Gasless submental-transoral combined approach endoscopic thyroidectomy: a new surgical technique.

Background: The development of transoral endoscopic vestibular approach thyroidectomy (TOETVA) has been limited by inherent defects, such as mental nerve injury and carbon dioxide (CO2)-related complications. Herein, we proposed a new technique without CO2 called gasless submental-transoral combined approach endoscopic thyroidectomy (STET) to solve the problems in TOETVA. Methods: We reviewed 75 patients who successfully underwent gasless STET using novel instruments at our institution from November 2020 to November 2021. A main incision of approximately 2 cm was made in the natural submental crease line and then combined with two vestibule incisions to complete the procedure. Demographic data, surgical technique and perioperative outcomes were retrospectively recorded. Results: Thirteen male and sixty-two female patients with a mean age of 34.0 ± 8.1 years were enrolled in this study. Sixty-eight patients had papillary thyroid carcinomas and seven had benign nodules. We successfully performed all gasless STET without conversion to open surgery. The average postoperative hospital stay was 4.2 ± 1.8 days. One transient recurrent laryngeal nerve injury and two transient hypoparathyroidisms were observed. Three patients complained of slight lower lip numbness on the first postoperative day. One case of lymphatic fistula, subcutaneous effusion, and incision swelling occurred each, all of which were conservatively cured. One patient developed a recurrence six months after surgery. Conclusions: Gasless STET using our own designed suspension system is technically safe and feasible with reasonable operative and oncologic results.

Novel suspension system for gasless transoral vestibular thyroidectomy.

BACKGROUND: The transoral endoscopic thyroidectomy vestibular approach (TOETVA) is receiving increased attention, frequently due to growing requirements for cosmetic incisions. Here, we report our initial experience and discuss the safety and efficacy of the innovative surgical working space suspension system for gasless TOETVA. METHODS: We retrospectively analyzed 75 consecutive patients for whom gasless TOETVA with our novel working space suspension system was used. This suspension system included self-developed retractors, a sterile bandage, and an anesthesia stand. We also improved some main surgical instruments in gasless TOETVA. RESULTS: The study included 75 patients who successfully underwent thyroidectomy and central neck dissection via gasless TOETVA. The mean operating time was 143.27 ± 34.60 min. The mean number of retrieved lymph nodes was 8.00 ± 5.39. Conversion to open surgery did not occur, nor did patients exhibit serious postoperative complications. Postoperative complications included 4 cases of transient recurrent laryngeal nerve (RLN) palsy, 9 of transient hypoparathyroidism, and 3 of transient mental nerve injury. One patient with subcutaneous fluid after surgery recovered after aspiration. Another patient with submental minor perforation recovered well after suturing. There was no evidence of specific complications related to self-designed retractors. CONCLUSION: The innovative working space suspension system for gasless TOETVA provided enough and stable working space and optimized the clarity of the surgical field without CO2-related complications.

Autologous parathyroid gland in left-brachioradialis transplantation: A single-center study and long-term follow-up.

Parathyroid gland transplantation into the sternocleidomastoid muscle is effective, but it is not possible to confirm transplant survival with this method. In this study, we evaluated parathyroid autotransplantation into the brachioradialis muscle and its survival rate. OBJECTIVES: To evaluate autologous parathyroid gland left forearm brachioradial muscle transplantation and its survival rate. SUMMARY BACKGROUND DATA: The most commonly used transplantation site is the sternocleidomastoid muscle, but transplant survival cannot be confirmed using this method. Autologous parathyroid gland left forearm brachioradial muscle transplantation solves this problem, and we evaluate the transplant survival using this method. METHODS: We followed-up patients who underwent thyroidectomy and autologous parathyroid left forearm brachioradial muscle transplantation in our center from September 2013 to January 2018. The last follow-up date was January 2021; all enrolled patients underwent at least 3 years of follow-up. We calculated the transplant survival rate at several time points. RESULTS: We evaluated 238 transplanted cases, for which the long-term survival rate was 85.7% (204/238), and the short-term survival rate was 86.1% (205/238). Sixty-five cases had two parathyroid glands transplanted into the left forearm brachioradialis muscle. The long-term survival rate was 92.3% (60/65), and the short-term survival rate was 95.4% (62/65). CONCLUSIONS: Autologous parathyroid gland left brachioradialis transplantation is a reliable, measurable method with good survival rate, and we recommend this method for consideration for transplanting parathyroid glands in thyroidectomy.

