Morphological Characteristics of the Results of Experimental Modeling of Septic Peritonitis

SUMMARY: Experimental studies devoted to the study of the mechanisms of the pathogenesis of acute peritonitis and the development of new methods of medical and surgical treatment are becoming increasingly relevant. Today, experimental medicine knows many different ways to modeling septic peritonitis and eliminate it, but the role of the local immune system is underestimated, whereas it takes a direct part in inflammation. The objective of our work to study morphological features of results of experimental modeling of septic peritonitis in white rats. The study included 15 sexually mature white male rats weighing 276.75±6.56 grams. A simulation of septic peritonitis was performed by perforating the upper part of the cecum with four punctures with a G16 injection needle. As a result of the experiment, after examination of the peritoneal cavity, all 15 animals were diagnosed with omentum tamponade of perforated damage to the caecum. In 11 cases, the perforated wall of the caecum was covered by the greater omentum (73.34 %), and in the other 4 animals, tamponade was performed by one of the epididymal omentum (26.66 %). The initial stage of tamponade with the greater or epididymal omentums of a perforated caecum begins on the first day of the experiment and consists of tight interstitial consolidation between them, as well as in the invasion of blood vessels from the omentum side to the focus of infection, which ensure the delivery of the appropriate immunocompetent cells. As a result of this process, intensive lymphoid infiltrates are formed in this area, as well as the growth of adipose tissue, which isolates the inflammatory focus from the peritoneal cavity with a thick layer.

Las investigaciones experimentales dedicadas al estudio de los mecanismos de patogénesis de la peritonitis aguda y el desarrollo de nuevos métodos de tratamiento médico y quirúrgico son cada vez más relevantes. Hoy en día, la medicina experimental conoce muchas formas diferentes de modelar la peritonitis séptica y eliminarla, pero se subestima el papel del sistema inmunológico local, mientras que él participa directamente en la inflamación. El objetivo de nuestro trabajo fue estudiar las características morfológicas de los resultados del modelado experimental de peritonitis séptica en ratas blancas. El estudio incluyó 15 ratas macho blancas, sexualmente maduras que pesaban 276,75 ± 6,56 gramos. Se realizó una simulación de peritonitis séptica perforando la parte superior del ciego con cuatro punciones con una aguja de inyección G16. Como resultado del experimento, después del examen de la cavidad peritoneal, a los 15 animales se les diagnosticó taponamiento del omento o lesión perforada del ciego. En 11 casos, la pared perforada del ciego fue recubierta por el omento mayor (73,34 %), y en los otros 4 animales el taponamiento se realizó por uno de los epidídimos (26,66 %). La etapa inicial del taponamiento con omento mayor o epidídimo de un ciego perforado comienza el primer día del experimento y consiste en una estrecha consolidación intersticial entre ellos, así como en la invasión de los vasos sanguíneos desde el lado del omento hasta el foco de infección, que aseguran la entrega de las células inmunocompetentes apropiadas. Como resultado de este proceso, se forman intensos infiltrados linfoides en esta zona, así como el crecimiento de tejido adiposo, que aísla el foco inflamatorio de la cavidad peritoneal con una gruesa capa.

Guía de práctica clínica para el tratamiento y seguimiento de personas con cáncer diferenciado de tiroides. Parte I: Vigilancia activa

Introducción: El cáncer de tiroides es una enfermedad frecuente en el mundo, con mayor prevalencia del tipo diferenciado. El diagnóstico temprano y manejo pertinente, individualizado y adaptable puede mejorar su pronóstico. Objetivo: Generar recomendaciones basadas en evidencia sobre el tratamiento y seguimiento de personas adultas con cáncer diferenciado de tiroides (CDT). Metodología: Guía de práctica clínica (GPC) a partir de revisión sistemática de literatura (RSL) y consenso de expertos clínicos. El grupo desarrollador definió el alcance y cuatro preguntas que se resolvieron a través de revisión de evidencia de GPC existentes, RSL, estudios primarios publicadas en español o inglés en diferentes fuentes de información desde 2013. Las preguntas de investigación fueron: 1. ¿Cuáles son las indicaciones de la vigilancia activa?, ¿cómo realizarla?, ¿cuándo y con que periodicidad realizarla? 2. ¿Cuál es el tratamiento y su indicación en pacientes con nódulos tiroideos sospechosos de cáncer? 3. ¿Cómo y cuándo realizar seguimiento de pacientes con CDT de acuerdo con el riesgo dinámico? 4. ¿Cuál es el manejo actual de los pacientes iodo refractarios? Se propusieron recomendaciones basadas en la evidencia, y analizadas y discutidas por el colectivo experto en sesiones asincrónicas. Se evalúo la calidad de la evidencia y las recomendaciones fueron gradadas en fuerte o condicional y a favor o en contra a partir del análisis de la calidad de la evidencia, contexto de implementación (disponibilidad e implementación) y la experticia clínica. En el presente documento se desarrollada la primera pregunta, referente a vigilancia activa. Resultados: 86 recomendaciones fueron propuestas y acordadas por el grupo desarrollador, categorizadas en tratamiento y seguimiento para resolver las preguntas planteadas. 10 de las recomendaciones corresponden a vigilancia activa y se incluyen en el presente documento. Recomendaciones claves incluyen, brindar información completa y oportuna a pacientes, conformación de equipos multidisciplinarios, análisis individualizado del paciente para la decisión de tratamiento, estadificación rutinaria de riesgo dinámico para evaluar la respuesta al tratamiento y ajustarlo, minimización de procedimientos fútiles o que aportan poco a la supervivencia y calidad de vida de los pacientes. Conclusión: Se presentan recomendaciones que esperan incidir en la estandarización de la práctica clínica cotidiana de pacientes con CDT y mejores resultados en salud.

