Expression of human epidermal growth factor receptor 2 in pancreatic ductal adenocarcinoma and its clinical significance / 中华胰腺病杂志

Objective:To investigate the expression of human epidermal growth factor receptor 2 (HER2) in pancreatic ductal adenocarcinoma(PDAC) and its relationship with the prognosis of patients with PDAC.Methods:From January 2001 to December 2012, 109 paraffin embedded PDAC tissue samples and 27 normal pancreatic tissue samples were collected from the Department of Pathology, Huadong Hospital Affiliated to Fudan University. The expression of HER2 protein in pancreatic tissue was detected by immunohistochemical Envision two-step method. HER2 expression was evaluated according to Hercept test, and its relationship with clinicopathological features and survival time was analyzed.Results:The expression of HER2 protein was negative (-) in 29.4% of PDAC tissues, weakly positive (+ ) in 35.8%, positive (+ + ) in 25.7% and strongly positive (+ + + ) in 9.2%, respectively, and the overexpression rate (+ + , + + + ) was 34.9%; the negative (-) and weakly positive (+ ) expression of HER2 protein in normal pancreatic tissues accounted for 88.9% and 11.1% respectively. There was no expression with positive (+ + ) or strongly positive (+ + + ), therefore, the overexpression rate was 0. The overexpression rate of HER2 protein in PDAC and normal pancreatic tissues was significantly different ( P=0.000). The expression of HER2 protein was significantly correlated with age, and the expression of HER2 protein in patients with PDAC over 65 years old was significantly higher than that in patients with PDAC under 65 years old ( P=0.043), but not with gender, tumor location, tumor grade, T stage, N stage and nerve invasion (all P>0.05). Univariate Cox proportional hazards analysis showed that HER2 expression was associated with postoperative survival time of patients with PDAC ( P=0.032). Multivariate Cox proportional hazards analysis showed that HER2 expression was an independent prognostic factor for survival of patients with PDAC ( P=0.040). The median survival period of patients with HER2 expression + + + was significantly longer than that of patients with HER2 expression -~+ + (128.4 months vs 21.5 months), and the difference was statistically significant ( P=0.038). Conclusions:The overexpression of HER2 in PDAC tissue was related to the age of patients. The survival time of patients with HER2 strongly positive PDAC was significantly longer. HER2 can be considered as an index to evaluate the biological behavior and prognosis of PDAC.

Constituent ratio and subtype changes of thyroid cancer in Guiyang during the 8 years before and after adjustment of iodized salt content / 中华内分泌代谢杂志

Objective To investigate the composition and pathological subtypes of thyroid cancer in patients with thyroid nodule surgery in Guiyang in recent 8 years, and to analyze their influencing factors. Methods A retrospective pathological analysis of 4 262 thyroid surgery cases in Affiliated Hospital of Guizhou Medical University during the 2009-2016 to investigate the proportion of thyroid cancer and pathological subtype. The iodine content of salt was reduced at the end of 2012 in Guiyang. 2009-2012 as the pre down-regulation group(n＝1 572), 2013-2016 as the after down-regulation group ( n＝2 690), then comparative analysis before and after the adjustment of the iodine content of salt composition of thyroid cancer and changes of pathological subtype was performed. Results From 2009 to 2016, the proportion of thyroid cancer were 17.08%, 17.52%,15.65%, 18.58%, 19.80%, 29.35%, 35.34%, and 48.33%, increased year by year (P＜0.05). Thyroid microcarcinoma were 2.14%, 4.74%, 3.40%, 3.65%, 3.80%, 7.03%, 9.10%, and 25.95%(P＜0.05). The constituent ratio of thyroid cancer after adjustment of salt iodine content was higher than before. Papillary thyroid carcinoma is the main pathological subtype before and after adjustment of salt iodine content. The proportion of female patients was higher than that of males. The age of patients with thyroid cancer after adjustmen was higher than before ( P＜0. 05). Conclusions In the past 8 years, the constituent ratio of thyroid cancer and thyroid microcarcinoma in Guiyang increased year by year. The reason may be related to the increase of radiation in the environment, the improvement of medical level and the higher detection rate of thyroid microcarcinoma. The relationship between iodine nutrition and thyroid cancer needs to be further studied.[Key words] Thyroid cancer; Thyroid microcarcinoma; Thyroid papillary carcinoma; Pathological type;Iodized salt; Iodine nutrition

