The temporary and permanent dysfunction caused by parathyroid injury are inevitable. The parathyroid contains a special fluorescent substance, although its mechanism is not clear. At present, two kinds of autofluorescence detection equipment(FLUOBEAM ® imaging system, PTeye fiber probe contact system)can be used for real-time localization of the parathyroid gland for intraoperative localization and protection. The major advantage of this technique is that is allows detection of the parathyroid in excised specimens. The ratios of autofluorescence intensities of the parathyroid and thyroid are 1.23 and 7.71, respectively. The proportion of autofluorescence parathyroid identification sensitivity was 76.3-98.0% and the accuracy was 90.5-99.0%. The parathyroid gland autofluorescence technique is non-invasive, less time-consuming, provides accurate real-time information, and does not use dye as a contrast agent.

Anaplastic thyroid cancer(ATC)is a rare invasive thyroid tumor associated with rapid progression and poor prognosis. Currently, there is no effective treatment or early diagnosis. Some scholars have shown that the poor prognosis of ATC is due to the early mutation and invasive growth of the tumor; consequently, new directions in research involve the driving mutation of the pathogenesis of ATC and targeted drug therapies. Different molecular pathways related to tumor progression are involved in ATC. Some scholars have explored the implementation of new therapies that act on these molecular pathways to improve patients' quality of life. The research results on the molecular structural characteristics of ATC bring hope for new targeted therapies. The new molecular mechanisms will help us discover more potential therapeutic targets. We have reviewed the recent research on the molecular mechanisms of ATC.

Objective Incorporating eXtreme Gradient Boosting(XGBoost)artificial intelligence, we aimed to build a predictive model using pre-operative enhanced computed tomography(CT)of cervical lymph node metastasis in patients with thyroid cancer, to provide a reference for pre-operative planning. Methods The clinical data of 38 patients with thyroid papillary carcinoma from October 2017 to May 2019 were retrospectively analyzed. A total of 135 lymph nodes were included. Using XGBoost artificial intelligence, the lymph node metastasis prediction model was established, and the accuracy of the prediction model was tested. Results The average accuracy of the XGBoost model was 87.41%, which was higher than that of the SVM model(79.2%). Important CT characteristics that are indicative of lymph node metastasis include degree and distribution of enhancement, location, and capsule invasion. Conclusion The predictive model of cervical lymph node metastasis in patients with thyroid cancer exhibits high accuracy and could help in the pre-operative evaluation of cervical lymph node metastasis, tumor staging, and surgical procedures.

Objective To explore the clinical treatment outcomes in thyroid papillary carcinoma patients with laryngotracheal invasion. Methods The study involved 87 patients with papillary thyroid carcinomas involving the larynx and trachea who reported to the Department of Otolaryngology at the Qilu Hospital of Shandong University between January 2010 and December 2019. Their basic demographic data, tumor resection procedures, tracheal repair procedures, postoperative extubation rate, and 3-year and 5-year survival rates were retrospectively analyzed. Results All the 87 patients were treated surgically. Tumor resection procedures included sharp shaving of the tracheal wall tumor(60 cases), tracheal wall wedge resection(15 cases), tracheal sleeve resection(3 cases), partial laryngectomy(1 case), total laryngectomy(4 cases), and palliative resection(4 cases). Airway reconstruction procedures included, suturing(5 cases), pectoralis major muscle flap repair(1 case), sternocleidomastoid clavicle periosteum flap repair(1 case), end-to-end anastomosis(3 cases), laryngoplasty(1 case), and tracheostomy(12 cases). Seventy-nine patients were followed for 4–122 months, of which 15 patients underwent tracheotomy, with an extubation rate of 66.7%(10 out of 15 patients). The 3-year and 5-year survival rates were 100% and 93.0%, respectively. Conclusion Accurate preoperative evaluation and reasonable surgical treatment may significantly improve the quality of life and facilitate the satisfactory survival of patients with thyroid papillary carcinoma involving the larynx and trachea.

