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Objective:To explore the association between body mass index (BMI) and the incidence of thyroid nodules, the clinical characteristics and efficacy evaluation of differentiated thyroid cancer (DTC), respectively.Methods:Clinical data of 1 375 healthy people (1 031 males, 344 females, age: (43.5±10.6) years) who underwent routine physical examination (PE) and 1 450 patients (490 males, 960 females, age: (44.3±12.4) years) with medium-high risk DTC in Tianjin Medical University General Hospital from April 2016 to July 2020 were analyzed retrospectively. PE and DTC patients were classified into underweight group (BMI<18.5 kg/m 2), normal weight group (18.5≤BMI<24.0 kg/m 2), overweight group (24.0≤BMI<28.0 kg/m 2) and obesity group (BMI≥28.0 kg/m 2) respectively. χ2 test was employed to analyze the relation between BMI and thyroid nodules (with/without), BMI and clinical characteristics and efficacy evaluation of DTC, respectively. Logistic regression analysis was used to analyze the independent risk factors for the occurrence of thyroid nodules and the aggressiveness of DTC. Results:Among PE, there were 779 cases with nodules, and 596 cases without nodules. Comparing with those without nodules, more overweight and obese were found in PE cases with nodules (42.1%(328/779) vs 37.2%(222/596), 24.5%(191/779) vs 20.5%(122/596); χ2=13.42, P=0.004). Higher risk of developing thyroid nodules was related with older age and lower thyroid stimulating hormone (TSH) level (odds ratio ( OR): 1.044, 0.919, 95% CI: 1.029-1.060, 0.845-0.999; P<0.001, P=0.046). People with high-risk nodules were more likely to be obese than those with intermediate and lower risk nodules (5/15 vs 24.3% (186/764); χ2=21.11, P<0.001). Among 1 450 DTC patients, comparing with patients with normal weight, patients in the overweight and obesity groups were more likely to have central regional lymph node metastasis ( OR: 1.418, 1.427, 95% CI: 1.075-1.870, 1.044-1.952; P values: 0.013, 0.026), and patients in obese group were with greater risk of lesions being bilateral ( OR=0.696, 95% CI: 0.519-0.934; P=0.016). BMI was not related with the efficacy evaluation of DTC ( χ2=9.13, P=0.425). Conclusions:The incidence of thyroid nodules in people with high BMI is higher. DTC patients with high BMI may have more aggressive incidence. But BMI has no correlation with the efficacy evaluation of DTC patients after treatment.
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Objective:To study whether male was the risk factor for prognosis of patients with differentiated thyroid cancer (DTC) after 131I treatment based on propensity score matching (PSM) method. Methods:From April 2016 to January 2021, 1 677 patients (age: 11-84 (43.9±12.5) years) with DTC who underwent total thyroidectomy and received 131I treatment in Tianjin Medical University General Hospital were retrospectively enrolled and patients were divided into male group ( n=546) and female group ( n=1 131). The evaluation results of patients were divided into excellent response (ER), indeterminate response (IDR), biochemical incomplete response (BIR) and structural incomplete response (SIR). Among them, ER and IDR were divided into good prognosis group, and BIR and SIR were divided into poor prognosis group. The PSM method was adopted to process all data to reduce the influence of data bias and confounding variables. χ2 test was used for data analysis. Multivariate logistic regression was used to analyze the risk factors affecting prognosis, and ROC curve was used to analyze the relationship between stimulated thyroglobulin (sTg) level and poor prognosis. Results:Before PSM, the proportion of male patients with poor prognosis was significantly higher than that of female patients (21.2%(116/546) vs 14.0%(158/1 131); χ2=17.53, P=0.001). After PSM, there was no difference in the proportion of poor prognosis between male and female groups (19.9%(107/537) vs 15.6%(84/537); χ2=5.43, P=0.143). Multivariate logistic regression analysis showed that male (odds radio ( OR)=1.439 (95% CI: 1.016-2.038), P=0.040), high T stage(T3+ T4 stage)( OR=1.816 (95% CI: 1.273-2.590), P=0.001), N1b stage ( OR=1.766 (95% CI: 1.233-2.530), P=0.002), M1 stage ( OR=9.833 (95% CI: 3.190-30.309), P<0.001) and sTg level ( OR=1.035 (95% CI: 1.029-1.042), P<0.001) were risk factors for poor prognosis before PSM, while high T stage (T3+ T4 stage)( OR=1.870 (95% CI: 1.212-2.886), P=0.005), M1 stage ( OR=8.993 (95% CI: 2.434-33.225), P=0.001), sTg level ( OR=1.040 (95% CI: 1.030-1.049), P<0.001) were still risk factors, and N1b stage ( OR=1.459 (95% CI: 0.938-2.270), P=0.094), male ( OR=1.383 (95% CI: 0.912-2.096), P=0.127) were no longer risk factors for poor prognosis after PSM. ROC curve analysis showed that the cut-off value of sTg was 10.25 μg/L, with the sensitivity of 81.0%(222/274) and the specificity of 84.2%(1 181/1 403). Conclusions:After reduction of selection bias by PSM, male is no longer a risk factor for prognosis after 131I treatment of DTC. In addition, high T stage(T3+ T4 stage), M1 stage and sTg≥10.25 μg/L were risk factors for poor prognosis.