Diagnosis value of thyroid imaging reporting and data system in thyroid nodules / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the diagnostic value of the proposed thyroid imaging reporting and data system (TI-RADS) classification in thyroid nodules, and to investigate interobserver variability among different observers using TI-RADS classification for ultrasound.@*METHOD@#We reviewed 667 thyroid nodules conventional ultrasound image data from 532 patients who were confirmed by Pathological diagnosis. Those ultrasound images were reviewed by 4 experienced sonographers who can independently assessed the sonographic characteristics and analyzed according to the TI-RADS classification. It is to assess the diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the TI-RADS classification. The multirater kappa statistics were used to assess the interobserver agreement among different observers.@*RESULT@#The overall sensitivity, specificity, negative predictive value (NPV) and Accuracy were 94%, 79%, 97% and 81%, respectively. Positive predictive values (PPVs) for categories 4 and 5 were 55% and 92%. There was substantial interobserver agreement for categories 3, 4B and 5 (Kappa = 0.62, 95% CI, 0.58-0.65), and was moderate agreement for category 4A (Kappa = 0.57) and 4B(Kappa = 0.60).@*CONCLUSION@#The diagnostic criteria of TI-RADS for differentiating between benign and malignant thyroid nodules have a high diagnostic value. There was substantial interobserver agreement in different experienced sonographers. The TI-RADS diagnostic criteria have a high diagnostic value and has great practical value in making a proper and further treatment plan.

Study on the correlation between BRAF(V600E) mutation and lymphatic metastases in papillary thyroid cancer staged preoperativelv as N0 / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the prevalence of BRAF(V600E) mutations in small (≤ 2 cm) papillary thyroid carcinoma (PTC), explore the correlation with occult central nodal metastasis (CNM) of clinically-nodal negative (cN0) neck for small (≤ 2 cm) papillary thyroid carcinoma (PTC).@*METHOD@#Primary tumor tissue (paraffin-embedded) from 72 patients with small (≤ 2 cm) cN0 PTC who underwent prophylactic central neck dissection (pCND) was tested for BRAF mutation. by nested PCR, the factors of lymph node metastasis such as clinicopathologic including tumor size, multifocality, extrathyroidal invasion, and BRAF mutations were analyzed. Prediction scores were generated using logistic regression models and BRAF was evaluated to see if it was a risk factor for CNM.@*RESULT@#The prevalence of BRAF was 47.22% (34/72) while the rate of CNM was 36.11% (26/72). Univariate analysis showed that the risk factors of lymph node metastasis for cN0 PTC were significantly correlated with tumor size (P = 0.016), bilateral tumor (P = 0.010), multifocality (P = 0.026), extrathyroidal invasion (P = 0.024), and BRAF mutations (P = 0.041). Univariate analysis showed that tumor size (OR = 2.674, 95% CI = 1.702-3.997), multifocality (OR = 1.371, 95% CI = 1.065-2.087), extrathyroidal invasion (OR = 0.540, 95% CI = 0.396-0.794) and BRAF (OR = 1.647, 95% CI = 1.101-2.463) were risk predictors of CNM.@*CONCLUSION@#The incidence of central neck micrometastatic disease is 36.11% in patients with PTC deemed N0 preoperatively by clinical examination and ultrasound of the neck lymph nodes and intraoperatively by inspection of the central compartment. The factors of high risk of CNM included tumor size, multifocality, extrathyroidal invasion, BRAF mutations. When a patient has the risk factors of lymph node metastasis should be electived prophylactic CCND.

Peripheral Th17 cell frequencies predict postoperative complications in patients with hepatitis B virus-related liver cirrhosis following liver transplantation / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate the relationship between level of Th17/CD4+T cell ratio in peripheral blood and postoperative complications in patients with hepatitis B virus (HBV)-related cirrhosis after orthotopic liver transplantation (OLT).</p><p><b>METHODS</b>Fifty-one patients with HBV-related cirrhosis who received OLT were enrolled in this study. Flow cytometry analysis was performed to measure the proportion of Th17 cells to CD4+T cells at the following time points:pre-OLT, and post-OLT days 7, 14 and 21. The relevant hepatic biochemistry indexes, serum concentration of FK506 and level of procalcitonin (PCT) were detected for all patients after OLT.</p><p><b>RESULTS</b>The transplant recipients were divided into four groups according to the postoperative complication, which included acute rejection (AR, n=12), postoperative infection (POI, n=10), transient intrahepatic cholestasis (TIHC, n=12) and no complications (n=17). The Th17/CD4+T cell frequencies were notably higher in the AR patients after OLT (vs. before OLT, P less than 0.01) and this increase was positively correlated with rejection activity index (RAI; r=0.759, P=0.004). Up to post-OLT day 14, the frequencies of Th1 7/CD4+T cells in the POI group were similar to those of the AR group but they decreased to near-baseline level at post-OLT day 21.Furthermore, the percentage of Th17/CD4+T cells in the POI group was positively correlated with PCT (r=0.768, P=0.010). The frequencies of Th17/CD4+T cells in the TIHC and no complications groups showed a slowly decreasing trend after OLT and became markedly lower than the before OLT levels (P<0.01). The concentration of FK506 in the AR group was significantly lower than that in the other groups at post-OLT day 14 (P=0.000).</p><p><b>CONCLUSIONS</b>Th17/CD4+T cell level in peripheral blood might be a useful marker for risk assessment and monitoring of OLT postoperative complications, such as acute rejection and postoperative infection, in the early stage, and might help to improve patient prognosis by allowing for timely application of anti-rejection and antibacterial agents.</p>