Objective This study aimed to investigate the clinical value of two-stage reconstructive strategy using a flap for the treatment of non-circumferential tracheal defects. Methods Patients who underwent tracheal reconstructions with a two-stage reconstructive strategy using a flap between March 2013 and December 2018 were retrospectively evaluated. Results Thirty-seven patients, with a tracheal defect length of 6-14 tracheal rings and circumferential ratio of 1/2 to 3/4, underwent stage I surgery. Twenty-two free flaps and 15 pedicled flaps were used in the stage I surgery, and the sizes of the flap ranged from 6×4 cm to 12×9 cm. Thirty-three patients underwent stage II surgery, and the postoperative respiratory, deglutition, and articulation functions recovered satisfactorily. Conclusion The two-stage reconstructive strategy using a flap is safe and effective for the treatment of non-circumferential tracheal defects.

Objective To explore the safety and efficiency of transoral endoscopic thyroidectomy vestibular approach(TOETVA)in papillary thyroid cancer(PTC). Methods This study retrospectively reviewed 146 patients who underwent TOETVA between June 2017 and January 2020 at the Affiliated Yantai Yuhuangding Hospital of Qingdao University. Of those, 139 patients with pathologically confirmed PTC were enrolled in this study. Analyses were performed of the workflow experience, visual pain score on the first postoperative day, length of hospital stay, number of central neck lymph nodes removed, complications, and results of follow-ups. Results A total of 135 cases required hemithyroidectomy plus isthmectomy and central neck dissection(CND)with a mean operation time of 132±34.9 min; 4 cases required total thyroidectomy and CND with a mean operation time of 168±38.5 min. The mean number of central neck lymph nodes removed was 7.1±4.6 and the metastasis rate was 47.5%(66/139). Postoperative hospital stay was 1.9±0.7 days. Regarding postoperative complications, the incidence of transient recurrent laryngeal nerve injury(RLN)and transient hypoparathyroidism was 1.4%(2/139)and 0.7%(1/139), respectively. No permanent RLN injury and hypoparathyroidism occurred. Mental nerve injury occurred in 5.0%(7/139). Transient abnormal motor function of the lower lip and marginal mandibular branches of the facial nerve was observed in nine cases and two cases, respectively. Conclusion TOETVA can be performed by standard workflow with the principle of enhanced recovery after surgery(ERAS). TOETVA is feasible in selected PTC patients for its cosmetical results and oncological safety.

Objective To explore the causes and treatment of chyle leakage after lymph node dissection(LND)for thyroid carcinoma. Methods A retrospective analysis was conducted in 647 patients who underwent LND for thyroid carcinoma. For the 11 patients who developed chyle leakage, measures such as intravenous nutrition, low-fat diet, local compression and negative pressure drainage were taken. Results Chylous leakage occurred on day 0.5 to 3 after surgery, and the incidence was 1.7%. The peak drainage of chylous leakage was 120 to 1100 mL/d. Unilateral lobectomy + isthmectomy was performed in 449 cases, total thyroidectomy in 152 cases, and unilateral lobectomy + isthmectomy + contralateral subtotal thyroidectomy in 46 cases. Simple central lymph node dissection was performed in 395 cases, 5 of whom developed chyle leakage, and the incidence was 1.26%(5/395). Lateral neck+central lymphatic dissection was performed in 83 cases, 4 of whom developed chyle leakage, and the incidence was 4.8%(4/83). Upper mediastinal dissection with endoscope was performed in 6 cases, 2 of whom developed chyle leakage, and the incidence was 33.3%(2/6). The ratio of left to right chylous leakage was 7:4. Three patients had relapse dissection(rRLN). When the daily drainage volume was less than 20 mL/d, the drainage tube was removed. The closing time of chylous leakage was 6 to 23 days, median 11 days. No second operation was performed. Conclusion When lymph node dissection for thyroid carcinoma is performed, the procedures should be standardized to prevent chylous leakage. In case chylous leakage occurs, measures such as diet adjustment and negative pressure drainage can help the cure. Surgery must be performed when the conservative treatment is ineffective.