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Objective:To explore new methods of treating Graves′ disease (GD) by targeting thyroid stimulating hormone receptor (TSHR) and intercellular adhesion molecule-1 (ICAM-1).Methods:The small interfering RNA (siRNA) targeting TSHR and the ICAM-1 monoclonal antibody (mAb) were designed and synthesized. Thirty GD model mice were randomly divided into siRNA treatment group, ICAM-1 mAb treatment group, and untreated GD group (10 mice in each group), and 10 normal mice were taken as blank control. Serum thyroxine (T 4), thyroid stimulating hormone (TSH), TSH receptor-stimulating antibody (TSAb) and TSH-stimulation blocking antibody (TSBAb) were measured before and after treatment. At the end of the treatment, body mass and heart rate of mice in each group were measured, and thyroid uptake of 99Tc mO 4-, thyroid size and pathological changes were evaluated. Independent-sample t test, paired t test and one-way analysis of variance were used to analyze data. Results:After three treatments, the body mass of mice in siRNA group and ICAM-1 mAb group were significantly lower than that of normal mice ( F=3.50, P=0.025); the heart rates of the mice in two groups were significantly lower than that of untreated GD mice ( F=24.73, P<0.001). Heart rate of mice treated with siRNA decreased significantly, close to that of normal mice. After treatment, the serum T 4((27.58±1.94) vs (65.71±6.89) μg/L, (27.24±3.50) vs (70.84±8.46) μg/L), TSAb ((331.44±43.38) vs (457.33±45.85) mU/L, (275.16±45.80) vs (443.91±42.32) mU/L) and TSBAb ((13.94±1.11) vs (15.83±5.92) mU/L, (14.59±1.02) vs (17.05±6.16) mU/L) levels of mice in both siRNA group and ICAM-1 mAb group significantly decreased ( t values: 4.45-10.87, all P<0.05), while the serum TSH levels of mice in two groups significantly increased ((0.13±0.05) vs (0.04±0.05) mU/L, (1.46±0.34) vs (0.06±0.03) mU/L; t values: -2.22, -5.87, P values: 0.007, <0.001). The elevated TSH level and decreased TSAb level of mice treated with ICAM-1 mAb were significantly different from those treated with siRNA ( t values: 1.03, -1.63, P values: 0.002, 0.031). After treatment, the uptake of 99Tc mO 4- in part of the thyroid lobes of mice was decreased, and the enlargement degree of the corresponding lobes was reduced. The thyroid pathology of mice in the treated groups showed that the absorption vacuoles of thyroid follicles were reduced, and the phenomenon of thinner colloids was improved. No obvious damage was observed in the heart, liver and kidneys of the mice. Conclusions:Both the siRNA targeting TSHR and ICAM-1 mAb have therapeutic effects on GD model mice. The siRNA is better at controlling heart rate, and ICAM-1 mAb is better at increasing TSH and decreasing TSAb. Each of the above treatment methods is safe and effective, which can provide new ideas for GD targeted therapy.
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Objective:To analyze the short-term effect of targeted drugs on quality of life in patients with radioactive iodine-refractory differentiated thyroid cancer (RAIR-DTC).Methods:From February 2020 to April 2022, 19 RAIR-DTC patients (10 males, 9 females; age (54.5±14.5) years) who received targeted drugs therapy (sorafenib, lenvatinib or anlotinib) in Tianjin Medical University General Hospital were prospectively enrolled. The thyroglobulin (Tg) levels prior and 1, 3, 6 months post the targeted treatment, and the adverse events were measured and recorded. Response evaluation criteria in solid tumors (RECIST) 1.1 version was used to evaluate the treatment response. The quality of life based on five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) was monitored prior and 3 months post the targeted treatment, and the prevalence rates of mobility, self-care, usual activities, pain/discomfort, and anxiety/depression were analyzed, and the scores of health assessment were assessed. Paired t test, Kruskal-Wallis rank sum test and χ2 test were used to analyze data. Results:The prevalence rates of mobility (8/19), self-care (6/19), usual activities (10/19), pain/discomfort (10/19), and anxiety/depression (12/19) in 3 months post treatment were higher than those prior treatment (1/19, 1/19, 1/19, 2/19, 2/19; χ2 values: 4.38-11.31, all P<0.05). The score of health assessment prior treatment was (84.37±6.25), which was higher than that at 3 months post treatment (71.63±9.14; t=5.02, P=0.001). After targeted treatment, 10 patients were with skin toxicity, 8 patients were with hypertension, 8 patients were with weight loss, 7 patients were with diarrhea, 6 patients were with fatigue, 5 patients were with hepatic dysfunction, 2 patients were with proteinuria, 2 patients were with muscle pain and 1 patient was with oral ulcer. Of 19 patients, 17 insisted on continuing treatment, and the other two stopped treatment. The Tg levels at 1, 3 and 6 months post treatment were 56.26(44.60, 210.50), 53.36(41.25, 203.07) and 54.35(34.71, 223.52) mg/L, respectively, which were lower than the level prior treatment with no significant difference (110.16(49.63, 294.50) mg/L; H=2.42, P=0.490). After 3 months of targeted treatment, the progression-free survival (PFS) rate was 16/17, including 7 patients with partial response (PR), 9 patients with stable disease (SD), and 1 patient with progression of disease (PD). After 6 months of targeted treatment, the PFS rate was 10/17, including 5 patients with PR, 5 patients with SD, and 7 patients with PD. Conclusion:After 3-6 months of targeted treatment, the tumor markers of most patients are decreased with metastases improved, but the adverse events of targeted drugs have a great impact on quality of life in patients with RAIR-DTC.
