A cross-specialty survey to assess the application of risk stratified surgery for differentiated thyroid cancer in the UK

Introduction

This study describes variability of treatment for differentiated thyroid cancer among thyroid surgeons, in the context of changing patterns of thyroid surgery in the UK.

Methods

Hospital Episodes Statistics on thyroid operations between 1997 and 2012 were obtained for England. A survey comprising six scenarios of varying ‘risk’ was developed. Patient/tumour information was provided, with five risk stratified or non-risk stratified treatment options. The survey was distributed to UK surgical associations. Respondent demographics were categorised and responses analysed by assigned risk stratified preference.

Results

From 1997 to 2012, the Hospital Episode Statistics data indicated there was a 55% increase in the annual number of thyroidectomies with a fivefold increase in otolaryngology procedures and a tripling of cancer operations. Of the surgical association members surveyed, 264 respondents reported a thyroid surgery practice. Management varied across and within the six scenarios, and was not related consistently to the level of risk. Associations were demonstrated between overall risk stratified preference and higher volume practice (>25 thyroidectomies per year) (p=0.011), fewer years of consultant practice (p=0.017) and multidisciplinary team participation (p=0.037). Logistic regression revealed fewer years of consultant practice (odds ratio [OR]: 0.96/year in practice, 95% confidence interval [CI]: 0.922–0.997, p=0.036) and caseload of >25/year (OR 1.92, 95% CI: 1.044–3.522, p=0.036) as independent predictors of risk stratified preference.

Conclusions

There is a substantial contribution to thyroid surgery in the UK by otolaryngology surgeons. Adjusting management according to established case-based risk stratification is not widely applied. Higher caseload was associated with a preference for management tailored to individual risk.     

Metabolic syndrome: treatment of hypertensive patients

Metabolic syndrome (MetSyndr), a constellation of abnormalities [obesity, glucose intolerance, insulin resistance (IR), dyslipidemia (low HDL-cholesterol, high LDL-cholesterol and triglycerides (TG)], and elevated blood pressure (BP)], increases the risk of cardiovascular (CV) disease and premature death. From 10% to 30% of the adult population in industrialized countries has MetSyndr, which effectively predicts the development of type 2 diabetes mellitus (T2D) and CV disease. Because of the complex etiology of MetSyndr, a multi-targeted, integrated therapeutic approach is required to simultaneously treat high BP, obesity, lipid disorders and T2D (if present), to fully protect CV, cerebrovascular and renal systems. If lifestyle modification (weight control, diet, exercise, smoking cessation, moderation of alcohol intake) is ineffective, pharmaco-theraphy should be added to treat simultaneously the lipid- and non-lipid CV risk factors.Patients with HTN and MetSyndr should be started on angiotensin-converting enzyme (ACE) inhibitors, unless contraindicated. The ACE inhibitors and angiotensin receptor blockers (ARBs) reduce the odds of developing new onset T2D and also decrease albuminuria. The ACE inhibitors provide cardioprotective and renoprotective benefits beyond their effect on BP; they also improve IR. The ARBs are renoprotective in addition to being cardioprotective. Long-acting calcium channel blockers are also recommended in hypertensive patients with MetSyndr; these drugs also improve IR. Thiazides (at low doses) and selected ss-blockers can be given to patients with HTN and MetSyndr. Celiprolol in combination with diuretics has a favorable effect on glucose tolerance and IR in patients with HTN and MetSyndr, and spironolactone added to ACE inhibitor or ARB therapy provides additional reno- and CV protective benefits in patients with diabetic nephropathy. Carvedilol, a ss-blocker with vasodilating properties, added to ACE inhibitor or ARB therapy, is effective in preventing worsening of microalbuminuria in patients with HTN and MetSyndr; it also improves IR and glycemic control. Most patients eventually require two or more antihypertensive drugs to reach BP goal. It is recommended that therapy in patients whose BP is more than 20/10 mm Hg above target at diagnosis be initiated with a combination of antihypertensive drugs, administered either as individual drugs or as fixed-dose formulations. Treatment with fixed-dose combinations, such as irbesartan + hydrochlorothiazide provides good BP control in more than two-thirds of hypertensive patients with MetSyndr. Lipid and BP targets are reached in a high percent of patients with HTN and CV disease treated with a combination of amlodipine + atorvastatin.In conclusion, hypertensive patients with the MetSyndr be treated aggressively for each component of the syndrome to provide CV, cerebrovascular and renal protection.     

