Objective To understand the latest research developments of the formation mechanism of psammoma body in human tumors and related issues. Methods Related domestic and foreign literatures were widely referred, analyzed, and reviewed. Results Psammoma body is unique pathological calcification in some tumors, which is arranged in concentric, laminar circles microscopically. Psammoma body is commonly seen in thyroid papillary carcinoma, meningiomas, ovarian serous papillary carcinoma, and so on. Conclusions Although arranged in concentric, laminar circles microscopically in tumor, the formation process of psammoma body is not entirely the same in different tumors. A comprehensive and objective understanding of psammoma body would be useful in cancer diagnosis and treatment.
Secondary and tertiary hyperparathyroidism are common complications in patients with chronic kidney disease, especially in end stage renal disease. Surgery is an important method for the treatment of secondary and tertiary hyperparathyroidism. The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism is the first evidence based guideline focus on renal hyperparathyroidism surgical management. Recommendations using the best available evidence by a panel of 10 experts in secondary and tertiary renal hyperparathyroidism constructed this guideline, which provides evidence-based, individual and optimal surgical management of secondary and tertiary renal hyperparathyroidism. This paper made a guideline interpretation on the indications of surgery, imaging examination, preoperative and perioperative management, relevant evaluation and treatment during perioperative period, and intraoperative parathyroid hormone monitoring during operation, and so on.
ObjectiveTo summarize the experience of diagnosis and treatment of 2 cases of intrathyroid thymic carcinoma(ITTC).MethodThe clinical data of 2 patients with ITTC treated in West China Hospital of Sichuan University since July 2019 were analyzed retrospectively.ResultsAfter the discussion of the multidisciplinary team (MDT), the diagnosis and treatment of 2 cases of ITTC were discussed together, and the prognosis of the patients was actively improved through multidisciplinary cooperation.ConclusionMDT cooperative therapy mode should be adopted in the clinical diagnosis and treatment of patients with ITTC in order to provide a better treatment plan.
ObjectiveTo clarify the application value of thyroid organoids in basic research and clinical translation of thyroid diseases, analyze the key challenges currently faced, and prospect future development directions. MethodsRelevant domestic and international literatures in recent years were systematically searched. This review summarized the construction strategies of thyroid organoids, and their application progress in disease model establishment (e.g., thyroid cancer, Hashimoto thyroiditis), drug screening, and personalized treatment. ResultsThyroid organoids can highly simulate the morphological structure and gene expression profile of native thyroid tissue. In terms of disease modeling, they can accurately reproduce the pathological characteristics and immune microenvironment of thyroid diseases. In drug screening, organoids can predict the response to radioactive iodine therapy and the sensitivity to targeted drugs, with high consistency between their drug sensitivity results and clinical efficacy. In mechanism research, organoids have been successfully used to reveal the roles of abnormal mitogen-activated protein kinase/phosphatidylinositol 3 kinase-protein kinase B signaling pathways, epithelial-mesenchymal transition, ferroptosis, and immunoregulatory mechanisms in thyroid carcinogenesis and disease progression, providing experimental evidence for target identification. ConclusionsAs an in vitro model that highly simulates the in vivo environment, thyroid organoids have become an important platform for thyroid disease research. Although challenges remain in standardized construction and clinical translation, with technical optimization and research evidence accumulation, they hold broad prospects in the field of precision medicine.
