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Objective@#To compare the difference in somatic gene mutation of PTC subtypes between 114 patients with papillary thyroid carcinoma (PTC) and The Cancer Genome Atlas (TCGA) database.@*Methods@#Totally 114 PTC patients admitted to The First Affiliated Hospital of Nanjing Medical University were recruited. The 18 hotspot genes associated with thyroid cancer were detected in thyroidectomy specimens were using next generation sequencing. PTC data were downloaded from the TCGA database in the cBioPortal website, and the difference in the somatic gene mutation was compared between 114 PTC patients and the TCGA database@*Results@#The 114 PTC patients included 73 women (64.04%) and had a mean age of (39.23±13.18) years. The prevalence of BRAF V600E (66.67% vs. 48.68%), TERTp (3.51% vs. 0.41%), PDGFRA (1.75% vs. 0%), PTEN (3.51% vs. 0.41%) and TP53 gene mutations (4.39% vs. 0.61%) was significantly higher among the 114 PCT patients than in the TCGA database (P<0.05). The prevalence of BRAF V600E (80.88% vs. 54.99%), TP53 (7.35% vs. 0.57%) and TSHR gene mutations (2.94% vs. 0%) was significantly higher in classical PTC(CPTC) patients than in the TCGA database, and the prevalence of BRAF V600E (36.84% vs.13.86%) and TERTp gene mutations (10.53% vs. 0%) was significantly higher in follicular variant PTC (FVPTC) patients than in the TCGA database. According to the American Thyroid Association Risk Stratification of Thyroid Cancer Recurrence, the prevalence of BRAF V600E and TP53 gene mutations was 77.14% and 8.57% among moderate-risk CPTC patients, the prevalence of BRAF V600E gene mutation was 27.27% among low-risk FVPTC patients, and the prevalence of TERTp gene mutation was 33.33% among moderate-risk FVPTC patients, which were all higher than in the TCGA database (55.10%, 0%, 3.28%, and 0%, respectively; P<0.05).@*Conclusion@#There are significant differences in the type and rate of somatic gene mutations between 114 PTC patients and the TCGA database.
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Objective:To explore the diagnostic value of radiomics based on arterial-venous mixed images derived from dual-energy CT (DECT) data in diagnosis of cervical lymph nodes (LNs) metastasis of papillary thyroid cancer (PTC).Methods:From June 2017 to December 2018, eighty-four patients with preoperatively DECT scanning and pathologically confirmed PTC (129 non-metastatic LNs and 97 metastatic LNs) in the First Affiliated Hospital of Nanjing Medical University were included in this study. The clinical and imaging data of all patients were retrospectively analyzed. The training cohort consisted of 62 PTC cases with 156 LNs (91 non-metastatic LNs and 65 metastatic LNs). An independent validation cohort consisted of 22 PTC patients with 70 LNs (38 non-metastatic LNs and 32 metastatic LNs). Semi-automatic LNs segmentation was conducted on arterial-venous mixed images derived from DECT using Syngo.via Frontier Radiomics software. Totally 1 226 radiomics features were extracted from arterial-venous mixed images for each LN. The least absolute shrinkage and selection operator (LASSO) regression was applied for radiomics features selection and signature building. The logistic regression modeling was used to construct diagnostic models based on the CT image features of LNs (model 1), the radiomics signature (model 2) and the combination of the CT image features and radiomics signature (model 3). An intuitive nomogram was plotted for model 3. The ROC curve analyses and area under the curve (AUC) were performed to evaluate the diagnostic efficiency of the three models, with the performances compared using the Delong test.Results:Model 1 was developed with LNs shape, degree of enhancement, pattern of enhancement, calcification and extra nodal extension. Three arterial phase radiomics features were selected and used to establish radiomics signature using LASSO regression (model 2). Model 3 was developed with LNs size, shape, degree of enhancement and radiomics signature. In both the training and validation cohort, model 3 showed the best diagnostic performance (AUC=0.965, 0.933), followed by model 2 (AUC=0.947, 0.910), and both these two models significantly outperformed model 1 (AUC=0.850, 0.846) (training cohort, Z=4.066 and 3.758, P both<0.001; validation cohort, Z=2.871 and 1.998, P=0.017 and 0.042) respectively. Conclusion:The radiomics model based on arterial-venous mixed images derived from DECT data can realize effective diagnosis of LNs metastasis in patients with PTC; and the combination model of radiomics signature with CT image features can further improve the diagnostic accuracy.