Survivin、血管内皮生长因子及微血管密度在正常胆管组织和胆管癌组织中的比较

目的:观察Survivin基因表达与胆管癌血管发生的关系。方法:实验于2006-02/05在安徽省立医院实验室完成。选取安徽省立医院1999-03/2006-02手术切除胆管癌标本32例,其中男16例,女16例,术前均未作放疗、化疗等抗肿瘤治疗;正常胆管组织9例,来源于法医系获得的交通意外死亡者标本,所有标本均经病理证实,应用免疫组织化学S-P法检测Survivin、血管内皮生长因子、微血管密度在32例胆管癌组织标本和9例正常胆管组织标本中的表达。结果:①在胆管癌组织中检测到CD34、血管内皮生长因子和Survivin的表达,而在正常胆管组织中无Survivin表达,且胆管癌组织中微血管密度值、Survivin、血管内皮生长因子的阳性表达率显著高于正常胆管组织。②胆管癌组织微血管密度值、血管内皮生长因子、Survivin的表达与转移有相关性。Survivin基因的表达与患者的性别、年龄、肿瘤的大小、分化无关。③32例胆管癌病例中,血管内皮生长因子阳性表达的有21例,其平均微血管密度为62.97;在Survivin表达阴性的9例病例中,只有1例血管内皮生长因子表达阳性,表明血管内皮生长因子表达与Survivin表达密切相关。结论:Survivin与胆管癌血管发生有密切联系,其在胆管癌中高度表达可能与胆管癌的发生、发展、转移有关。     

Calcium antagonists and atherosclerosis protection in hypertension

Calcium antagonists are effective in hypertensive patients of all ethnic groups, irrespective of age, dietary salt intake, salt-sensitivity status or plasma renin activity profile. Some prospective studies show that the calcium antagonists, nifedipine GITS and nitrendipine, reduce cardiovascular morbidity and mortality at least to the same extent as the diuretics. Other prospective studies are in progress to evaluate the effect of calcium antagonists on cardiovascular morbidity and mortality, and the progression of atherosclerosis in hypertensive patients. Calcium antagonists, especially the highly lipophilic amlodipine, lacidipine and nisoldipine, are shown to possess antioxidant properties. These drugs reduce the oxidation of LDL and its influx into the arterial wall, and reduce atherosclerotic lesions in animals. Platelet production of malondialdehyde, a marker of oxygen free radical formation, is suppressed by amlodipine, lacidipine or nifedipine in hypertensive patients. New evidence from long-term clinical trials of calcium antagonists indicates that these drugs can reduce the rate of progression of atherosclerosis in hypertensive and coronary heart disease patients. In the Regression Growth Evaluation Statin Study (REGRESS), co-administration of calcium antagonist, amlodipine or nifedipine with pravasatin caused a significant reduction in the appearance of new angiographic lesions. In the Verapamil in Hypertension and Atherosclerosis Study (VHAS), verapamil was more effective than chlorthalidone in promoting regression of thicker carotid lesions in parallel with a reduction in the incidence of cardiovascular events. In the Prospective Randomized Evaluation of the Vascular Effects of Norvasc Trial (PREVENT), amlodipine slowed the progression of early coronary atherosclerosis in patients with coronary artery disease. In a subprotocol of the Intervention as a Goal in the Hypertension Treatment (INSIGHT) study, nifedipine GITS significantly decreased intima-media thickness as compared to co-amilozide (hydrochlorothiazide + amiloride). Preliminary results of the European Lacidipine Study on Atherosclerosis (ELSA) show that lacidipine reduced the intima-media thickness progression rate as compared to atenolol. Thus, selective calcium antagonists are potential antiatherosclerotic agents.     

同期放化疗治疗晚期非小细胞肺癌

目的探讨长春瑞滨联合顺铂同期放疗综合治疗晚期非小细胞肺癌的疗效和毒副作用。方法对33例晚期非小细胞肺癌患者进行同期放化疗,化疗在放疗开始时同期进行,用药长春瑞滨25mg／m^2第1、8天静脉滴注;顺铂40mg／m^2第1、2天静脉滴注。28d为1个周期,共给6周期。放疗采用常规分割照射（1．8～2Gy／次,5次／周）,总剂量为45～55Gy。治疗结果与同期单纯放疗的41例晚期非小细胞肺癌进行对照。结果放化同期组的近期有效率为57．6％,单纯放疗组为34．1％（x^2=4．06,P〈0．05）。放化同期组1、2年生存率分别为63、6％、39．4％,单纯放疗组分别为29．3％、14．696（1年生存率的卡方检验：x^2=8．74,P〈0．01;2年生存率的卡方检验：x^2=5．87,P〈0．05）。放化同期组肿瘤进展时间平均为10．2个月,单纯放疗组为4．5个月（Log Rank检验：x^2=6．34,P〈0．05）。两组结果相比有显著性差异。两组患者治疗过程中出现的毒副反应主要为骨髓抑制,以及放射性食管炎等。但所有病例均顺利完成治疗过程,无治疗相关死亡。结论长春瑞滨联合顺铂同期放疗可以提高晚期非小细胞肺癌的近期疗效和远期生存率,是一种安全有效的综合治疗手段。     