Changes and significance of CD4+CD25+CD127low/-regulatory T cells in patients with portal hypertension and hepatitis B virus infection after splenectomy / 中华消化外科杂志

Objective To detect the changes of CD4 + CD25 + CD127low/-regulatory T (Treg) cells in peripheral blood in patients with portal hypertension and hepatitis B virus infection before and after splenectomy,and to study the effects of splenectomy on the immune function of patients with portal hypertension.Methods The clinical data of 20 patients with portal hypertension,hepatitis B virus infection and hypersplenism who were admitted to the Third Hospital of Hebei Medical University from May 2012 to May 2013 were retrospectively analyzed.The dynamic levels of CD4 + CD25 + CD127low/ Treg cells in the peripheral blood of the 20 patients (portal hypertension group) at 1 day before splenectomy and at postoperative week 1,month 1 and month 3 were detected by flow cytometry,and the dynamic levels of CD4 + CD25 + CD127low/ Treg cells in the peripheral blood of 10healthy individuals (control group) from the same hospital were also detected by flow cytometry.The effects of changes of Treg cells on the immune function were analyzed.All data were analyzed using the t test or repeated measures analysis of variance.Results The proportions of CD4 + CD25 + CD127low/-Treg cells before operation were 5.1％ ± 3.5％ in the portal hypertension group and 1.4％ ± 0.2％ in the control group,with significant difference between the 2 groups (t =2.573,P ＜ 0.05).The proportions of CD4 + CD25 + CD127low/ Treg cells in the portal hypertension group at postoperative week 1,month 1 and month 3 were 9.2％ ±2.7％,5.6％ ± 1.7％and 2.5％± 2.1％,respectively.There was significant difference in the proportion of CD4+ CD25 + CD127low/-Treg cells between postoperative week 1 and that before operation (F =9.814,P ＜ 0.05),while there was no significant difference in the proportion of CD4 + CD25 + CD127low/-Treg cells between postoperative month 3 and that before operation (F =2.364,P ＞ 0.05).Conclusion The proportion of Treg cells increases in a short period after splenectomy,and then it decreases as time passed by,which indicates that splenectomy has slight influence on the immune system from the perspective of Treg cells.

Clinical application of carbon nanoparticles labeled lymph node in cervical lymph node dissection with papillary thyroid cancer staged preoperatively as N0 / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the clinical application of carbon nanoparticles staining in cervical lymph node dissection on clinical neck lymph nodes the negative (cN0 period) thyroid papillary thyroid carcinoma (PTC).@*METHOD@#This retrospective analysis comprised 100 papillary thyroid cancer patients who met inclusion criteria,and they were randomly divided into the nano-carbon group (50 cases) and control group (50 cases). They underwent lobectomy, subtotal thyroidectomy or total thyroidectomies and were given elective central compartment neck dissection (CCND). The number of detected lymph nodes in each group was summed, and pathological examination was conducted. The number of lymph nodes (dyedor not dyed) and the location of metastatic nodes were recorded separately.@*RESULT@#In the nano-carbon group the average number of eliminated lymph nodes is significantly more than that of the control group(P<0.05). The metastasis lymph nodes in the nano-carbon group was higher than that in the control group(P<0.01). Among 100 cases, 2% had temporary vocal cord palsy, and 8% had temporary hypoparat hyroidism. No case of permanent vocal cord palsy or permanent hypocalcemia was observed.@*CONCLUSION@#The dyed lymph nodes can be easily identified and can be used as a guide for lymphnodes dissection in papillary thyroid carcinoma operation.