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OBJECTIVE@#: To evaluate the application of three-in-one intelligent screening in outpatient pre-inspection in Children's Hospital.@*METHODS@#We randomly enrolled 100 children pre-screened by traditional in the outpatient department of Children's Hospital Zhejiang University School of Medicine from February 6th to 16th, 2020, and another 100 children by the intelligent three-in-one mode from February 17th to 27th, 2020. The traditional triage was conducted by nurses based on face-to-face, one-by-one interview of the epidemiological history and consultation department, and the temperature was measured before manual triage. The intelligent three-in-one model of pre-inspection and triage combined online rapid pre-inspection and triage, on-site manual confirmation, as well as synchronized online health education system. For on-line registered patients, the system automatically sent the COVID-19 epidemiological pre-screening triage questionnaire one hour before the appointment, requiring parents to complete and submit online before arriving at the hospital. The on-site registered patients were controlled at 100 m outside of the hospital entrance. The nurses guided the parents to scan the QR code and fill in the COVID-19 epidemiological pre-examination triage questionnaire. At the entrance of the hospital, the nurse checked the guide sheet and took the temperature again. The children with red guidance sheet for isolation clinic were checked again and confirmed by pre-examination nurses, and accompanied to the isolation clinic by a special channel. The children with yellow guidance sheet were guided to fever clinic; parents with green guidance sheet took their children to the designated area by themselves, and then went to the corresponding consultation area after on-site manual pre inspection and registration. The whole process of health education was associated with outpatient notes, and the system automatically posted the corresponding outpatient instructions and education courses. Parents would read the courses on their mobile phones and counsel online. The time of pre-examination and the coincidence rate of triage were compared between the two groups.@*RESULTS@#The three-in-one intelligent pre-inspection mode took an average of (25.6±8.0) seconds for each child, which was significantly shorter than the traditional pre-inspection mode (74.8±36.4 seconds) (=13.182, 0.05).@*CONCLUSIONS@#The three-in-one intelligent pre-inspection model can effectively shorten the patient pre-check time, with similar triage coincidence rate to traditional model.
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OBJECTIVE@#To evaluate the application of three-in-one intelligent screening in outpatient pre-inspection in children's hospital.@*METHODS@#We randomly enrolled 100 children pre-screened by traditional method in the outpatient department of Children's Hospital of Zhejiang University from February 6th to 16th, 2020, and another 100 children by the intelligent three-in-one mode from February 17th to 27th, 2020. The traditional triage was conducted by nurses based on face-to-face, one-by-one interview of the epidemiological history and consultation department, and the temperature was measured before manual triage. The intelligent three-in-one model combined online rapid pre-inspection and triage, on-site manual confirmation, as well as synchronized online health education system. For on-line registered patients, the system automatically sent the COVID-19 epidemiological pre-screening triage questionnaire one hour before the appointment, requiring parents to complete and submit online before arriving at the hospital. The on-site registered patients were controlled at 100 m away from the hospital entrance. The nurses guided the parents to scan the QR code and fill in the COVID-19 epidemiological pre-examination triage questionnaire. At the entrance of the hospital, the nurse checked the guidance sheet and took the temperature again. The children with red guidance sheet were checked again and confirmed by pre-examination nurses, and accompanied to the isolation clinic through COVID-19 patients-only entrance. The children with yellow guidance sheet were guided to fever clinic. The children with green guidance sheet could go with their parents to the designated area, and then went to the corresponding consultation area. Health education was carried out throughout the treatment, and the system automatically posted the corresponding outpatient instructions and education courses. Parents would read the courses on their mobile phones and counsel online. The time of pre-examination and the coincidence rate of triage were compared between the two groups.@*RESULTS@#The three-in-one intelligent pre-inspection mode took an average of (25.6±8.0) s for each child, which was significantly shorter than the traditional pre-inspection mode (74.8±36.4) s (@*CONCLUSIONS@#The three-in-one intelligent pre-inspection model can effectively shorten the patient pre-check time, with similar triage coincidence rate to traditional model.
Subject(s)
Adult , Child , Humans , Betacoronavirus , COVID-19 , Coronavirus Infections/diagnosis , Internet , Outpatient Clinics, Hospital , Pandemics , Pneumonia, Viral/diagnosis , SARS-CoV-2 , Surveys and Questionnaires , Time , Triage/standardsABSTRACT
Objective To investigate the diagnostic value of pyruvate kinase M2 ( PKM2) gene expression in papillary thyroid carcinoma ( PTC). Methods Quantitative real-time PCR ( RT-qPCR) was used to detect the expression of PKM2 mRNA in benign thyroid nodules, PTC, and normal thyroid cells around nodules of fine-needle aspiration (FNA) specimens. Immunohistochemistry ( IHC) was used to detect the expression of PKM2 protein in thyroid tissue after thyroidectomy. The receiver operating characteristic curve was constructed to evaluate the diagnostic value of PKM2 in PTC. Results The expression of PKM2 mRNA was detectable in FNA specimens of thyroid nodules,higher in PTC than those in normal thyroid tissue and benign thyroid nodules (P<0.01). PKM2 expression level was correlated with diameter of PTC ( P<0.05) , but had no correlation with lymph node metastasis, BRAFV600E mutation, and American Joint Committe on Cancer( AJCC) stage ( P>0.05) . The expression level of PKM2 mRNA in FNA specimens of thyroid nodules was paralleled with the expression level of PKM2 protein in postoperation pathological tissues. The accuracy, sensitivity, specificity of PKM2 gene in the diagnosis of PTC were 62.8％, 46.9％, and 95.7％, respectively. The accuracy and sensitivity of PKM2 combined with BRAFV600E were increased to 87.6％and 83.7％. Conclusion Detection of PKM2 gene in FNA specimens is highly specific in the diagnosis of PTC, making it a valuable molecular marker for preoperative diagnosis. The combination of PKM2 and BRAFV600E detection shows a higher diagnosis efficiency.