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Objective:To explore the characteristics of local brain neural activity in post stroke aphasia (PSA) patients in different frequency bands and the relationship between Western Aphasia Battery (WAB) scores and specific frequency bands. Methods:From March, 2015 to May, 2018, 15 PSA patients, and 15 healthy adults as controls matched for age, gender and education were recruited. They were assessed with WAB and scaned with resting-state functional magnetic resonance imaging. The amplitude of low-frequency fluctuation (ALFF) and fractional amplitude of low-frequency fluctuation (fALFF) on the frequency bands of 0.01-0.08 Hz, 0.027-0.073 Hz, and 0.01-0.027 Hz were calculated. The ALFF and fALFF in different frequency bands were extracted and the correlation with the WAB scores in the patients were analyzed. Results:On 0.01-0.08 Hz, ALFF increased in the right precentral gyrus in the patients. On 0.027-0.073 Hz, ALFF increased values in the right precentral gyrus, and fALFF decreased in the right cerebellar Crus2 region; fALFF in the right cerebellar Crus2 region negatively correlated with the scores of information content (r = -0.576, P = 0.025), auditory comprehension (r = -0.658, P = 0.008), repetition (r = -0.616, P = 0.014) and aphasia quotient (r = -0.611, P = 0.016) of WAB. On 0.01-0.027 Hz, the fALFF decreased in the left inferior parietal limbic gyrus, and positively correlated with the scores of information content (r = 0.538, P = 0.039) and aphasia quotient (r = 0.526, P = 0.044). Conclusion:Resting-state fALFF abnormalities in PSA patients are frequency-dependent, which associate with some frequency-specific neurofunctional alterations.
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Objective:To investigate the therapeutic effect of levo-thyroxine ( L-T 4) gel on hypothyroidism in rat model. Methods:A total of 30 Wistar rats (15 males, 15 females, 2-month age) were completely randomized into 6 groups ( n=5 per group) with one group as the normal control and the other 5 groups were established as the hypothyroidism models by intraperitoneal injection of 18.5 MBq 131I. Of the 5 hypothyroidism groups, 3 groups were given 0.2 g (high-dose group), 0.1 g (medium-dose group) and 0.05 g (low-dose group) L-T 4 gel per 100 g body mass on alternate days, respectively, one group was given 0.1 g blank gel per 100 g body mass daily and the other group was given 5 μg levo-thyroxine sodium tablets (Euthyrox) per 100 g body mass daily. The levels of total thyroxine (TT 4), free triiodothyronine (FT 3), free thyroxine (FT 4) and thyroid stimulating hormone (TSH) in serum were determined by radioimmunoassay and chemiluminescence immunoassay at 2, 4 and 8 weeks after administration, respectively. One-way analysis of variance and Bonferroni test were used for data analysis. Results:At 2 weeks after administration, compared with the normal control group, TT 4, FT 4 decreased and TSH increased in the oral Euthyrox group (TT 4: (65.04±8.20) vs (40.34±1.41) nmol/L, FT 4: (29.63±4.03) vs (18.03±2.76) pmol/L, TSH: (6.04±0.80) vs (10.07±1.01) mU/L; F values: 60.081-108.128, t values: from -4.44 to 4.86, all P<0.05). However, TT 4 ((67.88±14.27) nmol/L), FT 3 ((4.04±0.84) vs (4.45±0.34) pmol/L), FT 4 ((33.76±7.71) pmol/L) and TSH ((8.20±0.40) mU/L) in the L-T 4 gel low-dose group showed no significant differences with the normal control group ( t values: 0.44-2.61, all P>0.05). At 4 weeks after administration, there were no significant differences of TT 4, FT 3, FT 4 and TSH between the L-T 4 gel low-dose group/the oral Euthyrox group and the normal control group ( F values: 34.527-90.976, t values: from -0.95 to 0.35, all P>0.05). The differences of TT 4, FT 3, FT 4 and TSH were not significant between the L-T 4 gel low-dose group and the oral Euthyrox group ( t values: from -0.71 to 1.03, all P>0.05), which was still not significantly different at 8 weeks ( F values: 47.239-160.679, t values: from -0.58 to 1.02, all P>0.05). Conclusions:L-T 4 gel has obvious therapeutic effect on hypothyroidism in rats. Its effect is fast and stable, and its therapeutic effect is better than L-T 4 sodium tablets (Euthyrox).
