Advances in the application of auxiliary imaging techniques in parathyroid diseases

Hypoparathyroidism is one of the main complications after total thyroidectomy,severely affecting patients’quality of life.How to effectively protect parathyroid function after surgery and reduce the incidence of hypoparathyroidism has always been a key research area in thyroid surgery.Therefore,precise localization of parathyroid glands during surgery,effective imaging,and accurate surgical resection have become hot topics of concern for thyroid surgeons.In response to this clinical phenomenon,this study compared several different imaging methods for parathyroid surgery,including nanocarbon,indocyanine green,near-infrared imaging techniques,and technetium-99m methoxyisobutylisonitrile combined with gamma probe imaging technology.The advantages and disadvantages of each method were analyzed,providing scientific recommendations for future parathyroid imaging.In recent years,some related basic and clinical research has also been conducted in thyroid surgery.This article reviewed relevant literature and provided an overview of the practical application progress of various imaging techniques in parathyroid surgery.

Clinico-pathological characteristics and prognosis of young women with breast

Background:Breast cancer is more common among young women in China than in developed countries.This study analyzes the clinicopathological features and prognosis of young women with breast cancer in southwest China.Materials and Methods:We reviewed the records of 406 breast cancer patients≤35 years old from 2008 to 2017 in southwest China,investigating their biological characteristics and prognosis.Results:In southwest China,8.77%of breast cancer patients were young women.Although the number of breast cancer cases increased over time,the proportion of young women declined.Patients in stages III and IV accounted for 32%of cases.Young women with breast cancer often experienced local and regional recurrence and had a poor prognosis(5-year disease-free survival rate of 54.9%and 5-year overall survival rate of 71.3%).T and N stages were significantly related to disease-free survival and overall survival.Hormone receptor status was associated with overall survival.Conclusions:In southwest China,young women with breast cancer tend to present with late-stage clinical features,and the prognosis remains poor.

Histopathological Features of Invasion of Breast Invasive Ductal Carcinoma and Safety of Breast-conserving Surgery

In order to investigate the relationship between the extent of tumor invasion and the tumor size, axillary lymph nodes metastasis, Her-2 gene overexpression, and histologic grading in breast invasive ductal carcinoma as well as the optimal extent of excision during the breast-serving surgery, the clinical data of 104 patients with breast invasive ductal carcinoma who had received modified radical mastectomy were analyzed. The correlation analysis on invasive extent, which was evaluated by serial sections at an interval of 0.5 cm from 4 different directions taking the focus as the centre, and the tumor size, axillary lymph nodes metastasis, Her-2 gene overexpression, and his- tologic grading was processed. There was a significant correlation between invasive extent and tumor size （r=-0.766, P〈0.01）, and lymph nodes metastases 0=0.574, P〈0.01）, but there was no significant correlation between invasive extent and Her-2 expression （r=-0.106, P〉0.05）, and histologic grading （r=-0.228, P〉0.05）. The 100% negative rate of infiltration in patients without nipple discharge with tumor size 〈2, 2-3 and 〉3 cm was obtained at 1.5, 2.0 and 2.5 cm away from the tumor respectively. It is concluded that the performance of breast-serving surgery in patients with breast invasive ductal carcinoma should be evaluated by tumor size in combination with axillary lymph nodes involvement to decide the possibility of breast-serving and the secure excision extent.

Relationship between Expression of Vascular Endothelial Growth Factor and Cervical Lymph Node Metastasis in Papillary Thyroid Cancer: A Meta-analysis

The aim of the present study was to examine the relationship between the protein expression of vascular endothelial growth factor（VEGF） and lymph node metastasis（LNM） in papillary thyroid cancer（PTC）. VEGF-related articles that had been published until August 2016 were searched from the Pub Med, EMBASE, and MEDLINE to identify the risk factors of LNM in PTC. Rev Man 5.3 software was used for the meta-analysis. Finally, 9 articles met the inclusion criteria and were included in our meta-analysis. LNM was found to be present in 176 of 318 patients（57.8%） with high VEGF expression and in 71 of 159 patients（47.0%） with low VEGF expression. The overall OR was 2.81（95% confidence interval, 1.49–5.29）. LNM occurred more frequently in patients with high VEGF expression than in those with low VEGF expression（P=0.001）. Heterogeneity was markedly decreased in the subgroup analyses of LNM in terms of the patients＇ country of origin and the detection methods. Our meta-analysis concluded that the VEGF protein expression is associated with LNM in PTC.

