BACKGROUND:The relationship between thyroid hormone sensitivity and the risk of recurrence in patients with papillary thyroid carcinoma (PTC) has not been thoroughly investigated, and it remains unclear whether factors such as thyroid-stimulating hormone suppression efficacy or underlying autoimmune mechanisms mediate this association. The primary objective of the present study was to examine the complex interrelationships among thyroid hormone sensitivity indices and their collective utility as biomarkers for predicting recurrence. METHODS:This study retrospectively analyzed a cohort of 196 patients who underwent initial surgical resection and received a pathological confirmation of PTC between January 2015 and July 2016. Logistic regression analysis was employed to evaluate the potential association of thyroid hormone sensitivity indices-specifically, the thyrotropin index (TSHI) and thyrotroph T4 resistance index (TT4RI)-with PTC recurrence, as well as to assess their predictive utility. RESULTS:In patients with PTC, multivariate logistic regression identified both TSHI ≥ 3.6 and TT4RI ≥ 54.2 as independent prognostic factors associated with reduced recurrence risk (TSHI: OR = 0.107, 95% CI: 0.012-0.948, P = .045; TT4RI: OR = 0.158, 95% CI: 0.026-0.529, P = .005). Furthermore, net reclassification improvement (NRI) and integrated discrimination improvement (IDI) analyses revealed that the inclusion of thyroid hormone sensitivity indices significantly enhanced the predictive accuracy for recurrence events (TSHI: NRI = 0.292, 95% CI: -0.001-0.602, P = .064; IDI = 0.032, 95% CI: 0.013-0.051, P = .001; TT4RI: NRI = 0.663, 95% CI: 0.376-0.951, P < .001; IDI = 0.053, 95% CI: 0.025-0.082, P < .001). Finally, receiver operating characteristic curve analysis demonstrated that the combination of TSHI and TT4RI yielded superior predictive performance, with an area under the curve of 0.790 (P < .001), significantly outperforming either index alone. CONCLUSION:In conclusion, thyroid hormone resistance, indicated by elevated TSHI and TT4RI, represents an independent protective factor against recurrence in PTC. The integration of these indices significantly improves recurrence prediction, with their combination offering superior discriminative ability, highlighting their collective utility as clinically relevant biomarkers for optimizing postoperative surveillance and management strategies in PTC.

Parathyroid carcinoma is a rare endocrine malignancy with unclear etiology, and its clinical manifestations are often difficult to distinguish from parathyroid adenoma. The concurrent occurrence of parathyroid carcinoma, parathyroid adenoma, and thyroid carcinoma is an extremely uncommon clinical scenario. This study retrospectively analyzed the clinical data of a 44-year-old female patient with this concurrent condition who was treated at the Department of Thyroid Surgery, China-Japan Union Hospital of Jilin University. The patient underwent radical resection of left parathyroid carcinoma (including left thyroid lobectomy with isthmusectomy and central compartment lymph node dissection), excision of right parathyroid adenoma, and partial right thyroid lobectomy. Postoperative pathological examination confirmed the diagnoses of parathyroid carcinoma, parathyroid adenoma, thyroid malignant tumor, and nodular goiter. Preoperative diagnosis of this concurrent disease is highly challenging, and intraoperative pathological examination is often required for confirmation. Given the overlapping endocrine tumor patterns, this condition may be associated with underlying multiple endocrine neoplasia syndromes. Therefore, personalized treatment strategies combining precise surgery and long-term endocrine monitoring are crucial to achieve both oncological control and correction of hormonal dysregulation. This study aims to provide useful insights for clinical practice; we also conducted a literature review summarizing the reported features, diagnostic approaches, and treatment options for this condition.