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Objective:To explore the impact of urinary iodine concentration (UIC) on response to 131I treatment in differentiated thyroid cancer (DTC) patients with different risk stratifications. Methods:A total of 181 patients with DTC (75 males, 106 females, age: (44.1±12.5) years), who received the first 131I treatment in Tianjin Medical University General Hospital between January 2018 and February 2019, were retrospectively analyzed. Patients were divided into low- to intermediate-risk and high-risk groups. The treatment response was categorized into excellent response (ER) and non-excellent response (non-ER). Factors being evaluated including age, sex, preablative stimulated thyroglobulin (ps-Tg), UIC, etc. Mann-Whitney U test, χ2 test and logistic regression analysis were used for data analysis. Results:The UIC and ps-Tg in the low- to intermediate-risk group ( n=113) was 111.60(55.80, 204.65) μg/L and 2.08(0.63, 4.91) μg/L, respectively. Compared with the ER subgroup ( n=86), non-ER subgroup ( n=27) had higher UIC and ps-Tg level ( z values: -2.585, -4.511, both P<0.05). In the high-risk group ( n=68), UIC was 115.40(61.23, 167.28) μg/L and ps-Tg was 16.65(4.52, 43.45) μg/L. Compared with the ER subgroup ( n=20), non-ER subgroup ( n=48) had higher ps-Tg level ( z=-4.677, P<0.01), while the UIC was not significantly different between ER and non-ER subgroups ( z=-0.013, P>0.05). The multivariate logistic analysis indicated the ps-Tg level was the significant variable for non-ER in low- to intermediate-risk group (odds ratio( OR)=6.157(95% CI: 1.046-36.227); OR=22.965(95% CI: 3.591-146.857), both P<0.05) and high-risk group ( OR=9.696 (95% CI: 1.379-68.169), P<0.05); a high UIC could be an indicator of non-ER only in the low- to intermediate-risk group ( OR=3.715(95% CI: 1.201-11.488), P<0.05). Conclusions:The non-ER is associated with UIC in the low- to intermediate-risk group; however, UIC does not affect the non-ER in the high-risk group. Higher ps-Tg level is associated with non-ER in patients with low- to intermediate-risk and high-risk DTC.
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Objective:To investigate the prognostic factors of differentiated thyroid cancer (DTC) patients with positive thyroglobulin antibody (TgAb) and varying ages after operation and 131I treatment. To explore the value of TgAb level and its change in the prognosis of DTC patients. Methods:Clinical data of 131 TgAb positive DTC patients were retrospectively analyzed. According to age, they were divided into young group(age<55 years, n=95) and elder group (age≥55 years, n=36). According to response, it was divided into excellent response group (110 cases) and non-excellent response group (21 cases). χ2 test and t test were used to compare the clinicopathological features between excellent response group and non-excellent response group. By logistic regression analysis, the independent risk factors affecting the prognosis of patients were analyzed. The receiver operating characteristic curve was used to determine the TgAb value of persistent or recurrent DTC, and the Kaplan-Meier regression curve was used to analyze the time of TgAb becoming negative. P<0.05 was statistically significant. Results:In young patients, the higher serum TgAb level before 131I treatment and the lateral lymph node metastasis were the independent influencing factors of poor prognosis [ OR=0.89(95% CI 0.83-0.95), OR=0.15(95% CI 0.05-0.52); both P<0.05]. In elder group, extraglandular invasion and higher serum TgAb before 131I treatment were associated with poorer prognosis [ OR=0.05(95% CI 0-0.83), OR=0.91(95% CI 0.76-1.13); P<0.05]. The serum TgAb thresholds for predicting DTC persistence/recurrence were 315.5 IU/mL(246.0 IU/mL in the young group and 516.5 IU/mL in the elder group). The mean time TgAb sera turned negative was (26.37±2.22) months [(23.28±2.37) months for young group and (32.64±4.07) months for elder group]. The TgAb decreased >50% in one year of the patients who had a lower probability of disease persistence/recurrence than the group without ( P<0.05). Conclusions:The high level of serum TgAb before 131I treatment and lateral lymph node metastasis were independent factors of poor prognosis in young patients, while in elder patients, extraglandular tumor invasion and the high level of serum TgAb before 131I treatment were independent factors of poor prognosis. The rate of TgAb change one year after treatment may be used as an early marker for predicting the disease status of TgAb positive patients.
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OBJECTIVE@#To evaluate the clinical efficacy of weight management combined with pharyngoplasty for treatment of obesity-related obstructive sleep apnea-hypopnea syndrome (OSAHS).@*METHODS@#Sixty obese patients with OSAHS were randomly assigned into the combined treatment group and control group (@*RESULTS@#After 6 months of treatment, the patients receiving the combined treatment showed significant reductions of BMI, neck circumference and waist circumference as compared with the measurements before treatment and with those in the control group (@*CONCLUSIONS@#Weight management combined with uvulopalatopharyngoplasty can produce a good clinical efficacy for treatment of OSAHS with obesity, and the patients should have strengthened continuous family weight management while receiving surgical treatment.
