ObjectiveTo develop and validate a nomogram for predicting overall survival among patients with breast apocrine carcinoma (BAC). MethodsThe patients diagnosed with BAC from 2010 to 2016 were selected from the Surveillance, Epidemiology, and End Results (SEER) database and then randomly divided into a training set and a validation set by a 7∶3 ratio. Additionally, external validation of the nomogram was conducted on BAC patients admitted to the Dongfeng Hospital Affiliated to Hubei Medical College from January 1, 2010 to December 31, 2018. The risk factors affecting the overall survival of BAC patients were determined by univariate and multivariate Cox regression analyses, which were used to develop the nomogram prediction model. The discriminative abilities of the nomogram for the 3- and 5-year overall survival rates were evaluated by the C-index and area under receiver operating characteristic curve (AUC), and the fit of actual data and nomogram-predicted data for calibrators should be evaluated. ResultsA total of 649 BAC patients who met the included criterion for this study were enrolled from the SEER database (including 454 in the training set and 195 in the internal validation set), and 21 BAC patients from the Dongfeng Hospital (external validation set) were included. The multivariate Cox regression analysis showed that the age, T stage, M stage, S stage, surgical method, and chemotherapy were the risk factors affecting the overall survival of BAC patients. The C-index values of the nomogram prediction model based on these risk factors was 0.76, 0.77, and 0.88 in the training set, internal validation set, and external validation set, respectively. The calibration curves of the actual 3- and 5-year overall survival rates and nomogram-predicted 3- and 5- year overall survival rates were close to the ideal curve. The AUCs (95%CI) of the nomogram prediction model for evaluating the 3-year and 5-year overall survival rates of BAC patients were 0.84 (0.78, 0.89) and 0.76 (0.71, 0.83) in the training set, 0.81 (0.73, 0.91) and 0.84 (0.77, 0.91) in the internal validation set, and 0.80 (0.70, 0.91) and 0.84 (0.76, 0.91) in the external validation set, respectively. ConclusionNomogram based on the SEER database to predict the overall survival of BAC patients has a good predictive effect for BAC patients.
ObjectiveTo explore the best timing of thyroid stimulating hormone (TSH) inhibition therapy by analyzing the trend of TSH level changes after unilateral thyroid lobectomy in patients with low-risk papillary thyroid microcarcinoma (PTMC).MethodsThe clinical data of patients with low-risk PTMC who underwent unilateral thyroid lobectomy in the Dongfeng Hospital Affiliated to Hubei Medical College from September 2016 to December 2018 were retrospectively analyzed. The TSH of all patients were measured before operation and in month 1, 3, and 6 after operation, respectively, and the change trend was analyzed.ResultsAccording to the inclusion and exclusion criteria, a total of 271 patients with low-risk PTMC were included in this study. The TSH level in month 1 after operation was higher than that of before operation [(2.93±1.09) mU/L versus (2.05±0.76) mU/L, t=19.9, P<0.001]. Among the 129 patients with TSHlevel ≤2.0 mU/L before operation, 56.6% (73/129) of them still had the TSH level ≤2.0 mU/L in month 1 after operation, 45.0% (58/129) in month 3 after operation and 39.5% (51/129) in month 6 after operation.ConclusionsTSH level of patient with low-risk PTMC is increased after lobectomy, so individualized TSH inhibition treatment should be formulated. For patients with TSH level>2.0 mU/L before operation, oral levothyroxine sodium tablets should be taken immediately after operation. For patients with preoperative TSH level ≤2.0 mU/L, TSH level should be dynamically monitored, and whether and when to start oral TSH inhibition therapy should be decided according to results of TSH level.
Objective To approach the effect of neck hyperextension position on hemodynamics of vertebral artery following thyroidectomy， and analyze the correlation between the change of hemodynamics and nausea and vomiting. Methods One hundred and fifty-eight patients with preparing for thyroidectomy （thyroidectomy group） and 89 patients with laparoscopic cholecystectomy （LC， LC group） were selected. The anesthesia method and the anesthesia drugs were the same in two groups. The indexes of hemodynamics of the bilateral vertebral artery at 6 h before and after thyroidectomy were measured. The difference of nausea and vomiting was observed and compared in two groups. Results The average blood flow velocity of the bilateral vertebral artery reduced and the blood flow decreased at 6 h after thyroidectomy as compared with at 6 h before thyroidectomy （P＜0.05）. The rates of nausea and vomiting of 0，2， 3， 4 times in the thyroidectomy group were significantly higher than those in the LC group （P＜0.05， P＜0.01）. The durations of nausea and vomiting of 1， 2， 3， 4 times in the thyroidectomy group were also significantly longer than those in the LC group （P＜0.01）. There was a positive correlation between the nausea and vomiting and the changes of blood flow velocity or blood flow （change of blood flow velocity：rs=0.697， P=0.03；change of blood flow：rs=0.897， P=0.01）. Conclusions There is a certain effect of the neck hyperextension position on hemodynamics of the bilatreal vertebral artery， and which might affect the nausea and vomiting following thyroidectomy.