BACKGROUND:Patients with medium and high-risk papillary thyroid carcinoma (PTC) demonstrate significantly poorer clinical outcomes compared to their low-risk counterparts. However, current prognostic stratification for this patient population remains suboptimal due to the absence of reliable biomarkers. This investigation aims to evaluate the clinical utility and prognostic potential of three hematological inflammatory indices: the platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR), and systemic immune-inflammation index (SII) in medium and high-risk PTC cases. METHODS:This study analyzed 1070 PTC patients from the "DTCC study" (2014-2016), a multicenter prospective cohort investigating the initial management of differentiated thyroid cancer (DTC) in China. Preoperative hematological parameters (including PLR, NLR, and SII) and baseline clinical characteristics were evaluated to assess their prognostic significance. RESULTS:In medium and high-risk PTC patients, PLR ≤ 115.6 predicted increased recurrence risk (OR = 4.579, 95% CI: 1.863-11.255, p = 0.001) and worse disease-free survival (DFS; p = 0.001). Multivariate Cox regression confirmed PLR ≤ 115.6 as an independent prognostic factor for reduced DFS (HR = 3.080, 95% CI: 1.115-8.507, p = 0.030). Notably, this association persisted in intermediate-risk patients. Among high-risk PTC patients, however, SII ≤ 360.9 (rather than PLR) demonstrated stronger predictive value for recurrence (OR = 15.154, 95% CI: 1.873-122.640, p = 0.011). Consistently, multivariate analysis identified SII ≤ 360.9 as an independent risk factor for shorter DFS (HR = 14.399, 95% CI: 1.823-113.730, p = 0.011). CONCLUSION:Our findings demonstrate that PLR and SII emerged as risk stratification-specific prognostic biomarkers: PLR independently predicted prognosis in intermediate-risk cases, while SII showed superior predictive value for prognosis in high-risk patients. The differential utility of these indices-PLR for intermediate-risk stratification patients and SII for high-risk stratification patients-highlights their complementary roles in clinical decision-making. As routinely available, cost-effective inflammatory markers, PLR and SII may enhance risk-adapted surveillance strategies, though further validation is warranted to standardize cutoff values and integrate them into existing clinical management systems. TRIAL REGISTRATION:The trial was registered at ClinicalTrials. gov under the identifier NCT02638077.

Background: To explore the effect of lower baseline amplitude on its predictive accuracy of postoperative vocal cord paralysis (VCP) in monitored thyroid surgery. Materials and methods: Clinical and electrophysiological data were collected during thyroid surgeries performed between November and December 2021 at China-Japan Union Hospital. Univariate/multivariate regression analysis were applied to these data to examine a possible correlation. A receiver operating characteristic curve was used to evaluate predictive efficacy. Results: A total of 631 nerves-at-risk (NAR) were identified in 460 patients who were divided into two groups according to postoperative development of VCP. The VCP group included a higher percentage of NAR with V1<1000 (68.2 vs. 40.7%, respectively; P =0.014) and NAR with R1<1400 (77.3 vs. 47.0%, respectively; P =0.005) compared with the non-VCP group. Multivariate regression analysis further identified V1<1000 [odds ratio (OR)=2.688, P =0.038], R1<1400 (OR=3.484, P =0.018) as independent risk factors for postoperative temporary VCP. The receiver operating characteristic curve showed the AUC value of V signal decline for predicting VCP was 0.87. The diagnostic efficiency of R signal decline reached as high as 0.973. A multivariate logistic regression analysis identified independent risk factors for V1<1000 and these included: higher BMI (OR=1.072, P =0.013), hypertension (OR=1.816, P =0.015), smoking (OR=1.814, P =0.031), and male sex (OR=2.016, P =0.027). Conclusion: In our cohort, lower baseline amplitude was an independent risk factor for developing transient postoperative VCP. It also affected the predictive efficacy of intraoperative amplitude changes on VCP. Higher BMI, hypertension, smoking, and male sex may also be closely associated with lower initial amplitude. Thus, maintaining a higher initial amplitude is critical for patient safety during thyroid surgery.

