目的 探讨峡部甲状腺乳头状癌（papillary thyroid carcinoma，PTC）更合理的治疗方式。方法 选取2007年5月至2013年12月本组手术治疗的90例峡部PTC患者，对患者是否多发癌灶、侵犯甲状腺被膜、中央区（Ⅵ区）淋巴结转移情况及之间的相...目的 探讨峡部甲状腺乳头状癌（papillary thyroid carcinoma，PTC）更合理的治疗方式。方法 选取2007年5月至2013年12月本组手术治疗的90例峡部PTC患者，对患者是否多发癌灶、侵犯甲状腺被膜、中央区（Ⅵ区）淋巴结转移情况及之间的相关性进行分析，并与82例腺体内PTC患者资料进行对比。结果 峡部癌组多灶癌与单发癌患者年龄比较（49．4±9．9 vs 42．7±9．5）岁，差异有统计学意义（P=0．004）；癌灶侵犯甲状腺被膜者与未侵犯被摸者肿瘤直径比较（1．02±0．43 vs 0．74±0．28）cm，差异有统计学意义（P=0．001）。峡部癌组多灶癌比例高于腺体内癌组（27．8 vs 14．6）％，差异有统计学意义（P=0．036），侵犯被膜的比例也显著高于腺体内癌组（42．2 vs 19．5）％，差异有统计学意义（P=0．001）；峡部癌组Ⅵ区淋巴结转移率高于腺体内癌组（53．3 vs 48．8）％，但差异无统计学意义（P=0．551）。结论 峡部PTC早期即可侵犯甲状腺被膜及多发癌灶，Ⅵ区淋巴结转移出现较早，且可为双侧转移。多数患者宜行双侧甲状腺全切除＋双侧Ⅵ区淋巴结清扫术，但对侧Ⅵ区清扫仅需清扫至气管旁即可，无需深入喉返神经后方。展开更多
Due to a complex geological and biotic history,the Isthmus of Tehuantepec(IT),has been long recognized as a driver for the evolutionary divergence of numerous lowland and highland taxa.Widely distributed in the lowlan...Due to a complex geological and biotic history,the Isthmus of Tehuantepec(IT),has been long recognized as a driver for the evolutionary divergence of numerous lowland and highland taxa.Widely distributed in the lowlands of the American continent,the White-Tipped Dove(Leptotila verreauxi)is a polytypic species with 13 recognized subspecies.Four of these have been recorded in Mexico,and the distribution of three abuts at the IT,suggesting a contact zone.To estimate phylogenetic patterns,divergence times and genetic differentiation,we examined two mt DNA(ND2 and COI)and one n DNA(β-fibint 7)markers.We also used correlative ecological niche models(ENM)to assess whether ecological differences across the IT may have acted as a biogeographical boundary.We estimated paleodistributions during the Middle Holocene,Last Glacial Maximum and Last Interglacial,to evaluate the influence of climate changes on the distribution and demographic changes.Our results showed genetically distinct lineages that diverged approximately 2.5 million years ago.Climatic and ecological factors may have played a dual role in promoting differentiation,but also in the formation of a secondary contact zone in the southern IT.Our ecological niche comparisons indicated that the ecological niche of sympatric lineages at the IT are not identical,suggesting niches divergence;in addition,environmental niche models across the region indicated no abrupt biogeographic barriers,but the presence of regions with low suitability.These results suggest that genetic differentiation originated by a vicariant event probably related to environmental factors,favored the evolution of different ecological niches.Also,the absence of a biogeographic barrier but the presence of less suitable areas in the contact regions,suggest that secondary contact zones may be also maintained by climatic factors for the eastern group,but also by biotic interactions for the western group.展开更多
Objective: The purpose of this study is to evaluate the clinicopathologic characteristics and treatment outcomes of Papillary Thyroid Carcinomas (PTC) of the isthmus and to establish an appropriate surgical strategy. ...Objective: The purpose of this study is to evaluate the clinicopathologic characteristics and treatment outcomes of Papillary Thyroid Carcinomas (PTC) of the isthmus and to establish an appropriate surgical strategy. Methods: Thirty-four patients with PTC in isthmus are managed by surgery in National Cancer Center/Cancer Hospital of Chinese Academy of Medical Sciences, Peking Union Medical College from 1985-2008. Demographic data, surgical procedures, pathological features, stages and outcomes are analyzed. Results: Seven patients were men and 27 were women. The median age was 41 years (range, 20 - 71). Twenty-five patients were treated with thyroid isthmusectomy or wide field isthmusectomy, five with hemithyroidectomy (lobectomy and isthmusectomy) and four with hemithyroidectomy and partial resection of the contralateral lobe. Twenty-eight patients had a pathologically T1 lesion (pT1);two patients had a pT2 lesion and four had a pT3 lesion. Five patients (14.7%) had papillary carcinoma detected in one of the pretracheal lymph nodes. Thirty-two patients had a solitary lesion confined to the thyroid isthmus. One patient had two lesions in the thyroid isthmus and another one had two lesions located in the thyroid isthmus and right lobe respectively. With a median follow-up of 94 months (range, 12 - 274), two patients had a recurrence and both survived after a re-operation. There was no regional lymph node or distant organ recurrences. No deaths occurred. Conclusions: Isthmusectomy or wide field isthmusectomy could be a sufficient treatment for PTC confined to the thyroid isthmus. We also recommend that pretracheal lymph node dissection be considered.展开更多
