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.
【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.
ObjectiveTo analyze the epidemic trend of thyroid cancer in China from 2005 to 2018, and understand the estimated epidemiological situation of thyroid cancer in China in 2022 based on the thyroid cancer registration data reported by the National Cancer Registration Center and the China Cancer Registration Annual Report. MethodsThe cases of new thyroid cancer and deaths in China were analyzed according to the data of approximately 700 cancer registries in 2018 and the data of 106 cancer registries from 2005 to 2018, then stratified by sex, age, urban and rural areas, and main regions in China. And the estimated incidence and mortality of thyroid cancer in China in 2022 were analyzed based on the population data in 2020. Results① The age standardized incidence rate (ASIR) and age standardized mortality (ASMR) of thyroid cancer in China from 2005 to 2018: in the whole population, the ASIR showed a relatively rapid upward trend and the ASMR showed a relatively slower upward trend; The ASIR and ASMR of men were lower than those of women and the trend of change was also slower than that of women; The ASIR of thyroid cancer in the whole urban population was markedly higher than that in the rural population and the average annual rising rate (AARR) in the urban and rural areas was 6.31% and 0.38% respectively, while the ASMR had no obviously difference between the urban and rural populations (the AARR was 3.23% and 2.33% respectively); The ASIR of thyroid cancer was the highest in the eastern region with a markedly rising, but its ASMR had a relatively lower rising rate, while the ASIR in the western region was relatively lower and the ASMR also showed a downward trend, and the ASMR in the central region had a relatively obvious rising rate. ② The estimated incidence and mortality of thyroid cancer in China in 2022: the estimated ASIR and ASMR of the whole population in 2022 was still rising as compared with in 2018 (ASIR: 24.64 per 100 000 vs. 12.01 per 100 000; ASMR: 0.45 per 100 000 vs. 0.37 per 100 000 ); The estimated ASIR and ASMR in women were still much higher than in men (ASIR: 36.51 per 100 000 vs. 13.25 per 100 000; ASMR: 0.55 per 100 000 vs. 0.35 per 100 000); Among the urban and rural populations, the estimated ASIR in urban was still higher than in rural areas (27.87 per 100 000 vs. 17.66 per 100 000), while the estimated ASMR had no marked difference between them (0.41 per 100 000 vs. 0.52 per 100 000). Compared with 2018, the development trend of the ASIR was still rising (urban: 27.87 per 100 000 vs. 15.58 per 100 000; rural: 17.66 per 100 000 vs. 8.95 per 100 000). The age specific ASIR of thyroid cancer showed a marked sex differences, that is, it began to rise rapidly from the 20–30 years old group, and reached the peak at the 45–50 years old group (the highest ASIR was 97.00 per 100 000) in women; However, which had been in a slower upward trend from the 0 to 20 years old group, while it had been rising rapidly from the 20 to 25 years old group, reaching the peak at the 30–35 years old group (the highest ASIR was 31.60 per 100 000) in men. The overall trend of age specific ASMR for thyroid cancer was similar for both males and females, with a slower increase starting from the 0–35 years old age group and continuous rising till 85 years old and above. ConclusionsThe incidence and mortality of thyroid cancer in China are rising, and the disease burden is still severe and the differences are existed in urban and rural areas, sex, age, and main regions. Overall, the prevention and control situation is complex and severe in China.
ObjectiveTo summarize the risk factors of the change of voice quality after thyroidectomy without recurrent laryngeal nerve injury and to provide reference for the prevention and treatment of postoperative voice quality damages.MethodThe research progress of the change of voice quality after thyroidectomy without recurrent laryngeal nerve injury was reviewed by reading the related literatures at home and abroad.ResultsEven if there was no obvious recurrent laryngeal nerve injury during the operation, the voice quality may change after the operation for the patients undergoing thyroidectomy. The change of voice quality after thyroidectomy without recurrent laryngeal nerve injury was associated with various risk factors such as dysfunction of superior laryngeal nerve, injury of anterior laryngeal band muscles, endotracheal intubation, surgical methods, age, gender and special occupations.ConclusionsThe change of voice quality is a common complication after thyroidectomy, which seriously affects the quality of life of patients. In the absence of significant recurrent laryngeal nerve injury, many patients will still experience problems with voice quality. Understanding the related risk factors of voice quality change after thyroidectomy is helpful to optimize postoperative voice function, to prevent possible secondary injuries, and to improve the quality of life of patients.
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.
目的 分析经病理证实的颈部无痛性肿大淋巴结的声像图特点，比较良、恶性疾病中异常淋巴结的声像图特征，为临床医师的鉴别提供可靠的诊断依据。 方法 将2007年7月－2009年12月以颈部无痛性肿大淋巴结就医、并经病理证实的良、恶性疾病的97例患者作为研究对象，其中男56例，女41例；共检出淋巴结365个，依据病理诊断结果将研究对象分为良性组（98个）和恶性组（267个）。 结果 ① 大多数良性淋巴结：L/S＞2，形态接近椭圆形、门部回声规则无移位、皮质较薄、髓质形态规则，居中； 大多数恶性淋巴结短径相对增大，L/S≤2，形态趋于类圆形，包膜不完整，门部大多数偏离中心，皮质不均匀增厚，髓质变形移位或消失。② 良性淋巴结多表现为无血流型或门部规则血流型；恶性淋巴结多表现为周边血流或混合血流型。③ 大多数良性淋巴结血流阻力指数偏低，RI＜0.60；大多数恶性淋巴结血流阻力指数偏高，RI＞0.70。 结论 高频超声在颈部无痛性淋巴结肿大的良恶性鉴别中能够提供重要的诊断信息。
In response to the “Healthy China 2030” strategy, the General Surgery Quality Control Center of Sichuan Province and the Thyroid Surgery Innovation and Transformation Branch of Sichuan Medical Science and Technology Innovation Association, jointly established 18 quality control (QC) nodes. This framework integrates evidence from many major domestic and international guidelines/consensus and regional clinical QC practices in Western China. The system encompasses three core dimensions: diagnostic logic accuracy (e.g., TQC-01 for targeted screening to avoid over diagnosis by specifying high-risk ultrasonography indications); evidence-based treatment hierarchy (e.g., TQC-06/TQC-08 standardizing staging protocols for surgical indications); treatment outcome optimization (e.g., TQC-17 for long-term quality-of-life tracking). A four-phase closed-loop management structure is implemented. Screening intervention: imaging restricted to high-risk populations. Standardized diagnosis: initial nodule evaluation with serological testing (TQC-02) and pathological verification (TQC-04). Treatment protocolization: stratified execution of surgery/ablation indications (TQC-10). Dynamic prognosis monitoring: 10-year survival tracking post-differentiated thyroid cancer surgery (TQC-17) and multidimensional ablation efficacy assessment (TQC-16). Under the collaborative governance of regional leading institutions, this framework has demonstrated significant impact: reduction of low-value care (e.g., avoidance of non-indicated biopsy for suspicious lesion <1 cm), elimination of critical process omissions (including mandatory TNM staging compliance), and advancement toward regional healthcare quality homogenization. These contributions establish a replicable paradigm for enhancing China’s national thyroid disease clinical quality ecosystem.
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.
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.