The optimal extent of lymph node dissection in N1b papillary thyroid microcarcinoma based on clinicopathological factors and preoperative ultrasonography.

Background: The optimal extent of lymph node (LN) dissection in the management of N1b papillary thyroid microcarcinoma (PTMC) is still under debate in clinical practice, so we aimed to identify the risk factors associated with multilevel lateral lymph node metastasis (LLNM) with regard to the extent of LN dissection. Methods: The clinical data of 182 N1b PTMC patients between January 2019 and June 2021 at Tianjin Medical University Cancer Institute and Hospital were retrospectively reviewed. The frequency pattern and distribution of LLNM were analyzed for risk factors. We assessed the diagnostic value of preoperative ultrasonography (USG) for identifying levels II-V metastasis in PTMC patients. Results: The proportion of multilevel LLNM in N1b PTMC was 72.1%, and the most common pattern was metastasis at two levels (41.2%). Capsule invasion [odds ratio (OR) =6.861, 95% confidence interval (CI): 1.462-32.190, P=0.015], upper pole [OR =2.125, 95% CI: 1.010-4.473, P=0.047], central LN ratio [OR =7.315, 95% CI: 1.309-40.877, P=0.023], thyroid-stimulating hormone (TSH) >1.5 mIU/mL [OR =2.773, 95% CI: 1.269-6.060, P=0.011], and extranodal extension (ENE) [OR =2.632, 95% CI: 1.207-5.739, P=0.015] were independent risk factors for multilevel metastasis. In addition, unltrasonography had high sensitivity and specificity in the diagnosis of metastasis at level V (75.0%, 78.4%) and multilevel LLNM (67.2%, 64.8%). Conclusions: Modified radical neck dissection (MRND) in N1b PTMC patients may be reserved for patients with simultaneous 3-level LLNM or clinically evident metastasis at level V. Preoperative USG may have certain suggestive significance in the diagnosis of multilevel LLNM in primary PTMC.

Classification of atrial fibrillation and normal sinus rhythm based on convolutional neural network.

Electrocardiogram (ECG) technology plays a vital role in detecting arrhythmia. Numerous achievements have been marked in ECG-related research. Most methods first pre-process ECG signals, then extract features, and finally classify them. Most of the ECG signals used in the related studies were analyzed in specific time intervals or using a fixed number of samples. However, it is not always possible to see significant changes in a short term, and the symptoms of some patients are relatively short-lived. Misjudgments are possible because the ECG signal was not accurately extracted. This study proposes a computer-aided diagnosis (CAD) system for classification of Atrial Fibrillation and Normal Sinus Rhythm based on ECG signals through convolutional neural network. The proposed system considers a single heartbeat, rather than a specific number of seconds. This study eschews the one-dimensional digital ECG signal used in previous studies and uses convolutional neural networks to analyze two-dimensional ECG image. This study explores whether two-dimensional image ECG requires signal filtering. The final classification results in filtered ECG signals is accuracy of 99.23%, sensitivity of 99.71%, and specificity of 98.66%. The best result in non-filtered ECG signals achieves accuracy of 99.18%, sensitivity of 99.31%, and specificity of 99.03%. With no cumbersome artificial settings, the results of this study are comparable to the related studies. The proposed CAD system has high generalizability; it can help doctors to diagnose diseases effectively and reduce misdiagnosis.

A Gibbs sampling method to determine biomarkers for asthma.

PURPOSE: To identify potential biomarkers and to uncover the mechanisms underlying asthma based on Gibbs sampling. METHODS: The molecular functions (MFs) with genes greater than 5 were determined using AnnotationMFGO of BAGS package, and the obtained MFs were then transformed to Markov chain (MC). Gibbs sampling was conducted to obtain a new MC. Meanwhile, the average probabilities of MFs were computed via MC Monte Carlo (MCMC) algorithm, followed by identification of differentially expressed MFs based on the probabilities of MF more than 0.6. Moreover, the differentially expressed genes (DEGs) and their correlated genes were screened and merged, called as co-expressed genes. Pathways enrichment analysis was implemented for the co-expressed genes. RESULTS: Based on the gene set more than 5, overall 396 MFs were determined. After Gibbs sampling, 5 differentially expressed MF were acquired according to alfa.pi>0.6. Moreover, the genes in these 5 differentially expressed MF were merged, and 110 DEGs were identified. Subsequently, 338 co-expressed genes were gained. Based on the P value<0.01, the co-expressed genes were significantly enriched in 6 pathways. Among these, ubiquitin mediated proteolysis contained the maximum numbers of 35 co-expressed genes, and cell cycle were enriched by the second largest number of 11 co-expressed genes, respectively. CONCLUSIONS: The identified pathways such as ubiquitin mediated proteolysis and cell cycle might play important roles in the development of asthma and may be useful for developing the credible therapeutic approaches for diagnosis and treatment of asthma in future.

