甲状腺功能亢进症再次131I治疗的时机及病例选择

目的分析甲状腺功能亢进症再次131I治疗的间隔时间、效果及预后状况,探讨甲状腺功能亢进症患者再次131I治疗的时机及病例选择。方法回顾性分析136例甲状腺功能亢进症患者再次131I治疗的临床资料。结果 136例再次131I治疗的患者治愈率88.2%,与首次治疗基本一致;甲状腺功能减退发生率36.7%,高于首次治疗;甲状腺功能减退的发生率与再次治疗的间隔时间、甲状腺大小有关。结论甲状腺功能亢进症第一次131I治疗后未愈或复发的患者可再次131I治疗,但治疗的间隔时间及治疗病例应有所选择。     

梅山地区体检人群甲状腺功能检查结果分析

目的 探讨梅山地区健康体检人群甲状腺功能紊乱的发病情况。方法：对2009年-2011年本体检中心12195例体检者的甲状腺功能检测结果进行分析,以甲状腺功能检测异常值结合临床诊断来判断甲状腺疾病的发病率及与性别、年龄、岗位的关系,并以三个时间段来评估其发病趋势。结果：各型甲状腺功能紊乱总的检出率：甲亢0.72%、亚临床甲亢0.40%、甲减0.73%、亚临床甲减9.09%;男性甲状腺功能紊乱检出率7.90%,女性18.37%;高温岗位人群甲状腺功能紊乱检出率低于其他岗位。2009、2010、2011年甲状腺功能紊乱总检出率分别为9.91%、10.96%、12.24%。结论：本地区甲状腺功能紊乱以亚临床甲减型为主,女性高于男性,且每年发病率有上升趋势,建议将甲状腺功能测定作为常规体检项目。     

基于三维CT影像的计算机辅助肺结节检测原型系统的临床应用

目的 探讨基于三维CT影像的计算机辅助肺结节检测原型系统在临床应用的效果.方法 分析2009年6月至2011年6月68例肺结节病例,分别采用单纯螺旋CT检查和应用基于三维CT影像的计算机辅助肺结节检测原型系统检测,以术后病理学检查结果 为"金标准",计算两种检查方法 判断肺结节良恶性的准确度.结果 单纯CT检查判断肺结节良恶性的准确度为75%,Kappa值0.504,术后病理检查结果 一致性一般;基于三维CT影像的计算机辅助肺结节检测原型系统检测,判断肺结节良恶性的准确度为91.6%,Kappa值0.805,术后病理检查结果 一致性较好.结论 基于三维CT影像的计算机辅助肺结节检测原型系统具有较好的临床应用价值,可以用于辅助医师进行CT图像中肺癌等肺部疾病的早期诊断.     

检验科开展病例讨论的模式探讨

病例讨论制度是临床的一项核心医疗规章制度,对提高医务人员能力素质,保证患者治疗的质量和安全至为重要。检验科从检验结果的综合判断入手,开展病例讨论,同样能够促进检验人员提高临床思维能力,全面掌握和应用检验医学知识,为临床提供更加全面、有指导性的咨询会诊意见,促进检验医学更好地与临床结合,提高临床诊疗质量和水平。     

462例健康体检者甲状腺功能检测异常结果分析

目的回顾性分析462例健康体检者甲状腺功能检测结果,了解大连地区居民甲状腺疾病患病情况。方法收集2017-03-01—2018-03-31在某院健康管理中心进行甲状腺功能检测的健康体检者共462例,其中女322例,平均年龄(47.4±13.4)岁,男140例,平均年龄(53.8±13.8)岁,筛查出异常的结果进行综合分析。结果女性临床甲亢、亚临床甲亢、临床甲减、亚临床甲减的检出率分别为2.48%、3.42%、3.73%、9.32%。男性检出率分别为1.43%、1.43%、3.57%、7.86%。结论在健康体检人群中,20岁以上女性甲状腺疾病检出率较高,30岁以上男性的亚临床甲减检出率较高,而其临床症状不明显,只能通过甲状腺功能检测提示异常。     