2D/2D Interface Engineering Promotes Charge Separation of Mo2C/g-C3N4 Nanojunction Photocatalysts for Efficient Photocatalytic Hydrogen Evolution.

The focus of designing and synthesizing composite catalysts with high photocatalytic efficiency is the regulation of nanostructures and optimization of heterojunctions. By increasing the contact area between the catalysts, additional reaction sites can be established and charge carriers can be transferred and reacted faster. Here, two-dimensional (2D) Mo2C is prepared via a novel approach by carbonizing precursors intercalated by low-boiling solvents, and a composite catalyst Mo2C/graphitic carbon nitride (g-C3N4) with 2D to 2D structure optimization was synthesized through the self-assembly of 2D Mo2C and 2D g-C3N4. The hydrogen production rate of the photocatalyst at the optimal ratio is 675.27 µmol g-1 h-1, which further exceeds 2D g-C3N4. It is 5.1 times that of the 7 wt % B/2D Mo2C/g-C3N4 photocatalyst and also 3.5 times that of 0.5 wt % Pt/g-C3N4. The enhanced photocatalytic activity is attributed to the fact that Mo2C as a cocatalyst can rapidly transfer the photogenerated electrons of g-C3N4 to the surface of Mo2C, and the 2D to 2D structure can provide abundant reaction sites for photogenerated electrons to prevent their recombination with holes. This study provides new ideas and techniques for the development of 2D platinum-like cocatalysts and the optimization of nanojunctions.

CircRNA circTIAM1 promotes papillary thyroid cancer progression through the miR-646/HNRNPA1 signaling pathway.

Papillary thyroid cancer (PTC) is a common endocrine tumor with a rapidly increasing incidence in recent years. Although the majority of PTCs are relatively indolent and have a good prognosis, a certain proportion is highly aggressive with lymphatic metastasis, iodine resistance, and easy recurrence. Circular RNAs (circRNAs) are a class of noncoding RNAs that are linked to a variety of tumor processes in several cancers, including PTC. In the current study, circRNA high-throughput sequencing was performed to identify alterations in circRNA expression levels in PTC tissues. circTIAM1 was then selected because of its increased expression in PTC and association with apoptosis, proliferation, and migration of PTC cells in vitro and in vivo. Mechanistically, circTIAM1 acted as a sponge of microRNA-646 and functioned in PTC by targeting miR-646 and heterogeneous ribonucleoprotein A1. Fluorescence in situ hybridization and dual-luciferase reporter assays further confirmed these connections. Overall, our results reveal an important oncogenic role of circTIAM1 in PTC and may represent a potentially therapeutic target against PTC progression.

circCAMSAP1 promotes osteosarcoma progression and metastasis by sponging miR-145-5p and regulating FLI1 expression.

Osteosarcoma is the most common primary malignant bone tumor in adolescents. While chemotherapy combined with surgery can improve the prognosis of some patients, chemo-resistance is still a huge obstacle in osteosarcoma treatment. Accumulating evidence demonstrates that circular RNAs (circRNAs) are involved in cancer progression and metastasis, but their specific role in osteosarcoma remains mostly undescribed. In this study, we performed circRNA deep sequencing and identified 88 distinct circRNAs from a human osteosarcoma cell lines group (143B, HOS, SJSA, and U2OS) and the human osteoblast hFOB 1.19 (control). We found that circCAMSAP1, also named hsa_circ_0004338, is significantly upregulated in human osteosarcoma tissues and cell lines, and it is positively correlated with osteosarcoma development. Silencing of circCAMSAP1 effectively suppresses osteosarcoma cell growth, apoptosis, migration, and invasion. Furthermore, we validated that circCAMSAP1 functions in osteosarcoma tumorigenesis through a circCAMSAP1/miR-145-5p/friend leukemia virus integration 1 (FLI1) pathway. FLI1 promotes osteosarcoma tumorigenesis and miR-145-5p suppresses FLI translation. circCAMSAP1 directly sequesters miR-145-5p in the cytoplasm and inhibits its activity to suppress osteosarcoma tumorigenesis. Moreover, the regulatory role of circCAMSAP1 upregulation was examined and validated in rats. In summary, our findings provide evidence that circCAMSAP1 act as a "microRNA sponge" and suggest a new therapeutic target of human osteosarcoma.