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Humans , Body Mass Index , Obesity/surgery , Plastic Surgery Procedures , Sleep Apnea, Obstructive/surgery , Waist CircumferenceABSTRACT
The cognitive neuroscience researches about post-stroke aphasia provide the interpretation of all aspects of linguistics. The word-picture research paradigm can be applied to assess different types of aphasia, in various ways of stimulation modes and models. It is more helpful combining functional magenetic resonance imaging to research the mechanism of brain damage and recovery objectively. The interactive application of language task and imaging has also become a new direction in the mechanism study of aphasia.
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Objective:To investigate the clinical features of patients with recurrent or metastatic differentiated thyroid carcinoma(DTC)after 131I therapy. Methods:From December 2000 to December 2017, a total of 40 patients[14 males amd 26 females, median age 48(29-60)years] with recurrent or metastatic DTC after 131I therapy in Tianjin Medical University General Hospital were reviewed. We analyzed the clinical pathological features of the patients receiving the initial 131I ablation to screen the relevant factors affecting the time of recurrence or metastasis, the dynamic serological changes, imaging characteristics and the iodine uptake in the lesion at diagnosis. Chi- square test, Mann- Whitney U test and Kaplan- Meier analysis were used to compare the differences between the two groups. Results:The time of recurrence or metastasis of DTC after 131I therapy was not statistically different in the patient′s age, gender, multifocal cancer, lymph node metastasis, the interval between the initial 131I therapy and the operation, stimulated thyroglobulin(Tg)levels before the initial ablation and last 131I therapy, and times of 131I therapy( P > 0.05), but associated with the T-stage of in-situ tumor, soft tissue metastasis and initial therapeutic dose of 131I. Patients with the T4-stage of in-situ tumor( P=0.033), soft tissue metastasis( P=0.008)and tumor initial dose≤3.7 GBq( P=0.002)were more prone to early recurrence or metastasis. From termination of 131I therapy to the diagnosis of tumor recurrence or metastasis, Tg [Tg antibodys(TgAb)negative] and TgAb(TgAb positive)showed a gradually increasing trend. Recurrent or metastatic lesions were mostly located in the cervical lymph nodes, and most of them were multiple. Among the 40 patients with recurrent or metastatic DTC, only 3 patients had iodine-avid lesions. Conclusion:The T-stage of in-situ tumor, soft tissue metastasis and initial therapeutic dose of radioiodine are important factors affecting the time of recurrence or metastasis after 131I therapy in DTC patients. Most of the recurrent or metastatic lesions don′t ever concentrate radioiodine, so it′s difficult to benefit from continued 131I therapy.
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Objective:To analyze the trends and influencing factors of residual radioactivity in patients with differentiated thyroid carcinoma (DTC) after 131I therapy. Methods:A total of 132 DTC patients (34 males, 98 females; age (42.8±12.8) years) who received 131I therapy from November 2018 to February 2019 in Tianjin Medical University General Hospital were prospectively analyzed. Patients were divided into first treatment (FT) group ( n=88) and repeat treatment (RT; with 131I treatment≥2 times) group ( n=44). In FT group, there were 30 patients received 131I for remnant ablation, 33 patients for adjuvant therapy and 25 patients for therapy. In RT group, there were 18 patients received 131I for remnant ablation and 26 patients for therapy. 131I dosage: 3.70 GBq for remnant ablation therapy, 3.70-5.55 GBq for adjuvant therapy, 5.55-7.40 GBq for therapy. The residual body radioactivity of patients was monitored at 24, 48 and 72 h after the administration of 131I by dynamic radiation whole-body scanner and compared among groups. All clinical data were reviewed to explore the factors associated with the residual radioactivity. Independent-sample t test, χ2 test and logistic regression analysis were used to analyze the data. Results:At 24 h after 131I therapy, the residual radioactivity of patients in FT group were significantly lower than those in RT group ((880.60±396.64) vs (1 022.31±503.94) MBq; t=-2.765, P=0.035). In FT group, the residual radioactivity of patients with 131I adjuvant therapy+ therapy at 24 and 48 h after 131I administration were higher than those with 131I ablation (24 h: (987.16±447.33) vs (766.27±277.87) MBq, 48 h: (233.47±146.52) vs (183.52±90.65) MBq; t values: -2.711 and -2.021, both P<0.05). In RT group, the residual radioactivity of patients with 131I therapy at 24, 48 and 72 h after 131I administration were (1 246.90±531.69), (244.57±131.35) and (90.65±67.37) MBq respectively, which were higher than those with 131I ablation ((715.50±300.07), (149.85±68.82) and (58.46±31.45) MBq; t values: from -3.822 to -2.682, all P<0.05). There were 17.4%(23/132; 10 patients in FT group, 13 patients in RT group) patients with residual radioactivity >400 MBq at 48 h after 131I treatment, and 100% (132/132) patients with residual radioactivity <400 MBq at 72 h after 131I treatment. T staging, N staging, stimulated thyroglobulin level, and 131I dosage were significant factors affecting the residual radioactivity of patients ( t values: from -2.562 to 4.211, χ2 values: 3.988-8.332, all P<0.05), and T staging and 131I dosage were independent factors ( Walds values: 4.253-14.035, all P<0.05). Conclusions:The residual radioactivity of patients at 24 h after 131I treatments is higher than 400 MBq and hospital isolation time should be appropriately controlled. At 72 h after 131I treatment, the residual radioactivity of patients meets the national standard of discharging hospital. The residual radioactivity of patients with more advanced T staging and 131I dosage (>5.55 GBq) may not reach the standard at 48 h after 131I therapy, and the isolation time should be extended to 72 h.