Objective Despite the high incidence of lateral neck lymph node metastasis in papillary thyroid carcinoma(PTC), its management has remained controversial. The accuracy of ultrasound and computed tomography(CT)in lateral neck evaluation for PTC is unsatisfactory. An unnecessary neck dissection may lead to increased complications, while undetected lymph node metastasis may facilitate recurrences and necessitate resurgery. We aimed to map the draining lymph nodes in the lateral neck using carbon nanoparticles and explore its potential in neck assessment. Methods We conducted a multicenter, prospective study from August 2016 to April 2019 in PTC patients who had unpalpable lateral lymph nodes that appeared suspicious on ultrasound and/or CT. Carbon nanoparticles were injected peritumorally into the thyroid gland, and modified lateral neck dissection(compartment Ⅱ-Ⅴ)was performed. The lateral lymph nodes were classified into dyed and undyed and sent for pathological analysis. Thyroidectomy and central neck compartment dissection were performed. Results A total of 125 neck dissections were performed in 122 patients. Of the dissections, 117 were for lateral neck metastases, 7 were for central metastases, and metastasis was absent in the remaining 1. A total of 4302 lateral lymph nodes were removed, 952 of them were dyed. The median number of dyed nodes was 6 per case(range: 1-33). The distribution of dyed nodes in the neck compartments was Ⅳ> Ⅲ> Ⅱ> Ⅴ, independent of tumor size, location, or extra-thyroidal extension. The percentages of dyed lymph node metastasis in Ⅱ-Ⅴ compartments were 33.3%, 60.0%, 68.8%, and 40.0%, respectively, on a per-case basis and 10.2%, 31.4%, 27.5%, and 20.8%, respectively, on a per-node basis. Compared to undyed nodes, the risk of metastasis in dyed nodes was significantly higher in all neck compartments(compartment Ⅱ: 19.9% vs. 5.6%, P<0.001; compartment Ⅲ 35.0% vs. 18.3%, P<0.001; compartment Ⅳ: 37.1% vs. 15.2%, P<0.001; compartment Ⅴ: 14.8% vs 3.7%, P<0.05). A lateral sentinel lymph node biopsy was performed in 51 patients. The sensitivity of the lateral neck sentinel lymph node biopsy was 89.5%, the false-negative rate was 26.7%, and the overall accuracy rate was 91.8%. Conclusion Using carbon nanoparticles, we successively mapped the lateral neck lymph nodes. We found that dyed nodes had a significantly higher risk of metastasis than that of undyed nodes. This method may be useful for lateral neck sentinel lymph node biopsies in PTC.

Objective To evaluate the clinical effect of Hashimoto thyroiditis(HT)on the ratio of BRAF^V600E alleles in papillary thyroid carcinoma(PTC). Methods Two hundred and forty-two patients who underwent surgery at our hospital between December 2017 and December 2019 were enrolled in this study. The ratio of BRAF^V600E alleles was measured using droplet digital PCR and formalin-fixed paraffin-embedded tissues, and its correlation with HT was analyzed. Using propensity score matching and based on the 63 patients with HT(1∶1), 179 PTC patients without HT during the same period were retrospectively enrolled as controls. Results There was a significant difference between the ratio of BRAF^V600E alleles(P<0.001)of the two groups(PTC patients with HT versus those without HT); the rates of positive-BRAF^V600E were not significantly different(87.3% vs 92.7%, P>0.05). After propensity score matching, the significant difference between the two groups at baseline was no longer observed. The ratio of BRAF^V600E alleles was still significantly lower in patients with HT(median 3.20%)than in those without HT(median 9.00%, P=0.001). Conclusion HT can significantly reduce the ratio of BRAF^V600E alleles in PTC, and this has an important effect on PTC progression and prognosis.

