Robotic thyroidectomy via bilateral axillo-breast approach: Experience and learning curve through initial 220 cases.

OBJECTIVE: This study is aim to summarize the experience of robotic thyroidectomy via bilateral axillo-breast approach of our center and also to find out the learning curve of this technique. METHODS: In total 220 initial patients who have undergone robotic thyroidectomy via bilateral axillo-breast approach from May 2015 to September 2017 were involved in this study. The data of operation time, clinical characteristics, surgical outcomes and oncological outcomes were collected. The moving average method is use to explore the learning curve. RESULTS: All patients had undergone robotic thyroidectomy successfully without conversion to other surgical approaches. The mean age of the enrolled subjects was 34.4 ± 7.8 years old, while the sex ratio (male/female) was 38/182. There were 50 benign tumor cases and 170 malignant tumor cases. The mean total operation time was 105.3 ± 37.6 min. Lymph node metastasis was observed in 61 (35.9%) patients. The mean retrieved lymph node count was 5.1 ± 3.8 while the mean metastatic lymph node count was 0.7 ± 1.5. The operation time decreased significantly after about 30-35 cases and formed the plateau. After 80 cases, the operation time significantly decreased again. CONCLUSION: For skilled endocrine surgeons, robotic thyroidectomy has proved to be safe and feasible, which could be applied extensively in patients strictly selected in high-volume centers, with a relatively short learning curve of about 30-35 cases. While the surgeons getting more experienced, this technique would be more efficient.

Up-regulation of chemokine receptor CCR4 is associated with Human Hepatocellular Carcinoma malignant behavior.

Studies indicate that the chemokine receptor is responsible for poor prognosis of hepatocellular carcinoma (HCC) patients. In this study, we initially demonstrated that CCR4 is overexpressed in HCC specimens, and its elevation in HCC tissues positively correlates with tumor capsule breakthrough and vascular invasion. Although overexpression of CCR4 failed to influent proliferation of HCC cells in vitro apparently, the prominent acceleration on HCC tumor growth in vivo was remarkable. The underlying mechanism may be involved in neovascularization. Interestingly, different from effect on proliferation, CCR4 overexpression could trigger HCC metastasis both in vitro and in vivo also induced HCC cell epithelial-mesenchymal transition (EMT) as well. Then we identified matrix metalloproteinase 2 (MMP2) as a direct target of CCR4 which plays an important role in CCR4-mediated HCC cell invasion, which was up-regulated by ERK/AKT signaling. Positive correlation between CCR4 and MMP2 expression was also observed in HCC tissues. In conclusion, our study suggested that chemokine receptor CCR4 promotes HCC malignancy and facilitated HCC cell metastases via ERK/AKT/MMP2 pathway. These findings suggest that CCR4 may be a potential new diagnostic and prognostic marker in HCC, and targeting CCR4 may be a potential therapeutic option for blocking HCC metastasis.

Anti-cancer activity and potential mechanism of a novel aspirin derivative.

Aspirin has been used in the treatment and chemoprevention of many malignant cancers. The mechanism of its anti-cancer activity mainly involves the inhibition of cyclooxygenase-2 (COX-2). However, the application of aspirin is limited by the serious gastric mucosal damage that accompanies its usage. We have previously reported the preparation of a novel aspirin derivative that we named Ca-Asp, and showed that it causes less damage to gastric mucosa of rat and inhibits the expression of COX-2 to higher degree than Asp. However, the anti-cancer effect and mechanism of Ca-Asp was not demonstrated. In this study, the anti-cancer effect of Ca-Asp was investigated and compared with those of Asp and Hydroxyapatite (Hap) at the cell level. The results showed that treatment of SGC-7901 cells (human gastric cancer cell line) with 200-400µg/ml Ca-Asp resulted in significant reduction in cell viability, compared to treatment with either Asp or Hap, and at a higher concentration (500µg/ml). Subsequent investigation into the possible underlying mechanism showed that Ca-Asp induced apoptosis and caused cell cycle arrest at the G1 phase. Ca-Asp also up-regulated the levels of caspase-3 and p53, but down regulated the level of cyclin D1, NF-κB, COX-2 and PGE2. Furthermore, simultaneous treatment of SGC-7901 cells with Ca-Asp and exogenous PGE2 reduced the anti-proliferative effect of Ca-Asp on the cells. Taken together, the results suggested that Ca-Asp might act as a potential anti-cancer drug, and that its suppression of PGE2 production might constitute an important part of its anti-cancer activity.

New variation of right recurrent laryngeal nerve: cases report.

