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Objective:To explore the clinical value of ultrasound-guided fine-needle aspiration biopsy in the diagnosis of thyroid cancer and assessment of cervical lymph node metastasis.Methods:The clinical data of 90 patients with thyroid cancer who received treatment in Zhoushan Hospital from October 2018 to April 2021 were retrospectively analyzed. All patients underwent a two-dimensional ultrasound examination and ultrasound-guided fine-needle aspiration biopsy before surgery. Taking surgical and pathological diagnosis as the gold standard, the efficiency of two-dimensional ultrasound examination versus ultrasound-guided fine-needle aspiration biopsy in the diagnosis of thyroid cancer and cervical lymph node metastasis and in the identification of benign and maligant lymph nodes were investigated. Multivariate Logistic regression analysis was performed to analyze the correlation between different ultrasound signs and the detection rate of lymph nodes. Results:Pathological results showed that among the 90 patients, 73 patients had thyroid cancer, and 17 patients had benign lesions. Ultrasound-guided fine-needle aspiration biopsy results showed that 70 patients had thyroid cancer, and 20 patients had benign lesions, including 4 cases of missed diagnosis and 2 cases of misdiagnosis. The diagnostic sensitivity, specificity, accuracy rate, and Kappa value were 94.52%, 88.24%, 93.33%, and 0.79, respectively. These were highly consistent with the surgical and pathological diagnosis (Kappa value > 0.75). Two-dimensional ultrasound revealed 69 patients with thyroid cancer and 21 patients with benign lesions, including 7 cases of missed diagnosis and 4 cases of misdiagnosis. The diagnostic sensitivity, specificity, accuracy rate, and Kappa value were 90.41%, 76.47%, 87.78%, and 0.63, respectively. Pathological results revealed that cervical lymph node metastasis occurred in 12 patients, and it did not occur in 78 patients. The diagnostic sensitivity, specificity, accuracy rate, and Kappa value of ultrasound-guided fine-needle aspiration biopsy were 83.33%, 97.50%, 95.65%, and 0.81 respectively. These were highly consistent with surgical and pathological results (Kappa value > 0.75). The diagnostic sensitivity, specificity, accuracy rate, and Kappa value of two-dimensional ultrasound examination were 75.00%, 94.87%, 92.22%, and 0.67, respectively. A total of 156 lymph nodes were detected by ultrasound-guided fine-needle aspiration biopsy, including 103 benign lymph nodes and 53 malignant lymph nodes, with a diagnostic accuracy rate of 94.17% and 96.22%, respectively. A total of 173 lymph nodes were detected by two-dimensional ultrasound, including 111 benign lymph nodes and 62 malignant lymph nodes, with a diagnostic accuracy rate of 91.89% and 91.93%, respectively. There were no significant differences in the diagnostic accuracy of benign and malignant lymph nodes between the two examination methods ( χ2 = 0.42, 0.92, both P > 0.05). Multivariate logistic regression analysis showed that hyperechoic masses, cystic lesions, and internal calcification were significantly correlated with the detection rate of lymph nodes diagnosed by two-dimensional ultrasound and ultrasound-guided fine-needle aspiration biopsy ( OR = 6.64, 5.32, 4.12, 7.07, 5.60, 5.06, all P < 0.05). Conclusion:Ultrasound-guided fine-needle aspiration biopsy has high diagnostic efficiency for thyroid cancer and cervical lymph node metastasis. Ultrasound signs of hyperechoic mass, cystic lesions, and internal calcification are significantly correlated with the detection rate of lymph nodes.