Objective To investigate the optimal diagnosis and treatment strategy of occult carcinoma of the thyroid (OCT) with neck lymph node metastasis as the first symptom. Method In order to discuss the optimal diagnosis and treatment strategy of OCT with neck lymph node metastasis as the first symptom, we collected 35 cases and analyzed their characteristics, diagnostic methods, operative schemes, metastasis situation, and death situation. Results Of the 35 cases, 28 cases went to hospital because of swollen lymph nodes, and other 7 cases were discovered by color Doppler ultrasound in medical examination. Thyroid nodules were found by color Doppler ultrasound in 32 cases, 3 cases were found no thyroid nodule. Lymph node of 23 cases were determined by ultrasound-guided fine-needle aspiration biopsy (US-FNAB), and 16 cases (69.56%) were diagnosed as metastasis of thyroid carcinoma or suspicious metastasis by US-FNAB. Thyroid biopsy were done in 21 cases, and 11 cases (52.38%) were diagnosed as thyroid carcinoma or suspicious thyroid carcinoma by fine needle aspiration biopsy. Of the 35 cases, 19 cases were performed total thyroidectomy and functional neck lymph node dissection, 11 cases were performed resection of unilateral thyroid and isthmus and regional neck lymph node dissection, 5 cases were performed nonstandard operations. All cases were followed up for 3–10 years after operation, and the median time was 7-year. During follow up period, 10 cases suffered from reccurrence. Among them, 3 cases reoccurred in the nonstandard operation group, 5 cases reoccurred in resection of unilateral thyroid and isthmus and regional neck lymph node dissection group, 3 cases reoccurred in total thyroidectomy and functional neck lymph node dissection group. There were 3 cases died. Among them, there was 1 case in each group of nonstandard operation group, resection of unilateral thyroid and isthmus and regional neck lymph node dissection group, and total thyroidectomy and functional neck lymph node dissection group. The recurrence rate of total thyroidectomy and functional neck lymph node dissection group was markedly lower than those of resection of unilateral thyroid and isthmus and regional neck dissection group (χ2=4.751,P<0.05) and nonstandard operation group (χ2=5.874,P<0.05). While there was no significance difference of the recurrence rate between the resection of unilateral thyroid and isthmus and regional neck dissection group and nonstandard operation group (χ2=0.291,P>0.05). There was no significance difference in the mortality among the three groups (P>0.05). Conclusion US-FNAB and intraoperation rapid frozen pathological section are important methods for diagnosis of OCT with neck lymph node metastasis as the first symptom, and standard operation is an principal treatment method for it.
ObjectiveTo investigate the significance of the expression of vascular endothelial growth factor (VEGF) in portal vein thrombosis after operation in patients with portal hypertension.MethodsThe serum of 146 patients with portal hypertension treated in Dongfeng Hospital Affiliated to Hubei Medicial College from January 2014 to December 2018 and the surgically removed splenic vein and spleen specimens were collected. The serum VEGF level was determined by enzyme-linked immunosorbent assay, and the expressions of VEGF in splenic vein and spleen tissues were detected by immunohistochemistry. According to whether portal vein thrombosis was formed after operation, the patients were divided into thrombosis group and non-thrombosis group, and the differences between the groups were compared.ResultsThe serum VEGF level in the thrombosis group was significantly higher than that in the non-thrombosis group (P<0.05). In splenic vein wall and spleen tissues, VEGF staining indexes in the thrombosis group were significantly higher than those in the non-thrombosis group (P<0.05).ConclusionsPostoperative portal vein thrombosis in patients with portal hypertension may be related to the serum VEGF level. The high expressions of VEGF in splenic vein wall and spleen suggest that VEGF may participate in the formation process of portal vein thrombosis.