目的 分析經病理證實的頸部無痛性腫大淋巴結的聲像圖特點，比較良、惡性疾病中異常淋巴結的聲像圖特征，為臨床醫師的鑒別提供可靠的診斷依據。 方法 將2007年7月－2009年12月以頸部無痛性腫大淋巴結就醫、并經病理證實的良、惡性疾病的97例患者作為研究對象，其中男56例，女41例；共檢出淋巴結365個，依據病理診斷結果將研究對象分為良性組（98個）和惡性組（267個）。 結果 ① 大多數良性淋巴結：L/S＞2，形態接近橢圓形、門部回聲規則無移位、皮質較薄、髓質形態規則，居中； 大多數惡性淋巴結短徑相對增大，L/S≤2，形態趨于類圓形，包膜不完整，門部大多數偏離中心，皮質不均勻增厚，髓質變形移位或消失。② 良性淋巴結多表現為無血流型或門部規則血流型；惡性淋巴結多表現為周邊血流或混合血流型。③ 大多數良性淋巴結血流阻力指數偏低，RI＜0.60；大多數惡性淋巴結血流阻力指數偏高，RI＞0.70。 結論 高頻超聲在頸部無痛性淋巴結腫大的良惡性鑒別中能夠提供重要的診斷信息。
【Abstract】Objective To find out if apoptosis is induced after intra-radiotherapy and its effects on pericarcinomal tissue. Methods From 1994 to 1998, 44 patients with unresectable liver cancer received 32P-GMS intra-radiotherapy. After 2 to 6 months the tumors in 3 cases could be resected and we used this cases as the treatment group. We use 4 patients with resectional HCC of same age, diseased region, differentiated but without anyother therapy as the control group. The TUNEL staining was used to stain the resected tissue, and the apoptosis index was counted. Results The apoptosis index of carcinoma was 29%～34%, average (31±16)% in the treatment group and that of the control group was 4%～6%, average (5±12.2)%. The apoptosis index of pericarcinomal tissue was 27%～37%, average (35±11)% in the treatment group and that of the control group was 0.3%～5%, average (4.1±3.3)%. Conclusion 32P-GMS intra-radiotherapy can enhance the apoptosis of HCC and its adjacent tissue.
Objective To assess the value and usage of real-time monitoring of the recurrent laryngeal nerve (RLN) during thyroid reoperation by RLN monitor. Methods One hundred and one patients were under general anesthesia and thyroidectomy. NIM-Response electromyographic (EMG) monitor system was used for assistant of dissection, exposure and protection of the RLN during the surgical procedures.Results There were 192 RLN were exposed during the surgeries in all 101 patients. The unilateral RLN injured in 10 patients was not specially explored the same side nerve. Among them 190 nerves were confirmed intact, the rest 2 nerves were resected because of tumor involving. Conclusions NIM-Response electromyographic monitor system is sensitive and accurate for preserving the integrity of RLN during the thyroid reoperations. It is valuable for protecting RLN against iatrogenic injury. This system deserves general utilization for thyroid surgery, especially reoperation.
Objective To compare the disadvantages and advantages of open thyroid surgery when using the harmonic scalpel (HS) vs conventional hemostasis (CH). Methods One hundred and fifty-one patients and 70 patients underwent thyroid surgery with HS or CH respectively. The tumor diameter, incisional length, the total operative time, thyroidectomy time, intraoperative bleeding volume, postoperative drainage volume and surgical complications were compared. The incisional length and the surgical complications in and after learning curve with harmonic scalpel were compared. Results There was no significant difference between the HS and CH group at baseline. Incisional length, total operative time, thyroidectomy time, intraoperative bleeding volume and postoperative drainage volume in HS group were significantly lower than those of CH group (P＜0.001); the surgical complications showed no significant difference between the HS and CH group (Pgt;0.05); the incisional length after learning curve was shorter than that in learning curve in HS group (P＜0.05); the surgical complications after learning curve were significantly lower than that in learning curve in HS group (P＜0.001). Conclusion HS provides significant advantages over conventional hemostasis in open thyroid surgery. However, it can’t be used in a blindly exclusive way but be combined with conventional knot tying appropriately.