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Objective:To investigate endoscopic thyroidectomy in the treatment of thyroid cancer and its effects on patient's quality of life.Methods:A total of 98 patients with thyroid cancer who received treatment in Zhoushan Hospital from March 2019 to March 2021 were included in this study. They were randomly divided into observation and control groups, with 49 patients in each group. Patients in the observation group underwent endoscopic thyroidectomy, and those in the control group underwent traditional surgery. Perioperative indicators and postoperative complications were compared between the two groups. Stress response measured before and 2 months after surgery and quality of life before and 3 months after surgery were compared between the two groups.Results:Operative time in the observation group was significantly longer than that in the control group [(89.82 ± 18.49)] minutes vs. (63.24 ± 17.28) minutes, t = 7.35, P < 0.05]. Intraoperative blood loss and postoperative drainage in the observation group were (10.32 ± 2.28) mL and (29.25 ± 3.17) mL, which were significantly lower than (15.42 ± 3.56) mL and (40.52 ± 4.95) mL in the control group ( t = 8.44, 13.42, both P < 0.05). There was no significant difference in length of hospital stay between the two groups ( P > 0.05). The incidence of postoperative complications in the observation group was significantly lower than that in the control group [4.08% (2/49) vs. 18.37% (9/49), χ2 = 5.01, P < 0.05]. At 2 days after surgery, white blood cell count, fasting plasma glucose, C-reactive protein in the observation group were (5.62 ± 0.41) × 10 9/L, (4.77 ± 0.38) mmol/L, and (13.25 ± 2.79) mg/L, which were significantly lower than (8.71 ± 0.98) × 10 9/L, (5.75 ± 0.45) mmol/L, (20.84 ± 3.86) mg/L in the control group ( t = 20.36, 11.64, 11.26, all P < 0.05). At 3 months after surgery, Karnofsky performance scale score in the observation group was significantly higher than that in the control group [(87.64 ± 4.35) points vs. (81.29 ± 4.02) points, t = 7.58, P < 0.05). Conclusion:Endoscopic thyroidectomy is highly effective on thyroid cancer, has few postoperative complications, produces little effect on stress response, and can improve the quality of life of patients.
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Objective@#To evaluate the short-term outcomes and safety of submucosal tunneling endoscopic resection (STER) for submucosal tumors (SMT) originating from muscularis propria (MP) layer at esophagogastric junction.@*Methods@#The clinical data of 31 patients with SMT originating from MP layer at esophagogastric junction underwent STER were collected and retrospectively analyzed.@*Results@#The success rate of STER of the thirty-one patients was 100%. The mean tumor size was (2.5±1.3) cm and the average operative time was (95.9±56.7) min. Perforation occurred in 3 patients and was successfully clipped by endo-clips during operation. One patient developed delayed bleeding and the bleeding was stopped by endoscopic hemostasis. Twenty-nine leiomyomas and two stromal tumors (GIST) were finally pathologically diagnosed. No local recurrence and distant metastasis were noted during the mean 15.4 months follow-up of 20 cases. According to the lesion size, 31 patients who received STER were divided into two groups. The operation time of maximum diameter ≥3.5 cm group was (134.0±70.6) min, significantly longer than (80.3±42.6) min of maximum diameter <3.5 cm group (P=0.014). However, the en bloc removal rate, postoperative hospital stay and the complication incidence between the two groups had no obvious differences (P>0.05). Univariate analysis showed that the piecemeal removal group had longer tumor diameter, higher incidence of irregular tumor morphology, and longer operative time than the en bloc removal group (all P<0.05). Stepwise logistic regression analysis showed that irregular shape was a risk factor for failure of en bloc removal (OR=18.000, 95% CI: 1.885~171.88, P=0.012).@*Conclusion@#As a new method of minimally invasive treatment, STER technology appears to be a safe and effective option for patients with SMT originating from MP layer at esophagogastric junction.