Analysis of risk factors of developing cardiac arrest in postreperfusion syndrome of orthotopic liver transplantation / 器官移植

Objective To investigate the risk factors of developing cardiac arrest in postreperfusion syndrome ( PRS) of orthotopic liver transplantation ( OLT ).Methods Clinical data of 192 patients who underwent OLT in the Third Hospital of Hebei Medical University from 2003 to 2013 were retrospectively analyzed.Among them, 38 patients developed PRS.According to the occurrence of cardiac arrest or not , the patients were divided into 2 groups, including 7 cases in cardiac arrest group (5 males and 2 females) and 31 cases in non-cardiac arrest group (23 males and 8 females).The probable influence factors of cardiac arrest were selected, including gender, age, preoperative cardiac indexes ( electrocardiogram or color doppler ultrasound of heart ) , preoperative albumin , borderline pH value during opening circulation , borderline temperature, borderline blood potassium level , blood calcium level after opening , degree of donor fatty liver , time of occluding inferior vena cava , and cold ischemia time of donor liver.Comparison of data between two groups was used t-test or Fisher exact probability test.Rick factors with significance differences between two groups were analyzed by unconditional Logistic regression analysis.Results Probable risk factors of developing cardiac arrest in PRS included borderline pH value <7.35 during opening circulation , borderline temperature<36 ℃during opening circulation , borderline blood potassium level >4 mmol/L during opening circulation and moderate fatty liver ( all in P<0.05 ).Results of unconditional Logistic regression analysis showed that moderate fatty liver was an independent risk factor of cardiac arrest in PRS.Conclusions Moderate fatty liver is an independent risk factor of cardiac arrest in PRS.The rational application of liver donors and paying more attention to perioperative treatment of recipients have important significance for reducing the incidence of cardiac arrest.

Reasons and treatments of lung hypervolemia in patients after liver transplantation / 中华器官移植杂志

Objective Objective To explore the reasons of lung hypervolemia after liver transplantation and the corresponding treatment strategies.Method 291 patients received liver transplantation,in which 35 cases underwent pulmonary edema at early stage (pulmonary hypervolemia group),and the rest without pulmonary hypervolemia served as control group.Average central venous pressure (CVP) was recorded pre-,intra-and post-operatively.Total intake,total discharge and fluid balance were also recorded intraoperatively and 3 days post-operatively.Result In pulmonary hypervolemia group,CVP was (12.33 ± 5.08),(14.33 ± 3.03) and (16.50 ± 4.57) mmHg pre-,intra-and post-operatively,significantly higher than that in control group (P＜0.05 for all).Total intake,total discharge and fluid balance in pulmonary hypervolemia group were significantly higher than those in control group intraoperatively and 3 days post-operatively (P＜0.05 for all).After diuretic therapy and hemodialysis,30 cases in pulmonary hypervolemia group recurred,and 5 cases died of infection.Conclusion Pulmonary hypervolemia at early stage after liver transplantation is related to fluid balance.The reasonable control of total intake,total discharge and fluid balance is necessary.

Prospective study on the effect of different iodine intakes on goiter and thyroid nodules / 中华内分泌代谢杂志

Objective To investigate the epidemiological characteristics of non-toxic goiter and non-toxic thyroid nodules in the regions with different iodine intakes and the factors influencing the occurrence, development and outcome of goiter and thyroid nodules. Methods 3 385 subjects, who had taken part in the previous survey in 1999 with the ultrasonic examination of thyroid, were composed of individuals in Panshan with chronic mild iodine deficiency,in Zhangwu with more than adequate iodine "after iodine supplementation and in Huanghua with excessive iodine. These 3 groups of subjects were followed up in 2004. Results (1) The cumulative incidences of diffuse goiter in Panshan ,Zhangwu and Huanghua were 7.1% ,4.4% and 6.9% ,respectively ,being the lowest in Zhangwu (P<0.01) and those of nodular goiter were 5.0% ,2. 4% and 0.8%, respectively, being the highest in Panshan (P<0.01). (2) The incidences of single nodule were 4.0% ,5.7% and 5.6%, respectively, and those of multiple nodules 0.4%, 1.2% and 1.0%, respectively. (3)The result of logistic analysis showed that iodine deficiency,iodine excess and positive thyroid autoantibodies (TAA) were the independent risk factors for the occurrence of goiter. (4)In Zhangwu ,the incidence of non-toxic goiter in the group with positive TAA was higher than that in the group with negative TAA(P<0.01) ,while there were no such differences in Panshan and Huanghua. (5)In these three regions, the rates of positive TAA in the individuals with diffuse non-toxic goiter were higher than those in the healthy subjects (P<0.05). And in Huanghua,the rate of positive TAA in subjects with non-toxic nodular goiter was also higher than that in the healthy individuals (P<0.05). Conclusion Iodine deficiency and iodine excess may both induce the raising incidence of goiter. Nodular goiter is prevalent in iodine deficient district and diffuse goiter is the predominant form in places with iodine excess. Thyroid autoimmunity is associated with occurrence and maintenance of goiter, and this phenomenon is more obvious in the community with previous iodine deficiency followed then by treatment with more than adequate iodine.