BackgroundPediatric papillary thyroid cancer presents with a more advanced stage of disease than adult PTC; and it is more likely to be aggresive and distant metastases, although the survival rate is high.MethodsA retrospective observational study was performed in children and adults with PTC. Fisher’s exact, chi-square, and rank-sum tests were used to examine the differences. Univariate and multivariate Cox regression analyses were applied to determine the possible risk factors for prognosis. A Kaplan-Meier curve analysis was performed to investigate the relationship between the clinicopathological characteristics and recurrence rate.ResultsThe study involved 156 children and 1,244 adults with PTC. Compared to the group without recurrence, proportions of tumors measuring > 1 cm (48.3% vs. 90.9%) and multifocality (30.3% vs. 63.6%) were higher, N1b stage occurred more frequently (33.8% vs. 100%). However, among adult PTC patients, those with recurrence were older (76.1% vs. 59.4%) than those without recurrence. Risk factors for pediatric PTC recurrence included tumor size and multifocality. However, in adult PTC, the risk factor was LLNM. The newly constructed Stratification.N showed better performance, as illustrated by the fact that patients who were classified into Stratification.N 3 showed an obviously poorer prognosis (P=0.01 and P=0.00062), especially in those aged >14 years (P=0.0052).ConclusionCompared with adult PTC, pediatric PTC showed unique characteristics in terms of clinical pathology and recurrence. Tumor size and multifocality were strong risk factors for pediatric PTC. Accordingly, the novel proposed risk stratification method could effectively predict the recurrence of pediatric PTC.

To examine the putative functions and mechanisms of lysine crotonylation (Kcr) during the development and progression of papillary thyroid cancer (PTC). Samples of thyroid cancer tissues were collected and subjected to liquid chromatography–tandem mass spectrometry. Crotonylated differentially expressed proteins (DEPs) and differentially expressed Kcr sites (DEKSs) were analyzed by Motif, dynamic expression model analysis (Mfuzz), subcellular localization, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway annotation, Go Ontology (GO) annotation, and protein–protein interaction analysis (PPI). Validation was performed by immunohistochemistry (IHC). A total of 262 crotonylated DEPs and 702 DEKSs were quantitated. First, for the tumor/normal comparison, a dynamic expression model analysis (Mfuzz) of the DEKSs revealed that clusters 1, 3, and 4 increased with the progression of thyroid cancer; however, cluster 6 showed a dramatic increase during the transition from N0-tumor to N1-tumor. Furthermore, based on GO annotation, KEGG, and PPI, the crotonylated DEPs were primarily enriched in the PI3K-Akt signaling pathway, Cell cycle, and Hippo signaling pathway. Of note, crosstalk between the proteome and Kcr proteome suggested a differential changing trend, which was enriched in Thyroid hormone synthesis, Pyruvate metabolism, TCA cycle, Cell cycle, and Apoptosis pathways. Similarly, for the LNM comparison group, the DEKSs and related DEPs were primarily enriched in Hydrogen peroxide catabolic process and Tight junction pathway. Finally, according to The Cancer Genome Atlas Program (TCGA) database, the differential expression of Kcr DEPs were associated with the prognosis of thyroid cancer, indicating the prognostic significance of these proteins. Moreover, based on the clinical validation of 47 additional samples, Kcr was highly expressed in thyroid tumor tissues compared with normal tissue (t = 9.792, P < 0.001). In addition, a positive correlation was observed between Kcr and N-cadherin (r = 0.5710, P = 0.0015). Moreover, N-cadherin expression was higher in the relatively high Kcr expression group (χ2 = 18.966, P < 0.001). Higher Kcr expression was correlated with thyroid tumorigenesis and lymphatic metastasis, which may regulate thyroid cancer progression by Pyruvate metabolism, TCA cycle, Cell cycle, and other pathways.