Background Previous studies have investigated the technique of linear ablation at the mitral isthmus （MI） in patients with idopathic atrial fibrillation （AF）, but MI ablation in patients with prosthetic natural mi...Background Previous studies have investigated the technique of linear ablation at the mitral isthmus （MI） in patients with idopathic atrial fibrillation （AF）, but MI ablation in patients with prosthetic natural mitral valves （MVs） was not described in detail. Present study sought to summarize our initial experience of ablating MI in patients with prosthetic MVs Methods Patients with drug refractory AF and prosthetic MVs were eligible for this study, and the patients with natural MVs but received MI ablation served as control group. Left atrium （LA） mapping and ablation was carried out guided by CARTO system. The anatomy of MI was assessed via computer topography scan. Results During the study period, a consecutive of 19 patients （male/female=12/7, mean age of （48±6） years） with prosthetic MVs （16 with metal valves, 3 with biologic valves） entered for AF ablation, other 35 patients served as control group. In study group, mapping along MI documented lower voltages （（2.0±1.0） vs. （3.1±1.3） mV, P=-0.002）, more fragmented potentials （19/19 vs. 20/15, P 〈0.001 ）, and higher impedance （（132±34） vs. （110±20） Ω, P=0.004）. After initial ablation, more residual gaps along the MI lesions were found in study group （2.4±0.4 vs. 1.7±0.3, P 〈0.001）. The mean length of MI （（6.2±3.3） vs. （7.1±2.3） cm, P=-0.25） was comparable between 2 groups, but the MI in study group was much thicker （（3.1±1.8） vs. （2.1±1.07） cm, P=0.01） and all were found as pouch type （19/19 vs. 2/35, P 〈0.001）. The follow-up results were comparable （65.1% vs. 72.3%, P=-0.30）. Conclusion For patients with prosthetic MVs, linear ablation at MI could be successfully carried out despite anatomical and pathological changes.展开更多
近年来,随着甲状腺乳头状癌(papillary thyroid carcinoma,PTC)的发病率逐渐升高,峡部甲状腺乳头状癌(papillary thyroid carcinoma of the isthmus,PTCI)的患者也越来越多,目前对其诊治尚无统一的观点。我们检索了近5年国内外文献,对P...近年来,随着甲状腺乳头状癌(papillary thyroid carcinoma,PTC)的发病率逐渐升高,峡部甲状腺乳头状癌(papillary thyroid carcinoma of the isthmus,PTCI)的患者也越来越多,目前对其诊治尚无统一的观点。我们检索了近5年国内外文献,对PTCI的流行病学及目前临床诊断和治疗中的进展作一综述,为今后PTCI的临床决策提供参考。展开更多
文摘目的 探讨峡部甲状腺乳头状癌（papillary thyroid carcinoma，PTC）更合理的治疗方式。方法 选取2007年5月至2013年12月本组手术治疗的90例峡部PTC患者，对患者是否多发癌灶、侵犯甲状腺被膜、中央区（Ⅵ区）淋巴结转移情况及之间的相关性进行分析，并与82例腺体内PTC患者资料进行对比。结果 峡部癌组多灶癌与单发癌患者年龄比较（49．4±9．9 vs 42．7±9．5）岁，差异有统计学意义（P=0．004）；癌灶侵犯甲状腺被膜者与未侵犯被摸者肿瘤直径比较（1．02±0．43 vs 0．74±0．28）cm，差异有统计学意义（P=0．001）。峡部癌组多灶癌比例高于腺体内癌组（27．8 vs 14．6）％，差异有统计学意义（P=0．036），侵犯被膜的比例也显著高于腺体内癌组（42．2 vs 19．5）％，差异有统计学意义（P=0．001）；峡部癌组Ⅵ区淋巴结转移率高于腺体内癌组（53．3 vs 48．8）％，但差异无统计学意义（P=0．551）。结论 峡部PTC早期即可侵犯甲状腺被膜及多发癌灶，Ⅵ区淋巴结转移出现较早，且可为双侧转移。多数患者宜行双侧甲状腺全切除＋双侧Ⅵ区淋巴结清扫术，但对侧Ⅵ区清扫仅需清扫至气管旁即可，无需深入喉返神经后方。
基金the financial support for this study by PAPIIT-UNAM grant(IN222817)to LAS-Gthe Fran?ois Vuilleumier Fund for Neotropical Bird Research from the Neotropical Ornithological Society(NOS)awarded to OJE-C。
文摘Due to a complex geological and biotic history,the Isthmus of Tehuantepec(IT),has been long recognized as a driver for the evolutionary divergence of numerous lowland and highland taxa.Widely distributed in the lowlands of the American continent,the White-Tipped Dove(Leptotila verreauxi)is a polytypic species with 13 recognized subspecies.Four of these have been recorded in Mexico,and the distribution of three abuts at the IT,suggesting a contact zone.To estimate phylogenetic patterns,divergence times and genetic differentiation,we examined two mt DNA(ND2 and COI)and one n DNA(β-fibint 7)markers.We also used correlative ecological niche models(ENM)to assess whether ecological differences across the IT may have acted as a biogeographical boundary.We estimated paleodistributions during the Middle Holocene,Last Glacial Maximum and Last Interglacial,to evaluate the influence of climate changes on the distribution and demographic changes.Our results showed genetically distinct lineages that diverged approximately 2.5 million years ago.Climatic and ecological factors may have played a dual role in promoting differentiation,but also in the formation of a secondary contact zone in the southern IT.Our ecological niche comparisons indicated that the ecological niche of sympatric lineages at the IT are not identical,suggesting niches divergence;in addition,environmental niche models across the region indicated no abrupt biogeographic barriers,but the presence of regions with low suitability.These results suggest that genetic differentiation originated by a vicariant event probably related to environmental factors,favored the evolution of different ecological niches.Also,the absence of a biogeographic barrier but the presence of less suitable areas in the contact regions,suggest that secondary contact zones may be also maintained by climatic factors for the eastern group,but also by biotic interactions for the western group.