Introduction: Thyroid cancer is a common disease in the world, with a higher prevalence of the differentiated type. Early diagnosis individualized and adaptive management can improve prognosis. Objective: Generate evidence-based recommendations on the treatment and follow-up of adults with differentiated thyroid carcinoma (DTC). Methodology: Clinical practice guideline (CPG) based on systematic literature review (RSL) and consensus of clinical experts. The development group defined the range and four questions that were resolved through a review of evidence from existing CPGs, RSLs, primary studies published in Spanish or English in various sources of information since 2013. The research questions were: 1. What are the indications for active surveillance? How to carry it out? When and how often to carry it out? 2. What is the treatment and its indication in patients with thyroid nodules suspicious for cancer? 3. How and when to follow up patients with CDT according to dynamic risk? 4. What is the current management of iodine refractory patients? Evidence-based recommendations analyzed and discussed by the expert group in asynchronous sessions were proposed. The quality of the evidence was evaluated, and the recommendations were graded as strong or conditional and in favor or against based on the analysis of the quality of the evidence, implementation context (availability and implementation) and clinical expertise. In this document, is developed the first question, referring to active surveillance. Results: 86 recommendations were proposed and agreed upon by the development group, categorized into treatment and follow-up to solve the questions raised. 10 of the recommendations correspond to active surveillance and are included in this document. Key recommendations include providing complete and timely information to patients, develop of multidisciplinary teams, individualized patient analysis for treatment decisions, routine dynamic risk staging to evaluate response to treatment and adjust it, minimization of futile procedures or that contribute little to the survival and quality of life of patients. Conclusion: Recommendations are presented that longs to influence the standardization of the daily clinical practice of patients with DTC and better health outcomes.

Clinical application status of multiple localization methods in the treatment of pulmonary nodules by sub-lobectomy / 中国胸心血管外科临床杂志

@#The precise localization of pulmonary nodules has become an important technical key point in the treatment of pulmonary nodules by thoracoscopic surgery, which is a guarantee for safe margin and avoiding removal of too much normal lung parenchyma. With the development of medical technology and equipment, the methods of locating pulmonary nodules are also becoming less trauma and convenience. There are currently a number of methods applied to the preoperative or intraoperative localization of pulmonary nodules, including preoperative percutaneous puncture localization, preoperative transbronchial localization, intraoperative palpation localization, intraoperative ultrasound localization, and localization according to anatomy. The most appropriate localization method should be selected according to the location of the nodule, available equipment, and surgeon鈥檚 experience. According to the published literatures, we have sorted out a variety of different theories and methods of localization of pulmonary nodules in this article, summarizing their advantages and disadvantages for references.

Invasiveness assessment by CT quantitative and qualitative features of lung cancers manifesting ground-glass nodules in 555 patients: A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective     To explore the correlation between the quantitative and qualitative features of CT images and the invasiveness of pulmonary ground-glass nodules, providing reference value for preoperative planning of patients with ground-glass nodules. Methods    The patients with ground-glass nodules who underwent surgical treatment and were diagnosed with pulmonary adenocarcinoma from September 2020 to July 2022 at the Third Affiliated Hospital of Kunming Medical University were collected. Based on the pathological diagnosis results, they were divided into two groups: a non-invasive adenocarcinoma group with in situ and minimally invasive adenocarcinoma, and an invasive adenocarcinoma group. Imaging features were collected, and a univariate logistic regression analysis was conducted on the clinical and imaging data of the patients. Variables with statistical difference were selected for multivariate logistic regression analysis to establish a predictive model of invasive adenocarcinoma based on independent risk factors. Finally, the sensitivity and specificity were calculated based on the Youden index. Results     A total of 555 patients were collected. The were 310 patients in the non-invasive adenocarcinoma group, including 235 females and 75 males, with a meadian age of 49 (43, 58) years, and 245 patients in the invasive adenocarcinoma group, including 163 females and 82 males, with a meadian age of 53 (46, 61) years. The binary logistic regression analysis showed that the maximum diameter (OR=4.707, 95%CI 2.060 to 10.758), consolidation/tumor ratio (CTR, OR=1.027, 95%CI 1.011 to 1.043), maximum CT value (OR=1.025, 95%CI 1.004 to 1.047), mean CT value (OR=1.035, 95%CI 1.008 to 1.063), spiculation sign (OR=2.055, 95%CI 1.148 to 3.679), and vascular convergence sign (OR=2.508, 95%CI 1.345 to 4.676) were independent risk factors for the occurrence of invasive adenocarcinoma (P<0.05). Based on the independent predictive factors, a predictive model of invasive adenocarcinoma was constructed. The formula for the model prediction was: Logit(P)=–1.293+1.549×maximum diameter of lesion+0.026×CTR+0.025×maximum CT value+0.034×mean CT value+0.72×spiculation sign+0.919×vascular convergence sign. The area under the receiver operating characteristic curve of the model was 0.910 (95%CI 0.885 to 0.934), indicating that the model had good discrimination ability. The calibration curve showed that the predictive model had good calibration, and the decision analysis curve showed that the model had good clinical utility. Conclusion     The predictive model combining quantitative and qualitative features of CT has a good predictive ability for the invasiveness of ground-glass nodules. Its predictive performance is higher than any single indicator.