Background Pyroptosis, an inflammatory form of programmed cell death, has been implicated in the pathogenesis and progression of several cancers. However, the significance of pyroptosis-related genes (PRGs) in papillary thyroid cancer (PTC) remains unclear. Methods Transcriptome and clinical data of PTC patients were obtained from The Cancer Genome Atlas. The expression patterns of PRGs were identified by consensus clustering. A prognostic model for predicting the thyroid cancer-free interval (TCFi) employed five machine learning methods. Enrichment and immune-related analyses were performed to elucidate the role of pyroptosis. The responses to radioactive iodine (RAI), immune checkpoint inhibitors (ICIs), molecular targeted therapy (MTT), and chemotherapy (CTx) were predicted based on pyroptosis-derived features. Additionally, the expression of prognostic PRGs was validated via six external datasets, 16 cell lines, and 20 pairs of clinical samples. Results PTC patients were classified into three PyroClusters, C1 exhibited BRFA-like tumors with the highest invasiveness and the worst prognosis, C2 presented RAS-like tumors, and C3 was characterized by gene fusion. Nine PRGs (CXCL8, GJA1, H2BC8, IFI27, PRDM1, PYCARD, SEZ6L2, SIGLEC15, TRAF6) were filtered out to construct a PyroScore prognostic model. A derived nomogram demonstrated superior predictive performance than four clinical staging systems. A strong correlation between pyroptosis and tumor immune microenvironment (TIME) remodeling was observed in mechanistic analyses. Patients with a high PyroScore exhibited “hot” tumor immunophenotypes and had a poorer prognosis but could benefit more from ICIs and CTx (such as paclitaxel). Patients with a low PyroScore were more sensitive to RAI and MTT (such as pazopanib and sorafenib). Conclusions PyroScore model can effectively predict TCFi in patients with PTC. Dysregulated expression of PRGs is associated with the TIME modeling. Pyroptosis features have potential significance for developing novel therapeutic strategies for PTC patients.

Objective:To analyze the potential factors influencing new-onset postoperative transient vocal cord paralysis (VCP) in thyroid cancer patients. Methods:Case information of 8340 thyroid cancer patients hospitalized at China-Japan Union Hospital of Jilin University, Jilin Province, China, in the Thyroid Surgery Department from January 2018 to December 2020 was collected retrospectively and analyzed. The possible influencing factors were analyzed using a chi 2 test, rank-sum test, and multiple logistic regression analysis. A nomogram was used to construct the clinical prediction model that was validated in the validation set by receiver operating characteristic, calibration curves, and Decision curve analysis. Results:The strengthening the reporting of cohort, cross-sectional, and case-control studies in surgery (STROCSS) guideline was followed to conduct a retrospective cohort study. A total of 8340 patients, including 1817 (21.8%) men and 6523 (78.2%) women, were enrolled in this study. The rate of temporary VCP was 3.6% (308/8340). Based on the results of postoperative laryngoscopy, the patients were divided into VCP group and non-VCP group. Comparative analysis between the groups revealed that potential factors associated with postoperative transient VCP were tumor location on the dorsal side of the gland (P=0.042), ultrasound showing a maximum nodal diameter >1 cm (P=0.002), multifocal carcinoma (P<0.001), invasion of surrounding tissue (P=0.005), lymph node metastases in the central compartment (P=0.034), lateral cervical lymph node metastasis (P<0.001), and prolonged operation (P<0.001). A multiple logistic regression analysis showed that the independent risk factors in postoperative transient VCP were T stage (OR=1.411, P=0.013, 95% CI: 1.075-1.853), multifocal carcinoma (OR=1.532, P=0.013, 95% CI: 1.095-2.144), and duration of surgery (OR=1.009, P<0.001, 95% CI: 1.006-1.012). Finally, a clinical prediction model was established via a nomogram and was validated in the validation set, although its diagnostic efficacy needs to be improved further. Conclusion:High T stage, multifocal carcinoma, and prolonged operation time may be independent risk factors for the occurrence of postoperative transient VCP in patients undergoing initial surgery for thyroid cancer.