剖宫产产妇术中低体温风险预测模型的构建及应用效果研究

目的 探讨剖宫产产妇术中低体温的影响因素,建立预测模型,并对应用效果进行检验。方法 采用便利抽样法选取2018年7月—2019年1月长沙市3所三级甲等医院的369名剖宫产产妇为研究对象,依据产妇剖宫产期间是否发生低体温分为低体温组（n=83）和非低体温组（n=286）,分析发生低体温的危险因素并建立预测模型,采用Hosmer-Lemeshow检验判断模型的拟合优度,ROC曲线检测模型的预测效能。结果 共纳入麻醉后体温、体重指数、妊娠期亚临床甲状腺功能减退、术中液体丢失量、术中冲洗腹腔液体量、主动保温持续时间、进入手术室室温7个因素构建预测模型。该模型Hosmer-Lemeshow检验结果显示,P=0.425,ROC曲线下面积为0.888,当最佳界值为-1.844时,灵敏度为0.880,特异度为0.741,实际应用准确率为79.7%,提示模型具有较好的拟合效果及鉴别效度。结论 该模型能较好地预测剖宫产术期间产妇低体温的发生风险,为医护人员及时对高危产妇采取预防性管理措施提供参考。     

anti-TGAb和anti-TPOAb抗体亲和力检测在HT患者甲状腺功能判断中的临床意义

目的探讨抗甲状腺球蛋白抗体(anti-thyroglobulin antibody,anti-TGAb)和抗甲状腺过氧化物酶抗体(anti-thyroid peroxidase antibody,anti-TPOAb)的亲和力检测在桥本甲状腺炎(hashimoto's thyroiditis,HT)患者甲状腺功能判断中的临床价值。方法收集2013年2月至2014年8月期间于我院就诊的52例HT患者,按照甲状腺功能检测结果分为甲状腺功能异常组33例,甲状腺功能正常组19例。采用ELISA法anti-TGAb、anti-TPOAb定量检测试剂盒,以尿素作变性剂,计算anti-TGAb、antiTPOAb的相对亲和力指数(relative avidity index,RAI),并分析这两种自身抗体的RAI与HT患者甲状腺功能的相关性。结果甲状腺功能异常组anti-TGAb和anti-TPOAb的RAI检测结果均高于正常组,且差异均有统计学意义(t=3.720,t=2.840,P=0.000,P=0.007)。anti-TGAb和anti-TPOAb的RAI用于判断HT患者甲状腺功能正常与否的cutoff值分别为39、35,受试者工作特征曲线下面积分别为0.779、0.730,灵敏度分别为84.8%、81.6%,特异性分别为63.2%、64.1%。在甲状腺功能异常组,两种抗体同为高RAI的占54.5%(18/33),而在甲状腺功能正常组仅为15.8%(3/19),两组间比较差异有统计学意义(χ2=7.520,P=0.007);在甲状腺功能异常组,两种抗体同为低RAI的占6.1%(2/33),而在甲状腺功能正常组达47.4%(9/19),两组间比较差异有统计学意义(χ2=12.330,P=0.000);仅一种抗体RAI增高的情形在甲状腺功能异常组中占39.4%(13/33),在甲状腺功能正常组占36.8%(7/19),两组间差异无统计学意义(χ2=0.030,P=0.868)。结论 anti-TGAb和anti-TPOAb的抗体RAI检测可用于判断HT患者甲状腺功能,从而有利于对该病的预后判断以及临床治疗。     