The Prevention and Treatment of Pulmonary Nodules “Nodule-cancer Transformation” Based on the View of “Disease with Latent Pathogen Induced by a New Pathogen” / 中医杂志

As one of the pathogenic mechanisms contained in The Inner Canon of Yellow Emperor （《黄帝内经》）， “disease with latent pathogen induced by a new pathogen” means that the induced new pathogen resulted to a combination of the latent previous pathogen and the new pathogen， which caused the disease. Based on this， it is believed that the change of “nodule-cancer transformation” of pulmonary nodules is actually based on the deficiency of original qi， and the new pathogen induces the latent pathogens like phlegm coagulation， qi stagnation， blood stasis， toxicity， so healthy qi can not drive the pathogens out， and the long-time detention generated into cancerous turbidity， and deve-loped into cancerous tumour at the end. Therefore， based on the three-stage treatment of unformed cancer， dense cancerous toxin， and developed cancer， the clinical practice applied six methods of clearing， expelling， dissipating， tonifying， harmonizing， and transforming， taking into account both the manifestation and root cause， moving the treatment window of pulmonary nodules forward， attacking the pathogens when the toxin was not yet overbearing， supporting the healthy qi before declining， delaying the process of nodules-cancer transformation， and providing ideas for the prevention and treatment of pulmonary nodules “nodule-cancer transformation” in traditional Chinese medicine.

Work and lifestyle influencing factors for thyroid cancer among young and middle-aged patients with thyroid nodules / 环境与职业医学

Background The number of persons with thyroid nodules has increased rapidly in recent years, and thyroid cancer caused by malignant nodules has become a key problem endangering the health of young and middle-aged groups in China. Objective To explore work and lifestyle influencing factors for developing thyroid cancer among young and middle-aged patients with thyroid nodules. Methods The subjects with thyroid nodules were reported by routine physical examines ordered at the Huadong Sanatorium. We conducted a 1∶4 matched case-control study in which 232 patients diagnosed with thyroid cancer from 2012 to 2022 were matched to 928 controls by gender and age (±5 years). A validated questionnaire was used to collect data on work and lifestyle behaviors. Univariate and multivariate logistic regression models were applied to explore potential relationships between selected factors (including environment, working hours, stress, diet, exercise, and mental health) and thyroid cancer. Spearman rank correlation was used to analyze the correlations between variables. Results The results of univariate logistic regression showed a history of thyroid cancer reported among first-degree relatives (OR=6.059, 95%CI: 1.007, 36.473), obesity (OR=1.973, 95%CI: 1.296, 3.004), noise and vibration exposure (OR=1.988, 95%CI: 1.143, 3.456), frequent stress (OR=2.093, 95%CI: 1.231, 3.559), frequent depression (OR=2.034, 95%CI: 1.048, 3.947), frequent anger (OR=1.791, 95%CI: 1.066, 3.012), frequent fried food diet (OR=1.535, 95%CI: 1.026, 2.297), and frequent fast food diet (OR=1.836, 95%CI: 1.048, 3.215) were risk factors for reporting thyroid cancer developing from thyroid nodules, while regular meals (OR=0.245, 95%CI: 0.061, 0.989) and frequent exercise (OR=0.571, 95%CI: 0.342, 0.952) were protective factors for reporting no thyroid cancer. The results of Spearman correlation analysis showed that body mass index was positively correlated with frequent fried food, fast food, and sugary beverage diets (r=0.123, 0.083, 0.077, P<0.01), and negatively correlated with frequent depression and anger (r=−0.090, −0.070, P<0.05). The results of multiple logistic regression found that a history of thyroid cancer reported among first-degree relatives (OR=6.712, 95%CI: 1.071, 42.066), obesity (OR=2.032, 95%CI: 1.321, 3.125), noise and vibration exposure (OR=1.991, 95%CI: 1.089, 3.637), and frequent stress (OR=2.468, 95%CI: 1.417, 4.300) were associated with an elevated risk of reporting thyroid cancer developing from thyroid nodules patients. Regular exercise (frequency≥3 times·week−1, > 30 min per episode) (OR=0.516, 95%CI: 0.300, 0.890) was associated with a lowered risk of reporting thyroid cancer. Conclusions Multiple risk factors associated with reporting thyroid cancer among young and middle-aged groups with thyroid nodules are identified, such as obesity, noise and vibration exposure, frequent stress, and lack of exercise.

A Case of New Rapidly Progressing Ground-glass Nodule Lung Adenocarcinoma Near Primary Lesion after Stereotactic Body Radiation Therapy / 中国肺癌杂志

Ground-glass nodule (GGN) lung cancer often progresses slowly in clinical and there are few clinical studies on long-term follow-up of patients with operable GGN lung cancer treated with stereotactic body radiation therapy (SBRT). We present a successful case of GGN lung cancer treated with SBRT, but a new GGN was found in the lung adjacent to the SBRT target during follow-up. The nodule progressed rapidly and was confirmed as lung adenocarcinoma by surgical resection. No significant risk factors and related driving genes were found in molecular pathological findings and genetic tests. It deserves further study whether new GGN is related to the SBRT. This case suggests that the follow-up after SBRT should be vigilant against the occurrence of new rapidly progressive lung cancer in the target area and adjacent lung tissue.
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Accuracy of ultrasound in predicting thyroid malignancy: a comparative analysis of the ACR TI-RADS and ATA risk stratification systems