Objective To investigate the clinical significance of the three iodide transporters in thyroid diseases. Methods Literatures about the Na+/I- symporter (NIS), pendrin and human apical iodide transporter (hAIT) in recent years were reviewed and their expressions in different thyroid diseases were also analyzed. Results NIS proteins express at the basolateral membrane of thyrocytes in normal thyroid tissue, while pendrin and hAIT proteins are limited to the apical membrane of thyrocytes lining in the follicular lumen. In the tissues of thyroid carcinomas, it was found that the NIS proteins expressed in the cytoplasm and their expressions decreased; The mutation of NIS gene may be one of the main causes of congenital hypothyroidism. The expression of prendrin protein may be related to the function of follicles: its expression level increased significantly both in Graves diseases and toxic adenomas, but significantly decreased in differentiated thyroid carcinoma. However, the correlation between the decrease and the degrees of differentiation of carcinoma cell line are still disputable. The expression of hAIT protein does not significantly altered in hyperfunctioning tissues. It only slightly decreased occasionally in hypofunctioning adenomas, but it decreased significantly in thyroid carcinomas. Conclusion The abnormal expressions of the three iodide transporters may be related closely with the type of thyroid diseases. However, their pathogenic mechanisms and the causes of their abnormal expression are still unknown, which need to be studied further.
Objective To explore the efficacy and safety of levothyroxine (L-T4) combined with desiccated thyroid extract (DTE) in patients with differentiated thyroid cancer (DTC) who had suboptimal response to long-term (≥6 months) thyroid-stimulating hormone (TSH) suppression therapy with L-T4 alone after surgery. MethodsA total of 123 eligible patients were prospectively enrolled and received TSH suppression therapy with DTE combined with L-T4. The Kaplan?Meier (KM) curve was used to analyze the TSH suppression rate and assess the efficacy of this combination therapy. The Thyroid-Related Patient-Reported Outcome-39 (THyPRO-39) questionnaire was used to assess the patient-reported symptoms before medication adjustment and at 1, 3, 6, 9, and 12 months after adjustment. ResultsAmong the 123 patients, 100 were ultimately included and completed follow-up, with a follow-up period of one year. After the first adjustment to L-T4+DTE combination therapy, the rate of TSH suppression was raised to 71.0% (71/100). The KM curve revealed that the TSH suppression rate gradually increased during the follow-up period, with a cumulative rate of 82.0%. The median TSH suppression time to reach the standard was 1.4 months. Eighteen patients (18.0%) still did not meet the target after multiple regimen adjustments. Univariate analysis indicated that sex and pre-treatment serum free triiodothyronine (FT3) levels were associated with the attainment rate of TSH suppression therapy (P<0.05). However, multivariate logistic regression analysis revealed that neither sex (OR=0.353, P=0.148) nor pre-treatment serum FT3 level (OR=2.596, P=0.101) was an independent influencing factor of TSH suppression attainment rate. Following L-T4+DTE combination therapy, the serum FT3 level significantly increased [(4.5±0.6) pmol/L vs. (5.5±1.1) pmol/L, P<0.001] but remained within the normal range, whereas the free thyroxine (FT4) level did not significantly change [(21.9±2.1) pmol/L vs. (21.5±3.0) pmol/L, P=0.075]. However, patients who did not achieve target levels exhibited a decrease in serum FT4 levels compared to baseline, and the magnitude of this decrease was significantly greater than that observed in the target-achieved group [–0.8 (–2.1, –0.9) pmol/L vs. –2.5 (–3.8, –0.8) pmol/L, P=0.022]. The questionnaire results indicated that the combined L-T4+DTE treatment regimen had no significant impact on overall quality of life scores during the follow-up period (χ2=4.006, P=0.548). Conversely, the hyperthyroidism symptom scores showed significant improvement over the treatment period (χ2=23.120, P<0.001), with the median scores demonstrating an overall downward trend. ConclusionFor postoperative DTC patients who fail to achieve TSH suppression with L-T4 monotherapy, L-T4+DTE combination therapy can significantly increase the TSH suppression attainment rate while alleviating thyrotoxicosis-related symptoms.