Objective The prevalence of differentiated thyroid cancer(DTC)has been increasing in children in recent years. Here, we have discussed the clinical characteristics of differentiated thyroid cancer(DTC)in children, and analyzed cases with recurrence. Methods We retrospectively investigated 50 children diagnosed with DTC at our hospital between January 1998 and July 2014. The clinical characteristics were compared for different age groups based on their age at initial diagnosis: pre-school group(≤ 7 years old)and school-age group(7-13 years old), and the clinical data of the recurrence and non-recurrence groups were also reviewed. The clinical features observed in this study included the TNM stage, and the AJCC recommended risk, recurrence, and metastasis. The Kaplan Meier method was used to evaluate the recurrence-free survival rate of all age groups. Results There was a significant difference between the pre-school and school-age groups in terms of local invasion(P=0.008). The proportion of local invasion in the pre-school group(6 cases, 42.6%)was higher than that in the school-age group(3 cases, 8.1%). There was a significant difference in the T stage between the two groups(χ2=12.584,P=0.028). The proportion of T2 in the school-age group was higher(19 cases, 51.4%)than that in the pre-school age group. Whereas the proportion of T4A in the pre-school age group was higher(5 cases, 38.5%)than that in the school-age group. The proportion of surgical complications in the pre-school group was significantly higher than that in the school-age group(χ2=9.632,P=0.008). The proportion of total thyroidectomy in the non-recurrence group was significantly higher than that in the recurrence group(85.7%, 53.3%)(χ2 = 11.227, P=0.004). Total thyroidectomy was found to reduce the recurrence risk of DTC in children. There was no significant difference in TNM and risk level between the recurrence group and the non-recurrence group. The total percentage of T1a, T1b and T2 was more than 50%, and the low-risk and medium-risk levels were 37.5% and 25%, respectively. More than half of the recurrence cases had a low TNM stage and low-risk level at the time of initial diagnosis. There was no significant difference in the postoperative recurrence rate of DTC in children(P>0.05). Discussion The proportion of local invasion, tumor stage, and surgical complications in patients with DTC in the pre-school group was higher than that in the school-age group. Age was found to be an important risk factor for children with DTC. More than half of the recurrence cases were low-risk at the time of initial diagnosis. Therefore, further study should be conducted regarding the risk assessment strategy of DTC recurrence in children. Understanding of the clinical characteristics of children with DTC should be improved so that appropriate treatment strategies can be implemented.

Objective To explore the perioperative application value of enhanced recovery after surgery(ERAS)in patients requiring radical surgery for thyroid carcinoma. Methods A total of 150 patients were randomly divided into the ERAS group(100)and control group(50). Both groups underwent radical surgery for thyroid carcinoma. Patients in ERAS group underwent a series of measures as recommended by the enhanced recovery philosophy, and those in the control group were treated by traditional method. Outcomes were assessed in terms of visual analogue scale(VAS), postoperative nausea and vomiting(PONV), postoperative complications, postoperative suction drainage, drainage tube removal time, subcutaneous hydrops, and postoperative stay. Results Compared to the control group, the ERAS group had lower postoperative pain score, fewer PONV cases, lesser medical expenses, and shorter drainage tube removal time and postoperative stay. Few postoperative complications were noted in both groups. Conclusion The application of ERAS in patients requiring radical surgery forthyroid carcinoma can effectively relieve postoperative discomfort such as pain and nausea, and shorten hospital stay.

Benign cystic tumors of the neck are relatively common. However, malignant manifestations, such as thyroid cancer, are rare. Accurate identification of cervical cystic masses in these patients is important in preventing incorrect diagnosis and misdiagnosis. We report a case of giant cystic formation by cervical lymph node metastasis in papillary thyroid carcinoma. Processes and their potential influence in diagnosis and treatment are briefly described.