BackgroundDespite improvements in overall survival, the recurrence of differentiated thyroid cancer (DTC) is becoming more common and remains a challenge necessitating accurate reappraisal of the patient. This study aimed to describe the characteristics, reasons, morbidity, and strategies of second operations for DTC.MethodsThis was a retrospective observational study of patients with DTC who underwent a second surgery between June 2008 and June 2021 in the Department of Thyroid Surgery at China–Japanese Union Hospital, Jilin University, P.R. China. All clinical characteristics were recorded, and the analysis was estimated using SPSS.ResultsSecond surgeries were detected in 683 patients. The proportion of second operations changed with the update of international guidelines from 2015 (P < 0.001). The true recurrence rate progressively increased from 21.3% to 61.5%. The rate of an “absence of preoperative FNA” or an “absence of intraoperative pathology at first surgery” decreased from 49.8% to 12.7%, while that of a “misdiagnosis of preoperative FNA at second surgery” decreased from 10% to 1.8%. The most common tumor location during the second surgery was the lateral lymph nodes (n = 104, 36.5%), with a median time to relapse of 36 months. Completion of thyroidectomy and lymph node dissection correlated with the second operation.ConclusionAfter 2015, second surgeries were more standardized, the incidence of complications decreased, and real recurrence became the most common reason for a second DTC surgery.

Background:No pan-cancer study has been conducted till date to explore the comprehensive oncogenic roles of pyruvate kinase M2 (PKM2).Methods:TCGA, TIMER, GEPIA, UALCAN, STRING, and other databases were used to analyze the expression, prognostic roles, epigenetic variants, and possible oncogenic mechanisms of PKM2. Proteomic sequencing data and PRM were applied to validate.Results:PKM2 showed higher expression in majority of cancers, the expression being significantly correlated with the clinical stage. Higher expression of PKM2 was associated with lower OS and DFS in several cancers, such as MESO and PAAD. In addition, the epigenetic variation of PKM2, including gene alteration, mutation type and sites, DNA methylation, and phosphorylation, showed diversity in different cancers. All four methods indicated that PKM2 is positively associated with the immune infiltration of tumor-associated fibroblasts, such as in THCA, GBM, and SARC. Further mechanistic exploration suggested that the ribosome pathway might play an essential role in the regulation of PKM2, and interestingly, four out of ten hub genes were found to be highly related to OS in several cancers. Finally, in thyroid cancer specimen, we validated the expression and potential mechanisms by proteomic sequencing and PRM validation.Conclusion:In the majority of cancers, the higher expression of PKM2 was highly associated with poor prognosis. Further molecular mechanism exploration implied that PKM2 might serve as a potential target for cancer survival and immunotherapy by regulating the ribosome pathway.

BackgroundCuprotosis is a newly discovered form of cell death that differs from other types of cell death. The aim of this study was to investigate the functional role and a possible prognostic model for thyroid cancer.MethodsTCGA and GEO were used to investigate the differential expression of CRGs in THCA. KEGG and GO enrichment analyses were applied to investigate the possible molecular functions. The features of CRGs were selected by LASSO regression. 20 pairs of samples were randomly collected from the hospital to compare expression between tumor and normal.ResultsAmong the 19 CRGs related to thyroid cancer recurrence, 16 genes were differentially expressed in thyroid cancer. KEGG analysis showed that the 19 CRGs were mainly enriched in cell death, cell cycle and ribosomal pathways. K-M survival analysis and subsequent multiple logistic regression revealed that the expression of BUB1 and GINS2 were potential risk factors for disease-free survival (DFS) of thyroid cancer. In addition, further LASSO-regression selected the following three DFS-related CRGs: FDX1, BUB1 and RPL3. A novel prognostic prediction model was constructed by nomogram, and the prediction probability for 1-, 3- and 5-year survival approached the actual time. As for the possible mechanisms, FDX1, BUB1 and RPL3 were associated with immune infiltration. The cell model experiment illustrated that the ATM signaling pathway might be involved in thyroid cancer cell death.ConclusionThree CRG models (FDX1, BUB1, RPL3) could better predict the prognosis of thyroid cancer. Immune cell infiltration and the ATM pathway were the possible mechanisms.

