Hallazgos ecográficos en el tejido tímico ectópico intratiroideo en niños y adolescentes. Una revisión sistemática

Intrathyroidal ectopic thymic tissue (IETT) is an indulgent, unusual entity and is part of the differential diagnosis of thyroid nodules in the pediatric population. Because of the low prevalence of IETT, the diagnosis may be difficult. Awareness of this diagnosis is definitive to avoid surgical interventions. The aim of this study was to review the literature on the echographic characteristics of IETT. We conducted a search of Ovid, PubMed and the virtual health library.A total of 619 patients with a mean age of 6.2 years old were included. IETT was located in the lower portion of both of the thyroidal lobes in 556 children, the echographic shape was reported for 173 patients, with the fusiform shape as the most representative, the appearance of the IETTs was reported for 121 patients, the most common was the hypoechogenic pattern with multiple internal echogenic foci. The average lesion diameter was 5.53 mm, and Doppler findings reported a hipovascular pattern in 56% of the lesions.In conclusion, IETT is an infrequent entity; nonetheless, it must be considered in the differential diagnosis of neck nodules in children and should be study and follow with echography to avoid unnecessary surgery.     

Maladie rénale chronique et immunosénescence prématurée : données et perspectives

Immune senescence is associated with age-related diseases (i.e. infectious disease, cardiovascular diseases and cancers). Chronic kidney disease patients die prematurely when compared with general population, because of a higher occurrence of infections, cardiovascular events and cancer. These diseases are commonly observed in the elderly population and frequently associated with immune senescence. Indeed, chronic kidney disease causes a premature aging of the T lymphocyte compartment, widely related to a decrease in thymic function, a phenomenon that plays a key role in the onset of age-related diseases in chronic kidney disease patients. The degree of immune senescence also influences patients’ outcome after renal transplantation, particularly the risk of acute rejection and infections. Partial reversion of pre-transplant immune senescence is observed for some renal transplant patients. In conclusion, to reduce the increasing incidence of morbidity and mortality of chronic kidney disease patients, a better knowledge of uremia-induced immune senescence would help to pave the way to build clinical studies and promote innovative therapeutic approaches. We believe that therapeutic reversion and immune senescence prevention approaches will be part of the management of chronic kidney disease patients in the future.     

Thymic teratoma masquerading as a thyroid lump

Teratomas are germ cell tumours commonly found in the sacrococcygeal region, ovary, testicle or, infrequently, the mediastinum. In very rare circumstances, these tumours are found in the neck. This case represents a thymic teratoma presenting as what appeared to be an intrathyroid lesion. This has not been described previously and demonstrates an unusual presentation of a neck lump necessitating two operations and a multidisciplinary approach for management. We would also like to highlight that while patients undergo imaging to guide surgery, the surgeon must always be prepared for the unexpected and recognise situations where the operation should be converted to an exploratory procedure instead of full resection. Often, combined surgical care is the best option for difficult congenital cases.     

鹅去氧胆酸浙贝乙素酯对H22荷瘤小鼠抑瘤作用*

目的研究新型化合物鹅去氧胆酸浙贝乙素酯(CDCA-Ver)对H22荷瘤小鼠体内肿瘤细胞生长和免疫器官的影响。方法采用鼠系肝癌细胞H22造荷瘤模型,将H22荷瘤小鼠40只,采用随机数字表法随机分成4组,每组10只,分别为模型对照组、环磷酰胺(CTX)组、CDCA-Ver腹腔注射组和CDCA-Ver静脉注射组。模型对照组按每日10 mL·kg-1无菌0.9%氯化钠溶液腹腔注射1次,CTX组按每日20 mg·kg-1剂量腹腔注射1次,CDCA-Ver腹腔注射组每日按20 mg·kg-1剂量腹腔注射1次,CDCA-Ver静脉注射组每日按20 mg·kg-1剂量小鼠尾静脉注射1次。接种24 h后给药,给药量为0.1 mL·(10 g)-1,连续给药10 d。以CTX为阳性对照药,考察CDCA-Ver(静脉注射和腹腔注射)对荷瘤小鼠肿瘤的生长抑制作用,评价CDCA-Ver对荷瘤小鼠的免疫脏器指数(胸腺指数和脾指数)的影响,采用组织病理学切片法研究CDCA-Ver对荷瘤小鼠瘤块组织病理学形态的影响。结果CDCA-Ver静脉注射和腹腔注射两种给药方式对荷瘤小鼠的肿瘤生长均具有良好的抑制作用,腹腔注射20 mg·kg-1剂量CDCA-Ver抑瘤率达48.3%,与模型对照组比较差异有统计学意义(P＜0.05),与CTX组作用相当。与模型对照组相比,CDCA-Ver腹腔注射组脾指数和胸腺指数没有显著变化(P＞0.05),而CTX组脾指数和胸腺指数均显著降低(P＜0.01),表明CDCA-Ver发挥体内抗肿瘤作用不会降低荷瘤小鼠的免疫功能。组织病理学结果也证实CDCA-Ver具有体内抗肿瘤作用。结论CDCA-Ver对H22荷瘤小鼠肿瘤生长具有明显的抑制作用。     

Hodgkin’s-like disease of the thymus. Clinical,surgical and morphological correlations

Summary The histogenesis and relationship of so-called ‘granulomatous thymoma’ to Hodgkin’s disease is still a matter of controversy. Three of these lesions were selected from 43 thymomas and their clinico-pathological patterns are described. Two cases were diagnosed as Hodgkin’s disease of the mediastinum because of the absence of epithelial structures of thymic origin. In one case, together with the morphological aspects of Hodgkin’s disease, we noticed epithelial structures indicating a primary neoplastic lesion in the thymus. Accordingly we conclude that the term ‘Hodgkin’s disease of the thymus’ must be limited only to those lesions of the mediastinum in which structures of thymic origin are present. Other mediastinal Hodgkin’s lesions, even in the presence of clinical, radiological and surgical evidence of thymic origin but in which it is not possible to observe such thymic structures, must be classified as Hodgkin’s disease localized to the anterior mediastinum.     