A Meta-Analysis of Randomized Controlled Trials of Yiqi Yangyin Huoxue Method in Treating Diabetic Nephropathy.

Objective. The purpose of this systematic review is to evaluate the evidence of Yiqi Yangyin Huoxue Method for diabetic nephropathy. Methods. 11 electronic databases, through September 2015, were searched to identify randomized controlled trials of Yiqi Yangyin Huoxue Method for diabetic nephropathy. The quality of the included trials was assessed using the Jadad scale. Results. 26 randomized controlled trials were included in our review. Of all the included trials, most of them were considered as high quality. The aggregated results suggested that Yiqi Yangyin Huoxue Method is beneficial to diabetic nephropathy in bringing down the microalbuminuria (SMD = -0.98, 95% CI -1.22 to -0.74), serum creatinine (SMD = -0.56, 95% CI -0.93 to -0.20), beta-2 microglobulin (MD = 0.06, 95% CI 0.01 to 0.12), fasting plasma glucose (MD = -0.35, 95% CI -0.62 to -0.08), and 2-hour postprandial blood glucose (MD = 1.13, 95% CI 0.07 to 2.20), but not in decreasing blood urea nitrogen (SMD = -0.72, 95% CI -1.47 to 0.02) or 2-hour postprandial blood glucose (SMD = -0.48, 95% CI -1.01 to 0.04). Conclusions. Yiqi Yangyin Huoxue Method should be a valid complementary and alternative therapy in the management of diabetic nephropathy, especially in improving UAER, serum creatinine, fasting blood glucose, and beta-2 microglobulin. However, more studies with long follow-up are warrant to confirm the current findings.

[Screening potential DNA barcode regions of genus Papaver].

DNA barcoding is an effective technique in species identification. To determine the candidate sequences which can be used as DNA barcode to identify in Papaver genus, five potential sequences (ITS, matK, psbA-trnH, rbcL, trnL-trnF) were screened. 69 sequences were downloaded from Genbank, including 21 ITS sequences, 10 matK sequences, 8 psbA-trnH sequences, 14 rbcL sequences and 16 trnL-trnF sequences. Mega 6.0 was used to analysis the comparison of sequences. By the methods of calculating the distances in intraspecific and interspecific divergences, evaluating DNA barcoding gap and constructing NJ and UPMGA phylogenetic trees. The sequence trnL-trnF performed best. In conclusion, trnL-trnF can be considered as a novel DNA barcode in Papaver genus, other four sequences can be as combination barcode for identification.

Interaction of toxin-1 and T lymphocytes in toxic shock syndrome.

Toxic shock syndrome (TSS) is a potentially fatal illness caused by infection with the bacterium Staphylococcus aureus. TSS toxin-1 (TSST-1) contains a T-cell epitope with specificity for human V-beta-2. Binding of TSST-1 to the human major histocompatibility complex and T cell receptors activates T cells and triggers the secretion of high amounts of inflammatory cytokines, leading to TSS and potentially death. During this process, CD4+ T cells are inhibited by TSST-1, while regulatory T cells are increased. This suggests a protective immune response by the body in TSS. Thus, TSST-1 can trigger both, an inflammatory response that attacks the body and a protective response. In this review, we discuss the interaction between TSST-1 and T lymphocytes in TSS.

[Clinical analysis of level V occult metastasis of papillary thyroid carcinoma].

OBJECTIVE: To analyze the occult level V lymph node (LN) metastases in papillary thyroid carcinoma (PTC) with clinical factors. METHODS: The clinical data of 203 PTC patients with clinical positive neck lymph nodes in level II, III and IV based on preoperative ultrasonography, who underwent therapeutic lateral neck dissection (level II-V) between January 2001 and June 2009 were retrospectively reviewed. There were 60 male and 143 female patients in the study. The median age at diagnosis was 42 years (ranging from 16 to 76 years). The 203 patients had undergone ipsilateral thyroidectomy and simultaneously neck dissections (II-VI). All patients had no suspicion of clinical positive neck nodes in level V. Univariate and Multivariate analysis were performed using the Pearson chi-square test and a binary logistic regression test, respectively. RESULTS: The rate of metastatic at levels II, III and IV was 47.3%(96/203), 79.8%(162/203), 81.3% (165/203), respectively. The rate of occult metastatic at level V were observed in 14.3%(29/203). In univariate analysis, LN metastasis in level V was statistically significantly more frequent in patients with positive level IV LNs (χ(2) = 5.651, P = 0.017) and positive LNs throughout the lateral neck (level III+IV) (χ(2) = 10.936, P = 0.001). Multivariate analysis showed that positive LN involvement in all lateral neck (level III+IV) is an independent predictive factor of level V LN metastasis (P = 0.046, OR = 4.550). CONCLUSION: In PTC patients without suspicious LNs in neck level IV by preoperative ultrasound, prophylactic level V LN dissection may be omitted.

[Tracheoesophageal shunt for vocal rehabilitation after laryngectomy].