Clinical and Sonographic Assessment of Cervical Lymph Node Metastasis in Papillary Thyroid Carcinoma

The purpose of this study was to assess the differences in clinical and sonographic features of papillary thyroid carcinoma（PTC） between cervical lymph node metastatic（CLNM） and nonmetastatic groups.Clinical data of PTC patients（414 patients with 624 malignant nodules） who underwent a preoperative ultrasonography and surgery between June 2010 and March 2015 at Renmin Hospital of Wuhan University were retrospectively analyzed.Clinical factors,preoperative ultrasound features and the final pathological findings were obtained.The differences in the sonographic features of PTC between the CLNM group and the non-CLNM group were analyzed.There were 187 CLNM and 227 non-CLNM patients.The median age at the diagnosis of this cohort was 45.4 years old（ranging from 18 to 77 years）.Ultrasonographic parameters that were significantly associated with CLNM [OR=2.569（1.502,4.393）,P〈0.001）] were as follows：the mulifocality of the nodules,size over 2 cm,the presence of microcalcifications,the distance ratio（DR） pattern showing the contact of the nodules with the thyroid capsule,and the extracapsular spread of the nodules.No significant differences in age,gender,thyroid stimulating hormone（TSH） levels and other ultrasonography parameters were found between the CLNM and the non-CLNM groups.Therefore,our results suggest that a larger size,microcalcifications,mulifocality,and the DR pattern showing the contact of the nodules with the thyroid capsule and extracapsular spread are significantly more indicative of CLNM in PTC.

TPX2 promotes migration and invasion of human breast cancer cells

Objective:To investigate the expression of targeting protein for Xenopus kinesin-like protein 2(TPX2) in breast cancer tissue and to explore its role in proliferation,migration and invasion of breast cancer cells.Methods:The mRNA and protein expressions of TPX2 in breast cancer tissue and cell lines were assessed by quantitative RT-PCR and Western blot.The effect of TPX2 with RNA interference on proliferation,invasion and migration of breast cancer cells was observed by MTT and Transwell assays.Results:Both mRNA and protein expressions of TPX2 were upregulated in breast cancer tissues compared to tumor-adjacent tissue.TPX2 expression was also upregulated in breast cancer cell lines,and the TPX2 interfered by small interfering RNA could inhibit the proliferation,invasion and migration of breast cancer cells by inhibiting matrix metalloproteinase-2 and matrix metalloproteinase-9.Conclusions:Significantly upregulated TPX2 expression is observed in breast cancer tissue and cells,and contributes to promote the proliferation,migration and invasion of breast cancer cells.

Intratumoral Bacteria Dysbiosis Is Associated with Human Papillary Thyroid Cancer and Correlated with Oncogenic Signaling Pathways

Emerging evidence suggests that microbial dysbiosis plays vital roles in many human cancers.However,knowledge of whether the microbial community in thyroid tumor is related to tumorigenesis remains elusive.In this study,we aimed to explore the microbial community in thyroid tissues and its contribution to papillary thyroid cancer(PTC).In parallel,we performed microbial profiling and transcriptome sequencing in the tumor and adjacent normal tissues of a large cohort of 340 PTC and benign thyroid nodule(BTN)patients.Distinct microbial signatures were identified in PTC,BTN,and their adjacent nontumor tissues.Intra-thyroid tissue bacteria were verified by means of bacteria staining,fluorescence in situ hybridization,and immunoelectron microscopy.We found that 17 bacterial taxa were differentially abundant in PTC compared with BTN,which included enrichment in PTC of the pathobionts Rhodococcus,Neisseria,Streptococcus,Halomonas,and Devosia,and depletion of the beneficial bacteria Amycolatopsis.These differentially abundant bacteria could differentiate PTC tumor tissues(PTC-T)from BTN tissues(BTN-T)with an area under the curve(AUC)of 81.66%.Microbial network analysis showed increased correlation strengths among the bacterial taxa in PTC-T in comparison with BTN-T.Immunefunction-corresponding bacteria(i.e.,Erwinia,Bacillus,and Acinetobacter)were found to be enriched in PTC with Hashimoto’s thyroiditis.Moreover,our integrative analysis revealed that the PTC-enriched bacteria had a positive association with key PTC-oncogenic pathway-related genes,including BRAF,KRAS,IRAK4,CTNNB1,PIK3CA,MAP3K7,and EGFR.In conclusion,our results suggest that intratumor bacteria dysbiosis is associated with the thyroid tumorigenesis and oncogenic signaling pathways of PTC.