ABSTRACT Objective: Thyroid nodules are very common in clinical practice, and ultrasound has long been used as a screening tool for their evaluation. Several risk assessment systems based on ultrasonography have been developed to stratify the risk of malignancy and determine the need for fine-needle aspiration in thyroid nodules, including the American Thyroid Association (ATA) system and the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS). The aim of this study was to compare the performance of the ATA and ACR TI-RADS systems in predicting malignancy in thyroid nodules based on the nodules' final histopathology reports. Materials and methods: We performed a retrospective review of medical records to identify patients who underwent thyroid surgery at King Abdulaziz University from 2017 to 2022. The ultrasound features of the nodules with confirmed histopathology (benign versus malignant) were evaluated. Both ATA and ACR TI-RADS scores were documented. Results: The analysis included 191 patients who underwent thyroid surgery and fulfilled the inclusion criteria. Hemithyroidectomy was performed in 22.5% of the patients, and total thyroidectomy was performed in 77.0% of them. In all, 91 patients (47.6%) were found to have malignant nodules on histopathology. We then compared the histopathology reports with the preoperative ultrasonographic risk scores. The estimated sensitivity and specificity in identifying malignant nodules were, respectively, 52% and 80% with the ATA system and 51.6% and 90% with the ACR TI-RADS system. Conclusion: Both ATA and ACR TI-RADS risk stratification systems are valuable tools for assessing the malignancy risk in thyroid nodules. In our study, the ACR TI-RADS system had superior specificity compared with the ATA system in predicting malignancy among high-risk lesions.

Surgical safety and effectiveness of bilateral axillo-breast approach robotic thyroidectomy: a systematic review and meta-analysis

Abstract Objectives To assess the safety and effectiveness of bilateral axillo-breast approach robotic thyroidectomy in thyroid tumor. Methods Bilateral axillo-breast approach robotic thyroidectomy and other approaches (open thyroidectomy, transoral robotic thyroidectomy, and bilateral axillo-breast approach endoscopic thyroidectomy) were compared in studies from 6 databases. Results Twenty-two studies (8830 individuals) were included. Bilateral axillo-breast approach robotic thyroidectomy had longer operation time, greater cosmetic satisfaction, and reduced transient hypoparathyroidism than conventional open thyroidectomy. Compared to bilateral axillo-breast approach endoscopic thyroidectomy, bilateral axillo-breast approach robotic thyroidectomy had greater amount of drainage, lower chances of transient vocal cord palsy and permanent hypothyroidism, and better surgical completeness (postopertive thyroblobulin level and lymph node removal). Bilateral axillo-breast approach robotic thyroidectomy induced greater postoperative drainage and greater patient dissatisfaction than transoral robotic thyroidectomy. Conclusion Bilateral axillo-breast approach robotic thyroidectomy is inferior to transoral robotic thyroidectomy in drainage and cosmetic satisfaction but superior to bilateral axillo-breast approach endoscopic thyroidectomy in surgical performance. Its operation time is longer, but its cosmetic satisfaction is higher than open thyroidectomy.

Local imaging to interpret tumor size in F18 fluorodeoxyglucose positron emission tomography/CT in lung cancers

SUMMARY OBJECTIVE: This study aimed to determine the thoracic and extra-thoracic extension of the disease in patients diagnosed with lung cancer and who had whole-body F18-fluorodeoxyglucose positron emission tomography/CT imaging and to investigate whether there is a relationship between tumor size and extrathoracic spread. METHODS: A total of 308 patients diagnosed with lung cancer were included in this study. These 308 patients were first classified as group 1 (SPN 30 mm>longest lesion diameter ≥10 mm) and group 2 (lung mass (longest lesion diameter ≥30 mm), and then the same patients were classified as group 3 (nodular diameter of ≤20 mm) and group 4 (nodular size of >20 mm). Group 1 was compared with group 2 in terms of extrathoracic metastases. Similarly, group 3 was compared with group 4 in terms of frequency of extrathoracic metastases. F18 fluorodeoxyglucose positron emission tomography/CT examination was used to detect liver, adrenal, bone, and supraclavicular lymph node metastasis, besides extrathoracic metastasis. RESULTS: Liver, bone, and extrathoracic metastasis in group 1 was statistically lower than in group 2 (p<0.001, p<0.01, and p=0.03, respectively). Liver, extrathoracic, adrenal, and bone metastasis in group 3 was statistically lower than that in group 4 (p<0.001, p=0.01, and p=0.04, p<0.01, respectively). The extrathoracic extension was observed in only one patient in group 3. In addition, liver, adrenal, and bone metastases were not observed in group 3 patients. CONCLUSION: Positron emission tomography/CT may be more appropriate for cases with a nodule diameter of ≤20 mm. Performing local imaging in patients with a nodule diameter of ≤20 mm could reduce radiation exposure and save radiopharmaceuticals used in positron emission tomography/CT imaging.

