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Objective To investigate the clinical and imaging characteristics of phosphaturic mesenchymal tumor and improve the clinical diagnosis. Methods From November 2014 to September 2017, 22 patients with pathologically confirmed diagnosis as phosphaturic mesenchymal tumor (PMT) were retrospectively analyzed, including 12 males and 10 females, age ranged from 30-72 years, mean (47 ± 11) years old. The clinical data, laboratory tests [serum calcium, phosphorus, alkaline phosphatase, parathyroid hormone and 1, 25- (OH) 2 D] and imaging examinations (X-ray, CT, MRI, nuclide) were collected and explored. Sixteen patients underwent SPECT scan and seven underwent PET/CT scan. Twenty patients had X-ray, eighteen patients had CT and 12 patients had MRI with enhancement. Results All patients suffered from diffuse pain for one to fifteen years, especially in lower back and lower extremities. All patients were found with low serum phosphorus, normal serum calcium. Twenty-one patients were found with elevated alkaline phosphatase, 16 with increased parathyroid hormone and 15 with decreased 1, 25 - (OH) 2 D. Thirteen lesions were located in the medullary cavity, seven in the soft tissue and two in the sinuses. Nineteen cases showed varying degrees of trabecular bone sparse, osteoporosis and osteomalacia on X-ray;There were 15 cases of multiple pseudo-fractures, including four cases of pelvic fracture complicated with femoral fracture, six cases of single fracture of pelvis, four cases of femur and one case of fibula. And seven cases showed multiple vertebral compression fractures. Thirteen lesions showed soft-tissue density and four in the medullary cavity showed high density on CT scan. The lesions presented low signal intensity on T1WI,high or low signal intensity on T2WI FLAIR and obviously enhanced in 12 patients who underwent MRI enhancement. Conclusion For patients with decreased serum phosphorus, elevated alkaline phosphatase, bone softening and fracture, octreotide or other nuclides should be primary imaging modality for confirming the location of the lesion. CT and MRI can further evaluate the nature of the lesion and improve diagnostic accuracy.
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Calcitonin participates in physiological regulation of calcium metabolism, but it might not be the key factor.Multiple immunoassay methods have been developed for serum calcitonin detection.However, significant differences exist among the methods, and the results of immunoassay are affected by many factors.This paper mainly discusses some major advances in experimental researches of calcitonin and the influence factors of immunological measurement.
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Objective To evaluate the differences of serum TSH of suspicious subclinical hypothyroidism determined by four automatic biochemical analyzers and the impact on clinical diagnosis and treatment.Methods Taking results of Roche Cobas e601 laboratory test as a reference, 103 serum samples with TSH 2.50-10.00 mU/L(90 with TSH≥4.27 mU/L) and normal FT3, FT4 were selected.Four different automatic biochemical analyzers (Cobas e601, Immulite2000, Centaur XP, I2000) were used to measure TSH of the serum samples at the same time.Wilcoxon signed rank test, Spearman correlation analysis were used for data analysis.Results TSH (M(P25, P75)) measured by 4 methods were 5.20(4.73, 6.40), 2.95(2.59, 3.48), 3.30(2.94, 4.15) and 4.10(3.43, 4.75) mU/L, which varied significantly from one assay to another (z values:-8.78,-8.41,-7.64,-8.09,-8.50, all P<0.05).The correlations between methods were of great differences (rs ranged from 0.45 to 0.92).Significant differences existed in each other for subclinical hypothyroidism diagnosis based on TSH cutoff respectively.Conclusion Results from different automatic immunoassay analyzers in patients with TSH of 2.50-10.00 mU/L varied widely, hence, it is indeterminate to diagnose subclinical hypothyroidism only relies on a single serum TSH test.
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Objective To interpret the major characteristics of literatures cited by 2015 ATA management guidelines for adult patients with thyroid nodules and DTC (2015 version).Methods The titles,datelines of the references,the medical specialties and regional distribution of the journals,and the definition of the scientific evidence rating for relevant references were extracted and analyzed.The data were roughly compared with those of 2009 revised ATA management guidelines for patients with thyroid nodules and DTC (2009 version).Results A total of 1 078 literatures,from 172 journals and 8 books,were cited by 2015 version,with 63 years spacing from 1952 to 2015.Extensive medical specialties were involved.The journals were world-wide distributed but the regional bias was obvious.Compared to the 2009 version,2015version adopted more recent literatures,and used more evidence rating for the recommendations.However,references with high-quality evidence were both less than 50％ in the two versions.Conclusion Huge amount of references with multi-specialties have been cited in 2015 version,however the regional distribution bias is distinctive and references with high-quality evidence are still insufficient.
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Objective To compare the consistence and difference between the assay results of the second generation of Tg (Tg Ⅱ) and the first generation of Tg (Tg Ⅰ) immunoassay,as well as to evaluate the impact of Tg Ⅱ on the clinical management of thyroid diseases.Methods Serum samples of 249 patients (30 with benign thyroid disorders and 219 with DTC;64 males and 185 females,average age 43.0 years)were collected and assayed by Tg Ⅱ and TgⅠ kits simultaneously.The measuring ranges of TgⅠ and TgⅡ were 0.10-1 000.00 μg/L and 0.04-500.00 μg/L,respectively.Data were analyzed by the Wilcoxon rank sum test and Spearman correlation analysis using IBM SPSS 19.0.Results The assay results of TgⅡ and TgⅠ strongly correlated (rs =0.979,P＜0.05).However,the median value of TgⅡ (2.31 (0.06-13.17) μg/L) was lower than that of TgⅠ(3.63(0.41-16.84) μg/L)(z=-13.25,P＜0.001).The difference between Tg Ⅱ and Tg Ⅰ got bigger when TgⅠ value decreased more.TgⅡ values were 11.09％ lower than TgⅠ (5.61(1.07-26.39) μg/L) vs 6.31(2.07-33.93) μg/L;z=-4.78,P＜0.05) in 30 patients with benign thyroid disorders and 37.71％ lower (2.18(0.07-7.47) μ.g/L) vs 3.50(0.39-10.18) μg/L;z=-9.02,P＜0.001) in 108 DTC patients without 131 Ⅰ treatment.But the above changes had no influence on clinical diagnosis and treatment.In the 71 DTC patients post 131Ⅰ treatment with low TSH and normal TgAb,there were 3 cases with TgⅠ＞1.0 μg/L but TgⅡ＜1.0μg/L,and 12 cases with TgⅠ＞0.1 μg/L but TgⅡ＜0.04 μg/L.Conclusions Serum TgⅡand Tg Ⅰ assay results are strongly correlated,though Tg Ⅱ value is slightly lower than Tg Ⅰ value.This difference may have no significant influence on the clinical diagnosis of thyroid diseases.However,TgⅡ may be better to evaluate the curative effect in some DTC patients post 131Ⅰ therapy.