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Objective To explore the expression and significance of vitamin D (VitD) in patients with rheumatoid arthritis (RA),and analyze the relationship between its expression and clinical indicators.Methods Clin-ical parameters and laboratory examinations of RA cases (n=250) were collected.Clinical parameters included were gender,age,disease course,swollen joints number,tenderness joints number,visual analog pain score (VAS),disease activity score (DAS)28 score.Laboratory examinations included erythrocyte sedimentation rate (ESR),C-reactive protein (CRP),rheumatoid factor (RF) and anti-cyclic citrullinated peptide (CCP) antibody,antinuclear (ANA) antibody,antikeratin (AKA) antibody,anti-perinuclear factor (APF),anti-mutated citrullinated vimentin (MCV),antibody and anti-6-glucose phosphate isomerase (GPI) antibody,lymphocyte subsets in the peripheral blood and lymphocyte subsets of CD4+T cells.The level of 25-(OH)-Vit-D and clinical parameters,laboratory examinations were analyzed retrospectively.One-way ANOVA and KruskalWallis test were used for comparison among the groups;and the correlation analysis was performed by Pearson and Spearman rank correlation analysis.Results ① The level of 25-(OH) D in RA patients was significantly lower than that in healthy controls (t=11.676,P＜0.01).② According to 25-(OH)D level,RA patients were divided into the deficiency group,insufficient group and normal group,the tender joints count (x2=17.793,P＜0.001),the number of swollen joints (x2=12.635,P=0.002),ESR (F=6.330,P=0.002),VAS score (F=5.095,P=0.007,DAS28 (F=4.990,P=0.008) were different significantly amorg the three groups.③RF (x2=6.742,P=0.034) and anti-CCP antibody (x2=6.836,P=0.033) were different significantly among the three groups and the level of 25-(OH) D was negatively correlated with RF (r=-0.202,P=0.001),anti-CCP antibody (r=-0.220,P＜0.01),anti-MCV antibody (r=-0.109,P=0.002) and AKA (r=-0.215,P=0.001).④ The level of 25-(OH) D in the RF (t=-2.715,P=0.007),anti-CCP antibody (t=-2.03,P=0.044),AKA (t=-2.108,P=0.036) negative group was significantly higher than that in patients with antibody positive group.⑤ The level of Th1 (IFN-γ) cells (F=3.259,P=0.043) and Treg (CD4+CD25+Foxp3+) cells (F=4.342,P=0.031) were significantly different among the three groups and the level of 25-(OH) D was positively correlated with Treg (CD4+CD25+Foxp3+) cells (r=0.146,P=0.025).Conclusion Vitamin D is generally deficient in RA patients,which is significantly correlated with disease activity,RF,anti-CCP antibody,anti-MCV antibody,AKA and Th1,Treg cells.It is suggested that vitamin D may play an important role in the immunological pathogenesis and disease progression of RA.
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Objective To determine the CD4+CD25+Foxp3+T regulatory (Treg) cell levels in peripheral blood (PB) of patients with autoimmune diseases (AID) and age-and sex-matched healthy controls. Methods Clinical data and laboratory examinations of AID cases (n=1561) and healthy controls (n=196) were enrolled. The levels of PB Treg cells, other T lymphocyte subsets [total T, CD4+T, CD8+T, T helper1 (Th1), T helper 2 (Th2), and T helper17(Th17) cells] and clinical indicators, laboratory test results were analyzed retro-spectively. Data were analyzed by t test, Mann-Whitney U test,χ2 test and Spearman correlation analysis. Results ①The absolute counts of Treg [22.9(18.31, 36.47) vs 30.24(21.85, 41.34), Z=-3.974, P<0.01], total T (Z=-4.234, P<0.01), CD8+T (Z=-3.801, P<0.01), Th17 (Z=-3.740, P<0.01) cells in PB of patients with AID were significantly lower than those of healthy controls, the levels of CD4+T/Treg (Z=-3.366, P=0.001), Th1/Treg (Z=-3.213, P=0.001) and Th2/Treg (Z=-2.490, P=0.013) in PB of AID patients were higher than those of healthy controls.② The levels of inflammatory indicators were associated with numbers of T lymphocyte subsets. ③ The levels of Treg (Z=-3.624, P<0.01), total T (Z=-2.954, P=0.009), CD4+T (Z=-3.005, P=0.003), Th2 (Z=-1.896, P=0.049) cells in PB of the patients who had been treated with hormones and/or biological or non-biological disease-modifying anti-rheumatic drugs (DMARDs) were significantly lower while the levels of total T/Treg (Z=-2.460, P=0.014), CD8+T/Treg (Z=-3.197, P=0.001) in PB were higher than those of the primary treatment patients. ④ The levels of Treg (Z=-7.105, P<0.01), total T (Z=-2.954, P<0.01), CD4+T (Z=-6.909, P<0.01), Th1 (Z=-4.875, P<0.01), Th2 (Z=-5.751, P<0.01), Th17 (Z=-5.121, P<0.01) cells in PB of the patients with important organs involvement were lower while the ratios of total T/Treg (Z=-4.500, P<0.01), CD8+T/Treg (Z=-5.925, P<0.01) were higher than those non-organ involvement patients. ⑤ The absolute counts levels of T lymphocyte subsets in the AID patients were not significantly correlated with whether there was a single AID and/or multiple AID overlaps. Conclusion The absolute number of peripheral Treg cells decreases significantly in AID, and is correlated with inflammatory indicators. Patients with retreated and organ involve-ment have fewer Treg cells. Our results suggest that Treg cells may play an important role in the pathogenesis of AID.