A NOVEL SCORING SYSTEM FOR THE RISK OF PAPILLARY THYROID CANCER METASTASES IN LYMPH NODES POSTERIOR TO THE RIGHT OF THE RECURRENT LARYNGEAL NERVE.

OBJECTIVE: Some surgeons believe that dissection posterior to the right recurrent laryngeal nerve lymph node (PRRLN-LN) is unnecessary for the low metastasis rate and high complication risk. However, persistent metastatic lymph nodes may have a higher recurrence rate, surgical risk, and complications. Thus, it is important to distinguish patients who require PRRLN-LN dissection. To identify the risk factors for lymph nodes posterior to the right recurrent laryngeal nerve metastasis (LN-prRLN) and establish a scoring system to help determine whether PRRLN-LN dissection is required in patients with papillary thyroid carcinoma. METHODS: 821 participants were randomly allocated to the development and validation cohorts in a 2:1 ratio. A nomogram-based predictive model for LN-prRLN was established based on the risk factors identified in the development cohort. RESULTS: LN-prRLN was diagnosed pathologically in 124 of 821 patients (15.1%) from the entire cohort. Multivariate analysis identified age (odds ratio [OR], 0.964; 95% CI, 0.945-0.983; P < .001), tumor size (OR, 1.536; 95% CI, 1.135-2.079; P = .005), extrathyroidal extension (OR 2.271, 95% CI, 1.368-3.770; P = .002), clinically involved right central compartment lymph node metastasis (OR 1.643, 95% CI, 1.055-2.559; P = .028), and right lateral lymph node metastasis (OR 4.271, 95% CI, 2.325-7.844; P < .001) as the predictors of LN-prRLN. A risk model was established and well validated. Calibration curves to evaluate the nomogram in both the development and validation cohorts revealed a concordance index of 0.756 ± 0.058 and 0.745 ± 0.042, respectively. CONCLUSION: Our scoring system may be useful for helping the surgeons decide which patients should undergo the dissection of PRRLN-LN.

Circular RNA circRUNX1 promotes papillary thyroid cancer progression and metastasis by sponging MiR-296-3p and regulating DDHD2 expression.

Papillary thyroid cancer (PTC) has a continuously increasing incidence and imposes a heavy medical burden to individuals and society due to its high proportion of lymph node metastasis and recurrence in recent years. Circular RNAs, a class of noncoding RNAs, participate in the progression of many cancers, but the role of circRNAs in PTC is still rarely reported. In this study, circRNA deep sequencing was performed to identify differentially expressed circRNAs in PTC. CircRUNX1 was selected for its high expression in PTC, and circRUNX1 silencing was directly associated with the week potential for migration, invasion and proliferation of PTC in vivo and in vitro. Fluorescence in situ hybridization (FISH) was further used to confirm the cytoplasmic localization of circRUNX1, indicating the possible function of circRUNX1 as a ceRNAs in PTC progression through miRNA binding. MiR-296-3p was then confirmed to be regulated by circRUNX1 and to target DDHD domain containing 2 (DDHD2) by luciferase reporter assays. The strong antitumor effect of miR-296-3p and the tumor-promoting effect of DDHD2 were further investigated in PTC, indicating that circRUNX1 modulates PTC progression through the miR-296-3p/DDHD2 pathway. Overall, circRUNX1 plays an oncogenic role in PTC and provides a potentially effective therapeutic strategy for PTC progression.