In Vitro Chemosensitivity Testing of Primary and Recurrent Breast Carcinomas and Its Clinical Significance

In this study, in vitro chemosensitivity testing was conducted on primary cultured breast cancer cells from 96 patients with breast cancer, and the results showed that the cells from a few patients with primary breast cancer developed multidrug resistance （MDR） prior to the first chemotherapy exposure. All the cells from the recurrent cancer patients had MDR. The findings suggested that patients having MDR would benefit from high-dose chemotherapy （HDC） regimens. In vitro chemo-sensitivity screening, which was aimed at improving the therapeutic efficacy and minimizing side effects, helps in choosing individualized treatment for breast cancer.

Development a survival prediction model for patients with Paget disease of the breast based on the SEER database

Background:We explored the risk factors that affect the prognosis of patients with Paget disease of the breast(PD)and constructed a survival prediction model.Methods:The data of PD patients from 2004 to 2014 were collected through the SEER database.The factors affecting the prognosis of PD patients were analysed by a single factor,and the prediction model of the independent risk factor transformation model diagram that affected their 1-,3-,and 5-year survival rates was screened by multivariate Cox proportional hazard regression analysis coefficients.The consistency index was used to evaluate its predictive value,and its predictive performance was tested by the 1000 bootstrap method.Then,the calibration curve was used to verify the predictive performance of the model,and the receiver operating characteristic curve and decision curve analysis were used to assess the sensitivity and practicability of the model compared to the American Cancer Commission staging(AJCC)staging system.Results:The consistency index of the model was 0.795(95%confidence interval 0.773–0.818).The calibration curve shows good consistency,while the receiver operating characteristic curve shows the sensitivity of the model to predict the survival rate of PD at 1,3,and 5 years.Decision curve analysis confirmed that the nomogram can predict the survival rate of PD patients at 1,3,and 5 years instead of the traditional AJCC system.Conclusion:Regarding the independent prognostic factors of age,marital status,AJCC classification,surgery,radiotherapy,chemotherapy and marital status conversion in PD patients,the nomogram established in sequence has higher accuracy and clinical value than the traditional AJCC system.

Colorectal cancer’s burden attributable to a diet high in processed meat in the Belt and Road Initiative countries