文摘Objective: The purpose of this study is to evaluate the clinicopathologic characteristics and treatment outcomes of Papillary Thyroid Carcinomas (PTC) of the isthmus and to establish an appropriate surgical strategy. Methods: Thirty-four patients with PTC in isthmus are managed by surgery in National Cancer Center/Cancer Hospital of Chinese Academy of Medical Sciences, Peking Union Medical College from 1985-2008. Demographic data, surgical procedures, pathological features, stages and outcomes are analyzed. Results: Seven patients were men and 27 were women. The median age was 41 years (range, 20 - 71). Twenty-five patients were treated with thyroid isthmusectomy or wide field isthmusectomy, five with hemithyroidectomy (lobectomy and isthmusectomy) and four with hemithyroidectomy and partial resection of the contralateral lobe. Twenty-eight patients had a pathologically T1 lesion (pT1);two patients had a pT2 lesion and four had a pT3 lesion. Five patients (14.7%) had papillary carcinoma detected in one of the pretracheal lymph nodes. Thirty-two patients had a solitary lesion confined to the thyroid isthmus. One patient had two lesions in the thyroid isthmus and another one had two lesions located in the thyroid isthmus and right lobe respectively. With a median follow-up of 94 months (range, 12 - 274), two patients had a recurrence and both survived after a re-operation. There was no regional lymph node or distant organ recurrences. No deaths occurred. Conclusions: Isthmusectomy or wide field isthmusectomy could be a sufficient treatment for PTC confined to the thyroid isthmus. We also recommend that pretracheal lymph node dissection be considered.
文摘Background Previous studies have investigated the technique of linear ablation at the mitral isthmus （MI） in patients with idopathic atrial fibrillation （AF）, but MI ablation in patients with prosthetic natural mitral valves （MVs） was not described in detail. Present study sought to summarize our initial experience of ablating MI in patients with prosthetic MVs Methods Patients with drug refractory AF and prosthetic MVs were eligible for this study, and the patients with natural MVs but received MI ablation served as control group. Left atrium （LA） mapping and ablation was carried out guided by CARTO system. The anatomy of MI was assessed via computer topography scan. Results During the study period, a consecutive of 19 patients （male/female=12/7, mean age of （48±6） years） with prosthetic MVs （16 with metal valves, 3 with biologic valves） entered for AF ablation, other 35 patients served as control group. In study group, mapping along MI documented lower voltages （（2.0±1.0） vs. （3.1±1.3） mV, P=-0.002）, more fragmented potentials （19/19 vs. 20/15, P 〈0.001 ）, and higher impedance （（132±34） vs. （110±20） Ω, P=0.004）. After initial ablation, more residual gaps along the MI lesions were found in study group （2.4±0.4 vs. 1.7±0.3, P 〈0.001）. The mean length of MI （（6.2±3.3） vs. （7.1±2.3） cm, P=-0.25） was comparable between 2 groups, but the MI in study group was much thicker （（3.1±1.8） vs. （2.1±1.07） cm, P=0.01） and all were found as pouch type （19/19 vs. 2/35, P 〈0.001）. The follow-up results were comparable （65.1% vs. 72.3%, P=-0.30）. Conclusion For patients with prosthetic MVs, linear ablation at MI could be successfully carried out despite anatomical and pathological changes.
文摘近年来,随着甲状腺乳头状癌(papillary thyroid carcinoma,PTC)的发病率逐渐升高,峡部甲状腺乳头状癌(papillary thyroid carcinoma of the isthmus,PTCI)的患者也越来越多,目前对其诊治尚无统一的观点。我们检索了近5年国内外文献,对PTCI的流行病学及目前临床诊断和治疗中的进展作一综述,为今后PTCI的临床决策提供参考。