CircECE1 activates energy metabolism in osteosarcoma by stabilizing c-Myc.

BACKGROUND: Osteosarcoma (OS) is the most common malignant bone tumor and has a poor prognosis. The potential involvement of circular RNAs (circRNAs) in OS progression remains unexplored. Here, we report that CircECE1, a circular RNA derived from human ECE1, plays a critical role in energy metabolism in OS. METHODS: The RIP chip sequence assay was performed to confirm CircECE1, through overexpression or knockdown of CircECE1 to verify its function in 143B and U2OS. RNA immunoprecipitation and immunoprecipitation were used to verify CircECE1's regulation of protein c-Myc and co- immunoprecipitation was used to verified the competitive binding relationship between CircECE1 and SPOP. The influence of CircECE1 on energy metabolism was evaluated by seahorse experiment, western blot, and immunohistochemistry. RESULTS: We found that CircECE1 is highly expressed in OS tissues and cells and that CircECE1 knockdown suppresses tumor proliferation and metastasis both in vitro and in vivo. Further, CircECE1 significantly promotes glucose metabolism in OS cells in vitro and in vivo. Mechanistically, CircECE1 interacts with c-Myc to prevent speckle-type POZ-mediated c-Myc ubiquitination and degradation. C-Myc inhibits thioredoxin binding protein (TXNIP) transcription and subsequently activates the Warburg effect. CONCLUSIONS: CircECE1 regulates the Warburg effect through the c-Myc/TXNIP axis. CircECE1 mediated signal transduction plays a important role in OS process and energy metabolism. These findings may identify novel targets for OS molecular therapy.

Prognostic values of m6A RNA methylation regulators in differentiated Thyroid Carcinoma.

N6-methyladenosine (m6A) is the most prevalent modification of RNA in mammals. m6A RNA methylation levels are dynamically regulated by m6A RNA methylation regulators. While increasing evidence has suggested that m6A RNA methylation is vital in the initiation and progression of human carcinoma, little is known about the expression and effect of m6A RNA methylation regulators in differentiated thyroid carcinoma (DTC). Herein, we demonstrate that most of the thirteen main m6A RNA methylation regulators are differentially expressed in DTC tissues and normal thyroid tissues. Based on consensus clustering of m6A RNA methylation regulators, DTC cases were divided into two subgroups (TC1 and TC2). Compared with the TC1 subgroup, the TC2 subgroup was associated with a poorer prognosis, older age, higher T grade, higher N grade and higher TNM stage. The results indicated that alteration of m6A RNA methylation regulators was closely related to DTC. We further established a risk signature of four m6A RNA methylation regulators that could evaluate prognosis and clinicopathological features in DTC. Finally, the results of the TCGA analysis were verified by other cohorts from Gene Expression Omnibus (GEO) database. In conclusion, m6A RNA methylation regulators play a crucial part in the progression of DTC and are potentially useful for evaluating the prognosis and providing potential novel insights into treatment strategies.

Identifying risk factors for metastasis to the level VII lymph node in papillary thyroid carcinoma patients.

BACKGROUND: The level VI lymph nodes are anatomically connected to the level VII lymph nodes and papillary thyroid carcinoma (PTC) can metastasis to both regions. The aim of this study was to identify clinicopathologic factors associated with level VII lymph node metastasis. METHODS: Between March 2015 and September 2016, a total of 275 consecutive patients were operated on for PTC with prophylactic level VII dissection at the Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, ZheJiang, China. Patients with PTC were performed via video-assisted approach. Multivariate logistic regression analysis was performed to evaluate the associations between clinicopathologic factors. RESULTS: Of the 275 subjects enrolled in this study, 79 patients (28.73%) showed lymph node metastasis to the level VII. The multivariate logistic regression analysis showed ultrasonography-positive lymph nodes (p < 0.001), the location of primary carcinoma (p = 0.002) and hashimoto thyroiditis (HT) (p = 0.04) were associated with level VII lymph node metastasis. CONCLUSIONS: Based on the results of our study, we considered central-compartment lymph node dissection (CLND) as an integral strategy. On the basis of surgery safety, transcervical level VII lymph node dissection could be considered for PTC patients with high risk factors such as ultrasonography-positive lymph nodes, tumor located in middle and lower thirds of the thyroid lobe and the patients without HT. In future, prognostic significance of level VII lymph node dissection should be evaluated through long-term surveillance.