BACKGROUND Colorectal cancer(CRC)plays a significant role in morbidity,mortality,and economic cost in the Belt and Road Initiative(“B and R”)countries.In addition,these countries have a substantial consumption of processed meat.However,the burden and trend of CRC in relation to the consumption of a diet high in processed meat(DHPM-CRC)in these“B and R”countries remain unknown.AIM To analyze the burden and trend of DHPM-CRC in the“B and R”countries from 1990 to 2019.METHODS We used the 2019 Global Burden of Disease Study to collate information regarding the burden of DHPM-CRC.Numbers and age-standardized rates(ASRs)of deaths along with the disability-adjusted life years(DALYs)were determined among the“B and R”countries in 1990 and 2019.Using joinpoint regression analysis,the average annual percent change(AAPC)was used to analyze the temporal trends of age-standardized DALYs rate(ASDALR)from 1990 to 2019 and in the final decade(2010–2019).RESULTS We found geographical differences in the burden of DHPM-CRC among“B and R”countries,with the three highest-ranking countries being the Russian Federation,China,and Ukraine in 1990,and China,the Russian Federation,and Poland in 2019.The burden of DHPM-CRC generally increased in most member countries from 1990 to 2019(all P<0.05).The absolute number of deaths and DALYs in DHPM-CRC were 3151.15[95%uncertainty interval(UI)665.74-5696.64]and 83249.31(95%UI 15628.64-151956.31)in China in 2019.However,the number of deaths(2627.57-2528.51)and DALYs(65867.39-55378.65)for DHPM-CRC in the Russian Federation has declined.The fastest increase in ASDALR for DHPM-CRC was observed in Vietnam,Southeast Asia,with an AAPC value of 3.90%[95%confidence interval(CI):3.63%-4.16%],whereas the fastest decline was observed in Kyrgyzstan,Central Asia,with an AAPC value of-2.05%(95%CI:-2.37%to-1.73%).A substantial upward trend in ASR of mortality,years lived with disability,years of life lost,and DALYs from DHPM-CRC changes in 1990-2019 and the final decade(2010-2019)for most Maritime Silk Route members in East Asia,South Asia,Southeast Asia,North Africa,and the Middle East,as well as Central Europe,while those of the most Land Silk Route members in Central Asia and Eastern Europe have decreased markedly(all P<0.05).The ASDALR for DHPM-CRC increased more in males than in females(all P<0.05).For those aged 50-74 years,the ASDALR for DHPM-CRC in 40 members exhibited an increasing trend,except for 20 members,including 7 members in Central Asia,Maldives,and 12 high or high-middle social development index(SDI)members in other regions(all P<0.05).CONCLUSION The burden of DHPM-CRC varies substantially across“B and R”countries and threatens public health.Relevant evidence-based policies and interventions tailored to the different trends of countries in SDIs or Silk Routes should be adopted to reduce the future burden of CRC in“B and R”countries via extensive collaboration.

Efficacy and prognostic factors of neoadjuvant chemotherapy for triple-negative breast cancer

BACKGROUND Breast cancer mainly occurs in young and premenopausal women;its incidence is increasing annually. Patients with triple-negative breast cancer(TNBC) have relatively high recurrence and transfer rates during the operation and 3 years after postoperative adjuvant chemotherapy. Currently, the treatment for patients with TNBC is mainly based on a comprehensive combination of surgery and chemotherapy. Therefore, identifying additional effective treatments to improve patient prognosis is important.AIM To explore and discuss the effects and prognostic factors of neoadjuvant chemotherapy in TNBC.METHODS In total, 118 patients diagnosed with TNBC from January 2016 to January 2020 in our hospital were selected and divided into the observation(n = 60) and control(n = 58) groups according to therapeutic regimen. The control group received routine chemotherapy, and the observation group received neoadjuvant chemotherapy. The therapeutic effects of the two groups were observed, and the survival of patients was followed up.RESULTS The karyopherin A2(KPNA2)-positive and SRY-related HMG box-2(SOX2)-positive expression rates of patients with TNBC with intravascular tumor thrombus and tumor-node-metastasis(TNM) stage IV were 92.00% and 91.67% and 96.00% and 95.83%, respectively, which were significantly higher than those of patients with no intravascular tumor thrombus and TNM stage Ⅲ(P < 0.05). KPNA2 was positively associated with SOX2 expression(rs = 0.514, P < 0.50). The short-term curative effect of the observation group was better than that of the control group(P < 0.05), and the total effective rate was 58.33%. After treatment, carcinoembryonic antigen, cancer antigen(CA) 19-9, and CA125 Levels in the observation group were 11.40 ± 2.32 mg/L, 19.92 ± 3.42 kU/L, and 54.30 ± 12.28 kU/L, respectively, which were significantly lower than those in the control group(P < 0.05). The median survival time of the observation group was 33 mo(95%CI: 31.21-34.79), which was significantly longer than that of the control group(P < 0.05). TNM stage, degree of differentiation, lymph node metastasis, KPNA2 and SOX2 expressions, and treatment plan were prognostic factors of TNBC(relative risk = 1.575, 1.380, 1.366, 1.433, 1.411, and 0.581, respectively, P < 0.05).CONCLUSION Neoadjuvant chemotherapy for TNBC treatment can achieve good curative effects. TNM stage, differentiation degree, lymph node metastasis, KPNA2 and SOX2 expressions, and treatment plan are prognostic factors of TNBC.

