species.

Gefitinib is the first targeted drug approved for non-small cell lung cancer (NSCLC) treatment. Clinical trails showed that patients with certain clinical and histologic characteristics (such as women, patients of East Asian descent, no history of smoking, and adenocarcinoma) had higher rates of response and overall survival. Despite excellent clinical response to gefitinib in certain NSCLC patients, nearly all patients who respond initially to gefitinib later develop drug resistance. Isothiocyanates have been shown to possess antitumor activity, inhibiting several types of cancer cells growth. However, there are limited studies on their effects on chemoresistance of cancer cells. In this report, we found that benzyl isothiocyanate (BITC) inhibited gefitinib-resistant human NSCLC cells growth by inducing apoptosis in a dose-dependent manner, and activated caspase-3. There were no effects of BITC on epidermal growth factor receptor and multidrug resistant proteins expression. BITC caused cell cycle arrest at G2/M phase, reactive oxygen species generation, and glutathione depletion. Akt activity and NFκB transcriptional activation were suppressed; mitogen-activated protein kinase and activator protein 1 (AP-1) were activated. Our results demonstrated that BITC overcame gefitinib resistance in lung cancer cells. The further understanding of the anti-resistance mechanism of BITC would contribute to establish it as a potent lead compound for the synthesis of novel anticancer drugs.

A comparative study of influential factors correlating with early and late hypothyroidism after (131)I therapy for Graves' disease.

BACKGROUND: (131)I therapy is recognized as the simplest, safest, least expensive, and most effective treatment, and accepted by more and more patients. However its curative effect is influenced by many factors, therefore there are some difficulties for doctors to establish individual treatment strategy. The aims of this study were to determine the incidence of early and late hypothyroidism after (131)I treatment for Graves' disease (GD) and to compare their correlation, to observe and analyze the influential factors and to understand the predictabilities of them. METHODS: Five hundred GD patients (144 males, 356 females; age (41.2 +/- 12.3) years) received (131)I treatment for the first time. The therapeutic procedure was carried out as the following: undergoing (131)I uptake test to obtain maximum of thyroid uptake value and effective half-life (EHL) time; estimating the thyroid's weight by ultrasonography; determination of thyroid hormones and correlative antibodies; pre-therapy physical examination; thyroid imaging; calculating (131)I therapeutic dosage; per os uptake of the determined (131)I dosage; follow-up appraisal of curative effect. The observing parameters included age, gender, thyroid weight, GD duration, condition of onset, state of disease, course of treatment, EHL time, maximum of thyroid uptake value, (131)I dosage and titer of correlative antibodies. We sorted out the data and used both univariate and multivariate analysis to evaluate them statistically. RESULTS: The incidence rates of early and late hypothyroidism were 33.2% and 6.6% respectively after (131)I treatment and approximately 22.2% cases of late hypothyroidism developed from early hypothyroidism. The influential factors of early hypothyroidism included course of GD, the highest thyroid uptake ratio of (131)I, EHL time and thyroid microsome antibody (TMAb), etc. A multivariate analysis on late hypothyroidism showed that female patients, with recurrence after anti-thyroid drug treatment and higher thyroid weight, had lower possibility of late hypothyroidism after (131)I therapy. CONCLUSIONS: The incidence of early hypothyroidism is higher than that of late hypothyroidism. The highest thyroid uptake ratio of (131)I, EHL and TMAb will increase the possibility of early hypothyroidism, while GD course is the protective factor. Higher (131)I dosage, longer EHL and higher TMAb titer will also increase the possibility of late hypothyroidism. The multi-perspective and multi-factor analysis has the benefit to establish individualized treatment strategy.

Effect of St. John's wort extract on depressive disorder in elderly patients with unstable angina.

BACKGROUND: The elderly patients with coronary heart disease (CHD) are often accompanied with depression. This study aimed to assess the effect of St. John's wort extract (SWE) on depressive disorder in elderly patients with unstable angina pectoris. METHODS: Altogether 170 patients who met the set criteria were enrolled in this prospective study. They were randomly divided into SWE group (44 patients), Deanxit group (44), psychotherapy group (42), and control group (40). The effectiveness of SWE was evaluated by reduced percentage of Hamilton depression (HAMD) scale and reduced frequency of angina pectoris attack, which were measured before and at 12 weeks after the treatment with SWE. RESULTS: The reduced percentages of HAMD scale were 79.5%, 56.8% and 57.1% in the SWE, Deanxit and psychotherapy groups, respectively. Compared with the control, the three groups had significant differences in the percentages (P<0.001). The improvement after the treatment was more significant in the SWE group than in the Deanxit or psychotherapy group (P<0.05). The improvement of angina pectoris evaluated by the Canadian Cardiac Society Classification was significantly better in the treatment groups (88. 7%, 65. 9%, 57.1%) than in the control group, and it was marked in the SWE group (P<0.001). Angina pectoris attack, its frequencies, durations and electrocardiographic changes were significantly improved in the treatment groups than in the control group (F=6.05, 4.58, 5.12, P<0.01). They are markedly improved in the SWE group (P<0.05). CONCLUSION: SWE can improve depressive symptoms more significantly in elderly patients with unstable angina pectoris than Deanxit or psychotherapy, proving that SWE contributes to better treatment of angina attack as well.