Synthesis of narrow-band curled carbon nitride nanosheets with high specific surface area for hydrogen evolution from water splitting by low-temperature aqueous copolymerization to form copolymers.

Carbon nitride has become a focus of photocatalytic materials research in recent years, but the low specific surface area, the bad separation efficiency of photocarriers, poor quantum efficiency, terrible photocatalytic activity hinder the development of carbon nitride in the field of photocatalysis. The preparation of carbon nitride nanosheets is one of the effective methods to improve the photocatalytic efficiency of carbon nitride, but the traditional top-down stripping process is time-consuming, complicated and expensive. Here we report a simple, cheap, non-toxic and environmentally friendly bottom-up method to prepare a curled g-C3N4 nanosheet (NS-C3N4), which is performed at low temperature and normal pressure. In the aqueous solution, melamine and cyanuric acid are copolymerized to form a copolymer. Glycerol is inserted between the molecular layers of the prepolymer by thermal diffusion. Finally, high-quality and high-yield curled g-C3N4 nanosheets (NS-C3N4) are obtained by thermal peeling and polycondensation. The NS-C3N4 has an highly efficient photocatalytic hydrogen production of 4061.8 µmol h-1 g-1, and the hydrogen evolution activity is 37.5 times that of bulk-C3N4 (B-C3N4). The specific surface area of NS-C3N4 is 60.962 m2 g-1. UV-vis absorption spectra, steady-state and time-resolved photoluminescence, and photoelectrochemical tests were used to study its photocatalytic mechanism.

Low expression of ryanodine receptor 2 is associated with poor prognosis in thyroid carcinoma.

Genetic alterations are vital in the progression of thyroid carcinoma. Ryanodine receptor 2 (RyR2) is reported to serve an important role in several types of human carcinoma. However, the expression and effect of RyR2 in thyroid carcinoma remain unknown. Therefore, the present study analyzed the status of RyR2 in thyroid carcinoma using bioinformatics tools. The mRNA profiles of thyroid carcinoma were downloaded from The Cancer Genome Atlas. RyR2 was distinguished as a differentially expressed gene that has not been reported in thyroid carcinoma. Further analysis indicated that there was selective downregulation of RyR2 expression in thyroid carcinoma tissues compared with that in normal thyroid tissues. Survival analysis showed that RyR2 expression was associated with poorer disease-free survival (DFS) for all patients with thyroid carcinoma. Univariate analysis revealed that a low expression of RyR2 was significantly associated with lymphatic metastasis, extracapsular extension, and the Tumor-Node-Metastasis stage. Cox analysis demonstrated that RyR2 was an independent prognostic factor in thyroid carcinoma for DFS. The biological processes and signaling pathways of RyR2 were reviewed with Gene Set Enrichment Analysis. In conclusion, the present study has revealed that RyR2 is downregulated in thyroid carcinoma, and that low expression of RyR2 is associated with poor prognosis in patients with thyroid carcinoma. RyR2 may therefore serve as a promising tumor suppressor gene in thyroid carcinoma.

Effects of dietary sorghum dried distiller's grains with solubles on growth performance, diet nutrient digestibility, carcass characteristics and immunity in growing rabbits.

