Purpose To investigate whether carbon nanoparticles (CNs) are helpful in identifying lymph nodes and metastatic lymph nodes and in parathyroid protection during thyroid cancer surgery. Methods English and Chinese literature in PubMed, Cochrane Database of Systematic Reviews, EMBASE, ClinicalTrials.gov, China Biology Medicine Database, China National Knowledge Infrastructure, China Master's and Doctoral Theses Full-Text Database, Wanfang database, and Cqvip database were searched (till March 22, 2016). Randomized controlled trials (RCTs) that compared the use of CNs with a blank control in patients undergoing thyroid cancer surgery were included. Quality assessment and data extraction were performed, and a meta-analysis was conducted using RevMan 5.1 software. The primary outcomes were the number of retrieved central lymph nodes and metastatic lymph nodes, and the rate of accidental parathyroid removal. Results We obtained 149 relevant studies, and only 47 RCTs with 4,605 patients (CN group: n=2,197; blank control group: n=2,408) met the inclusion criteria. Compared with the control group, the CN group was associated with more retrieved lymph nodes/patient (weighted mean difference [WMD]: 3.39, 95% confidence interval [CI]: 2.73-4.05), more retrieved metastatic lymph nodes (WMD: 0.98, 95% CI: 0.61-1.35), lower rate of accidental parathyroid removal, and lower rates of hypoparathyroidism and hypocalcemia. However, the total metastatic rate of the retrieved lymph nodes did not differ between the groups (odds ratio: 1.13, 95% CI: 0.87-1.47, P=0.35). Conclusion CNs can improve the extent of neck dissection and protect the parathyroid glands during thyroid cancer surgery. And the number of identified metastatic lymph nodes can be simultaneously increased.

/pdf/application-of-carbon-nanoparticles-in-lymph-node-dissection-4tu0vaywlx.pdf

Application of carbon nanoparticles in lymph node dissection and parathyroid protection during thyroid cancer surgeries: a systematic review and meta-analysis.

Detecting protein complexes within protein–protein interaction (PPI) networks is a major step toward the analysis of biological processes and pathways. Identification and characterization of protein complexes in PPI network is an ongoing challenge. Several high-throughput experimental techniques provide substantial number of PPIs which are widely utilized for compiling the PPI network of a species. Here we focus on detecting human protein complexes by developing a multiobjective framework. For this large human PPI network is partitioned into modules which serves as protein complex. For building the objective functions we have utilized topological properties of PPI network and biological properties based on Gene Ontology semantic similarity. The proposed method is compared with that of some state-of-the-art algorithms in the context of different performance metrics. For the purpose of biological validation of our predicted complexes we have also employed a Gene Ontology and pathway based analysis here. Additionally, we have performed an analysis to associate resulting protein complexes with 22 key disease classes. Two bipartite networks are created to clearly visualize the association of identified protein complexes with the disorder classes. Here, we present the task of identifying protein complexes as a multiobjective optimization problem. Identified protein complexes are found to be associated with several disorders classes like ‘Cancer’, ‘Endocrine’ and ‘Multiple’. This analysis uncovers some new relationships between disorders and predicted complexes that may take a potential role in the prediction of multi target drugs.

/pdf/a-multiobjective-approach-for-identifying-protein-complexes-4bho4svfp9.pdf

A multiobjective approach for identifying protein complexes and studying their association in multiple disorders

Background The aim of this study was to evaluate the association between the number of nodes harvested and the rate of node positivity, and to evaluate the effect of carbon nanoparticles (CNPs) in improving lymph node detection and staging accuracy in patients who received neoadjuvant chemoradiotherapy (NCRT) followed by curative resection. Study Design Between September 2008 and June 2014, 152 consecutive rectal cancer patients treated with NCRT and curative resection were included. Forty-five patients underwent preoperative submucosal injection of CNPs (CNP group); the other patients underwent surgery only (control group). The relationship between the number of lymph nodes harvested and the rate of node positivity was investigated. A comparison of the number of harvested lymph nodes and the node positivity rate between the 2 groups was also performed. The lymph nodes in the CNP group were analyzed in detail. Results The rate of node positivity increased gradually from 8.6% in patients with 1 to 5 nodes assessed to 37.8% in patients with 17 to 44 nodes assessed. The number of lymph nodes harvested was an independent risk factor for node positivity (p = 0.036). The mean number of lymph nodes retrieved in the CNP group was more than in the control group (21.1 vs 8.0, p = 0.000). The percentage of patients with positive lymph nodes was lower than in the control group (19.6% vs 35.6%, p = 0.037). In the CNP group, of 58 metastatic lymph nodes, 45 (77.6%) were dyed. Of 37 metastatic lymph nodes smaller than 5 mm, 33 (89.2%) were dyed. Conclusions More precise oncologic prognosis assessment was provided for patients with rectal cancer after NCRT by increasing the number of lymph nodes counted using a dye-tracing method, indicating that the use of CNPs is beneficial.