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Objective To explore the anatomical features and the dissection technique of thyrothymic ligament (TTL),and to explore the clinical significance of protecting the inferior parathyroid gland (IPTG) with this structure.Methods Patients who received the initial thyroid surgery in the Department of Thyroid Surgery of the First Affiliated Hospital with Nanjing Medical University from May.2017 to Dec.2017 were prospectively analyzed.We dissected TTL,identified and located the IPTG,described the structural features of TTL,and investigated the position relationship of TTL and IPTG to evaluate the possibility and value of protecting IPTG in situ.Results About 121 patients underwent the dissection,totally 194 sides dissected that included 96 left sides and 98 right sides.TTL was found in 143 sides (73.7％),78 left sides (81.3％) and 65 right sides (66.3％).Nearly 70.6％ IPTG can be proactively identify and located by the TTL during the operation.TTL was a kind of adipose connective tissue that was wide at the bottom and narrow at the top,accompanying with the inferior thyroid vein,from the thymus to the thyroid.76.2％ TTL were attached to the lower pole and the lower 1/3 dorsal of thyroid,containing fat and vessels.33.5％ IPTGs were located in the area surrounding around the ends of the TTL.25.3％ IPTGs were located in the TTL.4.6％ IPTGs were located in the thymus and 7.2％ IPTGs surrounding around the TTL.The incidence rate of post-operation hypoparathyroidism was 14.9％.Conclusions TTL commonly exists and has significant relationship with IPTG.TTL connects thymus and IPTG,which would be considered a complex (thymus-thyrothymic ligament-IPTG complex,TLIC).The meticulous TTL dissection technique will help proactively identify,locate and protect IPTG during operation,and reduce the incidence rate of post-operation hypoparathyroidism.
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ObjectiveA preliminary study on pediatrics nursing-sensitive qualityindicators was carried out to construct a systematic, scientific and sensitive quality system. Methods Delphi method was used to conduct two rounds of questionnaires for 55 pediatric nursing experts, used SPSS20.0 statistical software for data analysis. Analytic hierarchy process method was used to determine the weight of the indicators. Results The final determination agreed rate of experts equal to 75 percent, the importance of assignment mean was>3.5 and the variation coefficient<0.25, which including 5 structure indicators, 17 process indicators and 18 outcome indicators. Conclusion The evaluation system of pediatrics nursing-sensitive quality indicators was constructed in preliminary which could provide the reference and basis for pediatric nursing managers.
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Objective To compare the diagnostic efficiency of the thyroid imaging reporting and data system (TIRADS), the Bethesda system for reporting thyroid cytopathology(BSRTC) and BRAFV600E detection, and their combined use in the differentiation between benign and malignant thyroid nodules. Methods One hundred and twenty eight patients with 128 thyroid nodules who were scheduled for ultrasound-guided fine-needle aspiration biopsy (FNAB) were recruited for the study. All of them underwent ultrasound, fine-needle aspiration cytology(FNAC) examination, and BRAFV600E detection. TIRADS and BSRTC systems were adopted to judge the ultrasound and FNAC results. The receiver operating characteristic curve was established to assess the diagnostic value of each method. Results The sensitivity, specificity, and AUC of TIRADS were 74. 3%, 84. 5%, and 0. 794, respectively. BSRTC had higher specificity(98. 3%) and equal sensitivity compared to TIRADS. The sensitivity, specificity, and AUC of BRAFV600E detection were the highest ones among the three methods. Combinations of different methods could increase the diagnostic sensitivity and accuracy. The combination of FNAC and BRAFV600E detection significantly increased the diagnostic efficiency(AUC=0. 984), with sensitivity 98. 6% and specificity 98. 3%. Conclusions The diagnostic value of BRAFV600E detection in the differentiation of benign and malignant thyroid nodules is better than both TIRADS and BSRTC, and the combination of FNAC and BRAFV600E detection reaches the best diagnostic efficiency.