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Ulcerative colitis (UC) is a chronic,non-specific inflammatory disease mainly involving the colorectum.The main clinical manifestations are mucopurulent bloody stool,abdominal pain,diarrhea.The etiology of UC is not yet clear,and its treatment has become the focus of clinical work.Recent studies have confirmed that there is a certain correlation between the pathogenesis of UC and intestinal flora imbalance.Large number of clinical studies have been performed on the efficacy of probiotics and fecal microbiota transplantation (FMT) for UC.This paper reviewed the research status of treatment of intestinal flora imbalance in UC.
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Objective To explore the expression and their significance of peripheral Th17 cells and regulatory T cells (Tregs) in idiopathic inflammatory myopathy,and analyze the relationship between the expression and clinical indicators,imaging and pathological changes.Methods Clinical data,laboratory tests,imaging and pathological changes of IIM cases (n=85) and healthy controls (n=70) were enrolled.Clinical data included the classification,age,gender,course of the disease;laboratory tests including erythrocyte sedimentation rate (ESR),C-reactive protein (CRP),creatine kinase (CK),creatine kinase isoenzyme-MB (CKMB),lactate dehydrogenase (LDH),hydroxybutyrate dehydrogenase (HBDH).The level of peripheral Th17,Treg cells and clinical indicators,laboratory tests,imaging and pathological changes were analyzed retrospectively.Since the data was disregarded from the normal distribution,the median four quantile method was used for statistical description.Two samples were compared with Mann-Whitney U test,and the correlation between variables was Spearman rank correlation analysis.Results ①) The levels of Th17 cells in the case group was not significantly different from that in the control group [6.18(3.42,13.65) cell/μl vs 7.42(5.02,11.13) cell/μl,P＞0.05],the levels of Treg cells in patients was significantly lower than that in the control group [21.25(12.48,35.67) cell/μl vs 36.95(30.37,47.12) cell/μl,P＜0.05],the ratio of Th17/Treg was also significantly higher than that in the control group [0.31(0.21,0.47) vs 0.18(0.14,0.31),P＜0.05].② Peripheral Treg cells levels were not correlated with ESR,CRP,CK-MB,LDH and HBDH (P＞0.05).Peripheral Treg cells levels were negatively correlated with CRP (r=-0.279,P＜0.05),but no correlated with ESR,CK-MB,LDH and HBDH (P＞0.05).③ According to the involvement of important organs,patients were classified into two groups:organ involvement group and non-organ involvement group.The levels of Treg cells in the organ involvement group was fewer than that in non-organ involvement group [16.54(8.84,27.34) cell/ul vs 24.87(14.44,43.37) cell/ul,P＜0.05],and the ratio of Th17/Treg in the organ involvement group was significantly higher than that in non-organ involvement group [0.41(0.29,0.68) vs 0.29(0.19,0.39),P＜0.05].④) Peripheral Th17 cells levels in patients with skeletal muscle inflammatory edema was significantly higher than that of non-inflammatory edema patients [10.70 (4.11,14.51) cell/μl vs 3.10 (1.27,5.15) cell/μl,Z=-2.460,P＜0.05].⑤ The levels of Th17,Treg cells and ratio of Th17/Treg did not correlate with pathological features of inflammatory infiltration (P＞0.05).Conclusion The absolute number of peripheral Treg cells decreases significantly in IIM,and correlates with CRP.Patients with organ involvement have fewer Treg cells,and there is imbalance between Th17 and Treg.When muscle MRI presents with inflammatory edema,patients may have high level of Th17 cells.Our results suggest that Treg cells may play an important role in the pathogenesis of IIM.
