Objective To analyze the clinical and pathological factors related to the metastasis of contralateral central lymph nodes (Cont-CLNs) in unilateral near isthmus papillary thyroid carcinoma (PTC), and to establish a prediction model of lymph node metastasis, so as to provide reference for the scope of lymph node dissection. Methods A total of 381 unilateral PTC patients from February 2012 to June 2022 were collected in our hospital, and according to the location of the cancer, they were divided into the isthmus group (n=152) and the unilateral glandular lobe group (n=229) , and the correlation analysis was performed on whether there was Cont-CLNs metastasis. One hundred and fifty-two patients in the unilateral isthmus PTC group were further divided into metastatic and non metastatic groups based on whether Cont-CLNs metastasis occurred. Univariate analysis was used to analyze the relationship between gender, age, distribution of glandular lobe, tumor size, tumor location, pathological subtype, capsule invasion, thyroid stimulating hormone (TSH) level, combine Hashimoto’s thyroiditis (HT), ipsilateral central lymph nodes（Ipsi-CLNs) metastasis and Cont-CLNs metastasis. According to the univariate analysis results of this study and the possible high-risk factors of contralateral central lymph node metastasis of unilateral thyroid papillary carcinoma in other literatures, they were included in logistic multivariate analysis to obtain independent risk factors and establish a prediction model. Results The incidence of Cont-CLNs metastasis in unilateral isthmus PTC patients was higher than that in nilateral glandular lobe group (24.3% vs. 14.4%, χ²=6.009, P=0.014). Univariate analysis showed that Cont-CLNs metastasis in patients with unilateral near isthmus PTC was correlated with age (P=0.02), tumor size (P＜0.01), capsule invasion (P＜0.01) and Ipsi-CLNs metastasis (P＜0.01), but not with gender, distribution of glandular lobe, tumor location, pathological subtype, TSH level and whether to merge HT (P＞0.05). Further logistic multivariate analysis suggested that capsule invasion and Ipsi-CLNs metastasis were independent risk factors for Cont-CLNs metastasis in patients with unilateral near isthmus PTC. Moreover, the above logistic multifactor prediction model is proved to be effective by the test of goodness of fit by Hosmer and Lemeshow. Conclusions Capsule invasion and Ipsi CLNs metastasis are high risk factors for Cont-CLNS metastasis in patients with unilateral near isthmus PTC. It is suggested that such patients should be cleaned up with prophylactic Cont-CLNs while cleaning up Ipsi-CLNs.
【摘要】 目的 评价非那雄胺对良性前列腺增生（benign prostate hyperplasia，BPH）细胞外基质（extracellular matrixc，ECM）的影响，并探讨其作用机制。 方法 2008年6月－2009年3月选择具备手术指征的BPH患者20例，按入院顺序随机分为非那雄胺组和安慰剂组。服药4周后，行经尿道前列腺切除术（transurethral resection prostate，TURP），留取组织标本。另取正常前列腺标本6例，用免疫组织化学法结合图像分析系统研究正常组、安慰剂组和非那雄胺组前列腺组织纤维连接蛋白（FN）、胶原（CL）、基质金属蛋白酶2（MMP-2）、金属蛋白酶组织抑制因子2（TIMP-2）的阳性表达。 结果 安慰剂组前列腺组织的FN、CL的阳性表达较正常组增强（Plt;0.01），MMP-2/TIMP-2差异无统计学意义（Pgt;0.05）；非那雄胺组与安慰剂组相比，FN、CL的阳性表达减弱（Plt;0.01），而MMP-2/TIMP-2增高（Plt;0.01）。 结论 非那雄胺能降低BPH组织ECM成分，避免其沉积，其作用机制可能与其促进ECM降解有关。【Abstract】 Objective To evaluate influence of finasteride on extracellular matrix (ECM) in benign prostate hyperplasia (BPH) patients and study the mechanism. Methods Twenty BPH patients needing surgery were randomly divided into 2 groups according to the sequence of hospitalization from June 2008 to March 2009. The finasteride group and the placebo group had 10 patients each. Transurethral resection prostate (TURP) were performed and the specimens were collected after 4 weeks of drug administration. Moreover, 6 normal prostatic tissues were selected. Expressions of fibronectin (FN), collagen (CL), matrix metalloproteinase-2 (MMP-2) and tissue inhibitor of metalloproteinase-2 (TIMP-2) were studied in prostatic tissues in all groups (including the normal group) by immunohistochemistry and image analysis system. Results Expressions of FN and CL were significantly higher than those in the normal group (Plt;0.01), while expressions of MMP-2 and TIMP-2 were not significantly different between them (Pgt;0.05). Compared with the placebo group, expressions of FN and CL in the finateride group were significantly lower than the placebo group (Plt;0.01), while expressions of MMP-2 and TIMP-2 were significantly higher (Plt;0.01). Conclusions BPH is related to ECM depositing. Finasteride can decrease ECM of BPH and refrain it from depositing. Possibly, the principle is that finasteride can promote the degradation of ECM.
Objective To investigate the clinical efficacy of combined therapy of Gankang Granule and Entecavir for patients with chronic hepatitis B. Methods A total of 118 patients with chronic hepatitis B treated between January 2012 and January 2013 were randomly divided into treatment group (n=59) and control group (n=59). Patients in the treatment group were treated with Gankang Granule and Entecavir, while those in the control group were treated with Entecavir alone. Results Before treatment, there was no significant difference between the two groups in such liver fibrosis evaluation indexes as hyaluronic acid (HA), laminin (LN), procollagenⅢ(PCⅢ), and collegen typeⅣ(CⅣ) (P > 0.05). After treatment, the two groups had significant differences in HA, LN, PCⅢ, and CⅣ(P < 0.05). After 48 weeks of treatment, the alanine aminotransferase recovery rate was significantly different between the two groups (P < 0.05); but there was no significant difference in hepatitis B virus DNA negative conversion rate, hepatitis B e antigen negative conversion rate and hepatitis B e antibody seroconversion rate (P > 0.05). Forty-eight weeks after treatment began, 45 patients underwent liver biopsy which showed that liver fibrosis alleviation was significantly better in the treatment group than the control group (P < 0.05). Conclusions Gankang granule combined with antiviral drug Entecavir for chronic hepatitis B is better in protecting the liver and alleviating hepatic fibrosis than the sole Entecavir. The combined method is worthy of being promoted.