中高危分化型甲状腺癌手术后首次131I治疗的疗效分层及影响因素

目的 研究中、高危分化型甲状腺癌患者术后¹³¹I治疗的动态疗效评估，并探讨影响疗效的有关因素。方法 回顾性收集就诊于苏州大学第一附属医院的318例DTC患者。按照治疗疗效评估体系对4种治疗疗效进行评估并分析。结果中高危患者各疗效组间差异有统计学意义。ps-Tg≤3.53ng/mL,时间间隔≤233d及¹³¹I治疗剂量<150mCi是中危患者ER独立预测因素。ps-Tg≥11.8ng/mL是中危患者SIR的独立预测因素。ps-Tg≤1.04ng/mL是高危患者ER的独立预测因素。ps-Tg≥7.58ng/mL、远处转移是高危患者SIR的独立预测因素。结论 ps-Tg≤3.53ng/mL、时间间隔≤233d的中危患者首次¹³¹I治疗后的疗效较好；ps-Tg≥11.8ng/mL的中危患者首次¹³¹I治疗后疗效较差。ps-Tg≤1.04ng/mL的高危患者首次¹³¹I治疗后疗效较好；ps-Tg≥7.58ng/mL、远处转移的高危患者首次¹³¹I治疗后疗效较差...     

甲状腺切除术后应用甲状腺平面显像评估残余甲状腺:与治疗剂量131I扫描的对比

目的:我国常用^99mTc甲状腺扫描评估甲状腺癌术后残余甲状腺大小,本文拟对甲状腺扫描与治疗剂量的¹³¹I扫描进行比较分析。方法:148例（男51,女97）2年内就诊甲状腺癌术后病人入组,年龄（47.0±13.3）岁,2名核医学科医师独立、盲法阅片,采用5分法计分。统计学分析采用秩相关研究,相关系数采用t检验进一步比较。结果:69/148（46.6%）两种显像结果得分一致,79（53.4%）¹³¹I扫描得分高于甲扫。甲扫及¹³¹I扫描评分结果与甲状腺激素水平均相关（P<0.001）,且相关系数间甲扫与T₃、T₄相关程度更高（t₁=-1.933,P=0.028;t₂=-2.788,P=0.003）。结论:^99mTc甲状腺平面显像可作为术后残余甲状腺的评估方法,但¹³¹I扫描显示范围更大,两者与甲状腺激素水平均相关,但甲扫与其相关性可能更高。     

不同清甲剂量131I对中低危分化型甲状腺癌患者治疗后临床反应和免疫功能的影响

目的 探讨不同清甲剂量¹³¹I对中低危分化型甲状腺癌(differentiated thyroid carcinoma, DTC)患者治疗效果和免疫功能的影响。方法 选取2019年10月至2020年9月四川省肿瘤医院收治的已行甲状腺全切除术和颈部淋巴清扫术,且术后采用¹³¹I清甲治疗的54例DTC患者为研究对象。根据¹³¹I清甲剂量大小分为小剂量治疗组(1.11GBq, 21例)和大剂量治疗组(3.70GBq, 33例),比较两组间清甲治疗效果和免疫功能变化差异。结果 治疗后6个月左右,两组间治疗后反应完全比率差异无统计学意义(χ²=0.006,P=0.936);清甲治疗后5～7天与治疗前比较,免疫功能均有降低(P<0.001),大剂量组比小剂量组的免疫功能降低幅度更大(P<0.05);治疗后6个月左右,两组间免疫细胞百分比值(Treg细胞除外)基本恢复到治疗前水平(P>0.05)。结论 对于中低风险DTC患者而言,大剂量和小剂量清甲治疗后反应完全率接近,而小剂量治疗组在短期内对免...     

甲状腺球蛋白测定与131I全身显像在甲状腺乳头癌复发监测中的意义

探讨甲状腺球蛋白(Tg)和131I全身显像(131I-WBS)在甲状腺乳头癌(PTC)复发监测中的意义. 30例PTC患者术后6周,行131I(3.7GBq)首次清除残留甲状腺组织治疗,6个月后再给予131I 治疗1次,治疗中同时测定Tg和进行131I-WBS.结果表明,在首次清除残留甲状腺组织治疗时,显像发现淋巴、肺及骨转移6例,其余转移灶于6个月治疗时发现,有3例患者(10%)Tg测定在正常范围,而131I-WBS出现转移灶,4例患者(13.3%)Tg测定异常,而131I-WBS正常.Tg测定和131I-WBS可作为诊断PTC有无转移的重要指标,二者监测复发应联合应用,可互相补充.     