Traditional Chinese combined with western therapy in treatment of upper extremity edema after breast cancer surgery: A meta-analysis

Objective:To evaluate clinical efficacy by traditional Chinese combined with western therapy to treat upper extremity edema after breast cancer surgery.The clinical efficacy was described by the effective rate and the change of peripheral diameter of the affected limb.Methods:National Knowledge Internet(CNKI),Wan Fang Digital Journals(Wan Fang),VIP Chinese periodical service platform(VIP),Chinese biomedical literature service system(CBM),PubMed and EMBASE were searched on computer.And clinical randomized controlled trials(RCT)of the treatment of upper extremity edema after breast cancer surgery with integration of Chinese and western treatment were selected.The time was from January 2011 to May 2020.Upper extremity edema after breast cancer surgery was the first key word and the second was traditional Chinese combined with western therapy.Note Express was used to screen and extract literature.Bias risks of all the literature included in the study were evaluated and analyzed by RevMan5.3 software.Results:10 randomized controlled clinical tests,644 patients in conformity to the inclusion criteria,9 for the observation of curative effectiveness,5 of changes in limb circumference.322 cases were included in the observation group and the same number of cases in the control group,all of which were in Chinese.The results expressed that the curative effect in the observation group was 91.1%,and it was higher than the curative effect in the control group treated by single western treatment obviously,and it was only 68.9%[95%CI(1.22,1.44),Z=6.55,P<0.00001].The peripheral diameter shrinking degree of the affected limb in the observation group was also clearly higher than that in the control group which was healed by simple western treatment[95%CI(-0.98,-0.64),Z=9.40,P<0.00001].Conclusion:Traditional Chinese combined with western therapy treating upper extremity edema after the surgery of breast cancer had a notable clinical effect,which treated the disease and effectively lessened the peripheral diameter of the affected limb.The method was worthy of clinical application.However,owing to the low quality of the included documents,further discussion and learning were still needed.

Application of Ultimate Oncoplastic Surgery in Breast-Conserving Surgery

Objective To investigate the application of oncoplastic surgery in breast-conserving surgery.Methods We retrospectively analyzed the clinical data of 103 breast cancer patients who underwent breast-conserving surgery in the First Affiliated Hospital of Henan University.All the patients were female whose tumor volume-to-breast volume ratio was greater than 20%.Fifty-two patients were treated with oncoplastic breast-conversing surgery(observation group),and 51 patients were treated with traditional breast-conserving surgery(control group).The volume of resected tissue,subjective satisfaction with breast shape,objective score of breast shape,and follow-up were compared between the two groups.Results In the observation group,the weight of resected breast tissue was 64.2–172.1 g,with a median of 98.7 g.In the control group,the weight of resected breast tissue was 67.5–175.7 g,with a median of 102.3 g.After 12 months of follow-up,the subjective satisfaction rate and objective score of breast shape in the observation group were significantly better than those in the traditional breast-conserving surgery group(P<0.05).There was no recurrence,metastasis,or death in the two groups.There was no significant difference in postoperative complications between the two groups(P>0.05).Conclusion Oncoplastic breast-conserving surgery leads to better cosmetic results and a more satisfactory clinical results.

Design,synthesis,and biological evaluation of novel chrysin derivatives as poly(ADP-ribose)polymerase 1(PARP1)inhibitors for the treatment of breast cancer

In this study,we reported the discovery and structure-activity relationship analysis of chrysin derivatives as a new class of inhibitors targeting poly(ADP-ribose)polymerase 1(PARP1).Among these derivatives,compound 5d emerged as the most effective chrysin-based inhibitor of PARP1,with an IC50 value of 108 nmol·L^(-1).This compound significantly inhibited the proliferation and migration of breast cancer cell lines HCC-1937 and MDA-MB-436 by inducing DNA damage.Furthermore,5d induced apoptosis and caused an extended G1/S-phase in these cell lines.Molecular docking studies revealed that 5d possesses a strong binding affinity toward PARP1.In vivo,in a xenograft model,5d effectively reduced tumor growth by downregulating PARP1 expression.Overall,compound 5d shows promise as a potential therapeutic agent for the treatment of BRCA wild-type breast cancer.