OBJECTIVE: To discuss the clinical value of functional tracheoesophageal shunt for vocal rehabilitation after laryngectomy. METHODS: One hundred and twenty seven cases of tracheoesophageal shunt for vocal rehabilitation after laryngectomy in Cancer Hospital of Tianjin Medical University from 1981 to 2006 were analyzed retrospectively. RESULTS: Among 127 cases, 105 cases got successful phonation and the total success rate of vocal rehabilitation was 82.7%, all successful cases were followed up from 2 to 27 years had good phonation quality and no aspiration. Analyzing the reasons of failure in phonation of the 22 cases, 9 cases were because of improper operation (7 cases for narrow fistula and 2 cases for broad fistula), 13 cases were because of postoperative infection (10 cases for narrow fistula and 3 cases for broad fistula). The key to successful phonation was the size of fistula, the main causes of the failure in phonation were related to uncorrected operative procedure and postoperative infection. CONCLUSIONS: This method for vocal rehabilitation after laryngectomy has high success rate of vocal rehabilitation and low complications, it is relatively simple and worth popularizing in clinical treatment.

[Clinical and pathological analysis of malignant carotid body tumor].

OBJECTIVE: To summarize the clinical, pathological and prognosis character of malignant carotid body tumor and explore its methods of diagnosis and treatment. METHODS: The data of clinic, pathology, treatment and follow-up of nine patients with malignant carotid body tumor in Tianjin Cancer Hospital from February 1982 to June 2006 were analyzed retrospectively. RESULTS: Four Male and five female cases were included, their average history was 6.5 years. Shamblin classification: one case was type II, eight cases were type III. All the patients were underwent ultrasonic inspection, four digital subtraction arteriography (DSA) and three magnetic resonance angiography (MRA). Seven cases were diagnosed as carotid body tumor. Five cases underwent Matas test training course. All the patients were performed wide excision of tumor and surrounding tissue. Three carotids were occludes, one of them reconstructed with vascular prosthesis, two were resected. There were no perioperative hemiplegias or deaths. Before operation, one case had atrophy of left side of tongue and fixed left vocal card; two cases had Horner syndrome. After operation, eight cases had 13 cranial nerve deficits, they were: two cerchnus, four glossal deviation, three Horner syndrome and one drop of oral corner, one choking cough. Pathologic diagnosis included nine malignant carotid body tumors, two with capsule, seven without capsule, one cervical and one lung metastasis. Two of them underwent radiotherapy. The median follow-up was 6 years (range: 6 months-14 years). Six patients survived. Two cases died, one died of cervical recurrence, the other of lung cancer. One case was lost. CONCLUSIONS: Malignant carotid body tumor is rare in clinic, and often invade the carotid and cranial nerve, the diagnosis of malignant tumor should base on occurring extensive invasion of adjacent organs and metastasis; Wide surgical excision should be selected early, radiotherapy is effective, the effect of chemotherapy is uncertainty.

[Operation strategy for follicular thyroid carcinoma].

BACKGROUND & OBJECTIVE: The operation strategies for follicular thyroid carcinoma (FTC), a kind of differentiated thyroid carcinoma, are controversial. This study was to summarize the prognosis of FTC patients after operation, and explore the optimal operation pattern. METHODS: Clinical data of 176 FTC patients who underwent operation at Cancer Hospital of Tianjin Medical University from Jan. 1956 to Dec. 2004 were analyzed. Of the 176 patients, 21 underwent total thyroidectomy, 155 underwent partial thyroidectomy. RESULTS: The overall 5-, 10-, and 15-year survival rates were 88.9%, 82.4%, and 79.0%. Lymph node metastasis, distant metastasis and pathologic type (widely invasive follicular carcinoma, WIFTC/minimally invasive follicular carcinoma, MIFTC) had significant influences on the prognosis (P<0.01). The 5-, 10-, and 15-year survival rates were 85.7%, 80.9%, and 80.9% in total thyroidectomy group and 89.0%, 83.2%, and 78.1% in partial thyroidectomy group (P>0.05). The 5-, 10-, and 15-year recurrence rates were significantly higher in total thyroidectomy group than in partial thyroidectomy group (0 vs. 3.2%, 4.8% vs. 6.4%, 4.8% vs. 7.7%, P<0.05). The overall lymph node metastasis rate was 11.9%. The occult metastasis rate in 21 stage cN0 patients was 19.0%. Among 21 cases of lymph node metastasis, 16 (76.2%) were located in region VI. The lymph node metastasis rate was significantly higher in WIFTC group than in MIFTC group (21.1% vs. 5.7%, P<0.01). CONCLUSIONS: We suggest total thyroidectomy for the patients with WIFTC or distant metastasis, and unilateral lobectomy and isthmectomy for the patients with MIFTC. Neck dissection is not necessary for stage cN0 patients, but routine follow-up is necessary for WIFTC patients.