1016例妊娠妇女甲状腺功能指标结果分析

目的对1016例早期妊娠妇女进行甲状腺功能筛查和检测,及时诊断孕期甲状腺疾病,以便给予相应治疗。方法采集1016例早期妊娠妇女和800例孕前健康体检妇女的静脉血,检测其血清中的游离三碘甲状腺氨酸(FT3)、游离甲状腺素(FT4)、血清促甲状腺素(TSH)和甲状腺过氧化物酶抗体(TPOAb)四项甲状腺功能指标,并对检测结果进行统计分析。结果1016妊娠妇女甲状腺功能指标筛查显示:甲状腺功能正常但TPOAb升高35例(3.3%),甲状腺功能减低22例(2.1%),亚临床甲状腺功能减低32例(3.0%),甲状腺功能亢进2例(0.2%),亚临床甲状腺功能亢进5例(0.5%)。妊娠组与非妊娠组FT3,FT4水平无显著性差异,(P0.05)而TSH有显著性差异(P0.05)。结论妊娠期妇女中存在一部分甲状腺功能异常的人群,其中以甲状腺功能正常但TPOAb升高和亚临床甲状腺功能减低的病例多见。因此,在孕前及孕期应常规筛查甲状腺功能及其相关自身抗体,及时干预孕期甲状腺疾病,减少甲状腺功能异常对母婴造成的危害。     

超声在甲状腺结节手术决策中的作用:北京协和医院11年回顾

  目的  探讨超声在甲状腺结节手术决策中的作用  目的  检索北京协和医院2004年1月至2014年12月因甲状腺结节而行手术切除的病例, 按10%~15%的比例分别对2004、2006、2008、2010、2012、2014年手术病例进行随机抽样, 查阅抽样的门诊及住院病历, 记录是否行术前超声检查, 超声报告是否给予诊断提示, 如提示则与病理结果对照判断提示是否正确。计算术前超声检查比例、超声提示诊断比例、提示诊断正确率和超声诊断正确率  结果  2004年至2014年甲状腺结节手术例数逐年上升, 其中恶性结节的比例逐年增高, 由2004年的15.65%上升至2014年的69.91%。抽样结果显示, 术前超声检查比例范围为80.65%~96.65%;超声提示诊断比例呈逐年上升趋势, 范围为46.94%~92.36%;超声提示诊断正确率在78.26%~93.62%范围内; 超声诊断正确率呈逐年上升趋势, 范围为36.73%~81.40%  结论  近年来甲状腺结节和甲状腺癌患者急剧增加, 超声诊断水平逐年提高, 在甲状腺结节的外科决策中发挥了越来越重要的作用。     

基于指南建议的脑梗死病人院内健康教育决策方案的构建

[目的]基于指南建议构建脑梗死病人院内健康教育决策方案,为进一步建立脑梗死健康教育信息平台提供理论框架。[方法]在前期现况调查与循证研究的基础上,初步形成脑梗死病人院内健康教育决策方案专家咨询问卷,通过德尔菲法,构建基于指南建议的脑梗死病人院内健康教育决策方案。[结果]经2轮专家咨询,形成的脑梗死健康教育决策方案共包含每日评估项目、健康教育项目、临床路径中固定匹配健康教育内容、依据不同评估结果匹配健康教育内容、依据不同病情指证匹配康复训练内容、生命体征平稳及症状不再进展的判断指标以及健康教育项目学习周期7项内容,共112个条目。[结论]基于指南建议的脑梗死病人院内健康教育决策方案可靠性高,不仅规范了脑梗死病人院内健康教育的内容,还为健康教育信息平台的开发提供了理论框架。     

Concomitant paraganglioma and thyroid carcinoma:A case report

BACKGROUND Paraganglioma/pheochromocytoma and medullary thyroid carcinoma can coexist and are often found in multiple endocrine neoplasia(MEN). However,very few cases highlight papillary thyroid carcinoma. We present herein a rare case of head and neck paraganglioma associated with papillary thyroid carcinoma.CASE SUMMARY A 51-year-old man presented to our department with right-sided neck swelling and hypertension. Physical examination showed neck masses with obvious pulsation. Concentrations of serum calcium, phosphorus, parathormone, thyroid stimulating hormone, free thyroxine, and calcitonin were within normal limits.Enhanced computed tomography revealed an irregular solid nodule, located in the carotid artery bifurcation. A low-density nodule of the thyroid isthmus with a spot-like dense shadow was also detected. The diagnosis of carotid body tumor was raised and an ultrasound-guided fine needle aspiration biopsy of the thyroid nodule revealed papillary thyroid carcinoma. The patient underwent surgery for lesion excision, total thyroidectomy, and neck dissection, and the pathology was reported as paraganglioma and papillary carcinoma. Genetic studies showed negative results for germline mutation of succinate dehydrogenase subunit D on 11q23. He was treated with ¹³¹I after surgery and remained disease-free so far.CONCLUSION The presence of concomitant paraganglioma and thyroid papillary carcinoma could be either coincidental or a result of an unknown mutation.     