Predictive Value of BRAF^V600E Mutation for Lymph Node Metastasis in Papillary Thyroid Cancer:A Meta-analysis

BRAF^V600E mutation has been thought to be a valuable molecular marker that may predict a worse prognosis for papillary thyroid cancer (PTC).But whether BRAF^V600E mutation is associated with lymph node metastasis (LNM)remains controversial. Different surgical strategies may bring a bias in demonsstrating the association between them.In order to delineate a risk stratification to guide a tailored initial approach to tumors that express BRAF^V600E mutation,we performed this meta-analysis by using the articles in which total or near-total thyroidectomy plus bilateral central lymph node dissection was routinely performed to avoid the bias from the surgical strategy.We searched the Medline,Embase and CNKI database for eligible studies from January 2003 to May 2018.Meta-analysis was performed using the STATA 12.0 software.Odds ratios (ORs)and 95% confidence intervals (CIs)were calculated under fixed-effects or random-effects models.Fifteen clinical studies were included with a total of 4909 PTC patients. Our meta-analysis results reported that BRAF^V600E mutation was associated with LNM (OR=1.34;95% CI:1.09-1.65;P=0.005),as well as central LNM (OR=1.59;95% CI: 1.35-1.88;P<0.00001).Moreover,in patients with papillary thyroid microcarcinoma, we also confirmed the predictive value of BRAF^V600E mutation for LNM (OR=3.49;95% CI:2.02-6.02;P<0.00001).This meta-analysis demonstrates that BRAF^V600E mutation is closely related to LNM in PTC patients.The results suggest that BRAF^V600E mutation can be considered as a risk factor for LNM in PTC.Moreover,combining BRAF^V600E mutation with other risk factors to determine the initial surgical treatment may bring benefits for PTC patients.

Effects of Notch-1 Down-regulation on Malignant Behaviors of Breast Cancer Stem Cells

This study examined the effect of Notch-1 signaling on malignant behaviors of breast cancer cells by regulating breast cancer stem cells （BCSCs）. BCSCs were enriched by using serum-free me- dium and knocked out of Notch-1 by using a lentiviral vector. Real-time polymerase chain reaction （RT-PCR） and Western blotting were used to detect the Notch-1 expression levels in breast cancer cell lines and BCSCs, and fl0w cytometry to detect the proportion of BCSCs in BCSC spheres. The BCSC self-renewal, migration, invasion, and tumorigenicity were examined by the tumor microsphere-forming assay and transwell assay and after xenotransplantation. The results showed that the Notch-1 silencing reduced the number of BCSC spheres, the proportion of BCSCs, and the number of cells penetrating through the transwell membrane. It also decreased the size of tumors that were implanted in the nude mice. These results suggest that Notch-1 signaling is intimately linked to the behaviors of BCSCs. Blocking Notch-1 signaling can inhibit the malignant behaviors of BCSCs, which may provide a prom- ising therapeutical approach for breast cancer.

Clinicopathological Features of Breast Cancer with Different Molecular Subtypes in Chinese Women

A retrospective study was performed to explore the relationship between molecular subtypes and clinicopathological features of breast cancer in Chinese women. Six hundred and twenty-eight Chi- nese women with breast cancer were classified into four molecular subtypes according to their estrogen receptor （ER）, progesterone receptor （PR） and Her-2 status. The prevalence rate of each molecular sub- type was analyzed. Relationship between the subtypes and clinicopathologic features was determined. The distribution of molecular subtypes was as follows： luminal A 46.5%, luminal B 17.0%, basal 21.5%, HER2/neu 15.0%. The subtypes had no significant difference under different menopausal status. How- ever, in the age-specific groups, the age group of〈35 years was more likely to get basal cell-like cancer （36.9%）. Statistically significant differences were found among molecular subtypes by age, nuclear grade, tumor size, lymph node （LN） metastasis, tumor stage by American Joint Committee on Cancer （AJCC）, radiotherapy but not by chemotherapy, types of surgery. After adjusting for several relative confounding factors, the basal subtype more likely had lower nodal involvement in both the incidence of LN metastasis （〉1 positive LN） and incidence of high-volume LN metastasis （〉4 positive LN）. The HER2/neu subtype had higher nodal involvement in the incidence of high-volume LN metastases. After adjusting for relative confounding factors, the HER2/neu subtype more likely had higher AJCC tumor stages. It was suggested that there existed close relationship between molecular subtypes and clinicopa- thological features of breast cancer. In addition, the breast cancer subtypes have been proven to be an independent predictor of LN involvement and AJCC tumor stage. These findings are very important for understanding the occurrence, development, prognosis and treatment of breast cancer in Chinese popu-lation.