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@#社区康复是机构康复的延伸，是康复的重要组成部分，让康复进入社区是工伤保险乃至工伤康复给予工伤职工的切实权益和福祉。因此，积极探索，因地制宜，多方式、多渠道建立社区康复服务模式是本文的主要目的，介绍资源中心社区服务模式是本文的重点。
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Objective To evaluate ultrasound combined with thri-operators and the blood-oxygen functional image (TOBOFI) technology in diagnosis of breast cancer in young women. Methods 221 breast tumor patients under 45 years old were selected to analyze their TOBOFI and ultrasonographic characteristics respectively. Based on pathological result, the two diagnostic methods were compared to determine the accurate rate. Results Of all the 221 patients, 82 (37.1%) were malignant and 139 benign. The sensitivity of TOBOFI and ultrasonography was 90.24% and 83.57% respectively, while the accurate rate of the two was 89.14% and 84 62% respectively. Accurate rate was improved to 93.90 % (77/82) if the two were combined. Conclusion TOBOFI has unique clinical value in diagnosing breast cancer in young women, especially in combination with ultrasound.
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Objective To explore the safety of total thyroidectomy surgery on patients with thyroid carcinoma. Methods From Jan 1986 to Dee 2006, clinical data of patients who underwent total thyroidectomy (total thyroidectomy group) and sub-total or near-total thyroidectomy surgery (control group) for thyroid carcinoma were retrospectively analyzed to identify the incidences of complications, recurrent laryngeal nerve paralysis (RNLP) and secondary hypoparathyroidism in the two groups. Results In the control group there were 433 thyroid carcinoma patients who underwent sub-total or near-total thyroidectomy. Transient unilateral RLNP(13 eases), permanent unilateral RLNP(5 eases), transient hypoparathyroidism (11 cases) was diagnosed. There was no permanent hypoparathyroidism in this group. In the 70 cases of thyroid carcinoma patients receiving total thyroidectomy, there were 4 eases suffering from transient unilateral RLNP, one case from permanent unilateral RLNP (P > 0.05), and there were 7 eases from transient hopyparathyroidim (P < 0.01), 2 eases from permanent hypoparathyroidism (P < 0.05). Conclusion The incidence of RLNP after total thyroidectomy was not higher than that after subtotal or near-total thyroideetomy. Postoperative hypocalcaemia was the most common postoperative complication of total thyroidectomy. It is our belief that total thyroidectomy should be performed in selected patients.
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Objective To evaluate our experience of minimal access parathyroidectomy for primary hy-perparathyroidism (PHPT) caused by parathyroid adenoma. Methods From Jan 2000 to Jan 2009, clinical data of 28 cases of PHPT treated by minimal access surgery were analyzed retrospectively. Results All patients except 3 had severe clinical manifestations, serum calcium and parathyroid hormonal (PTH) of all the cases were elevat-ed. The rate of accuracy of preoperation localization by the sestamibi scan combined with ultrasound was 100%.The pathological diagnoses of all the 28 cases were uni-gland parathyroid adenoma. Within the follow-up of 6 months, no case suffered complication and recurrence, the levels of serum calcium were normal or decreased slightly, and the levels of PTH were normal or elevated slightly but no higher than 2 times of normal PTH level. Conclusions Preoperative localization is very helpful by using combination of sestamibi and ultrasound scan. Minimally invasive parathyroidectomy is a kind of improving procedure for the localized parathyroid adenoma.
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Objective In China primary hyperparathyroidism is not a kind of common disease as in the wesyrn countries.This article reports the current status in the diagnosis and treatment of primary hyperparathyroidism in the mainland of China. Methods We collected 730 cages of primary hyperparathyroidism diagnosed and treated in 7 top hospitals for endocrine surgery from 1965 to 2005.Results In this study.652(89.3%)cases were clinically symptomatic while 78(10.7%)cases were asymptomatic:442 cases were positive on 99mTc-MIBI scanning.Bilateral explorations were undertaken in 377 patients and unilateral or uni-gland exploration through the conventional incision in 204 cases.Minimally invasive parathyroidectomy in 143 cases.Endoscopically assisted 2 cm incision was taken in 6 cases for unilateral gland exploration.Pathologically 632(86.6%)cases were identified as adenoma,58(8.3%)cases were of hyperplasia and 40(5.5%)cases were of carcinoma.There were no major postoperative complications.While 20 patients suffering from recurrence or persistent postoperative hyperparathyroidism,the others are of normal or depressed serum level of calcium. Conclusions Preoperative localization is very helpful: Unilateral exploration for parathyroid adenoma is feasible; minimally invasive parathyroidectomy throush minimal incision is a kind of improving procedure for the localized parathyroid adenoma.