Background:Medullary thyroid carcinoma (MTC) patients have poor survival, tumor/node/metastasis (TNM) stage and biochemical prognosis are the most important factors. We investigated the clinical significance of calcitonin (Ctn) to assess the biochemical prognosis of MTC.Methods:This retrospective observational study enrolled 77 MTC patients with complete information and primary surgery at the Department of Thyroid Surgery, China-Japan Union Hospital of Jilin University between 2009 and 2020. Patient and MTC characteristics were recorded. All patients were divided into remission, stable, and progression according to biochemical prognosis. We analyzed the correlation between preoperative serum Ctn, TNM stage and biochemical prognosis.Results:Elevated preoperative serum Ctn was positively correlated with TNM stage. Patients with higher Ctn, multifocality, and bilateral tumors were associated with a higher TNM stage. Multivariate logistic regression analysis showed that preoperative serum Ctn level was an independent risk factor for TNM stage. Receiver operating characteristic (ROC) analysis found the best Ctn cut-off value for predicting TNM III was 45.88 pg/mL, which had a sensitivity of 87.2% and a specificity of 65.8%. The best Ctn cut-off value for predicting TNM IV was 167.00 pg/mL, with a sensitivity of 92.9% and a specificity of 77.6%. In univariate analysis, patients with higher preoperative serum Ctn, multifocality, bilateral tumors, and higher TNM stage were more likely to progress. The optimal cut-off value for progression was 195.5 pg/mL, which had a sensitivity of 80.0% and a specificity of 70.2%. For every 1-unit increase in preoperative serum Ctn levels, the risk of progression increased by 1.004 times (P=0.008), and patients with TNM stage III [hazard ratio (HR) =9.663; 95% confidence interval (CI): 1.411, 66.156] were nearly 9.7-fold more likely to progress than those in TNM stage I/II.Conclusions:Elevated preoperative serum Ctn predicted poor clinical outcomes in MTC.

BackgroundNeutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), mean platelet volume (MPV), and platelet distribution width (PDW) have been used as prognostic biomarkers in various cancers. We aim to investigate the relationship between the above inflammatory indices, clinicopathological features, and postoperative calcitonin (Ctn) progression in medullary thyroid carcinoma (MTC).MethodsSixty-eight patients diagnosed with MTC who underwent surgery at our institution between 2009 and 2020 were retrospectively evaluated. Areas under the receiver operating characteristic curves (ROC) and logistic regression were applied to explore the potential risk factors.ResultsPDW was predictive of lymph node metastasis (LN) (AUC=0.645, P=0.044), PLR, PDW, and MPV were predictive of capsule invasion (AUC=0.771, P=0.045; AUC=0.857, P=0.008; and AUC =0.914, P=0.002, respectively), and MPV and LMR were predictive of postoperative Ctn progression (AUC=0.728, P=0.003; AUC=0.657, P=0.040). Multivariate analysis revealed that PDW ≤ 16.4 [(OR=7.8, 95% CI: 1.532-39.720, P=0.013)] and largest tumor size ≥1 cm (OR=4.833, 95% CI: 1.514-15.427, P=0.008) were potential independent risk factors for lateral LN metastasis. We also found that, MPV ≤ 8.2(OR=13.999, 95% CI: 2.842-68.965, P=0.001), LMR ≤ 4.7 (OR=4.790, 95% CI: 1.034-22.187, P=0.045), and N1 (OR=45.890, 95%CI:3.879-542.936, P=0.002) were potential independent risk factors for postoperative Ctn progression. In addition, compared with the single indicator, the appropriate combination of MPV and LMR could improve the specificity and sensitivity of predicting postoperative Ctn progression.ConclusionsPLR, LMR, PDW, and MPV were associated with clinicopathological features and postoperative Ctn progression in MTC, suggesting that those inflammatory indices might be potential biomarkers of MTC.

