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1.
Article in Chinese | WPRIM | ID: wpr-993565

ABSTRACT

Objective:To investigate the value of cellular immune status before initial 131I treatment for predicting treatment response in young and middle-aged patients with papillary thyroid cancer (PTC). Methods:From March 2018 to April 2019, 150 young and middle-aged patients with PTC (46 males, 104 females, age (40.0±9.8) years) who underwent total thyroidectomy and neck lymph node dissection in the Affiliated Hospital of Qingdao University were enrolled retrospectively. All patients underwent radioablation 1-2 months after operation, and the serum lymphocyte subsets (CD3 + , CD4 + , CD8 + , CD4/CD8) as well as natural killer (NK) cells were detected 1 d before the initial 131I treatment. Patients were divided into excellent response (ER) group and non-ER group according to the response of 6-12 months after 131I treatment. Clinicopathological characteristics, preablative stimulated thyroglobulin (psTg), initial 131I dose and lymphocyte subsets that might affect the response to 131I treatment were analyzed (independent-sample t test, Mann-Whitney U test, χ2 test, multiple logistic regression analysis). ROC curve analysis was used to evaluate the predictive value of significant factors for non-ER. Results:Of 150 patients, 84 cases were in ER group (56.00%), and 66 cases (44.00%) were in non-ER group. Age ( z=-2.86, P=0.004), M stage ( χ2=13.64, P<0.001), psTg ( z=-8.94, P<0.001), initial 131I dose ( z=-7.60, P<0.001), CD4 + ( t=2.50, P=0.014), CD4/CD8 ( z=-2.22, P=0.027) of the two groups were significantly different. Multivariate analysis showed that psTg (odds ratio ( OR)=1.27, 95% CI: 1.16-1.40, P<0.001) and CD4/CD8 ( OR=0.39, 95% CI: 0.15-0.99, P=0.048) were independent factors for predicting 131I treatment response. The cut-off values of psTg and CD4/CD8 for predicting non-ER were 6.78 μg/L and 1.67, respectively. Conclusions:Cellular immune status before initial 131I treatment may predict treatment response in young and middle-aged patients with PTC. It indicates non-ER response when Tg is higher than 6.78 μg/L and CD4/CD8 is lower than 1.67.

2.
Article in Chinese | WPRIM | ID: wpr-884810

ABSTRACT

Objective:To investigate the preoperative diagnostic value of 99Tc m-methoxyisobutylisonitrile (MIBI) planar imaging and SPECT/CT imaging for primary hyperparathyroidism (PHPT), and analyze the relevant factors affecting the imaging results. Methods:From June 2016 to September 2019, a total of 62 patients (15 males, 47 females, age range: 27-80 years) confirmed as PHPT by postsurgical pathology in Affiliated Hospital of Qingdao University were retrospectively enrolled. The diagnostic efficacies of 99Tc m-MIBI planar imaging and SPECT/CT imaging were compared using χ2 test. The differences of preoperative serum parathyroid hormone (PTH), Ca and the maximum diameter of lesion between the positive and negative groups of planar imaging were analyzed using independent-sample t test and Mann-Whitney U test. The region of interest (ROI) method was applied to calculate the uptake ratio of lesions to normal tissues at the early phase (T/Ne) and delayed phase (T/Nd) in positive cases of planar imaging. Pearson or Spearman correlation analysis was used to evaluate the correlation of T/Ne, T/Nd with preoperative serum PTH, Ca and the maximum diameter of lesion. The receiver operating characteristic (ROC) curves of preoperative serum PTH, Ca and positive planar imaging were drawn and the cut-off values were obtained. Results:The sensitivity of planar imaging and SPECT/CT imaging was 69.35%(43/62) and 87.10%(54/62) respectively ( χ2=5.729, P=0.017). The preoperative serum PTH, Ca levels and the maximum diameter of lesion in patients with positive planar imaging (253.32(107.00, 331.70) ng/L, 2.78(2.51, 2.87) mmol/L, (2.01±0.88) mm) were higher than those with negative planar imaging ((111.86±44.29) ng/L, (2.59±0.21) mmol/L, (1.42±0.55) mm; z values: -2.802, -1.978, t=3.300, all P<0.05). T/Ne was positively correlated with preoperative serum PTH ( rs=0.511, P<0.001) and the maximum diameter of lesion ( r=0.381, P=0.012), and T/Nd was positively correlated with preoperative serum PTH ( rs=0.538, P<0.001), Ca ( rs=0.348, P=0.022) and the maximum diameter of lesion ( r=0.463, P=0.002). The area under the ROC curve between preoperative serum PTH, Ca and planar imaging was 0.725 and 0.646, respectively. Preoperative serum PTH had a better predictive value with the optimal cut-off value of 150.4 ng/L. Conclusions:Preoperative serum PTH, Ca and the maximum diameter of lesion are positively correlated with 99Tc m-MIBI uptake in PHPT patients with positive planar imaging results. When preoperative serum PTH is lower than 150.4 ng/L, planar imaging is prone to false negative. SPECT/CT imaging has a significant value in preoperative diagnosis and the combination of PTH and CT can improve the positive rate.