Cáncer de tiroides en pediatría: a propósito de una entidad poco frecuente

El cáncer de tiroides es una entidad infrecuente en población pediátrica, tiene un conjunto único de características clínicas, patológicas y moleculares en niños. La clínica típica es un nódulo tiroideo de meses de evolución asintomático, como en el caso descrito. En comparación con los adultos, los niños presentan con mayor frecuencia una enfermedad agresiva en etapa avanzada. La conducta de manejo y tratamiento es la cirugía de tiroides radical y el vaciamiento ganglionar amplio, luego yodoterapía y suplencia tiroidea. La supervivencia es excelente, a los 10 años es mayor a 98% sin embargo, se deben recordar las complicaciones relacionadas con el tratamiento de por vida las cuales no son infrecuente.

Thyroid cancer is a rare condition in the pediatric population, it has a unique set of clinical, pathological and molecular characteristics in children. The typical presentation is an asymptomatic thyroid nodule of months of evolution, as in the described case. Compared with adults, children more often present with late-stage aggressive disease. The management and treatment approach is radical thyroid surgery and extensive lymph node dissection, then iodotherapy and thyroid replacement. Survival is excellent, at 10 years it is greater than 98%, however, complications related to lifelong treatment, which are not uncommon, should be kept in mind.

Hallazgos ecográficos de nódulos tiroideos: un reto diagnóstico en pediatría / Ultrasound findings of thyroid nodules: a diagnostic challenge in pediatrics

Resumen Los nódulos tiroideos son poco frecuentes en pediatría, pero uno de cada cuatro de ellos es maligno. La ecografía es el método de elección en la detección de estos nódulos porque brinda información que permite, en muchos casos, determinar la probabilidad de malignidad. Las características a definir en un nódulo tiroideo son: composición, márgenes, ecogenicidad, calcificaciones, vascularización, dureza y la presencia de ganglios linfáticos cervicales patológicos. La composición comprende la apariencia quística, sólida o mixta (contiene al subtipo espongiforme). Los márgenes se describen como lisos, irregulares, mal definidos o lobulados. La ecogenicidad se define como hiperecoicos, hipoecoicos o isoecoicos en relación con el parénquima tiroideo adyacente. En los casos de nódulos heterogéneos se describe el patrón predominante. Dentro de las calcificaciones se describen las microcalcificaciones y macrocalcificaciones. La vascularización se clasifica como normal, aumentada central o periférica, y mixta al examen Doppler color. La elastografía mide la rigidez del nódulo evaluado en comparación con el tejido tiroideo adyacente. Por último, se debe evaluar la cadena ganglionar cervical en búsqueda de alteración de su ecoestructura. Es primordial el reconocimiento de las características de benignidad y malignidad de estas lesiones, ya que permitirá guiar al especialista para la toma de decisiones.

Abstract Thyroid nodules are rare in pediatrics, but up to one in four of them is malignant. Ultrasound is the method of choice in the detection of thyroid nodules because it provides information that allows to determine the probability of malignancy in many patients. The characteristics to be defined in a thyroid nodule are: composition, margins, echogenicity, calcifications, vascularization, stiffness and the presence of pathological cervical lymph nodes. Composition includes cystic, solid or mixed appearance (contains the spongiform subtype). Margins are described as smooth, irregular, ill-defined or lobulated. Echogenicity is defined as hyper-, hypo- or isoechoic to the adjacent thyroid parenchyma. Calcifications are described as microcalcifications and macrocalcifications. Vascularization is classified as normal, increased central or peripheral, and mixed on color Doppler. Elastography measures the stiffness of the evaluated nodule compared to the adjacent thyroid tissue. Finally, cervical lymph nodes should be evaluated for alterations in its echostructure. It is essential to recognize the benign and malignant characteristics of this type of lesions, as this will guide the specialist in making decisions.

Computer-aided diagnosis system versus conventional reading system in low-dose (< 2 mSv) computed tomography: comparative study for patients at risk of lung cancer

ABSTRACT BACKGROUND: Computer-aided diagnosis in low-dose (≤ 3 mSv) computed tomography (CT) is a potential screening tool for lung nodules, with quality interpretation and less inter-observer variability among readers. Therefore, we aimed to determine the screening potential of CT using a radiation dose that does not exceed 2 mSv. OBJECTIVE: We aimed to compare the diagnostic parameters of low-dose (< 2 mSv) CT interpretation results using a computer-aided diagnosis system for lung cancer screening with those of a conventional reading system used by radiologists. DESIGN AND SETTING: We conducted a comparative study of chest CT images for lung cancer screening at three private institutions. METHODS: A database of low-dose (< 2 mSv) chest CT images of patients at risk of lung cancer was viewed with the conventional reading system (301 patients and 226 nodules) or computer-aided diagnosis system without any subsequent radiologist review (944 patients and 1,048 nodules). RESULTS: The numbers of detected and solid nodules per patient (both P < 0.0001) were higher using the computer-aided diagnosis system than those using the conventional reading system. The nodule size was reported as the maximum size in any plane in the computer-aided diagnosis system. Higher numbers of patients (102 [11%] versus 20 [7%], P = 0.0345) and nodules (154 [15%] versus 17 [8%], P = 0.0035) were diagnosed with cancer using the computer-aided diagnosis system. CONCLUSIONS: The computer-aided diagnosis system facilitates the diagnosis of cancerous nodules, especially solid nodules, in low-dose (< 2 mSv) CT among patients at risk for lung cancer.