Objective Retrospectively summarize the efficacy of different transplantation schemes for parathyroid gland resection in patients with secondary hyperparathyroidism. Methods A total of 86 patients who had undergone total parathyroid gland transplantation in our hospital between March 2013 to March 2018 were divided into three groups according to the three different transplantation schemes. The preoperative, postoperative, and follow-up PTH results, hospital stay, postoperative calcium supplementation days, postoperative complications, and recurrence were collected to determine the efficacy. Results The short-term treatment efficacy(1 day after surgery-1 month after surgery)was different among the three groups, while the long-term treatment effect was not different. The short-term treatment effect of group A was the worst. The short-term treatment effect of group B and group C were similar, but overall, group C was better than group B. Conclusion The particle size of the transplanted parathyroid and the blood supply of the transplanted bed are closely related to the survival and growth of the transplanted parathyroid. Refractory secondary hyperparathyroidism can be efficaciously treated by the transplantation of small particles of parathyroid tissue into the sternocleidomastoid muscle sac.

Objective To investigate the relationship between clinicopathological features such as the tumor location, maximum diameter, extranodal thyroid invasion, and anterior superior mediastinal lymph node metastasis of thyroid carcinoma. Methods We analyzed the clinical and pathological data of 60 patients with thyroid papillary carcinoma who were admitted to the Head and Neck Surgery Department at Sichuan Cancer Hospital for primary surgery between September 2018 and February 2019. The correlation between the clinical and pathological features and the positive rate of the anterior and upper mediastinal lymph nodes was analyzed using the chi-square test. Results Among the features of tumor location, maximum diameter, number, extranodal invasion, number of involved gland lobes and lymph node metastasis in region Ⅵ, as well as the age of patients and other relevant factors, only the lymph nodes in region Ⅵ affected the status of anterior superior mediastinal lymph nodes. Ten of the 60 patients(16.67%)had anterior superior mediastinal lymph node metastasis. The rates of anterior superior mediastinal lymph node metastasis were compared among the related factors: age > or equal to 55 years vs. younger than 55 years(20% vs. 16.36%; P<0.05); mass located in the lower pole vs. the upper pole vs. the middle pole(P>0.05); maximum diameter greater than or equal to 1.5 cm vs. less than 1.5 cm(18.18% vs. 15.79; p >0.05), single focus vs. multiple focus(21.88% vs. 10.71%; P>0.05), single vs. multiple leaves(17.5% vs. 15%; P>0.05); males vs. females(20% vs. 15.55%; P>0.05); positive vs. negative lymph nodes in area Ⅵ(24.43% vs. 3.57%; P<0.05). Conclusion The rate of anterior and upper mediastinal lymph node metastasis in thyroid papillary carcinoma is relatively low. In this study, it was found that the status of lymph nodes in Ⅵ region may be related to anterior superior mediastinal lymph node metastasis, and prospective studies with large samples are still needed in the future.

Objective The objective of this study was to introduce a negative pressure drainage device for dermal dilatation of microtia during the second phase of auricular reconstruction surgery. Methods A total of 420 patients with microtia who required skin expander implantation and cartilage framework grafts for auricular reconstruction were included in the study and randomly divided into two groups according to postoperative drainage. The study group used a special negative pressure drainage device(n=290)and a negative pressure drainage tube was placed routinely in the control group(n=130). We statistically compared the rates of subcutaneous hematoma formation between the two groups. Results In the study group, subcutaneous hematomas were less frequent than in the control group(P<0.05). Conclusions The special negative pressure drainage device effectively prevented subcutaneous hematomas during dermal dilatation of microtia in the second phase of auricular reconstruction surgery. This device is widely used clinically.

