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The liver reserve function refers to the compensatory ability to maintain liver function after damage, providing implication for the resection of hepatic malignant tumor. Hepatobiliary scintigraphy imaging can provide quantitative evaluation of liver blood perfusion, and has advantages on the evaluation of liver reserve function and the prediction of postoperative complications. 99Tc m-galactosyl serum albumin (GSA) and 99Tc m-mebrofenin are commonly used imaging agents for hepatobiliary scintigraphy imaging assessment of liver reserve function. This article reviews the application and progress of hepatobiliary scintigraphy in liver reserve function assessment.
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Objective:To investigate the differential diagnostic value of 18F-FDG PET/CT in multiple myeloma (MM) and unknown osteolytic metastasis (UOM). Methods:A retrospective study was performed on 18F-FDG PET/CT imaging of 43 patients (29 males, 14 females, age: (61.5±12.9) years) with multiple bone destructions and without extraosseous primary malignant tumor between June 2017 and March 2020 in Tenth People′s Hospital of Tongji University. Through follow-up, 20 patients (13 males, 7 females, age: (61.1±12.2) years) were pathologically confirmed as MM and 23 patients (16 males, 7 females, age: (61.4±13.9) years) were pathologically confirmed as UOM. The whole body skeleton was categorized to 8 sites including skull, spine, ribs, pelvis, sternum, clavicle, scapula and limb bone. The differences of the cross-sectional length of the lesion, cortical bone damage, SUV max and the distribution of imaging agent were compared between the two groups in different parts. Independent-sample t test and Mann-Whitney U test were used to analyze data. Results:The UOM group was invisible on clavicles, and spine and pelvis were the most predilection sites in both MM and UOM groups (spine: 41.30%(299/724) and 49.37%(117/237); pelvis: 24.45%(177/724) and 26.58%(63/237)). The cross-sectional length of lesions in the skull, spine, ribs, pelvis and limb bone in MM group were significantly shorter than those in UOM group (5.45(4.30, 8.06) vs (13.89±11.66) mm, 6.15(3.89, 10.06) vs 11.48(7.73, 16.90) mm, 7.01(4.59, 10.56) vs (24.61±16.22) mm, 8.20(5.14, 13.71) vs (21.12±13.31) mm, (8.48±5.75) vs (19.13±14.26) mm; z values: from -8.88 to -2.52, t=-2.76, P<0.001 or P<0.05) and SUV max of above lesions and scapula in MM group were significantly lower than those in UOM group (1.50(1.00, 2.20) vs 17.15±11.40, 2.60(2.00, 4.10) vs 8.20(5.65, 11.90), 2.30(1.40, 5.28) vs 10.58±5.52, 2.50(1.80, 3.90) vs 9.34±6.01, 3.08±2.41 vs 11.38±6.38, 2.45(1.50, 4.43) vs 6.90(4.63, 17.80); z values: from -13.87 to -2.41, t=-4.85, P<0.001 or P<0.05). The imaging agents in lesions on the skull, spine, ribs, pelvis, scapula and limb bone were more evenly distributed in MM group, while the imaging agents in lesions were more unevenly distributed in UOM group. On the skull, spine and ribs sites, the MM group was more likely to show no cortical bone damage; however, the UOM group showed cortical bone damage in the above sites. Conclusion:It is helpful for doctors to distinguish MM and UOM by comparing the cross-sectional length of the lesion, cortical bone damage, SUV max and the distribution of imaging agent in 18F-FDG PET/CT imaging before getting pathologic results.
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Iodine is an essential trace element in the human body, and the gastrointestinal tract is the main way for the body to intake iodine. The intestinal tract contains trillions of microorganisms that have important impacts on the substance-energy metabolism and the genetic information processing in the human body. Gut microbiota or their metabolites can act on the thyroid through the circulatory system (namely the " gut-thyroid axis" ), thus potentially regulating iodine metabolism in thyroid. This article reviews the effects of gut microbiota on intestinal iodine uptake, as well as the effects of gut microbiota and their metabolites on the expression and activity of sodium iodide symporter (NIS) in thyroid cells, thus exploring the potential regulatory mechanisms of gut microbiota that involved in thyroid iodine metabolism. Potential factors affecting thyroid iodine metabolism by gut microbiota include the direct and the indirect factors. The direct factors include lipopolysaccharides, short-chain fatty acids, microbial peptides, and microbial proteins, which may affect the expression or activity of NIS in thyroid by regulating the nuclear factor kappa-B pathway, histone acetylation modifications, or antigen-antibody reactions. The indirect factors include the altered cellular environment that effected by gut microbiota which can further affect the transport of iodine ions in thyroid cells by manners like regulating the levels of thyroid-specific transcription factors and regulating the signal pathways mediated by thyroid-stimulating hormone and its receptor.