Características clínicas, epidemiológicas y quirúrgicas de pacientes con afecciones nodulares tiroideas / Clinical, Epidemiological and Surgical Characteristics of Patients with Thyroid Nodular Conditions

Introducción: En las últimas décadas la incidencia del cáncer tiroideo en el curso de la enfermedad nodular se ha incrementado debido a las novedosas técnicas de diagnóstico; sin embargo, la tasa de mortalidad se ha mantenido muy baja. Objetivo: Evaluar las características clínicas, epidemiológicas y quirúrgicas de pacientes con afecciones nodulares tiroideas. Métodos: Se realizó un estudio descriptivo observacional de cohorte prospectivo, longitudinal con los pacientes operados de afecciones tiroideas durante el período comprendido entre enero del 2008 y diciembre del 2018. El universo y la muestra quedaron constituidos por 467 pacientes que cumplieron con los criterios de inclusión. Resultados: Predominaron el sexo femenino (89,5 por ciento) y el grupo etario de 45-60 años (29,5 por ciento). Asociaron comorbilidades 338 pacientes y algún factor de riesgo de malignidad (6,2 por ciento). Un total de 174 pacientes manifestaron síntomas y 264 mostraron algún signo. Predominaron los reportes ecográficos (TI-RADS) y citológicos (Bethesda) tipo II (54,3 por ciento) y (55,5 por ciento), respectivamente. La hemitiroidectomía fue el procedimiento más realizado (59,9 por ciento) y la disfonía la complicación más encontrada (1,9 por ciento). Conclusiones: El diagnóstico oportuno del cáncer tiroideo en el curso de una enfermedad nodular contribuye a individualizar todas las decisiones terapéuticas atendiendo a las características de cada paciente y sus circunstancias(AU)

Introduction: In recent decades, the incidence rates of thyroid cancer in the course of nodular disease has increased due to novel diagnostic techniques; however, the mortality rate has remained very low. Objective: To evaluate the clinical, epidemiological and surgical characteristics of patients with nodular thyroid disease. Methods: A descriptive, observational, of prospective cohort, longitudinal and observational study was conducted with patients operated on for thyroid disorders during the period from January 2008 to December 2018. The study universe and sample consisted of 467 patients who met the inclusion criteria. Results: The female sex (89.5 percent) and the age group 45-60 years (29.5 percent) predominated. Comorbidities were present in 338 patients, as well as some risk factor for malignancy in 6.2 percent. A total of 174 patients manifested symptoms and 264 showed some sign. There was a predominance of echography (TI-RADS) and cytology (Bethesda) type II reports, accounting for 54.3 percent and 55.5 percent, respectively. Hemithyroidectomy was the most performed procedure (59.9 percent), while dysphonia was the most encountered complication (1.9 percent). Conclusions: Timely diagnosis of thyroid cancer in the course of nodular disease contributes to individualizing all therapeutic decisions considering the characteristics of each patient and their circumstances(AU)

Fluoroscopia por tomografia computadorizada - biópsia percutânea guiada de nódulos pulmonares ≤ 10 mm: análise retrospectiva de procedimentos realizados no período de pandemia de COVID-19 / Computed tomography fluoroscopy-guided percutaneous biopsy of pulmonary nodules ≤ 10 mm: retrospective analysis of procedures performed during the COVID-19 pandemic

Resumo Objetivo: Avaliar o desempenho diagnóstico da biópsia pulmonar percutânea transtorácica (BPPT) guiada por fluoroscopia associada a tomografia computadorizada (FTC) em nódulos pulmonares ≤ 10 mm no período de pandemia de COVID-19. Materiais e Métodos: No período de 1º de janeiro de 2020 a 30 de abril de 2022, 359 BPPTs guiadas por FTC foram realizadas em um centro terciário de radiologia intervencionista. As lesões pulmonares mediam entre 2 mm e 108 mm. Dessas 359 BPPTs, 27 (7,5%) foram realizadas com agulha 18G em nódulos de 2 mm a 10 mm. Resultados: Das 27 BPPTs realizadas nos nódulos ≤ 10 mm, quatro lesões tinham dimensões menores que 5 mm e 23 lesões mediam entre 5 e 10 mm. Sensibilidade e acurácia diagnóstica das BPPTs guiadas por FTC foram de 100% e 92,3%, respectivamente. A dose média de radiação ionizante para os pacientes durante o procedimento de BPPT guiada por FTC foi de 581,33 mGy*cm, variando de 303 a 1129 mGy*cm. A média de tempo dos procedimentos de biópsia foi de 6,6 minutos, variando de 2 a 12 minutos. Nas 27 BPPTs, nenhuma complicação maior foi descrita. Conclusão: A BBPT guiada por FTC resultou em alto rendimento diagnóstico e baixas taxas de complicações.

Abstract Objective: To evaluate the diagnostic performance of computed tomography (CT) fluoroscopy-guided percutaneous transthoracic needle biopsy (PTNB) in pulmonary nodules ≤ 10 mm during the coronavirus disease 2019 pandemic. Materials and Methods: Between January 1, 2020 and April 30, 2022, a total of 359 CT fluoroscopy-guided PTNBs were performed at an interventional radiology center. Lung lesions measured between 2 mm and 108 mm. Of the 359 PTNBs, 27 (7.5%) were performed with an 18G core needle on nodules ≤ 10 mm in diameter. Results: Among the 27 biopsies performed on nodules ≤ 10 mm, the lesions measured < 5 mm in four and 5-10 mm in 23. The sensitivity and overall diagnostic accuracy of PTNB were 100% and 92.3%, respectively. The mean dose of ionizing radiation during PTNB was 581.33 mGy*cm (range, 303-1,129 mGy*cm), and the mean biopsy procedure time was 6.6 min (range, 2-12 min). There were no major postprocedural complications. Conclusion: CT fluoroscopy-guided PTNB appears to provide a high diagnostic yield with low complication rates.