药物难治性Graves病131I治疗疗效分析

目的 探讨放射性碘治疗对药物难治性Graves病(Graves’ disease, GD)患者的临床疗效。方法 回顾性分析2018年1月至2019年12月在我院就诊的药物难治性GD患者110例,监测患者¹³¹I治疗前1d以及¹³¹I治疗后5、15d、1、2、3、6月及1年的甲状腺功能水平,在¹³¹I治疗后6月进行疗效评价。将其疗效分为治愈、部分缓解、无效和复发,治愈及部分缓解均纳入疗效有效范围内。结果 接受¹³¹I治疗后,治愈患者92例,部分缓解14例,无效患者1例,复发患者3例,有效率为94.7%。FT₃在¹³¹I治疗后5、15d、1、2月及3月分别下降了38.3%、41.3%、45.7%、55.1%、68.4%,FT₄在治疗后15d、1、2月及3月分别下降了18.4%、36.4%、48.2%、64.5%,差异均有统计学意义(P<0.001)。¹³¹I治疗后第15天、第1个月、第2个月、第3个月及第6个月...     

抗甲状腺球蛋白抗体在甲状腺癌合并结节性甲状腺肿患者中对复发或转移的诊断价值

目的 分析247例分化型甲状腺癌(differentiated thyroid carcinoma, DTC)合并结节性甲状腺肿(nodular Goiter, NG)患者经全切或次全切术后我科接受¹³¹I治疗前血清抗甲状腺球蛋白抗体(antithyroglobulin antibody, TgAb)的水平对甲状腺癌复发或转移的诊断价值,并确定其相应的截断值。方法 DTC合并NG患者根据TgAb水平分为TgAb阳性和阴性两组,并比较两组患者的临床病理特征。经随访所有患者分为有或无复发/转移两组,进行受试者特征工作曲线(receiver operating characteristic, ROC)分析,计算DTC合并NG患者消融前TgAb预测复发或转移的截断值。结果 研究数据显示,TgAb阳性患者的TNM分期I级高于TgAb阴性组患者,且差异具有统计学意义。在DTC合并NG患者中,以ROC分析计算出TgAb预测复发或转移的截断值为152.3kIU/L(灵敏度65.4%,特异性78.4%)。TgAb的曲线下面积(AUC)为0.757。结论在DTC合并NG患者中,以RO...     

直接免疫组化技术在术中甲状腺乳头状癌诊断中的应用价值

<正>甲状腺乳头状癌(papillary thyroid carcinoma, PTC)是最常见的滤泡细胞起源的恶性肿瘤，约占甲状腺恶性肿瘤的80%,易发生淋巴结和远处器官转移，影响患者的存活率^[1-2]。WHO(2022)甲状腺肿瘤分类中，建议不要将“乳头状微小癌”视为特殊亚型^[3],虽然最大径<1 cm的PTC预后较好，但其生物学行为与PTC一致，同样有局部甲状腺外浸润、颈部及全身淋巴结转移等特征^[4]。     

甲巯咪唑对甲状腺功能亢进症患者甲状腺激素及甲状腺体积的影响

目的:探讨甲巯咪唑治疗对甲状腺功能亢进症(简称甲亢)患者甲状腺激素及甲状腺体积的影响。方法:前瞻性选择2018年9月至2020年9月汝南县人民医院收治的160例甲亢患者作为研究对象,随机数字表法分为观察组与对照组,每组各80例。对照组患者行丙硫氧嘧啶治疗,观察组患者行甲疏咪唑治疗。对比两组患者治疗前及治疗3m后甲状腺激素水平包括血清游离甲状腺素(Free thyroxine,FT₄)、促甲状腺素(T hyroid-stimulating hormone,TSH)、游离三碘甲腺原氨酸(Free T riiodothyronine,FT₃)、血清指标[抗甲状腺过氧化物酶(Anti-thyroperoxidase antibody,A-TPO)]、抗甲状腺球蛋白抗体(Anti-thyroglobulin antibody,A-TG)和促甲状腺受体抗体(Thyroid stimulating hormone receptor antibody,TRAb)与甲状腺体积,同时记录治疗期间不良反应发生状况。结果:与治疗前相比,两组治疗3m后的FT₃、FT₄水平明显降低,TSH水平明显升高,血清A-TPO、A-TG和TRAb水平明显降低,甲状腺体积明显缩小(P<0.05),且甲疏咪唑组各作用均更为明显(P<0.05);两组不良反应发生率对比,无显著差异(P>0.05)。结论:甲疏咪唑治疗甲亢患者可显著改善甲状腺激素水平,降低血清A-TPO、A-TG和TRAb水平,有效减小甲状腺体积,但需预防白细胞减少及皮肤瘙痒的发生。     