Background Lymphocyte to monocyte ratio (LMR), platelet to lymphocyte ratio (PLR), mean platelet volume (MPV) and fibrinogen (FIB) have been identified as predictive biomarkers in several malignancies. The aim of this study was to explore the association between inflammatory index with clinicopathologic features as well as recurrence risk in intermediate-to high-risk papillary thyroid carcinoma (PTC). Methods Retrospective evaluation of 212 patients diagnosed with intermediate-to high-risk PTC who underwent surgery at China-Japan Union Hospital between 2015 and 2016. Logistic regression and receiver operating curves (ROC) were used to explore possible risk factors. Results LMR was predictive of capsular invasion (AUC=0.595, P =0.017), FIB was predictive of lymph node metastasis (LN) (AUC=0.714, P =0.002), MPV was predictive of largest LN size ≥1cm (AUC=0.639, P =0.002), PLR and MPV were predictive of recurrence (AUC=0.616, P =0.032; AUC=0.626, P =0.020). In addition, FIB ≤ 2.6 (OR=6.440, 95%CI:1.777-23.336, P =0.005) and capsular invasion (OR=3.773, 95%CI:1.171-12.159, P =0.026) were identified as independent risk factors for lymph node metastasis by multivariate analysis. In addition, LN metastasis ( P =0.048), largest LN size ≥ 1 cm ( P =0.032), MPV > 9.4 ( P =0.046), and PLR ≤ 128.1 ( P =0.032) were significantly related with recurrence. Further multivariate regression analysis revealed that PLR ≤ 128.1 was a potentially independent risk factor for recurrence. Specifically, the risk of recurrence was 2.951 times higher in patients with a PLR ≤ 128.1 compared with patients with a PLR > 128.1 (OR=2.951, 95% CI:1.238-7.037, P =0.015). Conclusion In intermediate-to high-risk PTC, LMR, PLR, MPV, and FIB could predict clinicopathologic features and recurrence, with lower PLR being the potential risk factors for recurrence.

在全世界绝大多数国家,乳腺癌是女性中最常见的恶性肿瘤之一,是目前女性癌症发病和死亡的首要原因.据最新统计数据显示,2020 年乳腺癌新增人数达226 万,已成为全球第一大癌症.在我国,乳腺癌亦是女性最常见的癌症之一,严重威胁着女性的身心健康[1-2].目前我国乳腺癌患者术前诊断方式不统一,手术方式各样,随访内容预测预后效果欠佳.寻找潜在的肿瘤标志物辅助诊断非常有必要.

随着医学研究生教育培养体系深化改革,临床医学硕士专业学位研究生培养,同时与住院医师规范化培训（简称"规培"）相结合,即"并轨制"[1]。"并轨制"实施后,研究生临床能力得到明显提升,临床技能达到"规培"要求,但易出现"重临床,轻科研"的培养偏差,给研究生教育培养体系带来矛盾[2-4]。

目的 探讨神经监测技术在继发性甲状旁腺功能亢进手术中的应用.方法 回顾性分析手术治疗继发性甲状旁腺功能亢进病人59例,术中均应用神经监测技术.结果 术后喉返神经(RLN)损伤暂时性损伤1例(1.6％,1/59),喉镜见左侧声带固定于旁正中位,术后6周双侧声带运动对称、闭合良好.术后无喉上神经及迷走神经损伤症状的病例.在神经监测技术保护下,本组共切除异常甲状旁腺236枚,术中甲状旁腺的位置对RLN损伤没有统计学意义(P＞0.05).异常甲状旁腺平均长径≥2 cm的81枚,其中1例(0.7％)出现RLN损伤;平均长径＜2 cm甲状旁腺134枚,无RLN损伤,异常甲状旁腺大小对RLN损伤没有统计学意义(P＞0.05).手术时间≥1.5 h43例,＜1.5 h 16例,术后一日咽部不适47例,无咽部不适12例,手术时间长短并不是出现RLN损伤的原因,是出现术后出现咽喉部不适的因素(P＜0.05).结论 对继发性甲状旁腺功能亢进病人,术中常规应用神经监测技术对降低喉神经损伤并发症,缩短手术时间有显著应用价值.

