ABSTRACT
Objective:To summarize the ultrasound features of medullary thyroid cancer (MTC) and analyze its diagnosis value for MTC.Methods:91 patients with medullary thyroid carcinoma (103 nodules) in Department of Thyroid Surgery of the First Affiliated Hospital of Zhengzhou University from Apr. 2013 to Nov. 2018 were retrospectively analyzed, including 36 males and 55 females. Preoperative ultrasound features and serum calcitonin levels were recorded. SPSS 22.0 was used and the measurement data of normal distribution was expressed as ± s, and the enumeration data was described by ratio or rate. The comparison between groups was performed by single factor ANOVA and rank sum test. Results:83.5% (86/103) of the MTC nodules were located in the middle and upper thyroid gland. Hypoechoic accounted for 78.6% (80/103) . 81.6% (84/103) of them had calcification and 74.8% (77/103) of these nodules had abundant blood flow signals (color Doppler flow imaging, CDFI Ⅱ-Ⅲ) . 91.3% (94/103) of them had aspect ratio less than 1, 87.4% (90/103) were solid and 35.0% (36/103) had comet tail sign. The positive rate of preoperative serum calcitonin was 86.8% (79/91) . There were significant differences in shape ( P=0.001) , margin ( P=0.012) , cystic ( P=0.004) , comet-tail ( P<0.001) , lymph node ( P<0.001) and color Doppler flow imaging ( P=0.001) through comparing MTC nodules in different TI-RADS grades. Conclusions:MTC can behave as single, solid, hypoechoic, large round nodule located in the middle or upper thyroid gland, with thick calcification and abundant blood flow signals in ultrasound. The surrounding area may be accompanied with comet tail sign, and the probability of lymph node metastasis is high. The suspicious nodules screened by ultrasound can be further diagnosed by serum calcitonin.
ABSTRACT
Objective:To investigate the difference of radiofrequency ablation combined with ethanol ablation and radiofrequency ablation in the treatment of benign cystic solid thyroid nodule.Methods:A total of 80 patients who visited the Thyroid Surgery Department of the First Affiliated Hospital of Zhengzhou University from January 2015 to July 2018 were selected. All selected patients are required to meet the following criteria: (1)Color doppler ultrasonography of the neck revealed a cystic solid thyroid nodule greater than 20 mm in diameter. (2) The results of fine needle aspiration cytology of thyroid nodules were benign. (3)The patients is to undergo radiofrequency ablation of thyroid nodule. According to the condition and patients′ wishes, radiofrequency ablation (Group A, n=40) and combined ethanol and radiofrequency ablation(Group B, n=40) were performed respectively to observe the changes of nodule volume and maximum diameter at 3, 6 and 12 months after surgery.The difference of intraoperative radiofrequency ablation energy, postoperative complications and patient satisfaction at 12 months after operation were also observed. The respective clinical effects of the two groups and the difference of curative effects between the two groups were analyzed. Two-factor repeated measurement analysis of variance or independent sample t test was used to compare the measurement data in line with normal distribution between groups. Friedman′s rank sum test was used for comparison of measurement data groups that did not conform to normal distribution, and Bonferroni correction was used for pairwise comparison. Chi-square test was used to compare the counting data between groups. Results:On the 12th months after operation, the volume reduction of of nodules in group B was greater than that of group A, and the difference was statistically significant[(7.0±5.1) mL vs (5.5±4.9) mL, P<0.05]. The maximum diameter reduction of nodules in group B was greater than that of group A and the difference was statistically significant [(1.5±0.6) cm vs (1.4±0.8) cm, P<0.05]. During the period of 6 to 12 months after operation, the trend of nodular shrinkage in group B was more obvious than that in group A ( P<0.05). The radiofrequency ablation energy of group was lower than that of group A, and the difference was statistically significant [(2.37±1.18) kJ vs (3.89±1.17) kJ, P<0.05]. Voice reduction occurred in 2 cases and recovered within 2 weeks.Local bleeding occurred in 1 case during the operation, which was stopped after ablation. There was no statistical significance in the satisfaction of patients in group A and group B (87.5% vs 90%, P>0.05). Conclusion:Compared with radiofrequency ablation, radiofrequency ablation combined with ethanol ablation for benign cystic solid thyroid nodules can achieve better nodule reduction effect and reduce the ablation energy.
ABSTRACT
Inflammatory response is an important mechanism of secondary nerve injury in ischemic stroke, which is still a research hotspot in the field of neuroscience at present. Astrocytes are characterized by extensive distribution in brain, strong hypoxia tolerance, and the ability to interact with almost all cells in neurovascular unit, thus becoming potential therapeutic targets for alleviating ischemic injury. After ischemic stroke, astrocytes quickly become reactive astrocytes, releasing a large number of inflammatory cytokines, promoting the activation and invasion of other inflammatory cells, triggering a cascade of inflammatory responses, and aggravating ischemic injury. A variety of basic studies have shown that inhibiting the astrocytes activation and astrocytosis can significantly reduce neuroinflammatory response and infarct volume, and significantly improve the neurological function recovery in a model of middle cerebral artery occlusion. In this paper, the research progress of inflammatory response of astrocytes after ischemic stroke was reviewed from the aspects of astrocyte activation and polarization, release of inflammatory cytokines, interaction of inflammatory cells and corresponding targeted therapy strategies.
