BACKGROUND:Papillary thyroid carcinoma (PTC) frequently metastasises to lymph nodes, with lymph node metastasis (LNM) occurring with high frequency in small, early-stage tumors. The present study examines the inverse l-shaped relationship between tumor size and the likelihood of LNM in patients diagnosed with PTC. METHODS:We performed a detailed retrospective cohort analysis of 48,021 cases of papillary thyroid cancer using data from the Epidemiology, and End Results (SEER) database from 1992 to 2019. Our study used various analytical methods, including logistic regression, spline curve fitting, and variable interaction assessment, to clarify the association between tumor size and LNM rates. We rigorously controlled for potential confounders such as patient age, sex, ethnicity, tumor size, extrathyroidal extension (ETE), histopathological characteristics and distant metastases. In addition, we thoroughly investigated and quantitatively assessed the relationship between adjusted tumor size measurements and the likelihood of LNM development. RESULTS:The median tumor size among the 48,021 patients diagnosed with PTC was 1.3 cm. Among these patients, 12,365 (25.75%) had LNM, with a median tumor size of 1.9 cm in this group. A comparative analysis shows a significant difference in tumor sizes between PTC patients who were LNM-positive and those who were LNM-negative. The relationship between tumor size and the likelihood of LNM exhibits a distinct nonlinear pattern. Specifically, below a diameter threshold of 1.978 cm, the probability of LNM significantly increases with larger tumor sizes (odds ratio [OR] = 2.363, 95% confidence Interval [CI]: 2.214-2.523). Once this threshold is surpassed, the effect of tumor size on LNM incidence levels off (OR = 1.031, 95% CI: 1.003-1.061). CONCLUSION:The results of this study confirm that tumor size significantly determines the likelihood of LNM in patients with PTC. We found an inverse l-shaped relationship between tumor size and the probability of LNM. As the tumor size increased below 1.978 cm, the likelihood of LNM increased, but not with tumor size above that threshold. These findings provide new insights into the complex relationship between tumor size and LNM in PTC.

目的 观察皮下组织整形联合超减张缝合减轻甲状腺结节患者术后瘢痕形成的效果.方法 招募2020 年7 月至2021 年7 月于广西壮族自治区南溪山医院行甲状腺开放手术的甲状腺结节患者400 例,采用随机数字表法将其分为对照组和观察组,每组200 例.观察组采用皮下组织整形联合超减张缝合法,对照组采用传统单纯间断缝合法.比较两组术后24 h、48 h疼痛程度、术后切口皮瓣水肿发生率,以及术后6 个月及1 年温哥华瘢痕评估量表(VSS)瘢痕指数评分.结果 两组均未出现术口感染、术口裂开情况,术口达甲级愈合,术后切口皮瓣水肿发生率比较差异无统计学意义(P＞0.05).两组术后24h及48h视觉模拟量表(VAS)评分比较差异无统计学意义(P＞0.05).在术后6 个月及 1 年,观察组VSS瘢痕指数评分低于对照组,差异有统计学意义(P＜0.05).结论 皮下组织整形联合超减张缝合可有效减轻甲状腺结节患者术后瘢痕形成,值得临床推荐.

OBJECTIVETo study whether ulinastatin has a protective role in cold preservation of liver and its mechanism.METHODSTo study the role of ulinastatin in protection of liver after cold preservation, the isolated rat liver with perfused either with cold perfusion fluid or perfused with cold perfusion fluid with ulinastatin. Liver tissue was harvested at 0, 12 and 24 hours after cold perfusion, and morphological changes were examined, alanine aminotransferase (ALT), lactate dehydrogenase (LDH), myeloperoxidase (MPO), malondialdehyde (MDA) and superoxide dismutase (SOD) contents were also determined.RESULTSALT, LDH, MPO and MDA contents were significantly lower in ulinastatin group than those in the control group at 12 and 24 hours, and levels of ALT, LDH, MDA and MPO were increased along with prolongation of preservation time (all P<0.01), but SOD was higher in ulinastatin group than the control group and it was increased along with the prolongation of time (all P<0.01). Compared with ulinastatin group, the control group showed obvious pathological changes.CONCLUSIONProtective effect of UW solution used in clinic weakens gradually as cold preservation time is prolonged. Ulinastatin has protective effect on liver against cold preservation injury, and its effect is better than the simple UW solution. Its mechanism is related to inhibition of anti-oxidation and aggregation neutrophil's accumulation effect of ulinastatin.

OBJECTIVE:To investigate the protective mechanism of dipyridamole preconditioning against hepatic ischemia/reperfusion injury. METHODS:Thirty SD rats were randomly divided into normal control group, ischemia/reperfusion group, and dipyridamole group, with 10 rats in each group. Using 45-minute ischemia/reperfusion rat model at normal temperature, 10 mg/kg of dipyridamole normal saline were injected into portal vein before ischemia. Only normal saline was injected in the ischemia/reperfusion group. An hour later, blood was obtained from the portal vein to determine the enzyme levels, including alanine aminotransferase (ALT) , lactate dehydrogenase (LDH) and tumor necrosis factor-alpha (TNF-alpha), and endothelin-1 (ET-1). The alteration in pathological morphology of the ischemia lobe was observed. The content of adenosine phosphates in the liver was determined. RESULTS:The ALT and LDH activity, TNF-alpha, ET-1 levels were significantly higher in the ischemia/reperfusion group than those in the control group (all P<0.01). The levels of these variables were much lower in the dipyridamole group than those of the ischemia/reperfusion group (P<0.01), but little higher than those of the control group (P>0.05). The adenosine phosphates levels of ischemia/reperfusion group were significantly lower than those of the control group (P<0.01). They were much higher in the dipyridamole group than those of the ischemia/reperfusion group (P<0.01), but little higher than those of the control group (P>0.05). The control group had obvious alteration in pathological morphology, but only slight alteration was found in dipyridamole group, compared with control group. CONCLUSION:Dipyridamole preconditioning protects against ischemia/reperfusion injury of the liver.

目的为了探讨重症急性胰腺炎的治疗方法。方法回顾性分析1999~2006年收治的51例重症急性胰腺炎的治疗临床资料。结果在271例急性胰腺炎病例中诊断重症急性胰腺炎51例(18.8%)。其中41例(80.4%)治愈,10例(19.6%)死亡。手术治疗13例,7例治愈,6例死亡,手术死亡率41.6%。结论对重症急性胰腺炎本文主张实施个体化治疗原则。对于暴发性急性胰腺炎早期行网膜囊连续灌洗,为预防继发性感染和减少手术创伤,后腹膜及胰包膜不必切开。