Sorghum dried distiller's grains with solubles (S-DDGS) are distillation extract residues from the ethanol fuel industry. In this experiment, two hundred 42-day-old rabbits were randomly allocated to five experimental diets containing 0 g/kg (control), 75, 150, 225 and 300 g/kg S-DDGS. The experiment lasted for 4 weeks. No difference was found in the average daily feed intake (ADFI; p > 0.05). With increasing sorghum inclusion, the average daily gain (ADG) was linearly (p < 0.001) and quadratically (p = 0.039) reduced, while, conversely, the feed conversion ratio (FCR) linearly (p < 0.001) increased. Increasing the amount of S-DDGS in the diet linearly decreased (p < 0.001) the apparent total tract digestibility (ATTD) of dry matter (DM), organic matter (OM), crude protein (CP) and ash. Carcass weight, carcass yield, heart and liver weights were linearly decreased by an increase in the amount of S-DDGS added to diets (p < 0.001), but no difference was observed between the 0, 75 and 150 g/kg S-DDGS groups (p > 0.05). Serum IL-6, IL-10 and SIgA linearly increased (p = 0.008) with increasing levels of S-DDGS in the diet. Rabbits fed 0, 75 and 150 g/kg of S-DDGS had similar IL-6 and IL-10 levels. Statistically significant differences in SIgA were observed between rabbits fed control diets and feed mixtures containing S-DDGS (p < 0.01). To conclude, S-DDGS can safely be added up to 75 g/kg, to the diet of rabbits. Increasing dietary S-DDGS inclusion may decrease the growth performance, nutrient digestibility and carcass traits, and activate immune responses.

Predictors of graft function after parathyroid autotransplantation during thyroid surgery.

BACKGROUND: The purpose of this study was to identify predictors associated with graft function after parathyroid autotransplantation during thyroid surgery. METHODS: One hundred fifty patients who underwent thyroid surgery with parathyroid autotransplantation were enrolled prospectively. During surgery, the misresected or devascularized parathyroid gland was autografted in the brachioradialis muscle of the forearm. Parathyroid hormone (PTH) levels in both arms were measured regularly after surgery. Patient age, sex, extent of surgery, and postoperative serum calcium levels were recorded. RESULTS: Graft function was documented in 115 patients (76.7%). Univariate analysis revealed that graft function had a significant association with lower serum calcium level 1 day after surgery. The cutoff point was 2.11 mmol/L, which was confirmed by a receiver-operating characteristic (ROC) curve. CONCLUSION: Low serum calcium levels in the early postoperative period may stimulate a functional recovery in an autografted parathyroid gland. Therefore, a moderate calcium supplement strategy was recommended for patients who underwent parathyroid autotransplantation during the early stage after total thyroidectomy.

Comparison Between Video-Assisted and Open Lateral Neck Dissection for Papillary Thyroid Carcinoma with Lateral Neck Lymph Node Metastasis: A Prospective Randomized Study.

BACKGROUND: The safety and oncologic completeness of video-assisted lateral neck dissection (VALND) for papillary thyroid carcinoma (PTC) with lateral neck lymph node metastasis (LNM) have been reported. However, their generalization has remained limited because the advantages and drawbacks are not well demonstrated. MATERIALS AND METHODS: A total of 64 patients with PTC and unilateral lateral neck LNM who underwent total thyroidectomy with central compartment neck dissection and lateral neck dissection (LND) were prospectively enrolled. They were randomly assigned to the video-assisted (VA) group (n = 32) or open group (n = 32) and were treated either by VALND or conventional open LND, respectively. We compared operating time, complications, oncologic completeness, postoperative pain, and cosmetic results between the two groups. RESULTS: The complication rate and oncologic completeness, including the results of radioactive iodine scans, mean number of lymph nodes retrieved, and mean postoperative serum thyroglobulin levels, were similar between the groups. Postoperative pain was observed less frequently after surgery in the VA group (P < .0001). Cosmetic results evaluated by a verbal response scale and a numeric rating scale were in favor of the VA group (P < .0001 and P = .0004, respectively). Total operating time was 176 ± 16 minutes in the VA group and 161 ± 16 minutes in the open group (P = .0003). CONCLUSIONS: VALND yielded complication and oncologic completeness rates that were similar to those of open LND. However, VALND resulted in less postoperative pain and better cosmetic results.

A comparative study of the surgical outcomes between video-assisted and open lateral neck dissection for papillary thyroid carcinoma with lateral neck lymph node metastases.