3.
Article in Chinese | WPRIM | ID: wpr-798838

ABSTRACT

Objective@#To investigate the response to 131I therapy and to explore the influence factors in postoperative differentiated thyroid carcinoma (DTC) patients with negative preablative stimulated thyroglobulin (psTg) and iodine-positive lymph node after the first radioablation.@*Methods@#From May 2016 to October 2018, 108 DTC patients (28 males, 80 females, age: (45.7±10.4) years) with negative psTg who underwent 131I treatment for the first time in the Affiliated Hospital of Qingdao University were retrospectively enrolled. All patients had iodine-positive lymph nodes, which were showed by SPECT/CT imaging 5-6 d after 131I treatment. The treatment response was evaluated at 6-24 month after 131I treatment. Patients were divided into excellent response (ER) group and non-excellent response (non-ER) group according to the response to the first 131I treatment. Independent-sample t test, χ2 test and Mann-Whitney U test were used to analyze differences of factors (e.g. age, gender, extraglandular infiltration) between the 2 groups, and then multivariate logistic regression was performed to find the influence factors for treatment response. The receiver operating characteristic (ROC) curve was employed to evaluate the predictive value of the iodine-positive lymph node size in 131I treatment response.@*Results@#A total of 82 patients (75.93%, 82/108) achieved ER, and 26 (24.07%, 26/108) was non-ER patients. There were significant differences in age (t=-2.540, P=0.016), extraglandular infiltration (χ2=5.764, P=0.016), T stage (χ2=19.857, P<0.001), N stage (χ2=14.145, P=0.001), risk stratification of recurrence (χ2=11.487, P=0.003), ultrasound results before 131I treatment (χ2=44.819, P<0.001), dose of the first 131I treatment (U=780.0, P=0.018), size (long diameter) of iodine-positive lymph node (U=184.0, P<0.001), and psTg level (U=776.0, P=0.037) between ER and non-ER groups. Multivariate logistic regression showed that age, size of iodine-positive lymph node and ultrasound results before 131I treatment were closely related to 131I treatment response. The odds ratio (OR) values (95% CI) were 1.123 (1.025-1.231), 4.275 (1.893-9.653) and 260.86 (8.123-8 376.764), respectively. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value for non-ER were 100%(26/26), 70.73%(58/82), 77.78%(84/108), 52.00%(26/50) and 100%(58/58) respectively when the cut-off value of iodine-positive lymph node size was 5.5 mm.@*Conclusion@#The response of some DTC patients with negative psTg and iodine-positive lymph node after the first radioablation were non-ER. Age, ultrasound results before 131I treatment and size of iodine-positive lymph node are sensitive indicators for predicting clinical outcome in DTC patients with negative psTg and iodine-positive lymph node after the first radioablation.