The recognition of variation in recurrent laryngeal nerves is important for both surgeons and the prognosis of patients undergoing surgery of the neck. Here, we reported a new variation of the right recurrent laryngeal nerves in five patients with thyroid surgery. The new variation is characterized by the additional ascending intracranial branches after division of laryngeal branches.

[A variation of the recurrent laryngeal nerve at its entry to larynx found in the thyroid surgery].

OBJECTIVE: To describe a new variation of the recurrent laryngeal nerve (RLN) at its entry to larynx. METHODS: A retrospective study including 3 078 consecutive cases received thyroidectomy was performed from January 1998 to December 2008. The age ranged from 15 to 82 years, 2 395 cases were female and 683 cases were male. A total of 4 241 RLNs were exposed successfully for avoiding the injury of the nerve. A kind of variation of the RLN was reported in this study. RESULTS: Forty-four varied RLNs were identified at the entry into the larynx (1.0%, 44/4241). Variation happened at the truck or the branches of RLN entering the larynx far from the posterior cricothyroid joints. The distance from the entry to the back of cricothyroid joints was over 5 mm. Among these, eight RLNs (23.5%, 8/34) walked distally from the dorsal cricothyroid joint without extra laryngeal branches and entered the larynx at the abnormal point. There were four different kinds of sub-variations identified: type I: there was no branch in RLN and the varied RLN entered the larynx far from the posterior cricothyroid joints, total 35 cases (79.6%, 35/44); type II: there were two branches in RLN, one branch entered the larynx at the posterior cricothyroid joints and the other far from the posterior cricothyroid joints, total 5 cases (11.4%, 5/44); type III: there were two branches in RLN, and both branches entered the larynx far from the posterior cricothyroid joints, total 3 cases (6.8%, 3/44); type IV: there were three branches in RLN, the lateral branch of the varied RLN entered the larynx far from the posterior cricothyroid joints, total 1 case (2.2%, 1/44). Four varied RLNs were injured during the operation (9.1%, 4/44). CONCLUSION: The variation of RLN reported in this study is more dangerous and should be paid more attention to lower the injury of the nerve.

[FTIR spectra analysis of the reactive activity of lignin when modified by laccase].

In company with the development of nonaqueous enzymology, the enzymatic modification of lignin has gained increasing interests, especially in the synthesis of high molecular material. In the present article, the enzymatic modification of spruce alkali lignin in cetyltrimethylammonium bromide (CTAB) reversed micelles (100 mmol x L(-1) 1, pH 6.0, W/O = 40), alcohol lignin in ethanol solution (50%), lignin sulphonate in sodium phosphate buffer (pH 5.8, 20 mmol x L(-1)) and steam-explosion wheat straw alkali lignin in alkaline solution (pH 10.0, 20 mmol x L(-1) NaOH) by mycelia sterilia YY-5 laccase was studied. Laccase was isolated from Mycelia Sterilia YY-5 (CGMCC-1462) which was an entophytic fungus of Rhus Chinensis Mill. FTIR spectrum was used to assay the structure of lignins and gel permeation chromatography (GPC) was used to determine the molecular weight and molecular weight polydispersity of lignins. Bands of lignin in FTIR spectra of all lignins changed obviously after treated with YY-5 laccase, which indicated that some bond breakage or rearrangement occurred to lignin. The shift of non-conjugated C=O and conjugated carbonyl groups (alpha-carbonyl groups) stretching vibration, the decrease of phenol hydroxyl stretching vibration and the increase of C--O--C stretching vibration of ester bond proved that phenolic hydroxyl, carbonyl group and side chain substituent all might participate in the laccase modification reactions of lignin. Meanwhile, the results of GPC indicated that the molecular of lignins all have certain increase and molecular polydispersity decreased. From the point of the molecular mass polydispersity, the modification effect of YY-5 laccase on steam-exploded wheat straw alkali lignin and spruce alkali lignin was more significantly than other two lignins. The molecular mass polydispersity for steam-exploded wheat straw alkali lignin and spruce alkali lignin was 1.211 and 1.375 respectively, which might contribute to the alkali-stable enzyme for YY-5 laccase. Correspondingly, alkali solution was chosen as the optimum medium for YY-5 laccase to modify lignins.

[Expression and localization of multi-drug resistance-associated protein 2 and radixin after hepatic ischemia-reperfusion: experiment with rats].