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Anti-thyroid drug (ATD), radioactive iodine (RAI) and thyroidectomy are treatment options for Graves disease (GD). Treatment strategies for Graves ophthalmopathy (GO) patients include thyroid function control, oral or intravenous corticosteroids, orbital radiotherapy or orbital decompression surgery. However, current treatments for GD and GO are also less ideal because they target the signs and symptoms rather than the pathogenic mechanisms. The development of treatment strategies that targeting the thyroid-stimulating hormone receptor (TSHR) or insulin-like growth factor 1 receptor (IGF-1R) alone or in combination may yield effective and better tolerated treatments for GD and GO. This paper reviews the progress and limitations of the 2 methods.
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Objective:To investigate the correlation between 131I uptake and therapeutic efficacy in metastatic differentiated thyroid carcinoma (DTC). Methods:The clinical data of 138 patients with metastatic DTC (42 males, 96 females, age range: 8-74 years) treated with 131I in nuclear medicine departments of 31 centers all over China were retrospectively analyzed. The lesional 131I uptake was quantitatively analyzed with target-to-nontarget (T/NT) ratio through the regions of interest in metastatic lesions confirmed by either planar or tomographic 131I SPECT/CT imaging. The efficacies of 131I treatment on the metastatic DTC were divided into complete remission (CR), partial remission (PR), stable disease (SD) and progress disease (PD) based on the change of the lesion diameter before and after the treatment. Factors which may affect therapeutic efficacy were assessed by the univariate (Kruskal-Wallis rank sum test, χ2 test and one-way analysis of variance) and binary logistic regression analyses. The receiver operating characteristic (ROC) curve of lesional T/NT ratio to predict the ineffectiveness of 131I therapy was performed. Results:A total of 1 165 efficacies were evaluated. The planar imaging results ( n=653) showed that there was no statistically significant difference of T/NT ratio among CR, PR, SD and PD groups ( χ2=4.15, P>0.05). The tomographic imaging results ( n=512) suggested CR, PR, SD and PD in 7.6%(39/512), 65.8%(337/512), 22.9%(117/512), and 3.7%(19/512) of individuals, respectively, and the T/NT ratio among the four groups was significantly different ( χ2=30.46, P<0.01). The univariate analysis also showed that age, stimulated thyroglobulin(sTg), 131I dose were the factors affecting therapeutic efficacy ( F or χ2 values: 2.561, 7.095 and 8.799, all P<0.05). Furthermore, binary logistic regression analysis revealed that older patients (odds ratio ( OR)=1.034, P=0.022) or patients with lower lesional T/NT ( OR=1.086, P=0.006) had a higher probability of ineffectiveness. The area under ROC curve for T/NT ratio to predict ineffectiveness was 0.726, and the cut-off value was 6.2, with a sensitivity of 78.7%(107/136) and a specificity of 73.1%(275/376). Conclusions:131I therapy is an effective treatment for metastatic DTC. The age at the time of metastatic diagnosis and the lesional T/NT ratio are independent influential factors for ineffectiveness of 131I therapy. When the leisonal T/NT ratio is lower than 6.2, the inefficiency of 131I is higher.
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Objective To investigate the influence of different time discontinuation of compound iodine solution on 131Ⅰ uptake and curative effect of 131Ⅰ therapy in patients with Graves disease (GD).Methods A total of 1 585 patients (415 males,1 170 females;age range:17-62 years) treated with 131Ⅰ therapy for the first time between January 2012 and November 2016 were enrolled in this retrospective study.All patients were divided into preliminary treatment group (n =85) and control group (no iodine solution taking,n =1 500).Preliminary treatment group including 4-7 d discontinuation subgroup (group A,n=35),8-14 d discontinuation subgroup (group B,n=28) and 15-30 d discontinuation subgroup (group C,n=22).The high-est radioactive iodine uptake (RAIU),effective half-life,free triiodothyronine (FT3) and free thyroxine (FT4) levels before 131Ⅰ therapy were compared,and curative effects were evaluated.One-way analysis of variance,Ridit analysis and x2 test were used to analyze the data.Results The highest RAIU in group A,group B,group C and control group was (64.86 ± 13.20) ％,(67.40 ± 9.10) ％,(73.46 ± 4.65) ％ and (74.14±9.87) ％,respectively (F =1.658,P＞ 0.05).No significant difference was found in the effective half-life among 4 groups (F=0.651,P＞0.05).FT3 level in group A and group B ((11.90±4.85) and (15.51±2.95) pmol/L) was significantly lower than that in control group ((23.98±4.98) pmoL/L) and group C ((22.08±2.31) pmol/L;F=13.972,t values:6.57-12.08,all P＜0.05).FT4 level in group A and group B ((25.65±11.95) and (32.33±6.25) pmol/L) was obviously lower than that in control group ((73.65±21.55) pmol/L) and group C ((68.41±13.94) pmo]/L;F=21.238,t values:36.09-48.00,all P＜0.01).The overall curative effect of preliminary treatment group and that of control group were not statistically significant (u=0.397,P＞0.05),and no significant difference was found in the complete remission rates among 4 groups (x2 =1.169,P＞0.05).Conclusions If pretreatment with compound iodine solution is used before 131Ⅰ therapy in GD,it is feasible to carry out 131Ⅰ therapy within 2 weeks after withdrawal.In order to avoid the possibility of severe hyperthyroidism after 131Ⅰ therapy,it is recommended that radioiodine treatment should be carried out after discontinuation for 4-7 d.