Utilización del sistema Bethesda para el diagnóstico citológico de nódulos tiroideos / Use of the Bethesda system for the cytologic diagnosis of thyroid nodules: en

Introducción: El nódulo tiroideo es un hallazgo común en la actualidad y, por sus características ecográficas, constituye una lesión distinta al parénquima glandular, con una prevalencia alta en la población general. Objetivo: Describir el uso del sistema Bethesda como método de diagnóstico de nódulos tiroideos y el grado de malignidad. Métodos: Se efectuó un estudio descriptivo y retrospectivo de 1771 pacientes con diagnóstico de nódulo tiroideo, a quienes se les realizó citología por aspiración con aguja fina en el Departamento de Anatomía Patológica del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba durante el cuatrienio 2016-2019. Resultados: En la serie predominó el grupo etario de 41-50 años y la edad media fue de 49,51±13,14 años. Asimismo, sobresalió la categoría II del sistema Bethesda (73,8 %); en tanto, de los 204 diagnosticados correspondientes a la categoría III, 111 fueron intervenidos quirúrgicamente y 29 de estos presentaron neoplasias malignas (27,6 %). El grado de malignidad osciló entre 22,8 y 36,0 %. Conclusiones: La aplicación del sistema Bethesda fue muy útil para el diagnóstico citopatológico de nódulos tiroideos y el grado de malignidad se correspondió con cifras adecuadas.

Introduction: The thyroid nodule is a common finding nowadays and, for its echographic characteristics, it constitutes a lesion different to the glandular parenchyma, with a high prevalence in the general population. Objective: To describe the use of the Bethesda system as diagnostic method of thyroid nodules and the degree of malignancy. Methods: A descriptive and retrospective study of 1 771 patients with diagnosis of thyroid nodule was carried out, who underwent fine needle aspiration cytology, in the Pathology Department of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba during 2016-2019. Results: In the series there was a prevalence of the 41-50 age group and the mean age was of 49,51±13,14 years. Also, the category II of the Bethesda system was notable (73.8 %); as long as, of the 204 diagnosed corresponding to the category III, 111 were surgically intervened and 29 of them presented mlignancy (27.6 %). The degree of malignancy oscillated between 22.8 and 36.0 %. Conclusions: The application of the Bethesda system was very useful for the cytopathologic diagnosis of thyroid nodules and the degree of malignancy corresponded with appropriate figures.

Quiste hidatídico de la glándula tiroides: Reporte de tres casos

Introducción: La enfermedad hidatídica puede desarrollarse en cualquier órgano del cuerpo, siendo las localizaciones más frecuentes el hígado y pulmón, pero ocasionalmente puede afectar a otros órganos como la glándula tiroides. En Chile existen escasas publicaciones previas. El objetivo de este reporte es presentar el diagnóstico, tratamiento y seguimiento de tres pacientes portadores de quiste hidatídico de la glándula tiroides. Casos Clínicos: Se refiere a dos mujeres de 9 y 56 años y un paciente de sexo masculino de 56 años, provenientes de la zona rural de la Región de Aysén en la Patagonia, todos enviados por aumento de volumen sintomático de la glándula tiroides. El diagnóstico presuntivo se realizó mediante los antecedentes anamnésticos e imágenes de ultrasonografía. Todos fueron sometidos a tiroidectomía subtotal y a quimioprofilaxis post operatoria con Albendazol por 30 días. La confirmación diagnóstica se realizó mediante el estudio histopatológico. Ninguno ha presentado recurrencia, llevando una de ellas 22 años de seguimiento. Conclusión: Aunque la glándula tiroides rara vez se ve afectada, la enfermedad hidatídica no debe pasarse por alto en el diagnóstico diferencial de lesiones quísticas de la glándula, especialmente en pacientes que viven en regiones donde la enfermedad es endémica.

Introduction: Hydatid disease can develop in any organ of the body, the most frequent locations being the liver and lung, but occasionally it can affect other organs such as the thyroid gland. In Chile there are few previous publications. Aim: The aim of this report is to present the diagnosis, treatment and follow-up of three patients with hydatid thyroid cysts. Clinical Cases: Two women, ages 9 and 56, and a 56 year old male patient, referred from Aysén in Patagonia, all of them due to a symptomatic increased volume in thyroid gland. The diagnosis was made through anamnestic history and ultrasound images. All underwent subtotal thyroidectomy and postoperative chemoprophylaxis with Albendazole for 30 days. Diagnostic confirmation was made by histopathological study. None had recurrence, one of them has been followed for 22 years. Conclusion: In conclusion, although the thyroid gland is rarely affected, hydatid disease should not be overlooked in the differential diagnosis of cystic lesions of the thyroid gland, especially in patients living in regions where the disease is endemic.