Preoperative Submucosal Injection of Carbon Nanoparticles Improves Lymph Node Staging Accuracy in Rectal Cancer after Neoadjuvant Chemoradiotherapy.

Distant metastases from follicular thyroid carcinoma are mainly hematogenous and are commonly observed in the lungs and bones. Other rare sites are the parotid gland, skin, brain, ovary, adrenal gland, kidney, pancreas and breast, with chest wall lymph node metastasis being even more rare. Over the past 10 years, three surgeries were performed on a 69-year-old women with a history of follicular thyroid cancer and its metastatic lesions. The patient presented with a 3-month history of masses in the left chest. She underwent detailed examination of the chest wall tumors, and surgery was then performed to resect all of the tumors. Based on the histopathology, these lymph nodes were confirmed to harbor metastatic follicular thyroid carcinoma. This study reports the first case of follicular thyroid carcinoma metastasis to the chest wall lymph node.

/pdf/chest-wall-lymph-node-metastasis-from-follicular-thyroid-3difwbqzl2.pdf

Chest wall lymph node metastasis from follicular thyroid carcinoma: a rare case report

Objective
To assess the efficiency of carbon nanoparticle in guiding level Ⅵ lymphadenectomy and parathyroid preservation in thyroidectomy for carcinoma.


Methods
One hundred and nine patients with well differentiated thyroid carcinoma, in whom thyroidectomy and bilateral lymphadenectomy for level Ⅵ were carried out at the same time, were prospectively studied. Fourty-five cases received carbon nanoparticle injecion in thyroid consistitued trial group, while sixty-four underwent conventional surgery as control group. The numbers of total dissected lymph nodes, metastasis lymph nodes, black-stained lymph nodes, detected parathyroids and mistakenly removed parathyroids were counted respectively. The PTH levels were measured at 1 d, 5 d and 30 d after surgery, respectively. Student′s t test and Chi-square analysis were used for analyzing data.


Results
The number of lymph node found in the trial group in level Ⅵ was checked out as (9.7±1.7)each side, whereas that of the control group was (6.7±1.9)each side. The discrepancy of two groups was statistical meaningful (t=23.14,P<0.001). The discrepancy of the rate of lymph node black-stained 90.5%(738/815), incidence of metastasis of the black-stained lymph nodes 45.9%(339/738) and that without black-staining 13.0%(10/77),was statistical meaningful(χ2=30.91,P<0.001).On average, the trial group showed(1.8±0.9)parathyroid each side, and had 5.9%(5/84) of mistakenly removed incidence, on contrary, the control group showed(1.8±1.0)parathyroid each side, and had 8.2%(11/134) of mistakenly removed incidence averagely as well. The discrepancy of two groups was statistical meaningful. In the trial group, the amount of PTH 1 d, 5 d and 30 d postoperatively were 7.30, 11.19 and 30.50 ng/L respectively, while that of the control group were 7.51, 10.90 and 28.30 ng/L respectively. The amount discrepancy between the two groups was not differences. No permanent recurrent nerve paralysis was found in both groups.


Conclusion
Carbon nanoparticle may improve the detected rate of metastasis lymph nodes, but may not be helpful to the prevention of postoperative hypoparathyrosim.


Key words: 
Thyroid neoplsms; Carcinoma, papillary; Neck dissection; Nanotubes, carbon; Parathyroid glands

Efficiency of carbon nanoparticles in level VI lymphadenectomy for thyroid carcinoma and prevention of postoperative hypoparathyroidism

Cognitive function in patients with primary hyperparathyroidism (PHPT) may be affected and be identified to have been linked to the level of parathyroid hormone (PTH). Previous studies have suggested that patients with PHPT present poor sleep quality, which might interact with cognitive decline. The purpose of this study was to determine whether sleep quality mediates the association between PTH level and cognitive function and investigate whether surgery improves sleep quality and cognition in PHPT patients.Between June 2019 and August 2022, we recruited 146 patients diagnosed with PHPT (n = 146). We collected clinical data from medical records and evaluated sleep quality and cognition preoperatively and 2 months postoperatively by using the Pittsburgh Sleep Quality Index and Min-Mental State Examination. We examined the mediation effects of sleep disturbance and latency on correlations between PTH level and cognitive impairment by using the Bootstrap method.The sleep quality and cognitive function were correlated with PTH level before surgery. Sleep latency or sleep disturbance exhibited a partial mediating effect on the association between PTH level and MMSE scores in PHPT patients (p < 0.05). In PHPT patients, there was a significant decline in PTH levels and an improvement in cognitive function post-surgery compared to pre-surgery, but no significant differences in sleep quality.Sleep disturbance and sleep latency may mediate the association between PTH level and cognitive impairment in PHPT before surgery. The surgery could reduce PTH levels and improve cognition, but might not improve sleep quality in PHPT patients. 