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Objective To sum up the nursing experience of injection of sulphur hexafluoride microbubbles as contrast agent for thyroid contrast-enhanced ultrasound (CEUS).Methods The clinical data of 413 cases who injected sulphur hexafluoride microbubbles as a contrast agent for CEUS were retrospectively analyzed.Nursing observation and coordination were done on the CEUS examination process,venous puncture technique,the correct configuration and use of sulphur hexafluoride microbubbles as contrast agents,operating process,the correct treatment of adverse reactions.Results The success rate of thyroid CEUS in 413 cases was 100％.After completion of the CEUS procedure,2 cases revealed slight dizziness,1 case with the contrast agent extravasation,others did not have adverse reactions such as dizziness,the contrast agent extravasation,skin rashes,itching,pain at the injection site.Conclusion The key nursing points including mastery of the whole CEUS process,operator's qualified venous puncture technique,the correct configuration and use of sulphur hexafluoride microbubbles for injection as contrast agent,careful nursing observation in the operating process and correctly treatment of adverse reactions are significant for enhancing success rate of thyroid CEUS and relieving relevant adverse effects.
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Objective To cast light on the mechanisms governing anaplastic thyroid carcinoma (ATC) and to evaluate the minichromosomes maintain protein (MCM) 5 and MCM7 expression in human normal thyroid (NT),papillary thyroid carcinoma (PTC),and ATC samples,as well as in primary culture cells.Methods We tested the expression of MCM5,MCM7and PCNA in NT,PTC and ATC by immunohistochemistry.We used Western blot and Northern blot to test the expression of MCM5,and MCM7.ATC cells were transfected with MCM7 siRNA,and Western blot was used to examine the change of the expression of MCM7.Results In ATC samples,MCM5 had high expression in 65％ patients,and MCM7 had high expression in 73％ patients.The expression of MCM5 and MCM7 in NT and PTC samples were very low which can be ignored.In ATC cells,high MCM5 and MCM7 expression was paralleled by high levels of MCM2 and MCM6.Inhibition of MCM7 protein levels by small inhibitory duplex RNAs could reduce the rate of DNA synthesis in ATC cells.Conclusion MCM protein expression is upregulated in ATC and leads to excessive proliferation of ATC.
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Objective:To evaluate the clinical performance of CAD/CAM zirconia all-ceramic restorations.Methods:287 all-ce-ramic Zirconia restorations in 206 patients were included in a 3-year prospectively survey with California Dental Association Standard (CDA)as a reference.The effects and the related factors such as restoration type,tooth region,fiber reinforced composite application on survival rate were analyzed.Kaplan-Meier survival analysis and Log-Rank test were used for data analysis.Results:Chipping frac-tures in 5 restorations,intense gingivitis at 4 restorations and periapical inflammation for 3 restorations were observed during the obser-vation period.The 3-year cumulative survival rate (CSR)of CAD/CAMzirconia restorations was 95.7%,The differences among the CSR of single crowns(96.3%),linked crowns (93.6%)and fixed partial dentures(95.7%)were not statistically significant(P >0.05).The difference was not statistically significant(P >0.05)between the CSR of the anterior region group(94.5%)and posterior region group(96.3%)as well as difference(P >0.05)between the CSR of fiber reinforced composite group (95.0%)and without fiber reinforced composite group(96.1%).Conclusion:The cumulative survival rate of CAD/CAM zirconia all-ceramic restorations is high.Chipping fracture is the main reason of failure.Restoration type,tooth region and fiber reinforced composite have no significant effect on the survival of zirconia restorations.