甲状腺重量及血清TSH浓度对小剂量131Ⅰ治疗甲亢疗效的影响

目的:评价甲状腺重量及血清TSH浓度对小剂量131Ⅰ治疗甲状腺功能亢进症(甲亢)疗效的影响.方法:患者治疗前均行甲状腺SPECT扫描并检测血清FT3、FT4、TSH浓度;131I治疗的剂量为常规剂量的1/2～2/3.结果:①治疗前一次给药组TSH浓度为0.10±0.34mμ·L-1,重复给药组为0.04±0.10mμ·L-1,两者差异有显著性(P＜0.05);②治疗前甲状腺的重量一次给药组为51.22±26.09g,重复给药组87.34±63.69g,两者差异有显著性(P＜0.0001).结论:小剂量131Ⅰ治疗甲亢的疗效良好,多数患者能一次治愈,但对于大甲状腺患者或血清TSH浓度很低者则需多次治疗.     

DTC术后131I清甲治疗患者血清Tg及TgAb变化及其与病灶检出相关性分析

目的 探讨分化型甲状腺癌(DTC)患者在术后接受131I治疗后,血清甲状腺球蛋白(Tg)、甲状腺球蛋白抗体(TgAb)的变化及其与131I全身显像(Dx-WBS)结果的相关性,从而为DTC复发、转移的诊断提供依据.方法 入选我院DTC患者83例,均在行甲状腺全切或次全切手术4～6周后,给予131I治疗,半年后TSH刺激状态下(停用甲状腺素片并低碘饮食3周),检测血清Tg及TgAb,并对甲功各项指标进行复查,同时行131I全身显像检查.结果 TgAb阳性率随着Tg水平的变化而发生改变,对血清Tg的检出存在一定干扰性,将Tg与Dx-WBS二者联合进行判断,DTC复发及转移诊断准确率可达95％.结论 DTC术后131I清甲治疗半年后,Tg检测的准确性相对较高,但受TgAb干扰,存在假阴性,应与Dx-WBS进行联合作为DTC复发及转移的重要诊断指标.     

Co-ordination of cough and swallow in vivo and in silico

Coughing and swallowing are airway-protective behaviours. The pharyngeal phase of swallowing prevents aspiration of oral material (saliva, food and liquid) by epiglottal movement, laryngeal adduction and clearing of the mouth and pharynx. Coughing is an aspiration-response behaviour that removes material from the airway. Co-ordination of these behaviours is vital to protect the airway from further aspiration-promoting events, such as a swallowing during the inspiratory phase of coughing. The operational characteristics, primary strategies and peripheral inputs that co-ordinate coughing and swallowing are unknown. This lack of knowledge impedes understanding and treatment of deficits in airway protection, such as the co-occurrence of dystussia and dysphagia common in Parkinson's and Alzheimer's diseases, as well as stroke.     

Incorporation and Disappearance of Sulfate in Different Regions of Mouse and Rat Costal Cartilage in vivo and in vitro

A rapid and simple method for liquid scintillation counting of ³³S-sulfate in biological tissues is described. Sulfate incorporation per mg dry weight into selected lateral, medial and intermediate regions of ribs was studied using costal cartilage from rats and mice. In vitro, cartilage pieces embracing the osteochondral junction had 2–4 times larger incorporation rate than the remaining homogeneous parts of the ribs, both if entire rib cages or stripped and diced cartilage were incubated. After in vivo injection to rats and mice the incorporation rates of sulfate into the region of the osteochondral junction was 2.6 times that found in “resting” cartilage in rats and 4.4 times in mice. The ³⁵S-sulfate uptake in the ribs per mg dry cartilage diminished in the caudal direction. Growth of the chest cage was mainly a longitudinal growth of the bony segments. Marked differences in the disappearance rates of previously incorporated sulfate were found in different regions along the rib. Rapid sulfate disappearance was found in the bony segment which, however, had incorporated only one seventh of the amount per mg taken up by “resting” cartilage. The “resting” cartilage segments exhibited a steady slow disappearance rate for sulfate and the osteochondral junction region consisting of several differently active tissues showed a rapid sulfate disappearance in the beginning followed by a slow clearance after 2 weeks similar to that of “resting” cartilage. The necessity of careful selection of costal cartilage samples with respect to regional differences is emphasized.     