OBJECTIVE: To investigate the mechanism of increase of serum bilirubin after hepatic ischemia-reperfusion. METHODS: 104 SD rats were randomly divided into 2 groups: Group A (sham operation group) and Group B (undergoing 70% hepatic 35 min ischemia-reperfusion). Then the rats were subdivided into subgroups according the different time points (1 and 6 hours, and 1, 3, 5 days after reperfusion). Bile of the ischemic hepatic lobes and blood from the vena cava were collected to examine the conjugated bilirubin (CB) in the bile and serum, and total bilirubin (TB) and alanine aminotransferase (ALT) in serum, and the bile generation rate was calculated. Tissues of the left liver lobe were collected to undergo microscopy with hematoxiline and eosin staining. Real time fluorescence PCR was used to analyze the mRNA expression of multi-drug resistance-associated protein 2 (MRP2) and radixin, a cytoskeleton crosslinker protein. Laser confocal method was used to analyze the localization of MRP2 and radixin in canalicular membrane. RESULTS: Pathological examination showed that there was only a mild inflammation in the liver tissues that had undergone ischemia-reperfusion, and no necrosis of hepatocytes was seen. 1 h approximately 3 d after reperfusion, the bile generation rate and CB level in bile were significant decreased, and the serum TB and CB levels were significantly increased 1 h approximately 5 d after reperfusion. Radixin expression was significantly reduced 6 h approximately 1 d after reperfusion, but down-regulation of MRP2 only occurred 6 h after reperfusion. Localization of MRP2 in the canalicular membrane was absent when the expression of radixin was missing. CONCLUSION: Absence of MRP2 localization in canalicular membrane resulted from missing of radixin expression may be the mechanism of an increase of serum bilirubin after hepatic ischemia-reperfusion.

[The protective effect of heat shock protein 72 by Doxorubicin in cold ischemia-reperfusion injury of the rat liver].

OBJECTIVE: To observe induction of heat shock reaction by pretreatment of Doxorubicin (DXR) in long-term cold preservation-reperfusion injury of the rat liver. METHODS: The rats were administered intravenously by DXR at a dose of 1 mg/kg body weight in DXR group and by saline in control group. After 48 hours, the rat liver was perfused by using cold University of Wisconsin (UW) solutions and was preserved in UW solution at 4 degrees C for 48 hours. Recipient liver was perfused for 1 and 3 hours after orthotopic liver transplantation. Tumor necrosis factor-alpha (TNF-alpha) mRNA, cytokine-induced neutrophil chemoattractant (CINC) mRNA, macrophage inflammatory protein (MIP-2) mRNA was measured by RT-PCR and heat shock protein 72 (HSP72), nuclear factor-kappaB (NF-kappaB) by Western blot. The serum levels of TNF-alpha, CINC, MIP-2 by ELISA and AST were measured. The survival rate of 7 days was observed. RESULTS: The expression of TNF-alpha mRNA, CINC mRNA and MIP-2 mRNA was stronger in control group than in DXR group. HSP72 was expressed in SA group but not in control group and oppositely NF-kappaB was expressed in control group but not in DXR group. Serum AST, TNF-alpha, CINC and MIP-2 concentrations were significantly lower in DXR group than in control group (P < 0.05). The survival rate of 7 days was significantly higher in DXR group than in control group (50% vs. 0%, P < 0.05). CONCLUSIONS: These data suggested that long-term cold ischemia-reperfusion injury was attenuated in liver graft with pretreatment of DXR. The induction of HSP72 may offer protection to hepatocytes by restraining the activation of NF-kappaB and inflammation.

Over-expression of fibroblast growth factor receptor 3 in human hepatocellular carcinoma.

AIM: To describe the significant over-expression of fibroblast growth factor receptor 3 (FGFR3), which is a signal transduction and cell proliferation related gene in hepatocellular carcinoma (HCC). METHODS: Following DNA microarray, Northern blot and quantitative real-time PCR were employed to confirm FGFR3 expression difference in HCC tissues and surrounding non-neoplastic liver tissue. FGFR3 expression levels were further determined by immunohistochemical study in 43 cases of HCC. RESULTS: Northern blot results showed the significant over-expression of FGFR3 in HCC tissues, which was consistent with that from DNA microarray. Quantitative real-time PCR demonstrated that the mean ratio of FGFR3 mRNA to glyceraldehyde-3-phosphate dehydrogenase (GADPH) mRNA in HCC tissue was 0.250, whereas the ratio in non-neoplastic liver tissue was 0.014. Statistical analyses of 43 cases of HCC revealed that HCC scored higher than the matched non-neoplastic liver tissues. Examination of clinicopathological features revealed a strong correlation of over-expression of FGFR3 with poor tumor differentiation and high nuclear grade. CONCLUSION: Over-expression of FGFR3 may play an important role in liver carcinogenesis. FGFR3 may be an ideal candidate as a molecular marker in the diagnosis of HCC and a potential therapeutic target.