椎板开窗手术治疗腰椎间盘突出症108例分析

目的　探讨椎板开窗法摘除髓核治疗腰椎间盘突出症的可行性及其手术操作要点。方法　对10 8例腰椎间盘突出症行椎板开窗法摘除髓核术并对疗效作出评价。结果　采用椎板开窗法摘除髓核术治疗腰椎间盘突出症 ,疗效优良达 97%。结论　本术式具有操作简便、损伤小、出血少、病人恢复快等优点 ,值得临床推广。     

CT诊断肾损伤的应用研究

目的评价CT检查诊断急性肾损伤的应用价值及其临床意义。方法回顾性分析33例急性肾损伤的CT影像特征。结果Ⅰ型肾挫伤（肾内血肿）2例，Ⅱ型包膜下血肿11例，Ⅲ型严重肾损伤（肾横断或碎裂）14例，Ⅳ型单纯肾周血肿6例。结论CT检查迅速、安全，可明确诊断并确定肾损伤类型，为临床诊疗提供可靠依据，宜作为首选检查方法。     

Gender-specific leptinemia and its relationship with some components of the metabolic syndrome in Moroccans

The levels of the liporegulatory hormone leptin are increased in obesity, which contributes to the metabolic syndrome; the latter is associated with elevated cardiovascular risk and morbidity. Leptin may play a role in the metabolic syndrome since correlations have been observed between serum leptin levels and several components of the metabolic syndrome. The association of leptinemia and hypertension or diabetes is inconsistent. Leptin levels are higher in females versus males and obese versus lean individuals. We investigated if correlations exist between leptin levels and several indices of the metabolic syndrome in obese and lean Moroccan subjects with (63 males, 129 females) and without (123 males, 234 females) diabetes and/or hypertension. Plasma glucose and insulin and systolic and diastolic blood pressures were higher in obese versus lean individuals. Obesity had no effect on lipid profile, plasma IGF-1, or C-peptide levels. Leptin levels were higher in females versus males and in obese versus lean individuals. The levels correlated significantly with body mass index. Serum leptin concentration did not correlate with either systolic or diastolic blood pressure, although there was a trend for higher blood pressure with increased leptin levels in females. There was no significant difference in leptin levels between NIDDM patients and healthy controls. However, in hypertensive patients, leptin levels were significantly higher in both lean males and females with diabetes as compared to those without diabetes. Similarly, the higher leptin levels paralleled elevated insulin levels in obese nondiabetic males and females, and in male and female diabetics with hypertension. Correlations were observed between leptin levels and C-peptide (an estimate of endogenous insulin secretion), but not with serum IGF-1. The calculated values of HOMA-IR, a marker of insulin resistance, were somewhat higher, parallel with elevated leptin levels, in obese male and female individuals compared to their lean counterparts. There was no relationship between leptin levels and serum lipids. There was a trend for increased serum uric acid levels with higher leptin concentrations. Thus, leptinemia is related to some components of metabolic syndrome, and in turn, it may contribute to the syndrome. This study is novel in that relationships were determined between leptin levels and various indices of metaboli syndrome in a large population of the same ethnic/regional background.     

AP-1和肿瘤的关系研究进展

转录因子AP-1(activatorprotein1),主要由Jun、Fos、ATF及JDP亚家族组成,亚家族单体以同源或异源二聚体的形式结合DNA靶序列,参与靶基因调节.对基因修饰小鼠和细胞的研究表明,AP-1参与细胞的正常生长和癌性转化过程,其在细胞中的作用取决于细胞类型、AP-1的组成和各组分的相对比例,也与刺激的种类密切相关.AP-1的活性受多种核因子调节,同时单体间也存在相互促进或拮抗作用.AP-1对各种刺激如应激、辐射或生长信号等作出生理或病理应答,参与细胞的增殖、分化和转化等过程,在肿瘤的形成、转移和侵袭中发挥重要作用,已经有学者研究通过抑制AP-1活性来发展抗肿瘤药物.