ABSTRACT
Objective To investigate the effect of donepezil on subventricular zone ( SVZ) neuro-genesis related neurotrophic factors after cerebral infarction. Methods Mice were randomly assigned into three groups: vehicle-treated sham group (Sham+vehicle,n=18),vehicle-treated middle cerebral artery oc-clusion (MCAO) group (MCAO + vehicle,n=30) and donepezil-treated MCAO group (MCAO+donepezil, n=30). Middle cerebral artery occlusion( MCAO) was induced by thread-occlusion method. Nissl staining was used to measure the infarct volume and the modified neurological severity score(mNSS) was used to as-sess neurologic function and brain water content was detected to assess brain edema degree. Proliferative cells and neuroblasts were labeled with 5-bromodeoxyuridine ( BrdU) and doublecortin ( DCX). The SVZ BrdU+/DCX+cells were detected by immunofluorescence. The expression of glial cell line-derived neurotro-phic factor (GDNF),brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) were detec-ted by Western blot. Results The infarct volume of MCAO + donepezil group ((13. 33±4. 55)%) was sig-nificantly lower than that of MCAO + vehicle group ((31. 33±3. 93)%,t=7. 34,P<0. 05). The neurologic deficits were significantly ameliorated after donepezil treatment,and the brain water content of MCAO + done-pezil group ((71. 82±10. 18)%)was significantly less than that of MCAO + vehicle group ((85. 93± 7. 54)%,F=13. 480,P<0. 05). All differences were statistically significant (P<0. 05). The area of BrdU+/DCX+cells within SVZ of MCAO + vehicle group ((6. 16±1. 79)%) was significantly larger than that of sham + vehicle group ((2. 25±1. 09)%),and was fewer than that of MCAO+donepezil group ((16. 19± 2. 16)%,F=102. 756,P<0. 05). MCAO significantly promoted the expression of GDNF,BDNF and NGF within SVZ compared with sham operation,and donepezil increased these protein levels(F=15. 114,27. 121, 27. 398,P<0. 05). Conclusion Donepezil regulates neurogenesis via increasesing the expression of GDNF, BDNF and NGF within SVZ after cerebral infarction.
ABSTRACT
Objective To investigate the impact of calcification on differential diagnosis of thyroid nodule using shear wave elastography (SWE). Methods One hundred and forty-six patients with thyroid nodules were prospectively enrolled in the study. Ultrasound observations included nodule size, boundary, shape, envelope, internal echotexture, posterior acoustic enhancement, and the relationship with surrounding tissue. According to the presence of internal calciifcation, patients were divided into calciifcation group (groupⅠ) and no calciifcation group (groupⅡ). Real-time shear wave elastography (young′s modulus value) were taken in both groups. Taking surgical pathologic results as the gold standard, receiver operating characteristic (ROC) curve of SWE in diagnosis of benign and malignant thyroid nodule were drawn for two groups respectively. Results In groupⅠ, 25 cases were benign and 38 cases were malignant. The malignant incidence was 60%. Among them the rate of malignant nodules in microcalcification group was 92%(24/26). The incidence of malignant nodules in coarse calcification group was 38%(14/37). The area under the curve (AUC) of SWE in groupⅠwas 0.564. In groupⅡ, 67 cases were benign and malignant had 16 cases. Using 30.43 kPa as the diagnostic point of young′s modulus value, the sensitivity, speciifcity, accuracy and AUC were 93.2%, 81.2%, 84.8%and 0.824. Conclusion In no calciifcation group, SWE is more meaningful in the differential diagnosis of benign and malignant thyroid nodules.
ABSTRACT
ObjectiveTo evaluate the clinical value of Young's modulus by supersonic shear wave elastography (SWE) in differential diagnosis of thyroid solid nod1ules.MethodsEighty-three patients with 113 solid nodules were examined by SWE.All the nodules were confirmed by pathology.According to Young's modulus,a receiver operating characteristic (ROC) curve was drawn,and it used to identify the value of optimal operating point for differential diagnosis of thyroid nodules.Results ① The mean of Young's modulus of benign nodules was (23.57 ± 9.35)kPa,which was significantly different from the valve of malignant nodules (43.73 ± 19.82) kPa ( t =6.31,P =0.00).(②) It showed that the optimal operating point of ROC curve as 27.49,with high sensitivity(93.2％),specificity(81.2％) and accuracy (85.8％).The area under ROC curve was 0.91.Conclusions SWE is a newly quantitative technique of ultrasonography,which is helpful to identify and distinguish in the differential diagnosis of thyroid nodules.
ABSTRACT
0.10). However, for patients with positive cervical lymph nodes, neck dissection plus radiotherapy resulted in a better local control rate than radiotherapy alone (P