PTH levels, sleep quality, and cognitive function in primary hyperparathyroidism

Reticular fibre structure in the differential diagnosis of parathyroid neoplasms

Objective
To study the clinical features of hyperparathyroidism due to parathyroid tumors, and evaluate the efficiency of surgical managment. 


Methods
Twenty-two patients with hyperparathyroidism resulted from parathyroid tumors were reviewed. The age ranged from 32 to 79 years, 9 males and 13 females. Recurrent laryngeal nerve was routinely exposed, and procedures were performed in normal tissue in initial surgery. Additional selective neck dissection of levels Ⅱ ,Ⅲ, IV, and VI was taken in the cases with recurrent cancer. Local flaps were used to repair the esophageal defects after reseeting tumors. The recurrent laryngeal nerves of 4 cases had to be sacrificed because they were embeded in the tumor tissues despite the nerves had normal function before operation. Prophylactic tracheostomy was performed in 5 cases. 


Results
Eight cases were identified pathologically as parathyroid carcinoma, of them four with neck metastasis,and 14 cases as parathyroid adenoma after surgery. Their PTH dropped to normal level within two hours after surgery and hypercalcemia disappeared in two days postoperatively. The PTH and serum calcium were in normal range during the follow-up of 12 to 40 months. Recurrence occurred again in two cases in 6 and 8 months after the removal of the recurrent tumor tissues respectively. Esophageal fistula, chylous fistula and dehiscence of sternotomy developed in three cases separately. The tracheostomy was removed in four cases two weeks after operation and in one case six weeks after operation. One patient with parathyroid adenoma died of hypocaleemia about two weeks after operation and another one with recurrent parathyroid carcinoma also died of hypercalcemia 52 months after revised surgery. 


Conclusion
Extended resection of tumor and introperative PTH assay were strongly suggested for the managements of both benign and malignant parathyroid tumors.


Key words: 
Hyperparathyroidism; Parathyroid neoplasms; Otorhinolaryngologic surgical procedured

Surgical treatment of hyperparathyroidism due to parathyroid tumors

Objective
To evaluate the factors contributed to the recurrence of parathyroid carcinoma with the invasion of the upper aerodigestive tract and the outcomes of reoperation. 


Methods
Six cases reviewed, in which the age ranged from 32 to 79 years old. The initial diagnoses and surgical procedures, the sites and surgical treatment of the recurrent disease, and the chemical markers, such as parathyroid hormone （PTH） and serum calcium, were retrospectively studied. The preoperative PTH levels ranged from 860 to 2830 ng/L. In 4 patients the recurrence diseases were founded in the tracheoesophageal groove, of them one with invasion of the larynx only and one with invasion of the larynx and pharynx in addition to the trachea and esophagus involvement. Selective neck dissection for levelⅡ , Ⅲ, Ⅳ and Ⅵ was taken in all cases in addition to the removal of the local recurrent diseases. Recurrent laryngeal nerves were so badly embeded in tumor tissue that they were intentionally resected in 4 patients although they were functionally normal before operation. Prophylactic tracheostomy was carried out in 5 cases. 


Results
PTH level dropped more than 70% of that prior the operation at 10 rain after the removal of the tumor-bearing tissues and to normal range within the first 2 hours postoperatively, and hypoealcemia disappeared in 2 days postoperatively. All eases experienced significant improvement in sympotoms and signs in the first three days postoperatively. PTH and serum calcium levels were within normal range in 4 cases during the follow-up of 11 to 40 months, while hyperparathyroidism was encountered 8 and 11 months postoperatively in other 2 cases, respectively. Esophageal fistula, ehylous fistula and dehiscence of sternotomy developed in 3 cases separately. Of 5 patients with tracheostomy, the tracheostomy tubes were removed two weeks in 4 cases and six weeks in the other one after operation. 


Conclusions
Recurrent parathyroid carcinoma even with invasion of the upper aerodigestive tract still has promising surgical outcomes. Both the pricise localization of the recurrent diseases and the intraoperative PTH assay are importance to the successful treatment of these diseases.


Key words: 
Parathyroid neoplasms; Reoperation

Surgical treatment of recurrent parathyroid carcinoma with invasion of the upper aerodigestive tract

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