An in vivo and in vitro study of selenium deficiency and infection in rats

Selenium deficiency in rats impairs the ability of neutrophils and peritoneal macrophages to kill Candida albicans organisms in vitro. In contrast, killing of Salmonella typhimurium and Staphylococcus aureus organisms is unaffected by the deficiency. Survival of rats after intraperitoneal injection of 8 X 10(7) S. aureus organisms was not affected by Se deficiency, but a 5-fold increase in the dose (4 X 10(8) S. aureus organisms) led to a significantly greater mortality in the Se deficient rats.     

Visualization and characterization of 5-HT receptors and transporters in vivo and in man

Ascending and descending efferent pathways from the nuclei of serotonergic neurones located in brainstem raphe nuclei project to all regions of the central nervous system. Therefore, in considering the major physiological roles played by this neurotransmitter system, it is not surprising that serotonin is implicated in the aetiologies of many CNS dysfunctions which underlie psychiatric and neurological disorders. The presynaptic serotonin uptake mechanism and the many receptor subtypes that mediate the neurotransmitter roles of serotonin have been, and continue to be, targeted by drug discovery programmes aimed at identifying improved therapies for CNS disorders. Here we review the radioligands available for the important task of visualizing and characterizing these targets in the living human brain using either positron emission tomography (PET) or single photon emission tomography (SPECT). Such studies are crucial for extending our knowledge of the involvement of serotonin neurotransmission in the aetiologies of these disorders and for the development of new and more effective therapies. Particularly important recent advances in the methodologies for imaging the 5-HT transporter, the 5-HT_2A receptor and the 5-HT_1A receptor will almost certainly lead to important clinical research into the changes occurring in serotonergic neurotransmission during the onset, progression and treatment of affective and neurodegenerative disorders.     

ALA和HMME水凝胶栓剂的制备和体内外释药研究

目的 制备光敏剂5-氨基酮戊酸(ALA)和血卟啉单甲醚(HMME)水凝胶栓剂,评价其对直肠肿瘤组织的光敏剂递送效率.方法 将皮下移植人直肠癌细胞SW837的BALB/c小鼠随机分为水凝胶栓剂直肠局部给药组、皮肤局部给药组、瘤内注射给药组和静脉注射给药组.用荧光光谱仪测量直肠壁、皮肤和皮下肿瘤中原卟啉(PpⅨ)和HMME的浓度,荧光光谱系统测定相应的光敏剂分布情况.结果 ALA水凝胶栓剂直肠局部给药组的PpⅨ浓度分别是皮肤局部给药组的9.76倍(1 h)和5.80倍(3 h),差异均具有统计学意义(均P＜0.05).皮肤局部给药后2h,ALA在肿瘤组织内达到最大穿透深度(3～6 mm).而HMME水凝胶栓剂直肠局部给药后,直肠壁中的HMME浓度极低,且皮肤局部给药后的最大肿瘤穿透深度不足2 mm.结论 与皮肤相比,ALA更易穿透黏膜屏障,以水凝胶栓剂形式直肠局部给药有望成为ALA用于光动力疗法治疗直肠癌的一种给药方式.     

高校组织学与胚胎学课程思政研究状况

<正>为了解我国高校组织学与胚胎学课程思政的开展情况。通过检索中国科学引文数据库、维普信息资源系统和万方数据库获得相关文献,从课程思政的基本概念和意义、组织学与胚胎学课程思政状况和展望3个方面进行了归纳。课程思政的提出,目的是为高校思想政治教育改革探索新模式。目前组织学与胚胎学课程思政工作主要从课程思政的目标、思政元素、方法、存在的问题和解决方法等方面开展了探索和研究。