Excessive secretion of PTH leads to disturbance of calcium and phosphorus metabolism in the body, which promotes bone, kidney, digestive system and nervous system diseases. Due to the short half-life of PTH, it becomes a difficult issue for PTH detection in the clinical diagnosis field. We explored a competitive immunofluorescent sensing mode based on FRET of two-color CdTe QDs for ratiometric PTH 1–84 antigen detection. The FRET effect and ratiometric fluorescence between the two-color CdTe QDs motivated accurate quantification of PTH 1–84 antigen concentration from 0.01 ng mL−1 to 0.08 ng mL−1 with a limit of detection of 3 pg mL−1. More importantly, under UV irradiation, samples with different concentrations of PTH 1–84 antigen achieved fluorescence visualization, which provides huge possibility for the practical application of PTH 1–84 antigen point-of-care detection.

Background: The aim of this report was dual: (a) to describe the step-by-step standardized intraoperative percutaneous injection of carbon nanoparticles (CNPs) procedure for CNP-stained central compartment lymph nodes (CLNs) and passive display of parathyroid gland by CNP-stained thyroid in endoscopic thyroidectomy via bilateral areola approach (ETBAA) and (b) evaluation and outcomes of percutaneous injection of CNPs in total thyroidectomy plus CLN dissection through ETBAA. Materials and Methods: Video describes the technique of intraoperative percutaneous injection of CNPs for central compartment LNs identification, dissection, and parathyroid glands preservation in ETBAA for papillary thyroid cancer. Results: Supplementary video shows that after intrathyroid injection of CNPs, black carbon can be seen rapidly along the lymphatic vessels to the surrounding LNs. Parathyroid gland can be passive display when the thyroid is black and the parathyroid gland is normal in color. Intraoperative neuromonitoring (Medtronic® NIM-Response 3.0) was applied to identify recurrent laryngeal nerve and external branch of superior laryngeal nerve. No patient had any side effects of CNPs from 152 patients followed up for an average of 19.6 months (6-34 months). LNs were easily found under ETBAA. The accuracy of black-dyed LN in thyroid cancers was 95.9% (1016/1059). The number of parathyroid glands passive display was 69.9% (267/382). Conclusions: It is feasible to use CNPs to show CLNs in thyroid cancer during ETBAA. CNP suspension is safe for thyroidal injection.

目的 探讨超声辅加绘图技术对继发性甲状旁腺功能亢进甲状旁腺术前定位的效果.方法 前瞻性收集2017年6月至2018年6月期间在吉林大学中日联谊医院甲状腺外科行手术治疗的继发性甲状旁腺功能亢进患者20例,术前由术者亲自操作超声检查.前5例(超声组)仅行超声检查,后15例(超声辅加绘图组)采取超声辅加手绘标记技术,记录术前定位与术中甲状旁腺位置的符合率.结果 超声组的超声识别率为77.78％(14/18),病理诊断符合率为100％ (18/18);超声辅加绘图组的超声识别率为93.85％ (61/65),病理诊断符合率为100％ (65/65).2组的超声识别率比较差异有统计学意义(x2=0.850,P＜0.05),超声辅加绘图组的超声识别率较高.超声组患者的手术时间长于超声辅加绘图组(t=0.876,P=O.041).2组患者术后均未出现喉返神经损伤,术后复查喉镜均未出现声带麻痹.结论 对继发性甲状旁腺功能亢进患者,术前超声辅加绘图技术定位甲状旁腺快速而准确,在临床制定手术方案、术中精准切除甲状旁腺及缩短手术时间方面有一定的应用价值.