PURPOSE: Video-assisted lateral neck dissection (VALND) for papillary thyroid carcinoma (PTC) with lateral neck lymph node metastases (LNM) has been described previously, however, the advantages and drawbacks of VALND have not been demonstrated in previous studies. The aim of this study was to compare the surgical outcomes of video-assisted and open lateral neck dissection for PTC with lateral neck LNM. MATERIALS AND METHODS: Between May 2013 and November 2014, 92 consecutive patients with PTC and lateral neck lymph node metastases underwent total thyroidectomy with central compartment neck dissection and unilateral lateral neck dissection. These included 54 individuals who underwent video-assisted surgery, and 38 in whom an open approach was used. The two groups were retrospectively compared with respect to their clinicopathological characteristics, surgical outcomes and oncological completeness. RESULTS: The mean follow-up period was 18.6months. The mean tumor size, tumor stage, mean numbers of retrieved lymph nodes, mean postoperative serum thyroglobulin levels, complication rates, and mean postoperative hospital stay were similar between the two groups. The mean operation time was longer (p=0.0001) and mean age was lower (p=0.0354) in the video-assisted group. The cosmetic results, evaluated by numerical scale and verbal response scale, were in favor of the video-assisted group (p=0.0003 and p<0.0001, respectively). CONCLUSIONS: The safety and oncological completeness of VALND was similar to that of open procedures, but the VALND resulted in improved cosmetic results. VALND is an effective treatment for the selected cases of PTC with lateral neck LNM.

Risk factors for posterior to right recurrent laryngeal nerve lymph node metastasis in papillary thyroid carcinoma.

OBJECTIVES: To identify the risk factors for posterior right recurrent laryngeal nerve lymph node metastasis (PRRLN-LNM) in papillary thyroid carcinoma (PTC). METHODS: We conducted a retrospective study of 389 patients with primary PTC who underwent right lobectomy or total thyroidectomy, and comprehensive right or bilateral central compartment dissection (CCD) with or without lateral neck dissection (LND) between January 2010 and May 2013 at the Department of Head and Neck Surgery, Institute of Micro-Invasive Surgery of Zhejiang University, Zhejiang, China. The clinicopathological findings were investigated, and relative risk factors for PRRLN-LNM were analyzed. RESULTS: Central compartment LNM were present in 50.9% (198/389), and PRRLN-LNM were present in 12.6% (49/389) of patients, wherein 3.1% (12/389) had PRRLN-LNM only. A multivariate analysis revealed that younger age (≤ 35 years), extrathyroidal extension (ETE), lateral compartment LNM, prelaryngeal LNM, pretracheal, and right paratracheal LNM were independent predictors of PRRLN-LNM. CONCLUSION: This study revealed that younger age (≤ 35 years), ETE, prelaryngeal LNM, lateral compartment LNM, and pretracheal and right paratracheal lymph nodes (anterior to the right recurrent laryngeal nerve [level VIa]), LNM were independent factors of PRRLN-LN (level VIb). Therefore, comprehensive right CCD should be routinely performed for such patients.

Minimally invasive endoscopic-assisted resection of benign tumors in the accessory parotid gland: 5 case studies.

BACKGROUND: A modified Blair's incision or standard facelift incision is recommended to remove tumors in the accessory parotid gland. These incisions frequently result in long and visible scars. Therefore, the authors have introduced an endoscopic approach via a small preauricular incision to achieve excision of benign tumors in the accessory parotid gland. METHODS: The endoscopic surgical technique was performed on 5 patients with benign tumors in the accessory parotid gland. RESULTS: Endoscopic-assisted resection of the benign tumors in the accessory parotid gland was feasible in all 5 patients. This procedure lasted 105 minutes on average. Facial paralysis, salivary fistula, and ear-lobular numbness were not found postoperatively. The follow-up period was 1 year, during which no Frey's syndrome and recurrence were found. All preauricular scars were aesthetically satisfactory. CONCLUSIONS: The minimally invasive endoscopic approach via a small preauricular incision is an optional method of the accessory parotid gland benign tumor resection.