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Objective:To develop an approach for the automatic diagnosis of bone metastasis and to design a parameter of quantitative evaluation for tumor burden on bone scans based on deep learning technology.Methods:A total of 621 cases (389 males, 232 females, age: 12-93 years) of bone scan images from the Department of Nuclear Medicine in Tenth People′s Hospital of Tongji University from March 2018 to July 2019 were retrospectively analyzed. Images were divided into bone metastasis group and non-bone metastasis group. Eighty percent of the cases were randomly extracted from both groups as the training set, and the rest of cases were used as the test set. A deep residual convolutional neural network ResNet34 was used to construct the classification model and the segmentation model. The sensitivity, specificity and accuracy were calculated and the performance differences of the classification model in different age groups (15 cases of <50 years, 75 cases of ≥50 and <70 years, 33 cases of ≥70 years) were analyzed. The regions of metastatic bone lesions were automatically segmented by the segmentation model. The Dice coefficient was used to evaluate the effect of the segmentation model and the manual labeled results. Finally, the bone scans tumor burden index (BSTBI) was calculated to assess the tumor burden of bone metastases.Results:There were 280 cases with bone metastases and 341 cases with non-bone metastases, including 498 in training set and 123 in test set. The classification model could accurately identify bone metastases, with the sensitivity, specificity and accuracy of 92.59%(50/54), 85.51%(59/69) and 88.62%(109/123), respectively, and it performed best in the <50 years group (sensitivity, 2/2; specificity, 12/13; accuracy, 14/15). The specificity in the ≥70 years group (8/12) was the lowest. The Dice coefficient of bone metastatic area and bladder area were 0.739 and 0.925 in the segmentation model, which performed similarly in the three age groups. Preliminary results showed that the value of BSTBI increased with the increase of the number of bone metastatic lesions and the degree of 99Tc m-MDP uptake. The machine learning model in this study took (0.48±0.07) s for the entire analysis process from input to the final BSTBI calculation. Conclusions:The deep learning based on automatic diagnosis framework for bone metastases can automatically and accurately identify segment bone metastases and calculate tumor burden. It provides a new way for the interpretation of bone scans. The proposed BSTBI may be used as a quantitative evaluation indicator in the future to assess the tumor burden of bone metastases based on bone scans.
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Differentiated thyroid cancer (DTC) is prone to relapse and metastasize. In addition to thyroglobulin (Tg) and its antibodies, ultrasound and 131I whole-body scan (WBS), 18F-FDG PET/CT gains more use in the setting of recurrent or metastatic DTC and shows promise. This article mainly reviews the value of 18F-FDG PET/CT in the location of recurrent or metastasized DTC with negative 131I WBS but positive Tg ( 131I WBS-/Tg+ ), evaluating their differentiation, predicting the prognosis, guiding 131I treatment and its value in restaging DTC with moderate and high risk of relapse and guiding treatment decision.
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Objective:To establish an analytical method for the simultaneous determination of five fat-soluble vitamins in serum using isotope dilution ultra high performance liquid chromatography-tandem mass spectrometry (ID-UPLC-MSMS).Methods:Fat-soluble vitamins were obtained from serum samples which collected from Shanghai Tenth People′s Hospital between April 2019 and August 2019 by the extraction method, and were detected by ID-UPLC-MSMS. The performance of the method was verified by referring to the relevant documents of the Clinical and Laboratory Standards Institute (CLSI).Results:The ID-UPLC-MSMS method for the rapid detection of various fat-soluble vitamins in serum was proposed and successfully verified. The linear range of the method: vitamin A: 25-2 500 μg/L, 25(OH)D 2: 2-200 μg/L, 25(OH)D 3: 2-200 μg/L, vitamin E: 0.25-50 mg/L, vitamin K1: 0.1-20 μg/L. The intra- and inter-assay precision standard deviations of the five analytes were within ± 15%, and the accuracy of the test results of the 25(OH)D 2 and 25(OH)D 3 standards was 96.44%-102.37%. Conclusion:The performance of ID-UPLC-MSMS method for the simultaneous determination of five fat-soluble vitamins is satisying, and the result is accurate and reliable, which suggested it can be used for the clinical sample.