Radiological insights of ectopic thyroid in the porta hepatis: A case report and review of the literature

BACKGROUNDEctopic thyroid is defined as a rare developmental anomaly where thyroid tissues are atypically found in locations other than its normal anatomical position: Anterolateral to the second, third, and fourth tracheal cartilages. An intemperate descent or a migration failure of the thyroid anlage results in sub-diaphragmatic thyroid ectopia, a sparse clinical entity.CASE SUMMARYThis case portrays a 63-year-old female patient presenting with chronic abdominal discomfort at a local hospital whereby a computed tomography (CT) scan revealed a well-defined mass in the hepatic entrance. For further examination, the patient underwent a CT scan with contrast, magnetic resonance imaging (MRI), and CT-angiography (CTA) at our department. The CT scan showed a well-defined and high attenuated mass measuring 43 mm × 38 mm in the hepatic entrance with calcification. The CTA revealed an additional finding: Blood supply to the mass from the right hepatic artery. MRI of the upper abdomen demonstrated a mass with mixed signal intensity on T1 and T2 weighted images in the hepatic entrance. The patient underwent surgery with resection of the mass which was sent for histopathology. Ectopic thyroid at the level of porta hepatis with nodules was the definitive diagnosis since histopathological report revealed presence of thyroid tissue in the resected liver mass.CONCLUSIONThis case delivers a rare insight of pre-operative radiological imaging of an ectopic thyroid located in the liver. These findings can aid in narrowing down potential differential diagnosis when managing a patient with those subsequent findings.     

Calcitonin-negative neuroendocrine tumor of the thyroid with metastasis to liver-rare presentation of an unusual tumor: A case report and review of literature

BACKGROUND Neuroendocrine tumors mainly occur in the stomach,intestine,pancreas,and lung and are rarely detected in the thyroid.Thyroid neuroendocrine tumors,designated medullary thyroid carcinoma,generally present with elevated calcitonin.Calcitonin-negative neuroendocrine tumors of the thyroid are extremely rare.CASE SUMMARY Here,we present a case report of a 56-year-old female patient with a neck pain complaint.Total thyroidectomy was conducted after comprehensive evaluation,and diagnosis was confirmed as calcitonin-negative neuroendocrine tumor of the thyroid.Two months later,liver metastasis was detected,and transcatheter arterial chemoembolization was subsequently performed to control growth.However,the curative effect was unsatisfactory and multiple intrahepatic metastases occurred after 3 mo.CONCLUSION Owing to the rarity of this disease,no clear guidelines are available for treatment.In addition to reporting this rare case,we have reviewed and summarized associated medical literature with an aim to provide a comprehensive reference platform for subsequent research.     

A method for vector displacement estimation with ultrasound imaging and its application for thyroid nodular disease

Ultrasound elastography is a promising imaging technique that can assist in diagnosis of thyroid cancer. However, the complexity of the tissue movements under freehand compression requires the use of a parametric displacement model and a specific estimation method adapted to sub-pixel motion. Therefore, the aim of this study was to develop a motion estimation method for ultrasound elastography and test its performances compared to a classical block matching technique. The proposed method, referred to as Bilinear Deformable Block Matching (BDBM), uses a bilinear model with eight parameters for controlling the local mesh deformation. In addition, a technique of motion initialization based on a triangle scan of the images adapted to ultrasound elastography is proposed. The BDBM method includes an iterative multi-scale process. This iterative approach is shown to decrease the absolute error of the displacement estimation by a factor of 1.4 when passing from 1 to 2 iterations. The method was tested on simulated images and the results show that absolute displacement estimation error was reduced by a factor of 4 compared to classical block matching. We applied the BDBM method on three experimental sets of data. In the first data set, a phantom designed for ultrasound elastography was used. The two other sets of data involve the thyroid gland and were acquired using freehand tissue compression by ultrasound probe of a clinical ultrasound scanner modified for research. A similarity measurement based on local cross-correlation shows that, for experimental data, the BDBM method outperforms the usual block matching.     