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Objective@#To compare the ablation efficacy and therapy response with 1.1 GBq and 3.7 GBq 131I in postoperative patients with low- and intermediate-risk differentiated thyroid carcinoma(DTC).@*Methods@#A total of 190 patients (43 males, 147 females, age: (45.8±11.1)years) were enrolled from July 2016 to July 2017. Among them, 96 patients received 1.1 GBq 131I and 94 were given 3.7 GBq 131I. Diagnostic whole-body scan was performed 6 months after 131I ablation for treatment response evaluation, and the successful rate of 131I ablation was calculated. χ2 test or Fisher′s exact test was used for data analysis. The cut-off value of 99Tcm-pertechnetate uptake for predicting the successful rate of remnant thyroid ablation in 1.1 GBq group was determined by receiver operating characteristic (ROC) curve analysis.@*Results@#The successful ablation rates in 1.1 GBq and 3.7 GBq groups were 79.2%(76/96) and 81.9%(77/94), respectively (χ2=0.229, P>0.05). There was no significant difference in the therapy response between the two groups (χ2=1.371, P>0.05). The successful ablation rate in 3.7 GBq group was higher than that in 1.1 GBq group for patients with stage Ⅲ (5/6 vs 1/7, P=0.029). Moreover, for patients with 5 μg/L<preablative-stimulated thyroglobulin (ps-Tg)≤10 μg/L, the ablation rate in 1.1 GBq group was lower than that in 3.7 GBq group (3/11 vs 10/13, P=0.038). ROC curve analysis showed the cut-off value of 99Tcm-pertechnetate uptake for prediction of the successful ablation rate in 1.1 GBq group was 0.061 5.@*Conclusion@#The low- and intermediate-risk DTC patients with stage Ⅲ disease, 5 μg/L<ps-Tg≤10 μg/L or higher 99Tcm-pertechnetate uptake of remnant thyroid should be given 3.7 GBq other than 1.1 GBq 131I to obtain a better ablation efficacy.
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Objective To investigate the risk factors of atrial fibrillation (AF) in hyperthyroidism patients.Methods The clinical data of 557 patients with hyperthyroidism receiving 131I treatment from January 2015 to May 2018 were enrolled in the study.There were 50 cases with AF and 507 patients without AF before the treatment.Univariate and multivariate logistic regression were applied to analyze the risk factors of AF in hyperthyroidism patients.Results Compareded to non-AF patients,AF patients had older age [(59.1±10.6) vs.(41.9±13.7) years,t=6.75,P＜0.01],more males[42.0％(21/50] vs.19.7％(100/507),x2=14.11,P＜0.01],longer duration of hyperthyroidism [66.0 (6.8,120.0) vs.12.0(3.0,72.0) months,Z=2.83,P=0.02],higher prevalence of coronary artery disease [16.0％(8/50) vs.2.6％(13/507)] and hypertension[30.0％(15/50) vs.9.3％(47 / 507)],higher serum creatinine (SCr) [51.5(46.0,64.3) vs.42.0(35.0,51.0) μmol / L,Z=4.62,P＜0.01],serum uric acid (SUA) [(360.6±90.3) vs.(313.4±80.3)μmol/L,t=3.76,P＜0.01]and gamma-glutamy transpeptidase (GGT)[72.1 (38.0,97.0)vs.42.2(17.0,48.8) U/L,Z=4.97,P＜0.01] and total bilirubin (TBIL) (21.3±8.8) vs.(13.8±7.7) U/L,t=5.26,P＜0.01],direct bilirubin(DBIL)[12.6(7.9,17.4) vs.5.5(4.1,7.9)μmol/L,Z=6.62,P=0.00)]and lower blood platelet (PLT) [(188.5±60.8) × 109/L vs.(241.0±65.1)× 109/L,t=4.52,P＜0.01].And there were no significant differences in thyroid hormone level and thyroid autoimmune antibody levels.Univariate and multivariate analysis showed that the age (OR=1.23,95％CI:1.09-1.38,P＜0.01),SUA (OR=1.01,95％CI:1.00-1.20,P=-0.05),DBIL (OR=1.65,95％CI:1.01-2.72,P=0.05),GGT (OR=1.04,95％CI:1.01-1.08,P=0.01) were risk factors for AF in patients with hyperthyroidism.Conclusion Older age,abnormal serum SUA,DBIL and GGT are risk factors for atrial fibrillation in patients with hyperthyroidism,to timely control hyperthyroid and to give symptomatic treatment for those patients are necessary.