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Objective:To investigate the relationship between the expression levels of chemokines in serum of patients with differentiated thyroid carcinoma (DTC) and the progression of DTC.Methods:From January to April in 2017, blood samples of 76 patients (25 males, 51 females, median age: 39 years) with DTC after surgery in Nuclear Medicine Department of Tenth People′s Hospital Affiliated to Tongji University were collected retrospectively for detecting the expression levels of 40 chemokines. Patients were divided into different groups according to (1) with or without metastasis: the non-metastasis group ( n=13) and the metastasis group ( n=63); (2) degree of gradual dedifferentiation: without metastasis group ( n=13), lymph node metastasis group ( n=48), highly malignant group ( n=11) and radioactive iodine refractory (RAIR) with distant metastasis group ( n=4); (3) frequency of 131I treatment in follow-up for nearly 2 years: single treatment group ( n=51) and multiple treatment group ( n=25). Differences in chemokine levels among groups were compared. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value of differential chemokines′ levels on DTC metastasis and multiple 131I treatment. Independent-sample t test, Mann-Whitney U test and one-way analysis of variance were used to analyze the data. Results:Compared with the non-metastatic group, the expression levels of Eotaxin-3 ((25.94±6.05) vs (21.76±5.71) ng/L), interferon-γ (IFN-γ; (116.04±28.98) vs (98.71±26.18) ng/L), macrophage-derived chemokine (MDC; (1 468.08±401.74) vs (1 082.94±423.30) ng/L) and thymus expressd chemokine (TECK; (505.22(419.80, 563.36) vs 402.89(347.43, 442.97) ng/L) in metastatic group were decreased, and the differences were statistically significant ( t values: 2.376, 2.131, 3.007, U=215.000, all P<0.05). The area under the ROC curve of IFN-γ+ MDC+ TECK for predicting DTC metastasis was 0.844(95% CI: 0.755-0.932, P<0.001), and the sensitivity was 79.37%(50/63). Only the differences of MDC among without metastasis group, lymph node metastasis group, highly malignant group and RAIR with distant metastasis group were significant ((1 468.08±401.74), (1 121.59±454.20), (976.07±281.04), (922.68±342.41) ng/L; F=3.564, P<0.05), and the expression was gradually decreased with the degree of dedifferentiation. Only IL-8 was significantly increased in the multiple treatment group compared with the single treatment group (28.20(23.22, 32.51) vs 30.51(26.98, 35.57) ng/L; U=801.000, P<0.05). The area under the ROC curve of IL-8 for predicting multiple 131I treatment was 0.648(95% CI: 0.523-0.773, P<0.05), and the sensitivity was 100%(25/25). Conclusions:Decreased expression of IFN-γ, MDC and TECK may be potential markers for predicting metastasis in DTC. MDC is likely to be a potential molecular target for detecting the dedifferentiation degree of DTC, decreased expression of which may indicate the increased malignancy of tumor. IL-8 may be used to predict whether patients need multiple 131I treatments.
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This article researches how to allocate medical protective consumables in hospital and ensure the safety of emergency marketing procurement under the condition that people are easily susceptible to COVID-19. To inform medical staffs about the standard instruction, we establish the corresponding hierarchical control management system and standards of medical protective consumables. To reduce the stress of clinical medical staff and prevent excessive protection, we enhance the training mechanisms and promote the superior normative guidance. The aim is to fully play the effectiveness of the key departments of medical protective consumables, reduce the risk of infection of clinical medical staff and ensure the safety of medical staffs.
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Humanos , Betacoronavirus , COVID-19 , Infecções por Coronavirus , Pandemias , Pneumonia Viral , SARS-CoV-2RESUMO
Objective@#To analyze the expression and clinical significance of solute carrier family 5 member 5 (SLC5A5), the coding gene of sodium/iodide symporter (NIS), in thyroid carcinoma.@*Methods@#The messenger RNA (mRNA) expression of SLC5A5 in thyroid carcinoma and normal thyroid tissues from The Cancer Genome Atlas (TCGA) was compared using independent-sample t test and results were shown in one scatter plot. The relation between clinical features of thyroid carcinoma and the changes of SLC5A5 mRNA was analyzed on LinkedOmics using Kruskal-Wallis test or Wilcoxon test.@*Results@#Data from TCGA showed that the SLC5A5 mRNA expression in thyroid carcinoma (1.419±0.049) was significantly reduced compared with that in normal thyroid tissues (3.301±0.087; t=12.66, P<0.01). The expression of SLC5A5 mRNA in thyroid carcinoma is affected by ethnicity (χ2=0.300, P<0.05). Moreover, the expression of SLC5A5 mRNA were decreased with the increase of pathologic grading (Ⅰ, Ⅱ, Ⅲ, Ⅳ) and T, N, M stages (χ2 values: 0.114, 0.215, z values: -0.345, -0.102, all P<0.05).@*Conclusions@#The expression level of SLC5A5 mRNA is associated with clinical characteristic of thyroid carcinoma. SLC5A5 mRNA has the potential to become one candidate biomarker to assess disease and predict the development of thyroid carcinoma.