Caracterização clínica e patológica dos linfomas hepáticos: um estudo retrospetivo unicêntrico / Clinical and pathological characterization of hepatic lymphomas: a retrospective single-center study

ABSTRACT Background: The incidence of hepatic lymphoma has been increasing recently and diagnosis can be challenging as clinical presentation and radiological findings are usually variable and non-specific. Objective The aims of this study were to describe their main clinical, pathological and imaging characteristics and identify poor prognostic factors. Methods A retrospective study that included all patients with histological diagnosis of liver lymphoma over a 10-year period at our center was performed. Results A total of 36 patients were identified, with mean age of 56.6 years and male predominance (58%). There were three patients with primary liver lymphoma (8.3%) and 33 with secondary liver lymphoma (91.7%). The most common histological type was diffuse large B-cell lymphoma (33.3%). The most common clinical manifestations included fever, lymphadenopathy, weight loss, night sweats and abdominal discomfort; three patients (11.1%) were asymptomatic. Computed tomography scan revealed heterogenous radiological patterns including a single nodule (26.5%), multiple nodules (41.2%) or diffuse infiltration (32.4%). The mortality rate during follow-up was 55.6%. Higher levels of C-reactive protein (P=0.031) and absence of treatment response (P<0.001) were significantly associated with higher mortality. Conclusion Hepatic lymphoma is a rare disease that may involve liver as part of a systemic disease or, less commonly, be confined to this organ. Clinical presentation and radiological findings are often variable and non-specific. It is associated with high mortality and poor prognostic factors include higher levels of C-reactive protein and absence of response to treatment.

RESUMO Contexto A incidência de linfoma hepático tem aumentando recentemente e o diagnóstico pode ser desafiante, na medida em que a apresentação clínica e os achados imagiológicos são geralmente variáveis e inespecíficos. Objetivo: Os objetivos deste estudo foram descrever suas principais características clínicas, patológicas e de imagem e identificar fatores de mau prognóstico. Métodos: Foi realizado um estudo retrospetivo que incluiu todos os pacientes com diagnóstico histológico de linfoma hepático num período de 10 anos no nosso centro. Resultados: Foram identificados 36 pacientes, com média de idade de 56,6 anos e predomínio de género masculino (58%). Havia três pacientes com linfoma hepático primário (8,3%) e 33 com linfoma hepático secundário (91,7%). O tipo histológico mais comum foi o linfoma difuso de grandes células B (33,3%). As manifestações clínicas mais comuns incluíram febre, linfadenopatia, emagrecimento, hipersudorese noturna e desconforto abdominal; 3 (11,1%) pacientes eram assintomáticos. A tomografia computadorizada revelou padrões radiológicos heterogêneos, incluindo um único nódulo (26,5%), múltiplos nódulos (41,2%) ou infiltração difusa (32,4%). A taxa de mortalidade durante o seguimento foi de 55,6%. Níveis mais elevados de proteína C reativa (P=0,031) e ausência de resposta ao tratamento (P<0,001) foram significativamente associados a maior mortalidade. Conclusão O linfoma hepático é uma doença rara que pode envolver o fígado como parte de uma doença sistêmica ou, menos comumente, estar confinado a este órgão. A apresentação clínica e os achados radiológicos são frequentemente variáveis e inespecíficos. Associa-se a elevada mortalidade e fatores de mau prognóstico incluem níveis mais elevados de proteína C reativa e ausência de resposta ao tratamento.

Microwave sensor for recognition of abnormal nodule tissue on body surface / 生物医学工程学杂志

For the detection and identification of abnormal nodular tissues on the body surface, a microwave sensor structure loaded with a spiral resonator is proposed in this paper, a sensor simulation model is established using HFSS software, the structural parameters are optimized, and the actual sensor is fabricated. The S21 parameters of the tissue were obtained when nodules appeared by simulation, and the characteristic relationship between the difference of S21 parameters with position was analyzed and tested experimentally. The results showed that when nodules were present in normal tissues, the curve of S21 parameter difference with position change had obvious inverted bimodal characteristics, and the extreme value of S21 parameter difference appeared when the sensor was directly above the nodules, which was easy to identify the position of nodules. It provides an objective detection tool for the identification of abnormal nodular tissues on the body surface.

Iodine nutrition status thyroid nodule detection and influencing factors in 450 health check-up residents in Chengdu / 公共卫生与预防医学

Objective To study the iodine nutrition status and analyze the detection of thyroid nodules and its related influencing factors in 450 health check-up residents in Chengdu area and to provide evidence for the prevention of thyroid nodules. Methods A total of 450 residents who underwent health check-up in the Western Theater General Hospital from January 2019 to January 2022 were selected as the research subjects. The gender, age, weight and other basic conditions of the subjects were investigated, and their urinary iodine levels and occurrence of thyroid nodules were examined. Univariate and multivariate methods were used to analyze the influencing factors of occurrence of thyroid nodules. Results The overall urinary iodine level of the 450 health check-up people in Chengdu area was (96.89 -212.38) μg/L, with an average of (164.86±42.58) μg/L. The urinary iodine level of males was significantly higher than that of females (P60 years old (P60 years old , people in rural areas and people with history of diabetes mellitus in the thyroid nodule group were higher than that in the non-thyroid nodule group, and thyroid stimulating hormone (TSH), thyroglobulin antibody (TGAb) and anti-thyroid peroxidase antibody (TPOAb) were higher than those in the non-thyroid nodule group (P60 years old, history of diabetes mellitus and high levels of TGAb and TPOAb were risk factors for the occurrence of thyroid nodules (P<0.05). Conclusion The overall iodine nutrition level of 450 health check-up people in Chengdu is in the appropriate range, and the detection rate of thyroid nodules is high. It is necessary to strengthen the examination of thyroid nodules in key populations (women , history of diabetes mellitus, the elderly, etc.), and provide early detection and active intervention to prevent the occurrence and progression of thyroid nodules.