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Objective To construct a model of Graves'disease ( GD ) with ( or ) Graves'ophthalmopathy ( GO) in BALB/c mice by immunization with pcDNA3. 1/TSHR289. Methods pcDNA3. 1/TSHR289 was injected into the bilateral gastrocnemius muscle of 35 model mice and electroporation was immediately performed. 10 control mice were injected with sterile saline and electroporated, while 5 blank mice were injected with sterile saline only. Each group of mice was immunized at 1, 4, 7, and 10 weeks, respectively. Serum total T4 , TSH, TSAb, and TSBAb were measured before immunization, 2 weeks after each immunization, as well as 5 and 8 weeks after the last immunization. CT scan was used to evaluate the morphological changes of the eyes of the mice.99m TcO4- imaging was used to measure the thyroid uptake function, and the pathological changes of the thyroid and orbital tissues were evaluated by HE staining. Results After the 2nd time immunization, the serum concentrations of TT4 , TSAb and TSBAb in GD mice were significantly higher than those of control and blank groups( F=13.781, 31.435, 36.112, P<0.01, respectively).The TSH continued to be significantly lower than that of control and blank groups(F=13.966, P<0.01) . After the 4th time immunizations, the ability of uptaking99m TcO4- in GD mice thyroid was significantly enhanced compared with the control group. The thyroid goiter with a large amount of lymphocyte infiltration, and the thyroid follicle was thin. CT scan of GO mice showed thickening and swelling of the extraocular muscles, and no abnormalities in tendon and muscle attachment points. HE staining showed thickening of extraocular muscle fibers, lymphocyte infiltration of extraocular muscles and orbital tissue, increased hyaluronic acid, and infiltration of fat cells. Conclusion GD or GO model can be successfully induced by multiple intramuscular injection of pcDNA3.1/TSHR289 in BALB/c mice.
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Objective To compare the ablation efficacy and therapy response with 1. 1 GBq and 3. 7 GBq 131I in postoperative patients with low- and intermediate-risk differentiated thyroid carcinoma (DTC). Methods A total of 190 patients (43 males, 147 females, age:(45.8±11.1)years) were enrolled from July 2016 to July 2017. Among them, 96 patients received 1.1 GBq 131I and 94 were given 3.7 GBq 131I. Diagnostic whole-body scan was performed 6 months after 131 I ablation for treatment response evaluation, and the successful rate of 131I ablation was calculated. χ2 test or Fisher's exact test was used for data analysis. The cut-off value of 99 Tcm-pertechnetate uptake for predicting the successful rate of remnant thyroid ablation in 1.1 GBq group was determined by receiver operating characteristic ( ROC) curve analysis. Results The successful ablation rates in 1.1 GBq and 3.7 GBq groups were 79.2％(76/96) and 81.9％(77/94), respec-tively (χ2=0.229, P>0.05). There was no significant difference in the therapy response between the two groups (χ2=1.371, P>0.05) . The successful ablation rate in 3.7 GBq group was higher than that in 1.1 GBq group for patients with stageⅢ(5/6 vs 1/7, P=0.029). Moreover, for patients with 5μg/L<preablative-stimula-ted thyroglobulin (ps-Tg)≤10μg/L, the ablation rate in 1.1 GBq group was lower than that in 3. 7 GBq group ( 3/11 vs 10/13, P=0.038) . ROC curve analysis showed the cut-off value of 99 Tcm-pertechnetate uptake for prediction of the successful ablation rate in 1.1 GBq group was 0. 0615. Conclusion The low- and inter-mediate-risk DTC patients with stageⅢdisease, 5μg/L<ps-Tg≤10μg/L or higher 99 Tcm-pertechnetate up-take of remnant thyroid should be given 3.7 GBq other than 1.1 GBq 131I to obtain a better ablation efficacy.
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INTRODUCTION@#Postgraduate medical education in Singapore underwent a major transition recently, from a British-style system and accreditation to a competency-based residency programme modelled after the American system. We aimed to identify the relative importance of factors influencing the choice of sponsoring institution (SI) for residency among medical students during this transition period.@*METHODS@#A questionnaire-based cross-sectional study of Singapore undergraduate medical students across all years of study was performed in 2011. Participants rated the degree of importance of 45 factors (including research, academia and education, marketing, reputation of faculty, working conditions, posting experience and influence by peers/seniors) to their choice of SIs on a five-point Likert scale. Differences in gender and seniority were compared.@*RESULTS@#705 out of 1,274 students completed the survey (response rate 55.3%). The top five influencing factors were guidance by mentor (4.48 ± 0.74), reputation for good teaching (4.46 ± 0.76), personal overall experience in SI (4.41 ± 0.88), quality of mentorship and supervision (4.41 ± 0.75), and quality and quantity of teaching (4.37 ± 0.78). The five lowest-rated factors were social networking (2.91 ± 1.00), SI security (3.01 ± 1.07), open house impact (3.15 ± 0.96), advertising paraphernalia (3.17 ± 0.95) and research publications (3.21 ± 1.00). Female students attributed more importance to security and a positive working environment. Preclinical students rated research and marketing aspects more highly, while clinical students valued a positive working environment more.@*CONCLUSION@#Quality of education, mentorship, experiences during clerkship and a positive working environment were the most important factors influencing the choice of SI.