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Purpose Papillary thyroid carcinoma (PTC) is frequently associated with central lymph node metastasis (CLNM). In the present study, we aimed to identify possible risk factors for CLNM in PTC, including suspicious ultrasound (US) features coexisting with thyroid diseases, immunohistochemical markers, and BRAFV600E. These were used to establish a model to predict the risk of CLNM. Methods From January 2016 to March 2018, we identified a cohort of patients with classic PTC who underwent cervical US and were diagnosed by postoperative pathology. Fine-needle aspiration biopsies were analyzed for the presence ofBRAFV600E, and immunohistochemistry was used to detect tumor markers. US imaging was performed in accordance with a standardized protocol. A model to determine the risk of CLNM was established using the outcomes of univariate and multivariate analyses. Results Age of ≥45 years, male sex, mean tumor diameter of ≥1.0 cm, taller-than-wide tumor shape, multiple PTCs, capsule contact, and HBME-1 expression were significant independent risk predictors of CLNM. Hashimoto’s thyroiditis, nodular goiter, andBRAFV600E were not significantly associated with CLNM. The cutoff value (area under the curve = 0.760) for predicting risk was determined from receiver operating characteristic curves (sensitivity, 75.6 %; specificity, 60.7 %). Conclusions Male sex, age of ≥45 years, mean tumor diameter of ≥1.0 cm, taller-than-wide shape, multiple tumors, capsule contact, and HBME-1 expression were independent predictors of the risk of CLNM in patients with PTC. The risk model may be useful for evaluating patients’ prognoses and selecting optimal surgical strategies.

Amac: Buyuk basit hepatik kistlerin tedavisinde geleneksel alkol skleroterapisinin etkinlii ve guvenilirlii tart›flmal›d›r. Bu cal›fl- mada, basit hepatik kistlerin tedavisinde, tekrarlayan aspirasyon ve alkol enjeksiyonu ad› verilen yeni bir skleroterapi proseduru- nun gelifltirilmesi ve deerlendirilmesi amaclanm›flt›r. Gerec ve Yontem: Araflt›rma prospektif, cift kor, randomize olarak duzen- lenmifltir. Buyuk basit hepatik kisti olan 67 hasta tek seferlik aspirasyon-alkol enjeksiyonu (alkol kaviteye enjekte edildikten 20 da- kika sonra tek seferde aspire edilmifltir) ve tekrarlayan aspirasyon ve alkol enjeksiyonu (kist icindeki hesaplanan alkol konsantras- yonunun %80'e ulaflana kadar kaviteye 30 -70 ml alkol enjeksiyonu ve hemen s›v›n›n k›smen aspirasyonunun 3-6 kez tekrarlanma- s›) olarak 2 gruba randomize edilmifl. Kist boyundaki kuculme yontemler aras› etkinliin karfl›laflt›r›lmas› icin kullan›lm›flt›r. Yon- temlerin guvenilirlii yan etkilerin deerlendirilmesi ve kan alkol duzeyinin 0 - 0,5 - 1 - 2 - 3. saatlerde olculmesi ile deerlendiril- mifltir. Bulgular: Kist hacmindeki kuculme tekrarlayan aspirasyon ve alkol enjeksiyonu grubunda tek seferlik enjeksiyon grubu- na gore anlaml› olaran yuksek bulunmufltur. Ortalama kist hacmindeki kuculme ile son aspire edilen kist s›v›s›ndaki alkol kon- santrasyonu aras›nda tekrarlayan aspirasyon ve alkol enjeksiyonu grubunda anlaml› bir iliflki bulunurken, tek seferlik alkol en- jeksiyonu grubunda anlaml› bir iliflki bulunmam›flt›r. Her iki grupta da minor yan etkiler tespit edilmifltir. Tum hastalarda kan alkol duzeyinde art›fl tespit edilmesine ramen ifllemden sonra 2-3 saat icinde normal deerlere donmufltur. Kan alkol duzeyi de- ¤erlerinde gruplar aras›nda anlaml› bir farkl›l›k tespit edilmemifltir. Sonuc: Tekrarlayan aspirasyon ve alkol enjeksiyonu, buyuk basit karacier kistlerinin tedavisinde tek seferlik alkol terapisine ustundur. Background/aims: The efficacy and safety of traditional alcohol sclerotherapy procedures are controversial in the management of large simple hepatic cysts. In this study, we aimed to develop and evaluate a novel alcohol sclerotherapy procedure, termed repea- ted aspiration and alcohol instillation sclerotherapy, for the treatment of simple hepatic cysts. Materials and Methods: A pros- pective, double-blind, randomized study was performed. Sixty-seven patients with large simple hepatic cysts were randomized into two groups to receive either single-session alcohol retention sclerotherapy (alcohol was instilled into the cyst cavity, kept