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Objective To develop a diagnostic model based on deep neural network for intelligent discrimination of thyroid function. Methods A total of 1616 patients ( 283 males, 1333 females, average age:52 years) who underwent thyroid imaging between May 2016 and June 2018 were selected. According to the clinical diagnosis, the 1616 cases included 299 normal thyroid cases, 876 hyperthyroidism cases and 441 hypothyroidism cases. Feature extraction and learning training were performed on 1000 training set sam-ples by two deep neural network models ( AlexNet;deep convolution generative adversarial networks ( DCGAN) ) using deep learning algorithm. Performance verifications were implemented on 616 test set samples. The con-sistency between the verification results of the two models and the clinical diagnosis was analyzed by Kappa test. Meanwhile, the time advantage of the intelligent diagnosis models was analyzed. Results The average diagnostic time of AlexNet model was 1 s/case, and the classification accuracy for normal thyroid, hyperthy-roidism, hypothyroidism were 82.29％(79/96), 94.62％(369/390), 100％(130/130), respectively. The Kappa value between results of AlexNet model and clinical diagnosis was 0.886 ( P<0.05) . The average di-agnostic time of DCGAN model was 1 s/case, and the classification accuracy for normal thyroid, hyperthy-roidism, hypothyroidism were 85.42％(82/96), 95.64％(373/390), 99.23％(129/130), respectively. The Kappa value between results of DCGAN model and clinical diagnosis was 0.904 ( P<0.05) . Conclusion The deep neural network intelligent diagnosis model can quickly determine the functional status of thyroid gland in thyroid imaging, and it has a high recognition accuracy, thus providing a new method for thyroid image review.
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Objective To investigate the unmet needs of thyroid cancer patients undergoing 131Itreatment and their relationship with psychological distress and quality of life.Methods From October 2014 to March 2016,a total of 338 patients (106 males,232 females,average age (35.50±9.98) years) with thyroid cancer who were receiving 131I treatment were enrolled.The 34 items of Supportive Care Needs Survey Short Form (SNCS-SF34) were used to investigate the unmet care needs of patients.Patients' perceptions of distress and main causes of distress were measured by Distress Thermometers (DT) and issue list.The 12-item Short-Form Health Survey (SF-12) was used to measure patients' quality of life.Pearson correlation analysis was used to analyze the data.Results The degrees of patients' unmet care needs from high to low were as following:health information needs (65.38％,221/338),psychological needs (47.93％,162/338),patients' care and support needs (44.08％,149/338),physical and daily needs (36.09％,122/338) and sexual needs (34.32％,116/338).There were 47.93％(162/388) patients with DT score ＞ 4.The top three causes of patients' distress were fears,fatigue and memory deterioration.Degree of unmet needs for patients had positive correlation with the degree of psychological distress (r values:0.232-0.462,all P＜0.01).The unmet physiological and daily needs and psychological needs of patients had negative correlations with several dimensions of quality of life (r values:from-0.367 to-0.202,all P＜ 0.05).Conclusions The unmet care needs of patients with thyroid cancer have correlations with their psychological distress and quality of life.Evaluation of the unmet care needs of patients with thyroid cancer could be beneficial for providing the targeted care.
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Objective To explore the correlation between thyroid nodules and uric acid levels and to find their gender differences.Methods A total of 68 056 subjects in a regional medical physical examination center of Shanxi Province from January 2013 to June 2015 were enrolled in this study.All the participants′ general information and parameters were recorded.Thyroid nodules were detected by color Doppler ultrasonography.Results The total prevalence of thyroid nodule was 35.5%, 30.7% in males and 40.0% in females.The prevalence of single nodule was 50.1%, and multiple 49.9%.Compared with no nodule group, thyroid nodule group tended to be older, with higher BMI, and with a worse metabolic status(all P<0.01).The uric acid levels were lower[(352.37±78.14 vs 357.70±77.51) μmol/L, P<0.01] in thyroid nodule group in male and higher[(260.22±61.91 vs 253.91±59.18) μmol/L, P<0.01] in female.Conclusion Thyroid nodules may be associated with metabolism and inflammation.In males, hyperuricemia group had lower, while in females, hyperuricemia ones were with a higher prevalence of thyroid nodules.
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Cervical and mediastinal lymph nodes ( CMLN) are usually close to some important ves-sels, nerves and organs, which brings much difficult for surgical and radiotherapy. CT-guided 125 I seed im-plantation is becoming an effective, safe and reliable treatment. CT could be used to observe the distribution of seeds, complication and therapeutic effect after the implantation. This paper focuses on the advances of CT-guided 125 I seed implantation on residual or relapsing metastatic CMLN.