鼻咽部原始神经外胚层肿瘤1例报告并文献复习

目的:提高对鼻咽部原始神经外胚层肿瘤(PNET)病理诊断的认识,减少误诊。方法:报告1例鼻咽部原始神经外胚层肿瘤患者的临床资料、病理特征,并复习相关文献。结果:该病临床无特异性,病理特征有肿瘤细胞体积较小,呈圆形或卵圆形,间质较少,有聚集成团倾向,肿瘤弥漫表达CD99,并不同程度地表达NSE、Syn、Vim、S-100等。结论:PNET是一种预后非常差的恶性小圆细胞肿瘤,认识其临床病理特点及免疫组化表型对于该恶性肿瘤的诊断及临床治疗意义重大。     

安徽省法定传染病疫情报告管理现状调查分析

１９９７年９月份安徽省在全省范围内组织开展传染病防治监督执法检查和调查研究，本文根据对１１８家卫生防疫机构和７０７家医疗保健机构调查的结果，总结分析了我省法定传染病疫情报告现状。《传染病防治法》实施八年来，全省建立起传染病疫情报告网络，各级医疗保健机构、卫生防疫机构疫情报告系统运转基本正常。但全省法定传染病疫情报告仍然存在着违法现象，漏报、迟报、不报等违法事例屡有发生。《传染病防治法》实施过程中，还缺乏一些可操作性的规范文件，本文对进一步加强传染病疫情报告管理工作进行了探讨.     

Primary leiomyosarcoma of the thyroid gland with prior malignancy and radiotherapy:A case report and review of literature

BACKGROUND Leiomyosarcoma(LMS) of the thyroid gland is a rarely presented tumor that offers poor prognosis. To the best of the authors' knowledge, there currently exist only 28 known cases described in the literature(limited to English).CASE SUMMARY Herein a case is reported of a 60-year-old female patient who had an LMS of the thyroid, which was accompanied by periodic dysphonia and breathing disorder as well as the feeling of pressure in the chest and neck. At the time the disease was diagnosed, no metastases were detected. Prior to the diagnosis, the patient experienced a uterine adenocarcinoma that had been treated by surgical procedure and radiotherapy. For the LMS, a total thyroidectomy was performed,followed by radiotherapy. Since metastases were also discovered in the lungs,sternum, and femur, chemotherapy was administered as well.Immunohistochemically, the tumor cells in the thyroid indicated positively for alpha smooth muscle actin, calponin, and H-caldesmon, but were negative for CD34, p63, estrogen receptor, progesterone receptor, and Epstein-Barr virus.CONCLUSION Although the etiology of the LMS is as of yet unknown, prior malignancy and radiation should be considered as risk factors.     

个案追踪法在产科手术患者护理质量督查中的运用

目的:探讨个案追踪法在产科手术患者质量督查中的作用。方法:对产科手术患者采用个案追踪法进行督查,收集实施后1年患者身份识别制度规范执行、交接流程落实、患者转运安全问题、婴儿回病房的交接、感染管理制度落实、人文关怀心理护理等各个环节合格率并与实施前进行比较。结果:个案追踪法实施1年后患者身份识别制度规范执行、交接流程落实、患者转运安全问题、感染管理制度落实、人文关怀心理护理等各个环节合格率较实施前提高(P0.05)。结论:个案追踪法体现以患者为中心,有效评价护理制度和流程的执行力,因此有利于医院护理质量和管理水平的不断提高。