for 20 mi- nutes and aspirated) or repeated aspiration and alcohol instillation sclerotherapy (instillation of 30-70 ml of alcohol and immedia- te aspiration with repetition 3 to 6 times until the estimated alcohol concentration exceeded 80%). The cyst volume reduction was calculated to compare the efficacy of the two procedures. We evaluated the safety of the procedure by monitoring side effects and as- saying blood alcohol concentrations at 0, 0.5, 1, 2 and 3 hours after sclerotherapy. Results: The cyst volume reduction in patients undergoing repeated aspiration and alcohol instillation sclerotherapy was significantly higher than that in those receiving alcohol- retention sclerotherapy. The concentration of alcohol in the last aspirated cyst fluid was correlated with the mean volume reducti- on in patients undergoing repeated aspiration and alcohol instillation sclerotherapy but not in the alcohol-retention group. Only mi- nor side effects occurred in both groups. Although elevated blood alcohol concentration was noted in all patients, it declined to nor- mal levels within 2-3 hours after treatment. There were no significant differences in blood alcohol concentration between the two groups. Conclusions: Repeated aspiration and alcohol instillation sclerotherapy is superior to single-session alcohol-retention scle- rotherapy in the management of large simple hepatic cysts.

Objective: To explore the possibility of reverting HBV-related hepatic fibrosis and cirrhosis with traditional Chinese medicine (TCM).Methods: A herbal recipe (861), comprising of 10 herbs includingSalvia miltiorrhiza, Astragalus membranaceus andSpatholobus saberectus were used as the antifibrotic agents. Three controlled clinical trials of treating HBV-related fibrosis and early cirrhosis were carried out. A total of 107 patients were assessed clinically and pathologically with double liver biopsies before and after treatment by means of modified Scheuer and Chevallier scoring system. Rat model of hepatic fibrosis induced by CC14 and human albumin immune injury, culture of separated hepatic stellate cells (HSC) were established. Total collagen content of the liver was determined by detection of hydroxyproline, amount of type I, III, IV collagens by histoimmunochemistry, quantitative measurement of mRNA for collagen I, III, IV, transforming growth factor-β (TGF-(3), matrix metalloproteinase (MMP1), MMP2, tissue inhibitor of metalloproteinase (TIMP) in liver tissue by dot blot hybridization. Serum and liver tissue collagenase activity was detected by method of Rajabi M and Emonard H. Histopathological study of liver specimen was done with H. E., Masson and sirius red stain as well as histoimmunochemistry.Results: (1) In HBV-related patients, after six months treatment with 861, the reversion rate was as high as 78% in S2, 82% in S3 (precirrhotic stage) and 75% in S4 (cirrhosis). These results correspond well with that obtained in animal experiment. (2) Total and type I, III, V collagen content in animal model liver were significantly reduced in amount after 861 treatment, whereas quantitation of mRNA for collagen I, III, V and TGF-β were also markedly suppressed either in liver tissue or cultured HSC, suggesting the suppression by 861 on fibrogenesis. At the same time, serum and liver tissue collagenase activity (latent and active) were enhanced significantly by administration of 861, while mRNA for MMP1 (interstitial collagenase) in cultured HSC and collagenase activity in the supernatant of the HSC culture were both increased, and meantime, mRNA for TIMP1 was significantly suppressed in quantity, indicating the enhancement of excessive extracellular matrix (ECM) degradation after 861 treatment.Conclusions: (1) Contrary to the conventional concept, the liver fibrosis and early cirrhosis due to HBV infection in man could be definitely reversed by TCM treatment of 861. This was also verified in CCI4 and immune injury models. (2) The mechanism leading to the reversal of fibrosis was due to suppression of fibrogenesis, and the concurrent enhancement of ECM degradation. In the latter, suppression of TIMP also plays an important role. (3) Both initiation by imflammation and perpetuation of the activation of HSC were suppressed by the 861.