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Objective To investigate the diagnostic value of sonographic changes of adipose tissue in benign and malignant breast lesions.Methods The sonographic characteristics of subcutaneous adipose tissue were retrospectively analyzed in 92 patients with 114 breast lesions,all lesions were confirmed by postoperative pathology.Receive operating characteristic (ROC) curve was drew with the pathological results as standard,the diagnostic value of subcutaneous adipose tissue changes in benign and malignant breast lesions was evaluated.Results The area under the ROC curve that derived from all of the lesions (61 benign and 53 malignant) was 0.862 (P =0.000).The ultrasonographic findings which showed subcutaneous adipose tissue changes at grade Ⅲ or higher suggested that the tumors were more likely malignant lesions.When adipose tissue changes at grade Ⅲ was taken as the diagnostic indicator for the presence of malignant breast lesions,the diagnostic sensitivity reached 73.6％ while specificity reached 93.4％.At ultrasound imaging scan,the adipose tissue in malignant lesions had the following manifestations:increased fibrosis,increased echogenicity,the sonographic images were turbidity or blurred,presence of ground-glass-like opacity.There were significant differences (P =0.000) between the benign and the malignant lesions in the range of adipose tissue changes.Conclusions The ultrasonographic changes were helpful to the differential diagnosis between the benign and the malignant breast lesions.
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Objective To investigate iodine nutrition and thyroid health status among residents in Zhoushan archipelago, and to analyse their relationship.Methods A total of 3 284 residents in Zhoushan archipelago were surveyed by questionnaire and their thyroids were examined by B-mode ultrasound.The levels of urinary iodine and thyroid function were detected.Results The median level of urinary iodine in 3 284 residents was 226.0 μg/L, being 320.7 μg/L in citizens, 188.9 μg/L in farmers, 122.2 μg/L in salt-makers, 193.6 μg/L in fishers, and 271.7 μg/L in buddhist.The prevalence of diffuse goiter, nodular goiter, colloid goiter, thyroid adenoma, thyroid carcinoma, hyperthyroidism, subclinical hyperthyroidism, hypothyroidism, subclinical hypothyroidism, and positve rate of TPOAb were 1.7% ,25.3% ,8.7% ,0.2% ,0.4% ,0.5% ,0.8% ,0.03%,1.0% ,and 9.5% repectively.The prevalence of thyroid diseases was increasing with aging, and higher in women than in men (P＜0.05).There was no significant relationship of the thyroid diseases with seafood, smoking,drinking, and tea (P＞0.05).Conclusions The citizens of Zhoushan archipelago have adequate iodine intake.It is pertinent to discuss Universal Salt Iodization.Excessive iodine intake may contribute to the high prevalence rate of thyroid diseases in Zhoushan.
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AIM: To explore a simple, reliable method for tissue processing and section staining by extracting DNA from the manually microdissectioned specimen, and to identify whether the extracted DNA is useful in the following study at molecule level. METHODS: The experiment was performed at the pathological laboratory of Guangdong Medical College from July 2004 to July 2007. The paraffin imbedding tissue sections of cervical cancer were thoroughly deparaffinized after mounted on slides for a long period of time. The nucleus was slightly stained with hematoxylin and microdissectioned under inverted microscope. The microdissectioned samples were put into EP tubes filled with digestion buffer to split the cells and then the DNA was extracted. During the whole course, PE tubes did not change, and the complicated phenol/chloroform extraction did not perform. The DNA extraction was rapid and simple. RESULTS: The DNA was measured by the spectrophotometer with concentrations from 0.14 to 5.25 g/L and absorbance values of A260/A280 were 1.6-1.8. All samples were amplified with PCR to produce expected length specific target fragment (231 bp). CONCLUSION: Rapid DNA extraction after manual tissue microdissection can produce adequate amount of DNA and maintain good quality of DNA template for PCR. The DNA meets the need of the following molecular experiments.