4.
Article in Chinese | WPRIM | ID: wpr-869122

ABSTRACT

Objective To investigate the response to 131I therapy and to explore the influence factors in postoperative differentiated thyroid carcinoma (DTC) patients with negative preablative stimulated thyroglobulin (psTg) and iodine-positive lymph node after the first radioablation.Methods From May 2016 to October 2018,108 DTC patients (28 males,80 females,age:(45.7±10.4) years) with negative psTg who underwent 131I treatment for the first time in the Affiliated Hospital of Qingdao University were retrospectively enrolled.All patients had iodine-positive lymph nodes,which were showed by SPECT/CT imaging 5-6 d after 131I treatment.The treatment response was evaluated at 6-24 month after 131I treatment.Patients were divided into excellent response (ER) group and non-excellent response (non-ER) group according to the response to the first 131I treatment.Independent-sample t test,x2 test and Mann-Whitney U test were used to analyze differences of factors (e.g.age,gender,extraglandular infiltration) between the 2 groups,and then multivariate logistic regression was performed to find the influence factors for treatment response.The receiver operating characteristic (ROC) curve was employed to evaluate the predictive value of the iodine-positive lymph node size in 131I treatment response.Results A total of 82 patients (75.93%,82/108) achieved ER,and 26 (24.07%,26/108) was non-ER patients.There were significant differences in age (t=-2.540,P=0.016),extraglandular infiltration (x2 =5.764,P=0.016),T stage (x2=19.857,P<0.001),N stage (x2 =14.145,P =0.001),risk stratification of recurrence (x2 =11.487,P=0.003),ultrasound results before 131I treatment (x2 =44.819,P<0.001),dose of the first 131 I treatment (U =780.0,P =0.018),size (long diameter) of iodine-positive lymph node (U=184.0,P<0.001),and psTg level (U=776.0,P=0.037) between ER and non-ER groups.Multivariate logistic regression showed that age,size of iodine-positive lymph node and ultrasound results before 131I treatment were closely related to 131I treatment response.The odds ratio (OR) values (95% CI) were 1.123 (1.025-1.231),4.275 (1.893-9.653) and 260.86 (8.123-8376.764),respectively.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value for non-ER were 100% (26/26),70.73% (58/82),77.78% (84/108),52.00% (26/50) and 100% (58/58) respectively when the cut-off value of iodine-positive lymph node size was 5.5 mm.Conclusion The response of some DTC patients with negative psTg and iodine-positive lymph node after the first radioablation were non-ER.Age,ultrasound results before 131I treatment and size of iodine-positive lymph node are sensitive indicators for predicting clinical outcome in DTC patients with negative psTg and iodine-positive lymph node after the first radioablation.

5.
Article in Chinese | WPRIM | ID: wpr-622586

ABSTRACT

A comparison teaching experiment was carried out in grade 2001 and grade 2002.The students majoring in clinical medicine in these two grades were taught surgery with graphical approach and traditional method respectively.The student number,the test marks and the survey by questionnaire show that graphical teaching approach is more attractive with its visualization and originality it can stimulate students' interests in learning,develop their thinking and improve their clinical analytic ability.It is an important approach to improve clinical teaching quality to lay a good foundation for students before their clinical practice.

6.
Article in Chinese | WPRIM | ID: wpr-550971

ABSTRACT

22 cases of chronic gastritis,8 cases of gastric cancer,and 3 cases of other gastric diseases.10 hea'thy adults were also studied to serve as the control.According to the diagnostic criteria of Chinese traditional medicine ,58 cases with epigastric pains out of the 80 were categorized into the group of spleno-gastric asthenia (SGA) of 35 cases and the group of hepatogastric incoordinatin (HGI) of 23 cases.The basal pressure and rhythmic contractions of the stomach in response to a definite volume loading were recorded.It was found that 60% of SGA cases and 56.8% of PU cases showed only a few low-amplitude or no contractions in response to all varieties of volume loading,which were significantly higher than that in HGI cases (26%) and the control (10%).In the interval between the contractions and relaxations of the proximal stomach the intra-gasrric pressure was significantly lower in SGA and PU cases than in HGI cases and the control.These findings indicate that the tension and contractility of the mesculature of the proximal stomach are markedly reduced in patients with PU and SGA.

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