Associations between coagulation factorⅫ,coagulation factorⅪ,and stability of venous thromboembolism:A case-control study

BACKGROUND Pulmonary embolism(PE)is a fatal clinical syndrome that is generally caused by an embolus from unstable deep venous thrombosis(DVT).However,clinical and biochemical factors that are related to the stability of DVT are not fully understood.AIM To evaluate the relationships between plasma antigen levels of factor XII(FXII:Ag)and factor XI(FXI:Ag)with the stability of DVT.METHODS Patients with DVT and no PE,DVT and PE,and controls with no DVT or PE that matched for age,gender,and comorbidities were included in this study.FXII:Ag and FXI:Ag in peripheral venous blood were measured using enzyme-linked immunosorbent assays.RESULTS Using the 95th percentile of FXI:Ag in patients with DVT and PE as the cut-off,a higher FXI:Ag was associated with a higher risk of unstable DVT(odds ratio:3.15,95%confidence interval:1.18-8.43,P=0.019).Stratified analyses showed consistent results in patients≤60 years(P=0.020),but not in those>60 years(P=0.346).CONCLUSION Higher plasma FXI:Ag might be a marker for unstable DVT,which might be associated with PE in these patients.

Combined targeted therapy and immunotherapy in anaplastic thyroid carcinoma with distant metastasis: A case report

BACKGROUND Anaplastic thyroid carcinoma(ATC),also called undifferentiated thyroid cancer,is the least common but most aggressive and deadly thyroid gland malignancy of all thyroid cancers[1].It has poor prognosis,and is the leading cause of death from malignant thyroid tumors.The one-year survival rate is 20%,with a median overall survival(OS)of only 5 mo[2].The aim of this report is to provide our experience in the diagnosis and treatment of ATC.CASE SUMMARY A patient with a thyroid mass underwent surgical treatment after developing symptoms of hoarseness.The resected tumor was pathologically diagnosed as ATC.Imaging examination revealed organ and lymph node metastasis.After multiple cycles of chemotherapy and local radiotherapy,the metastases were not relieved and gradually increased in size and new metastases appeared.The patient immediately received immunotherapy combined with targeted therapy.During treatment,immune-related adverse reactions occurred,which were improved after symptomatic treatment,and tolerated by the patient.The OS of the patient was more than 30 mo after immunotherapy combined with targeted therapy.CONCLUSION For metastatic ATC,surgical treatment,radiotherapy and chemotherapy have no significant effect on remission of the disease.However,immunotherapy has made a breakthrough in the treatment of ATC。

Small Cell Carcinoma:a Rare Subtype of Thyroid Cancer with Unanticipated Prognosis

The prognosis of small cell thyroid carcinoma(SCTC)in a large cohort has not been well reported in the literature.In this study,we analyzed the mortality of SCTC,in comparison to medullary thyroid cancer(MTC)and anaplastic thyroid cancer(ATC),based on the Surveillance,Epidemiology,and End Results(SEER)Program of the National Cancer Institute,to determine the prognosis of SCTC.Information regarding patients with a diagnosis of MTC,ATC,or SCTC,between 2004 and 2013,was acquired from the SEER database.Patient survival curves were assessed by Cox proportional hazards regression analyses,Kaplan-Meier analyses,and log-rank tests.In a Kaplan-Meier analysis of the entire cohort of thyroid cancer patients,cancer-specific survival declined sharply for patients with SCTC,but it declined more modestly for patients with MTC.The cancer-specific survival was not significantly different between SCTC and ATC.Unadjusted Cox regression analysis showed that SCTC had a higher cancer-specific mortality than MTC but a similar prognosis as ATC.SCTC showed a higher cancer-specific mortality than MTC and ATC after adjustments for various confounding factors.SCTC was found to have a more highly lethal clinical course than MTC and had a similar death rate to ATC.Therefore,we recommend that aggressive,radical treatment like surgery or radiation should be performed tor these patients.