快速平衡稳态采集与单次激发快速自旋回波序列

目的 比较MRI快速平衡稳态采集（FIESTA）与单次激发快速自旋回波（SSFSE）序列诊断正常胎儿胸腺的价值。方法 对366胎正常胎儿行MR检查,采用FIESTA与SSFSE序列分别观察胎儿胸腺的解剖和MR表现,结果行Kappa和χ²检验。于"三血管"层面测量胸腺面积（TA）、横径（TD）,于矢状位测量上下径（SID）,计算各孕周参数均值,拟合各参数与孕周的回归方程。结果 2名医师对FIESTA和SSFSE序列图像的评价结果一致性较好（Kappa=0.745、0.802,P均<0.01）,FIESTA和SSFSE序列图像显示清晰率分别为86.34%（632/732）和37.70%（276/732）,差异有统计学意义（χ²=367.520,P<0.001）。胎儿胸腺大小随孕周延长而增大,回归方程分别为：TA=－5.80+0.35×孕周（r=0.820,P<0.01）;TD=－14.59+1.63×孕周（r=0.817,P<0.01）;SID=－9.63+1.44×孕周（r=0.778,P<0.01）。结论 FIESTA较SSFSE序列可更清晰地显示胎儿胸腺的细微结构及其轮廓,MRI能清晰地显示孕22周后的胎儿胸腺。     

针刺对焦虑大鼠血浆及胸腺T细胞亚群的影响

目的:通过观察针刺对焦虑模型大鼠血浆CD 4+、CD 8+T淋巴细胞含量及胸腺细胞CD 4+、CD 8+表达水平的影响,探讨针刺治疗焦虑障碍的部分免疫调节机制。方法:健康SD大鼠34只,随机分为空白组(10只)、模型组(12只)、电针组(12只)。运用慢性不可预知应激刺激方法复制焦虑模型。电针"内关""神门"穴,隔日1次,每次15min,共治疗15d。运用高架十字迷宫测试大鼠焦虑行为,酶联免疫法检测血浆CD 4+、CD 8+的含量,免疫组化法观察成熟胸腺细胞CD 4+、CD 8+的表达。结果:与空白组相比,模型组大鼠在开臂的次数(OE)占进入两臂区停留总次数的百分比(OE%)明显下降(P0.05);与模型组相比,针刺组OE%值明显提高(P0.05)。与空白组相比,模型组血浆CD 4+浓度明显下降(P0.05),CD 8+浓度明显升高(P0.05),CD 4+/CD 8+比值有降低趋势(P=0.054);针刺可明显提高模型大鼠血浆CD 4+浓度和CD 4+/CD 8+比值(P0.05,P0.01),明显降低模型大鼠血浆CD 8+浓度(P0.05)。与空白组相比,模型组大鼠胸腺髓质CD 4+、CD 8+表达均显著降低(P0.01);针刺可显著提高模型大鼠胸腺髓质CD 4+、CD 8+的表达(P0.01)。结论:针刺在发挥抗焦虑效应的同时,还可能通过影响CD 4+、CD 8+的成熟、归巢与再循环,发挥其调节焦虑大鼠T细胞的作用。这可能是针刺调节焦虑障碍免疫功能的重要途径之一。     

人参皂苷Rg1对大鼠胸腺结构与功能的影响

目的 探讨人参皂苷Rg1对大鼠胸腺组织结构与功能的影响及相关机制。 方法 SD大鼠随机分为2组,每组10只。Rg1注射组,腹腔注射Rg1 20mg/kg,qd×28d;对照组,等时注射等量生理盐水。药物注射完成后第2天,取胸腺称重测定胸腺指数,石蜡切片与HE染色观察胸腺组织结构;衰老相关β-半乳糖苷酶（SA-β-Gal）染色检测胸腺细胞衰老,细胞计数试剂盒（CCK-8）检测胸腺细胞对刀豆蛋白A（ConA）刺激的增殖能力,ELISA检测胸腺细胞分泌肿瘤坏死因子-α（TNF-α）、粒细胞 巨噬细胞集落刺激因子（GM-CSF）、白细胞介素（IL)-2与IL-6的能力,流式细胞术检测胸腺细胞周期、细胞凋亡率与活性氧（ROS）含量,酶学检测丙二醛（MDA）、超氧化物歧化酶（SOD）含量与还原性谷胱甘肽（GSH）与氧化性谷胱甘肽（GSSH）的比值,Western blotting 检测细胞衰老相关蛋白P21、P53、Rb表达。 结果 与对照组相比,注射Rg1能提升大鼠胸腺指数,增加胸腺皮质面积比例,提高胸腺细胞增殖能力和S期比例,降低G₁期与G₂/M期细胞比例,减少胸腺细胞凋亡和SA-β-Gal阳性细胞百分率,促进胸腺细胞分泌GM-CSF,TNF-α、IL-2、IL-6,提升胸腺细胞SOD活性和GSH/GSSG比例,降低ROS、MDA含量,下调P53、P21、RB蛋白表达。 结论 人参皂苷Rg1对大鼠胸腺结构与功能有明确的保护作用,其机制可能与抑制氧化损伤和下调p53/p21/Rb信号通路有关。