Objective This study aimed to investigate the clinical applications of CO₂ laser microsurgery for laryngeal precancerous lesions and early glottic laryngeal cancer. Methods A total of 27 patients, nine diagnosed with laryngeal precancerous lesions and 18 with early glottic laryngeal cancer, who had undergone CO₂ laser microsurgery were selected from January 2014 to August 2018 from the otolaryngology department of the Nanjing First Hospital(Nanjing Medical University). We observed the postoperative complications, the before and after surgery quality of life, and the postoperative 1~2-year local recurrence rate and evaluated the therapeutic effects of CO₂ laser microsurgery. Results Patients were classified into two groups depending on the scope and depth of CO₂ laser microsurgical resection. In the precancerous lesions group, eight patients received a type I operation and one patient received a type II operation. In the glottic laryngeal cancer group, three patients received a type II operation, 11 patients received a type III operation, three patients received a type IV operation, and one patient received a type V operation. One patient underwent open surgery because the surgical margin was positive. None of the other patients underwent tracheotomy, and no serious complications such as airway burns were noted. The patients were offered soft food six hours after surgery; no adverse reactions such as choking or dyspnea were observed. Further, the patients received anti-infective and anti-inflammatory treatment for 2-3 days after surgery. The patients were followed up for 1~2 years postoperatively. The voices of the patients recovered after the operation. Conclusion CO₂ laser laryngeal microsurgery has significant clinical applications in the treatment of laryngeal precancerous lesions and early glottic laryngeal carcinoma, leading to increased safety, less trauma, faster voice recovery, and shorter hospitalization times, in turn leading to larynx function preservation and improvements in the postoperative quality of life.

Objective This study aimed to analyze the causes of repeat keratoplasty and the risk factors for failure of corneal grafts. Methods This retrospective consecutive clinical case series enrolled all cases at Qingdao Eye Hospital, Shandong Eye Institute, between January 2010 and December 2018. Causes of repeat keratoplasty, primary disease before first keratoplasty, surgical methods of the first and repeat keratoplasty, and postoperative complications were analyzed. Statistical analysis was performed using SPSS 22.0 software. Results A total of 2,060 corneal transplants was performed in our hospital, of which 228(11.07%)were repeat keratoplasties. From 2010 to 2018, repeat keratoplasties were performed in 207 eyes of 204(137 male and 67 female)patients-189 eyes with first repeat keratoplasties, 15 eyes with second repeat keratoplasties, and 3 eyes with third repeat keratoplasties. The patient age was 11 to 81(mean: 49.93±14.32)years. The main reasons for repeat keratoplasty were graft ulcers(60 cases, 26.32%), corneal graft endothelial decompensation(58 cases, 25.44%), recurrence of primary disease(41 cases, 17.98%), and graft opacity(32 cases, 14.04%). First keratoplasty was most commonly performed for purulent keratitis(69 eyes, 33.33%), followed by herpes simplex keratitis(32 eyes, 15.46%), corneal burns(22 eyes, 10.63%), and corneal dystrophy and degeneration(21 eyes, 10.14%). Penetrating keratoplasty was performed in 202 cases(88.60%)for repeat corneal transplantation, anterior lamellar keratoplasty was performed in 26 cases(11.40%), and endothelial transplantation was performed in 0 cases. There was a correlation between repeat keratoplasty and previous keratoplasty(continuous correction χ2=43.365, P<0.01). Previous surgery affects the operation of repeat keratoplasties. Infectious keratopathy(P=0.005), graft diameter >8.75 mm(P=0.040), postoperative secondary glaucoma(P=0.027), and corneal graft rejection(P=0.047)were risk factors for penetrating keratoplasty graft failure. In multivariate Cox regression analysis, infectious keratopathy(P=0.011)and graft diameter >8.75 mm(P=0.016)were risk factors for anterior lamellar keratoplasty graft failure. Conclusion The most common cause of repeat keratoplasty was corneal graft ulcer, followed by corneal graft endothelial decompensation, and recurrence of the primary disease. Infectious keratitis was the most common primary disease before the first keratoplasty, followed by herpes simplex keratitis and corneal burns. Previous surgery affects the operation of repeat keratoplasties. Infectious keratopathy, graft diameter >8.75 mm, postoperative secondary glaucoma, and corneal graft rejection were risk factors for penetrating keratoplasty graft failure, whereas infectious keratopathy and graft diameter >8.75 mm were risk factors for anterior lamellar keratoplasty graft failure.